Y5 Paediatric Cases (quick made for mock PACES) Flashcards
Key points in headache case?
SOCRATES for headache (inc location)
Headache red flags
Do cranial nerve exam (esp visual fields)
Persistent headaches for 3 months in child waking them up at night, affecting school performance + visual problems. Condition(top differential)?
Space-occupying lesion
Management for suspected SOL?
Investigate for SOL with MRI (better at visualising soft tissue than XR)
Keep headache diary
Key points in CF resp history?
CF-associated recurrent LRTI (pneumonia) always on DDx list
- Staph aureus + H influenzae (young)
- Pseudomonas aeruginosa (older)
Ask for resp exam findings
Investigations for pneumonia include organism + sensitivities (sputum culture)
Adolescent with Hx of chest infections, inc one hospital visit 1 month ago. Hx of CF. Cough, green phlegm, fever, difficulty breathing. Condition?
CF-associated recurrent LRTI (pneumonia)
Management of CF-associated recurrent LRTI?
Abx CXR Bloods (+CRP) Sputum culture Continue to manage CF
Key points in musculoskeletal history?
Any pain do SOCRATES
Septic arthritis usually in <2y/o
Do glass test on any rash to check meningitis
Unwell child (7y in case) + 3d fever + 1d unilateral knee pain + pink blanching macular rash on back. Condition?
Juvenile idiopathic arthritis (systemic onset + 1 joint affected)
Management of juvenile idiopathic arthritis?
Ix
- Bloods
- Joint aspirate (rule out septic arthritis)
- xray knee
Educate about disease
Control pain with regular NSAIDs
Physiotherapy + daily exercise
Key points counselling about MMR vaccination?
Counselling anti-vax about the science
Measles/mumps and rubella symptoms/signs to explain to mother
Vaccine side effects (any vaccine) to explain to mother
Main features of measles, mumps, and rubella?
Measles - fever, rash, loss of appetite, tiredness, cough. Koplik spots in mouth.
Mumps - low grade fever, loss of appetite, swollen glands in the cheeks/neck/under jaw, headache, aches and pains.
Rubella - fever, tiredness, swollen glands, sore eyes, red rash ears and neck
(Measles worst, mumps 2nd, rubella usually mild)
Key points in enuresis history?
Types of bedwetting (enuresis) (primary, secondary)
Ask about frequency
Don’t belittle child, assess support need
Types of bedwetting?
Primary - never continent at night (subtypes - w/day symptoms, w/o day symptoms)
Secondary - occurs after child has been dry at night for more than 6 months
Management of bedwetting/enuresis?
<5y reassure that this is normal
>5y reassure this may resolve without treatment
Offer enuresis alarm + positive reward system (desmopressin if alarm unsuitable)
Key points in recurrent abdo pain history?
SOCRATES
Check family history for GI disease (coeliac, IBS)
Don’t make patients feel like they don’t have anything wrong with them
Functional abdo pain in child, main condition?
Paediatric IBS
Management of paediatric IBS?
Reassure no serious underlying disease
Encourage child not to let the pain make them miss school
Dietary advice + probiotics
Key points of sickle cell disease history?
V young child
Swelling of fingers + fever + crying (?pain)
Hx of chest infections
Management of SCD?
Acute - Admit if fever >38 + chest signs. Give O2, fluids, abx, paracetamol/NSAIDs
Long-term - immunisation vs pneumococcal, haemophilus influenzae type B, meningococcus infection. Daily oral penicillin throughout childhood. Once-daily oral folic acid. Avoid exposure to cold, dehydration, exercise, stress, hypoxia.
Key points of an epilepsy history?
Limbs jerking seizure + FH of epilepsy
Ask about how long the seizure was (status epilepticus >30min)
Management of epileptic seizures?
T-C - sodium valproate, lamotrigine Absence - ethosuximide, sodium valproate Myoclonic - sodium valproate Infantile spasms - vigabatrin Anything else - valproate
Key points of DKA history?
7y vomiting, increasing severe + persistent abdo pain, drowsy, nauseous. Recent Hx of bedwetting + weird smell urine. V thirsty + drinking a lot. Some weight loss.
DKA management?
Ix
- cap blood glucose + ketones
- U&Es
- cap pH and bicarb
Mx
- ABC
- Fluids (add glucose if <14mmol/L
- Insulin infusion
- potassium replacement
Key points of congenital hypothyroidism history?
V young (4m) floppy child. No control of head, can’t roll over, v sleepy. Slow growing.
Investigations of congenital hypothyroidism?
Examine for truncal hypotonia + head lag Blood tests (def incl TFTs), Gurthie screen to exclude other causes
Key points of an intussusception history?
Intermittent abdo pain + vomiting + no pooing.
DDx is gastroenteritis (more common than intussusception)
Ix and Mx of intussusception?
Abdo x-ray - distended small bowel + no gas in distal colon/rectum
USS abdo - target/donut sign
Mx
- pain relief
- IV fluids if going into shock
- rectal insufflations to reduce intussusception (open surgical reduction if insuff fails/becoming peritonitic)
