diagnosis

Question 1

projectile vomiting first few months life, gastric peristalsis, palpable abdo mass, dehydrated

Answer 1

pyloric stenosis

Question 2

what should differentials be for lower abdo pain in child

Answer 2

exclude appendicitis, dkA, hepatitis, lower lobe pneumonia, pyelopnephritis, strangulated inguinal hernia, testicular torsion

Question 3

usually occurs between 3 months and 2 yrs, colicky pain, pallow, abdo mass, redcurrant jelly stool. treat with reduction then surgery if fails -

Answer 3

intussuception

Question 4

common causes of gastroenteritis in infants?

Answer 4

campylobacter, shigella and salmonela most common causes

Question 5

What should be concerned about in gastroenteritis in infants?

Answer 5

dehydration

Question 6

8-24 yrs age with abnormal stool, poor growth, distension, muscle wasting, anaemia, abdo pain.

Answer 6

gluten sensitive enteropathy - coeliacs

Question 7

How do you diagnose coeliacs?

Answer 7

Do IgA, tissue transgluatminase, endomysial Ab, duodenal biopsy

Question 8

What is hirschprungs?

Answer 8

absence of mysenteric plexus of rectum- have obstruction in newborn and cant pass meoconium - later on have constipation, growth fail and abdo distention

Question 9

How do you mx hirschprungs?

Answer 9

sunction rectal biopsy

Question 10

oedema, proteinuria and low albumin, no haematuria, normal BP, steroid-sensitive syndrome

Answer 10

nephrotic syndrome

Question 11

oedema, htn, low UO, haematuria and proteinuria

Answer 11

nephritic syndrome

Question 12

causes of nephritic syndrome

Answer 12

post-strep, henoch schonlein purpura, IgA nephropathy

Question 13

infant UTI presentation

Answer 13

fever, vomit, lethargy, irritable, poor feed/growth, jaundice, spetic, offensive urine, febrile seizure

Question 14

Child UTI presentation

Answer 14

febrile seizure; dysuria, freq, urgency, abdo pain, fever, lethargy, anorexia, vomit, diarrhoea, haematuria, offensive urine, enuresireoccurs

Question 15

What should you ask about in a paeds hx?

Answer 15

need to clarify who collateral hx is from
antenatal / postnatal
gestation
Growth scans
Mode of delivery
Complications in pregnancy and birth – drugs or infection, hospital stays
USS
Ask for red book
Apgar
Immunisations - askif up to date
Development - Ask the parent what they can do ; Motor, speech, language and vision
Family history
Neonate deaths – CONE scheme
Siblings- age, onset, health, age, may ask about height and weight
Social history
Second hand smoking
Whos at home, who looks after child
School or pre- school —? More likely to get infections
Social services involvement if appropriate
Pets
HEEADSSS - teens

Question 16

Describe how to do a cardio exam on a child

Answer 16

Feel for apex beat, thrills (palpable murmurs) and heaves
FEMORAL PULSE IF NEONATE
Hepatomegaly!!!!!!! - sig heart failure in infants
Heart failure- presents as oedema in groin- perianal and orbital NOT pitting
Fontanel (soft spot on head) —> goes in if dehydrated, up if raise in ICP

Question 17

describe how to do a resp exam on a child

Answer 17

Head bobbing, grunting, sternomastoid recession, trachel tug and sighing at end of breath and nasal flaring if struggle to breathe and use accessory muscles
RR and other obs are different – PEWS chart
Cyanosis – look on hands - and tongue for central
Clubbing – CF, congenital heart disease, IBD
Hyperexpansion/ barrel shape chest in asthma
Chest expansion
Location apex beat – mediastinal shift

Question 18

What signs may you see in a child with bronchiolitis?

Answer 18

Bronchiolitis: laboured breathing, hyperinflation, chest recession. Hyper resonant, fine crackles all zones, wheeze possible

Question 19

What signs may you see in a child with pneumonia?

Answer 19

Pneumonia: reduced chest movement and rapid shallow breaths, dull percussion and bronchial breathing/ crackles on auscultation

Question 20

What signs may you see in a child with asthma?

Answer 20

Asthma: use accessory muscles, hyper resonant on percussion, wheeze on auscultation

Question 21

What signs may you see in a child with croup?

Answer 21

Croup: chest wall retraction, stridor. Normal percussion

Question 22

how do you do a CN exam in a child?

Answer 22

1- smell
2-acuity
3, 4 and 6-fields if old enough to cooperate, light test pupils, squint? Nystagmus? accomodation
5- clench teeth and waggle jaw, feeling
7-eyes tight, cheeks, smile, show teeth, raise brows
8-whisper number
9, 10- ahhh - look palate, voice, cough, swallow
11-shrug shoulders and turn head with resistance
12-put out tongue

Question 23

How do you do an abdo exam on a child?

Answer 23

Actually do ISHRUG if in nappies apart from RECTAL – never do PR on a child
Liver, spleen, kidney, bladder
Localised pain in appendicitis, hepatitis and peritonitis
Liver and spleen may be 1-2cm below costal margin in infants

Question 24

What are causes of hepatomegaly in children?

Answer 24

Hepatomegaly causes: malaria, SCD, portal hypertension, leukaemia, lymphoma, wilms tumour, lipid storage disorder, heart failure

Question 25

What are causes of splenomegaly in children?

Answer 25

Splenomegaly causes: viral or bacterial infection, haemolytic anaemia, leukaemia, lymphoma, still’s disease