103. Cases 3 Flashcards by Andrew Love

8 week old baby boy presents for routine exam
He has murmur

What features should you ask about?

Cyanosis (lack of pink)
FH of heart disease (mum)
Preterm
Feeding 
Infections, alcohol,phenytoin 
Weight gain?
Breathlessness

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8 week old baby boy presents for routine exam
He has murmur

What features should you look for

Peripheral pulses 
Upper limb pulses
Hepatomegaly 
Dysmorphic features 
Tachycardia tachypnoeac

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8 week old baby boy presents for routine exam
He has murmur

What investigations should you do?

Refer to peads 
ECHO
Watch and wait 
Sats
BP upper and lower 
ECG

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Commones features of murmurs in children?

Vibratory
Soft
Systolic
Asymptomatic
Left sternal edge

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12 hour baby girl on routine post delivery exam, cyanotic, has peripheral pulses

Differential

Transposition of the great arteries

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12 hour baby girl on routine post delivery exam, cyanotic, has peripheral pulses

Differential

Sats- upper and lower limb
Admit to neonatal
Chest x-ray
ECHO
100% oxygen (check it’s heart) 
Ionotropes, ventilations, 
Prostaglandins to preserve duct

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What are the 5 T’s?

Truncus arteriosus 
Transposition of great arteries 
Tricuspid atresia
Tetralogy of fallout 
TAPVD

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How do you check a cyanosed baby at night?

TURN A LIGHT ON

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What are the common genetic conditions and there associated heart defects?

Downs- atrio ventricular septal defects
Turners- coarctation of the aorta
Williams- ppulmonary stenosis
Noonans- aortic stenosis

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What are the most common congenital heart defects

Ventricular septal defect- no cyanosis

Patent ductus arteriosus- prematurity

Atrial septal defect- late presentation

Tetralogy of fallot- cyanotic spells

Pulmonary stenosis- increased right sided heart pressure

Coarctation of the aorta- once duct closes they go to fuck

Aortic stenosis- fainting and syncope

Transposition of the great arteries- cyanosis at birth

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2 year old girl 2 days of runny nose, cough, no fever, doing well

Blood results- FBC, Hb 5.3, MCV 57, PLT 300, WBC 6.0

What’s the diagnosis?

Iron deficiency aneamia or beta thalassaemia

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2 year old girl 2 days of runny nose, cough, no fever, doing well

Blood results- FBC, Hb 5.3, MCV 57, PLT 300, WBC 6.0

What’s the investigations?

Normal ferritin, blood film

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2 year old girl 2 days of runny nose, cough, no fever, doing well

Blood results- FBC, Hb 5.3, MCV 57, PLT 300, WBC 6.0

What’s the treatment?

Increases dietary iron

Check and reduce milk consumption

Dietician referral

Oral iron

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What are the different types of anaemia and the tests you can do?

Microcytic hypochromic- ferritin levels

Normocytic normochromic- reticulocytes

Marcocytic- B12/folate

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Wee boy gets lethargy, looking pale, recurring fever

Examination shows multiple bruises on the legs back and chest,
Purpula, petichae, Lymph nodes enlarged and hepatocytes-splenomegaly

Diagnose and differentials?

Acute leukaemia
Septicaemia
Haemolytic ureamic syndrome

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Wee boy gets lethargy, looking pale, recurring fever

Examination shows multiple bruises on the legs back and chest,
Purpula, petichae, Lymph nodes enlarged and hepatocytes-splenomegaly

Investigations and management

FBC, blood films,

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Diferntrtials of bruises, purpura and petechia?

HSP
Sepsis
Trauma

What causes thrombocytopenia

ITP
Leukemia
Disseminated intravascualr coagulation

5 year old girl presents with a 24 hour history of reluctance to walk
She has a cold three days ago. No swelling, no skin changes, full range, movement in hips and knees

Diagnosis and differentials?

Osteosarcoma
JIA, tendon synovitis, septic athritis, osteomyelitis
SUFE, perthes
Transient synovitis 
Trauma

5 year old girl presents with a 24 hour history of reluctance to walk
She has a cold three days ago. No swelling, no skin changes, full range, movement in hips and knees

Assuming transient synovitis, what’s the management?

Watch and wait
USS if doesn’t settle
Change diagnosis if doesn’t settle
Blood cultures, X- rays if gets worse

Where can you find extra questions?

Learning guide- defo have a look at before exams

Last years case study powerpoints

What drug would you give to children with UTI?

Upper tract- co amoixiclav/IV cephlaspron

Lower tract- trimethoprim

3 week old baby boy, born at 29 weeks. On CPAP
Developed a rapid rise in his oxygen requirement and RR
Reduced air examination on the left

Differentials?

Pneumothorax

sepsis

3 week old baby boy, born at 29 weeks. On CPAP
Developed a rapid rise in his oxygen requirement and RR
Reduced air examination on the left

What signs would you see

Trans illumination of the chest (use a cold light on skin)
Tracheal deviation
Mediastinal shift (on x-ray) 
Low sats
Heart sod shifter 
Tachycardia/bradychardia

3 week old baby boy, born at 29 weeks. On CPAP Developed a rapid rise in his oxygen requirement and RR Reduced air examination on the left What action would you take?

Call for help ABCD Intubate Aspirate air 2nd intercostal space mid clavicular line Chest drain 4th intercostal space mid axillary line

26 day old baby noted to be jaundiced but the health visitor Referred to peads What features should you ask about?

Bowel movements- pale stool, bright urine is bad, also ask urine smells Vomit- biliary vomiting Breast feeding Putting on weight? How much First noticed jaundice Siblings with jaundice Gestation they were born at Maternal infections Feeding and lethargy Phototherapy

26 day old baby noted to be jaundiced but the health visitor Referred to peads What features should you look for in examination?

Look in eyes Skin pigmentation Splenomegaly, hepatomegaly Growth measurements Look for cephaloheamatology Anaemic signs- pallor, breathless feeding- ask revolta

26 day old baby noted to be jaundiced but the health visitor Referred to peads Differentials?

Physiological jaundice (unconjugated) Breast feeding jaundice (unconjugated) Infection , hemaolytic anemia (unconjugated) ``` Biliary atresia Neonatal hepatitis (congenital infections/ metabolic) ```

26 day old baby noted to be jaundiced but the health visitor Referred to peads Investigations

Conjugated vs unconjugated Full blood count (heamolysing) Blood film Liver function ALL OVER 3 WEEKS NEED INVESTIGATED Urine dipstick and culture

4 year old boy brought in to A+E with facial swelling, tight throat, difficulty breathing Lethargic RR50, HR 170, sats 88. Uterical rash and Bilateral wheeze Diagnosis?

Anaphylaxis Induced by nuts, latex or

4 year old boy brought in to A+E with facial swelling, tight throat, difficulty breathing Lethargic RR50, HR 170, sats 88. Uterical rash and Bilateral wheeze Management

``` ABCDE Adrenaline (out of hospital epipen, in hospitals premade pack) Oxygen 15l/m IV access and fluid resuscitation Antihistamines and hydrocortisone Salbutamol ```

4 year old boy brought in to A+E with facial swelling, tight throat, difficulty breathing Lethargic RR50, HR 170, sats 88. Uterical rash and Bilateral wheeze Advice on discharge?

Previous reactions? Dietary recall? Nuts before? What nuts? Epipen and antihistamines at all time Dietician

4 year old boy brought in to A+E with facial swelling, tight throat, difficulty breathing Lethargic RR50, HR 170, sats 88. Uterical rash and Bilateral wheeze Follow up investigations?

GOOD HISTORY AND EXAM BEST WAY Allergy referral skin prick IgA blood test

Summarise impetigo

Staph aureus honeycomb rash Skin swab Flucoxacillin oral if satellite lesions

Summarise herpes?

``` PCR swab needed Aciclovir ? IV fluids, Analgesia on the mouth (diflam spray) Prescribe ice cream ```

Summarise chicken pox

Caused be varicella zoster No investigations or treatment Definitely don’t give iboprufen

Discuss slapped cheek virus

``` Full body rash Tell nursery and school Safety netting (Bone marrow infiltration) Takes ages to go away Avoid pregnant women Parvovirus B19 Supportive care, antipyretics ```

Discuss periorbital infection

Staph aureus causing IV antibiotics If they can open their eye you can trial oral

Discuss erythema toxicum?

Nobody knows what causes it No treatment unless crusts- check staph and herpes Reassure parents

6 month, 24 year old fever Poor feeding and lethargy No cough, runny nose Not passes any urine in stools High temp, high heart rate, high rest rate, drowsy Diagnosis?

Sepsis!

What is are diffenial causes for fever in an infant

``` URTI LRTI gastroenteritis bug Meningitis Septicaemia Septic athritis, osteoarthritis Kawasaki and non infective disease ```

How do you investigate and manage sepsis?

Weigh nappies to assess output Give fluid resuscitation (crystalloid). 20ml per kilo Help Cefitraxin Monitor heart rate and blood pressure Review FBC, lactate, glucose, CRP, culture High flow oxygen