Case Studies 2

Question 1

A 3y old boy presents with 5 days of vomiting and bloody diarrhoea. He is tolerating oral fluids and recently visited a petting zoo
Examination showed no fever, HR 100, RR 25, no skin changes and mild general abdo discomfort
what is the diagnosis ?

Answer 1

gastroenteritis

Question 2

what are the causes of GE?

Answer 2

Campylobacter 
salmonella
E coil 0157 
shigella 
IBD

Question 3

what are the potential complications of GE?

Answer 3

HUS

Question 4

how do you assess hydration in children ?

Answer 4

capillary refill
pulse 
skin turgor 
skin colour 
skin temp 
mucous membranes 
HR 
BP 
alertness

Question 5

what investigations should be done for GE?

Answer 5

stool cultures 
blood film - check for HUS
FBC 
U&Es
Hb 
LDH - gets released during haemolysis

Question 6

what is the management of GE?

Answer 6

fluid management
monitor fluid in and out
monitor bloods for HUS

Question 7

what is the main organism to cause gastroenteritis ?

Answer 7

E coli 0157

Question 8

what is a complication of E coli 0157?

Answer 8

HUS (haemolytic ureamic syndrome)

Question 9

A 9y old boy is brought is because parents are concerned that he still wets the bed most nights.
He has no fever and abdominal/ spinal/ neuro examination is normal.
what is the diagnosis?

Answer 9

primary nocturnal enuresis

Question 10

what investigations should be done for noctural enuresis ?

Answer 10

urine dip stick

Question 11

what investigations should be done for UTI in an infant?

Answer 11

Urine dipstix, microscopy and culture

Question 12

how does an UTI present in neonates ?

Answer 12

fever, vomiting
lethargy
irritability

Question 13

how does an UTI present in children?

Answer 13

fever
frequency
dysuria

Question 14

what are the two main concerns of children having UTIs?

Answer 14

VUR (reflux)

renal scarring

Question 15

what isotope scan is used for renal scarring?

Answer 15

DMSA

Question 16

what is the triad of HUS?

Answer 16

microangiopathic haemolytic anaemia
thrombocytopenia
acute renal failure

Question 17

what does HUS stand for?

Answer 17

haemolytic uraemic syndrome

Question 18

what is a complication of HUS?

Answer 18

ESRF (end stage renal failure)

Question 19

does primary nocturnal enuresis affect boys or girls more?

Answer 19

boys

Question 20

what is the management of primary nocturnal enuresis ?

Answer 20

decrease night fluids
increase daytime fluids
pads

Question 21

what are the common features of an innocent murmur?

Answer 21

vibratory 
soft 
systolic 
localised 
varies with activity, position and respiration

Question 22

A 12h old 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
what is the DD?

Answer 22

cyanotic heart disease

• transposition of great arteries
• pulmonary atresia
• truncus arteriosus

Question 23

what heart condition is associated with downs ?

Answer 23

AVSD

Question 24

what heart condition is associated with turners ?

Answer 24

coarctation

Question 25

what heart condition is associated with noonans ?

Answer 25

pulmonary stenosis

Question 26

what heart condition is associated with williams ?

Answer 26

supravalvular aortic stenosis

Question 27

state some risk factors of congenital heart disease?

Answer 27

maternal antenatal health (DM, SLE) maternal substances (alcohol, lithium) TORCH (infections)

Question 28

what are the 8 most common heart lesions?

Answer 28

``` Ventricular Septal Defect (VSD) Patent Ductus Arteriosus (PDA) Atrial Septal Defect (ASD) Tetralogy of Fallot Pulmonary Stenosis Coarctation of the Aorta Aortic Stenosis Transposition of the Great Arteries ```

Question 29

what are the signs of a pneumothorax?

Answer 29

Reduced air entry on left (??Percussion), Low sats Tachypnoea Heart sounds shifted to right Altered perfusion (Tachycardia/ ?Bradycardia) Chest Transillumination

Question 30

what questions should be asked for a 26 day old baby with jaundice?

Answer 30

``` Full birth history (gestation/ delivery/ resus/ wgt) Age of onset/ phototherapy at birth Mode of feeding/ Weight gain Colour of urine/ stools Siblings with jaundice ```

Question 31

state some cause of unconjugated jaundice?

Answer 31

``` Physiological jaundice Breast milk jaundice Infection (urinary) Hypothyroidism Haemolytic anaemia ```

Question 32

state some cause of conjugated jaundice?

Answer 32

bile duct obstruction (biliary atresia) | neonatal hepatitis

Question 33

what investigations should be done for a baby with jaundice?

Answer 33

``` FBC blood film coombs split bilirubin LFTs TFTs (thyroid function tests) ```

Question 34

A 5y old girl presents with a 24h history of reluctance to walk and difficulty weight bearing. She had a “cold” 3 days ago. Examination shows Temp 37.50, no swellings, normal perfusion, no skin changes, full range of movement in hips and knees. Not weight bearing what is the DD?

Answer 34

Transient synovitis (Irritable hip) Reactive arthritis Trauma

Question 35

what is the treatment for transient synovitis?

Answer 35

self limiting illness

Question 36

what is the treatment of iron deficiency in children?

Answer 36

Increase dietary iron (red meat, green veg) Check (and reduce) milk consumption Dietician referral Oral iron supplementation (~3m)

Question 37

what are the three general causes of anaemia in children?

Answer 37

impaired red cell production increased haemolysis blood loss

Question 38

state some causes of increased haemolysis ?

Answer 38

``` hereditary spherocytosis G6PD deficiency thalassaemias sickle cell auto immune haemolytic anaemias ```

Question 39

A 3y old boy presents with 4 weeks of lethargy, looking pale and recurring fevers. Examination showed multiple bruises on the legs back and chest, enlarged cervical/ inguinal lymph nodes and hepato-splenomegaly. what is the diagnosis ?

Answer 39

ALL (acute lymphoid leukaemia)

Question 40

what investigations should be done for suspected ALL?

Answer 40

FBC and Film to confirm | Coag/ U+E/ LFT/ CRP

Question 41

state three causes of thrombocytopenia petechia?

Answer 41

Idiopathic thrombocytopenic purpura (ITP) Leukaemia Disseminated intravascular coagulation (DIC)