Common Outpatient Complaints

Question 1

If a child is complaining of abdo pain name 4 serious conditions you want to rule out in history?

Answer 1

Coeliacs
IBD
Malrotation
Intermittent volvulus

Question 2

What other features from abdo pain may a child with crohn’s disease have?

Answer 2

Reduced growth velocity and delayed puberty
Diarrhoea (blood can be present if colonic, stearrhoea if small bowel), weight loss, malaise, lethargy, anorexia, nausea, vomiting and low grade persistent fever
Mouth ulcers
Perianal disease
Extraintestinal features (uveitis, episcleritis, conjunctivitis, arthritis/ arthralgia, erythema nodosum, liver problems)

Question 3

Tests for IBD?

Answer 3

Blood tests (anaemia, raised ESR and CRP)
Stool test (faecal calprotectin and lactoferrin raised in active intestinal disease)

Question 4

What other features from abdo pain may a child with ulcerative colitis have?

Answer 4

Blood in stool with mucus
Diarrhoea with urgency
Malaise, lethargy, anorexia and weight loss (less severe than crohns)

Question 5

What other features from abdo pain may a child with coeliac disease have?

Answer 5

Diarrhoea or stearrhoea
Weight loss
Mouth ulcers and angular stomatitis
Dermatitis herpetiforms

Question 6

Serological test for coeliacs?

Answer 6

Tissue transglutaminase

Question 7

Classic picture of someone with appendicitis?

Answer 7

Central pain that radiates to RIF
Anorexia
Nausea
One or two vomits
May not have moved bowels

Question 8

Signs of appendicitis?

Answer 8

Mild pyrexia, mild tachycardia, guarding and rebound tenderness
Rosvig’s sign: palpation of the left lower quadrant of a person’s abdomen increases the pain felt in the right lower quadrant
McBurneys: point over the right side of the abdomen that is one-third of the distance from the anterior superior iliac spine to the umbilicus (navel). This point roughly corresponds to the most common location of the base of the appendix where it is attached to the cecum (pain over here would suggest appendicitis)

Question 9

Most growth concerns are due to what 2 things?

Answer 9

short stature and obesity

Question 10

Most short stature is due to?

Answer 10

Familial causes or constitutional delay

Question 11

What must you consider in an extremely overweight child with short stature?

Answer 11

Endocrine causes

Prader Willi

Question 12

UTIs are common in children, name 10 factors that make it more likely to be a complicated renal problem?

Answer 12

• Younger child
• Frequent and recurrent infection
• Spinal abnormality
• Poor urinary flow
• Non E. coli infection
• FH Renal Disease
• Abdo Mass
• Poor health
• Raised BP
• Abnormalities on antenatal scan with renal tract

Question 13

Most common pathogen causing UTIs in children?

Answer 13

E. coli

Question 14

Red flag for constipation?

Answer 14

Delay in passage of meconium more than 24 hrs

Question 15

Red flags for children headaches (6)?

Answer 15

Headache on waking, worse with coughing or bending, associated vomiting (esp in morning), visual disturbance, gait disturbance, cranial nerve palsy

Question 16

What may funny turns involve?

Answer 16

seizures, breath holding, night terrors, gratification disorder, faints

Question 17

Are most funny turns serious?

Answer 17

most are completely benign and settle on their own

Question 18

Red flags for funny turns?

Answer 18

Syncope in child with known congenital heart disease, syncope during exercise or when supine, FH of sudden death, prolonged QT or HOCM, syncope preceded by palpitations, heart murmurs or other abnormalities on CVS exam

Question 19

Are innocent heart murmurs in children common?

Answer 19

Yes

Question 20

Associated symptoms that point to a heart murmur being pathological?

Answer 20

Breathless
Blue
Sweaty
Poor feeding
Syncope
Dysmorphism
FH
Poor growth

Question 21

4 features of innocent heart murmurs?

Answer 21

Systolic
Low intensity and doesn’t radiate
Heart best in pulmonary area
Beneath either clavicle there may be a continuous venous hum that disappears when supine

Question 22

Innocent murmurs are heard best in the pulmonary area… what is this?

Answer 22

2 ICS

Left sternal age

Question 23

Features of pathological murmurs?

Answer 23

Diastolic
Loud more than grade 3 murmur and harsh
Associated thrill and radiates widely
Other symptoms

Question 24

Food allergy vs intolerance definition?

Answer 24

Allergy= type 1 hypersensitivity reaction that is IgE mediated and can cause anaphylaxis
Intolerance= delayed reaction with more varied symptoms

Question 25

Often consulted about minor abnormalities in infants but what are concerning features?

Answer 25

Abnormal growth, weight or OFC

Concerns about development particularly loss of skills

Question 26

Why is it so difficult to diagnose asthma in childhood?

Answer 26

Recurrent RTIs are common and can cause similar features particularly in under 2s
Tests are less helpful at making a diagnosis

Question 27

Four factors that make a diagnosis of asthma in a child more likely?

Answer 27

• Personal or FH of atopic disease (asthma, eczema, hay fever)
• Widespread wheeze on auscultation
• Wheeze, cough, difficulty breathing, chest tightness
• Particularly if worse at night/ early morning, in response to triggers such as exercise, pets, pollens, cold or damp air, emotion e.g. laughter and apart from RTIs

Question 28

Tonic clonic seizure after exercise may a sign of?

Answer 28

Arrhythmia

Question 29

What is a vasovagal episode?

Answer 29

Sudden drop in BP often due to reaction to something, will usually pass out, not usually serious

Question 30

Describe mutations in

• DiGeorge
• Prader Willi
• Turners
• Downs
• Sickle Cell

Answer 30

DiGeorge and Prader will are deletions so can be detected on chromosome microarray
Turners and Downs are whole or missing chromosome so can be detected on chromosome microarray
Sickle cell is point mutation so detected on next generation sequencing (or other things allowing you to see balanced locations)