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Child Health > Common Problems in Paediatric Outpatients > Flashcards

Common Problems in Paediatric Outpatients Flashcards

1
Q

What should be considered when a child is being allocated to a clinic?

A

Age of child (0-14), where they live, principal issues, degree of urgency, presence of red flags

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2
Q

What details should be included in a referral letter?

A

General health = growth/height/weight, all with centiles and development
Relevant social information (i.e on CP register)
Parental concern and impact on schooling

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3
Q

What is the role of secondary care in the management of paediatric outpatients?

A

Help make diagnosis/confirm GP diagnosis
Advice on ongoing management
Useful when there is concern in missing serious disease
Reassurance

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4
Q

What are the top ten reasons for paediatric outpatient referral?

A

Concerns about growth, UTI, constipation, abdominal pain, headaches, funny turns, heart murmurs, food allergy/intolerance, minor abnormalities, asthma

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5
Q

Why might a child display short stature?

A

Familial implication (i.e small parents) or constitutional delay

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6
Q

What should be considered in an obese child who also has short stature?

A

Endocrine causes

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7
Q

What is the most common pathogen implicated in UTIs in children?

A

E.coli

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8
Q

What determines whether a UTI should get further investigation?

A

The age of the child, nature of infection, family history of UTI/renal disease, other concerns about general health

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9
Q

Do all children with UTIs need to be seen in secondary care?

A

No = some can be managed at home

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10
Q

What are some more complicated renal problems that may present with a UTI?

A

Vesicouretric reflux, renal scarring, renal tract abnormalities

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11
Q

What are some concerning features of a child with a UTI?

A

Younger age, frequent infections, non-E.coli pathogens, family history of renal disease, poor growth/general health, poor urinary flow in infant, voiding problems/constipation, spinal abnormalities, raised BP, abdominal mass, renal tract abnormalities on antenatal scan

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12
Q

What is constipation defined as?

A

Pain, difficulty or delay in defaecation

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13
Q

What is the definition of soiling?

A

Escape of stool into underclothing = affects 2% of school age children

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14
Q

What is encopresis?

A

Passage of normal stool in abnormal places

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15
Q

How is constipation treated?

A

Laxatives, attention to food and drink, toileting behaviour advice

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16
Q

When should an underlying disease be considered in constipation?

A

Onset from early infancy or refractory to treatment

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17
Q

What is a red flag for constipation in paediatrics?

A

Delay in passage of meconium more than 24hrs after birth

18
Q

What aspect of a child’s life can abdominal pain interfere with?

A

Very disruptive to school attendance

19
Q

What should particular attention be paid to when taking a history in a child with abdominal pain?

A

The growth of the child

20
Q

What are important diagnoses not to miss that present with abdominal pain?

A

Coeliac disease, IBD, malrotation, intermittent volvulus

21
Q

What is a red flag in a child with abdominal pain?

A

Vomiting bile

22
Q

What are some concerning features in a child with abdominal pain?

A

Involuntary weight loss, deceleration of linear growth, GI blood loss, significant vomiting, chronic severe diarrhoea, family history of IBD, recurrent oral ulceration, perianal disease

23
Q

What are some specific sites of abdominal pain that may indicate a certain diagnosis?

A

Epigastric = if chronic, may indicate heartburn

Acute RIF pain = appendicitis

24
Q

How are headaches usually diagnosed?

A

By history and examination alone

25
Q

What are some red flags in a child with headaches?

A

Headache on walking, worse when coughing/bending, associated vomiting (especially in morning), visual disturbance, gait disturbance, cranial nerve palsy

26
Q

What is vital in diagnosing funny turns?

A

Clear history from a first hand witness

27
Q

What does the aetiology of a funny turn depend on?

A

The age of the child

28
Q

What are some causes of funny turns in children?

A

Seizures, breath-holding, reflex anoxic seizures, benign neonatal sleep myoclonus, night terrors, faints, gratification disorder, cardiac, ALTE, toxins

29
Q

What are red flags for children with cardiac syncope?

A

Syncope in child with known congenital heart disease
Syncope during exercise/when supine
Syncope preceded by palpitations
Heart murmur or other CV abnormalities on examination

30
Q

What are some features of the family history that would raise a red flag in children with cardiac syncope?

A

Family history of sudden death, prolonged QT syndrome or hypertrophic cardiomyopathy

31
Q

What are some red flag symptoms in children with heart murmurs?

A

Breathlessness, pallor, sweaty, poor feeding, dysmorphism, cyanosed

32
Q

Are most paediatric murmurs benign or malignant?

A

Most are benign murmurs that may resolve over time

33
Q

What are some features that would indicate an innocent heart murmur?

A

Systolic, low intensity, second left interspace, medial to the apex, beneath clavicle (may be continuous venous hum that disappears when supine)

34
Q

What are some red flag features of heart murmurs?

A

Any diastolic murmur, loud >= grade 3, harsh, associated thrill, radiates widely, symptomatic

35
Q

What are some features of food allergies?

A

Type 1 IgE mediated response, acute allergic reaction, may cause anaphylaxis

36
Q

What are some features of food intolerances?

A

Delayed reaction, more varied symptomatology, mechanism unclear

37
Q

What are some minor abnormalities that may occur in infants?

A

Head shape or size, skin lesions, feeding concerns, crying excessively

38
Q

What are some concerning features in children with minor abnormalities?

A

Abnormal growth (weight and OFC), concerns about development

39
Q

How do symptoms of minor abnormalities present in infants?

A

Non-specific = low index of suspicion

40
Q

How is asthma usually diagnosed in children?

A

Tests are less helpful = diagnosis often based on probability

41
Q

What are some features that increase the probability of a child having asthma?

A

Personal history or atopic disease, family history of atopic disease/asthma, widespread wheeze on auscultation, more than one of cough/wheeze/difficulty breathing/chest tightness

42
Q

In what scenarios would a child having symptoms indicate a diagnosis of asthma?

A

Frequent and recurrent onsets, worse at night or early morning, occur or are worse during exercise or with other triggers, occur apart from colds

Child Health (27 decks)

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