Passmedicine Flashcards
(36 cards)
A 2-month old baby is admitted to the Paediatric Ward with persistent, projectile vomiting, usually around 30 minutes after feeding, and failure to gain weight. There is a palpable mass on abdominal examination. There is a hypochloraemic, hypokalaemic alkalosis.
Pyloric stenosis
A mother brings her 14-month-old son into surgery. Since yesterday he seems to be straining whilst passing stools. She describes him screaming, appearing to be in pain and pulling his knees up towards his chest. These episodes are now occurring every 15-20 minutes. This morning she noted a small amount of blood in his nappy. He is taking around 50% of his normal feeds and vomited once this morning. On examination he appears irritable and lethargic but is well hydrated and apyrexial. Abdominal examination is unremarkable. What is the most likely diagnosis?
Intussusception
A 2-month-old boy is brought to the afternoon surgery by his mother. Since the morning he has been taking reduced feeds and has been ‘not his usual self’. On examination the baby appears well but has a temperature of 38.7ºC. What is the most appropriate management?
Admit to hospital:
- Since younger than 3 months
A 6-month-old baby who was born in Bangladesh is brought to surgery. Around one week ago he started with coryzal symptoms. His mother reports he has not been feeding well for the past two days and has started to vomit today. Her main concern is a cough which occurs in bouts and is so severe he often turns red. No inspiratory or expiratory noises are noted. Clinical examination reveals an apyrexial child with a clear chest. What is the most likely diagnosis?
Pertussis
A mother presents to your GP surgery with her six month old daughter. She has been struggling to feed her daughter, and her health visitor found that she was small for her age. Her mother is exhausted as she says her daughter sleeps poorly. On examination, the baby is just below the 3rd centile in length. She has epicanthic folds and low set ears. Her neck appears short and she has micrognathia. You hear an ejection systolic murmur on auscultation. What is the most likely diagnosis?
Turner’s Syndrome
A neonate is born at 38 weeks gestation via spontaneous vaginal delivery. The birth weight was 4.5kg. In the newborn postnatal check the attending doctor notes that there is adduction and internal rotation of the right arm. What is the most likely diagnosis?
Erb’s Palsy
What is macrosomia?
Any baby born with a weight >4kg
A 7-year-old boy is brought in to the GP surgery with an exacerbation of asthma. On examination he has a bilateral expiratory wheeze but there are no signs of respiratory distress. His respiratory rate is 36 / min and PEF around 60% of normal. What is the most appropriate action with regards to steroid therapy?
Oral prednisolone for 3 days
What is the commonest cause of headache in children?
Migraines
A 3 year old is brought by his Mum to your surgery. He has had a fever and has been refusing to eat. Mum has noticed some spots on his hands and buttocks. On examination the child has a mild vesicular rash to the hands, buttocks, face and a few spots on his ankles. His temperature is 38.1ºC. Your records state that he had chicken pox when he was 9 months old. What is the most likely diagnosis?
Hand, foot and mouth disease
A 3-year-old boy is brought into the emergency department with cough and noisy breathing following a 3-day history of coryzal symptoms. On examination, he is afebrile but has harsh vibrating noise on inspiration, intercostal recession and a cough. He is systemically well. What is the most likely causative organism?
This is croup:
- Parainfluenza
The parents of a 14-month-old girl present to their GP. They have noticed that in some photos there is no ‘red eye’ on the left hand side. When you examine the girl you notice an esotropic strabismus and a loss of the red-reflex in the left eye. There is a family history of a grandparent having an enucleation as a child. What is the most likely diagnosis?
Retinoblastoma
A neonate is born at 32 weeks gestation via spontaneous vaginal delivery. There was no meconium staining of the liquor. Shortly after delivery he develops cyanosis, tachypnoea, grunting and sternal recession. A chest x-ray demonstrates diffuse ground glass lungs with low volumes and a bell-shaped thorax. What is the most likely diagnosis?
Neonatal Respiratory Distress Syndrome (NRDS)
A 10-year-old boy is brought to the GP by his mother after two weeks of a productive cough and fevers. The GP who saw him last week sent him away advising to come back in a week if he was still no better. The patient is documented to be allergic to penicillin. Which antibiotic should be used to treat his respiratory infection?
Clarithromycin
What bacteria tend to cause meningism in the following age groups:
- Neonatal to 3 months
- 1 months to 6 years
- > 6 years
Neonatal to 3 months:
- Group B Streptococcus - E. coli and other Gram -ve organisms - Listeria monocytogenes
1 month to 6 years:
- Neisseria meningitidis (meningococcus) - Strep. pneumoniae (pneumococcus) - H. influenzae
Greater than 6 years:
- Neisseria meningitidis - Strep. pneumoniae
A 4-year-old boy presents with fever and a sore throat. Examination reveals tonsillitis and a furred tongue with enlarged papillae. There is a blanching punctate rash sparing the face
Scarlet fever
A 3-year-old girl with a two day history of fever and malaise. Developed a pink maculopapular rash initially on the face before spreading. Suboccipital lymph nodes are also noted
Rubella
A 4-year-old boy presents with fever, malaise and a ‘slapped-cheek’ appearance
Parovirus B19
What causes scarlet fever?
Group A Haemolytic strep
True or false; Almost all metabolic conditions are autosomal dominant?
False - They are usually all recessive
True or false; Almost all structural conditions are autosomal dominant?
True
You are asked to give a talk to local district nurses about childhood diseases. In the UK, what is the most common cause of death in children greater than one year old?
Accidents
A 2-year-old boy is seen in the Emergency Department with watery diarrhoea for the past two day. What is the most likely causative agent?
Rotavirus
Parents bring their 4 week old formula fed infant to the short stay paediatric ward. They are concerned because he has persistent non-bilious vomiting and is becoming increasingly lethargic. Despite this, his appetite is substantial. On examination, he appears pale and you can see visible peristalsis in the left upper quadrant. What is the most likely diagnosis?
Pyloric stenosis
