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Year 3 Paediatrics > 103. Cases 3 > Flashcards

103. Cases 3 Flashcards

1
Q

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

What features should you ask about?

A 
Cyanosis (lack of pink)
FH of heart disease (mum)
Preterm
Feeding 
Infections, alcohol,phenytoin 
Weight gain?
Breathlessness
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2
Q

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

What features should you look for

A 
Peripheral pulses 
Upper limb pulses
Hepatomegaly 
Dysmorphic features 
Tachycardia tachypnoeac
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3
Q

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

What investigations should you do?

A 
Refer to peads 
ECHO
Watch and wait 
Sats
BP upper and lower 
ECG
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4
Q

Commones features of murmurs in children?

A 
Vibratory
Soft
Systolic
Asymptomatic
Left sternal edge
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5
Q

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

Differential

A

Transposition of the great arteries

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6
Q

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

Differential

A 
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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7
Q

What are the 5 T’s?

A 
Truncus arteriosus 
Transposition of great arteries 
Tricuspid atresia
Tetralogy of fallout 
TAPVD
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8
Q

How do you check a cyanosed baby at night?

A

TURN A LIGHT ON

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9
Q

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

A

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

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10
Q

What are the most common congenital heart defects

A

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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11
Q

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?

A

Iron deficiency aneamia or beta thalassaemia

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12
Q

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?

A

Normal ferritin, blood film

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13
Q

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?

A

Increases dietary iron

Check and reduce milk consumption

Dietician referral

Oral iron

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14
Q

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

A

Microcytic hypochromic- ferritin levels

Normocytic normochromic- reticulocytes

Marcocytic- B12/folate

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15
Q

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?

A

Acute leukaemia
Septicaemia
Haemolytic ureamic syndrome

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16
Q

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

A

FBC, blood films,

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17
Q

Diferntrtials of bruises, purpura and petechia?

A

HSP
Sepsis
Trauma

18
Q

What causes thrombocytopenia

A

ITP
Leukemia
Disseminated intravascualr coagulation

19
Q

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?

A 
Osteosarcoma
JIA, tendon synovitis, septic athritis, osteomyelitis
SUFE, perthes
Transient synovitis 
Trauma
20
Q

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?

A

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

21
Q

Where can you find extra questions?

A

Learning guide- defo have a look at before exams

Last years case study powerpoints

22
Q

What drug would you give to children with UTI?

A

Upper tract- co amoixiclav/IV cephlaspron

Lower tract- trimethoprim

23
Q

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?

A

Pneumothorax

sepsis

24
Q

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

A 
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
25
Q

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?

A

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

26
Q

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

Referred to peads

What features should you ask about?

A

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

27
Q

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

Referred to peads

What features should you look for in examination?

A

Look in eyes

Skin pigmentation

Splenomegaly, hepatomegaly

Growth measurements

Look for cephaloheamatology

Anaemic signs- pallor, breathless feeding- ask revolta

28
Q

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

Referred to peads

Differentials?

A

Physiological jaundice (unconjugated)
Breast feeding jaundice (unconjugated)
Infection , hemaolytic anemia (unconjugated)

Biliary atresia
Neonatal hepatitis (congenital infections/ metabolic)
29
Q

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

Referred to peads

Investigations

A

Conjugated vs unconjugated

Full blood count (heamolysing)

Blood film

Liver function

ALL OVER 3 WEEKS NEED INVESTIGATED

Urine dipstick and culture

30
Q

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?

A

Anaphylaxis

Induced by nuts, latex or

31
Q

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

A 
ABCDE
Adrenaline (out of hospital epipen, in hospitals premade pack)
Oxygen 15l/m
IV access and fluid resuscitation 
Antihistamines and hydrocortisone
Salbutamol
32
Q

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?

A

Previous reactions?

Dietary recall?

Nuts before? What nuts?

Epipen and antihistamines at all time

Dietician

33
Q

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?

A

GOOD HISTORY AND EXAM BEST WAY

Allergy referral

skin prick

IgA blood test

34
Q

Summarise impetigo

A

Staph aureus honeycomb rash
Skin swab
Flucoxacillin oral if satellite lesions

35
Q

Summarise herpes?

A 
PCR swab needed 
Aciclovir ?
IV fluids, 
Analgesia on the mouth (diflam spray) 
Prescribe ice cream
36
Q

Summarise chicken pox

A

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

37
Q

Discuss slapped cheek virus

A 
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
38
Q

Discuss periorbital infection

A

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

39
Q

Discuss erythema toxicum?

A

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

40
Q

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?

A

Sepsis!

41
Q

What is are diffenial causes for fever in an infant

A 
URTI
LRTI
gastroenteritis bug
Meningitis
Septicaemia
Septic athritis, osteoarthritis
Kawasaki and non infective disease
42
Q

How do you investigate and manage sepsis?

A

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

Year 3 Paediatrics (42 decks)

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