Lecture 19 Paediatric Case Studies

Question 1

• 9-month-old girl presents with 48 hour of increasing wheeze and respiratory effort and afford a history of mild runny nose and cough
• Examination shows bilateral wheeze crackles. She has a sub coastal recession, a pink throat and red ears.
• Resp rate 60, sats 93% and temp 37.9 Celsius

What is the diagnosis?

Answer 1

Bronchiolitis

Question 2

What are the most common causes of bronchiolitis

Answer 2

Respiratory Syncital Virus
Para influenza
Adeno virus

Question 3

• An 18 month boy presents with a 4 hour history of barking cough and noisy breathing having been well the day before
• Examination shows a runny nose, loud stridor tracheal tug sub-costal recession (increasingly negative intrathoracic pressures cause indrawing of part of the chest), perfused peripheries and temp of 37.8 Celsius
• Diagnosis and Differential

Answer 3

Croup

Tracheitis

Question 4

• A 14-month-old girl presents with 12hour of increasing wheeze and respiratory effort and a 3 day history of runny nose and cough
• Examination shows bilateral wheeze, no creps and sub-costal recession, a pink throat and red ears.
• Resp rate of 60 and temperature 37.5
• Diagnosis and differential

Answer 4

Bronchiolitis

Viral induced wheeze

Question 5

• 13-year-old girl presents with a 4 day history of increasing lethargy, cough, fever and tummy pain
• She has vomited x4 in the last 2 days
• Examination showed temp 39.8, resp rate 40, nasal flaring, intercostal recession, no focal chest findings, RUQ discomfort, soft abdomen
• Diagnosis and differential

Answer 5

LRTI
UTI
Appendicitis

Question 6

• A 6-month-old girl presents with 3 day fever (39>), vomiting, poor feeding, being unsettled and having strong smelling urine
• Examination show RR 40, HR 150, no focal findings in the chest, abdomen ears or throat
• Diagnosis and differential

Answer 6

UTI

LRTI/Pneumonia

Question 7

• 13-year-old boy presents with 5 days of vomiting and bloody diarrhoea. He is tolerating oral fluids and recently visited a petting zoon
• Examination showed no fever, HR 100, RR 25, no skin changes and mild general abdo discomfort

Diagnosis and Diiferentials?

Answer 7

Gastroenteritis (E.coli)

Haemolytic Uraemic Syndrome

Question 8

• A 9-year-old boy is brought in because parents are concerned that he still wets the bed most nights
• He has no fever and abdominal/spinal/neuro examination is normal

Diagnosis

Answer 8

Primary nocturnal enuresis

Question 9

• A 12 hour baby girl is noted on routine post-delivery examination to be blue (face, tongue and limbs). Peripheral pulses are present. A loud systolic murmur is present
Differential Diagnosis?

Answer 9

Transposition of the arteries
Pulmonary atresia
Tetralogy of Fallot

Question 10

What congenital heart abnormality is seen in Down’s syndrome

Answer 10

ASD

VSD

Question 11

What congenital heart abnormality is seen in Turner’s

Answer 11

Coarctation of aorta

Question 12

What congenital heart abnormality is seen in Noonans

Answer 12

Pulmonary stenosis

Question 13

What congenital heart abnormality is seen in William’s

Answer 13

Supravalvular Aortic Stenosis