Presentations & Differential Diagnosis

Question 1

A child is brought to A+E with acute onset abdominal pain. What is the most common surgical cause of acute abdo in children?

Answer 1

Appendicitis

Question 2

A child is brought to A+E with acute onset abdominal pain. What is the most common non-surgical cause of acute abdo in children?

Answer 2

Gastroenteritis

Question 3

A neonate is brought to A+E with persistent crying and difficulty feeding. What might be wrong?

Answer 3

The child might have acute abdominal pain

Question 4

How does acute abdominal pain present in a child who can talk?

Answer 4

They tell you, duh

Question 5

What symptoms are important to ask about when taking an acute abdomen history in a child?

Answer 5

Vomiting, diarrhoea, fever, groin pain, urinary symptoms, bowel symptoms inc. bloody diarrhoea, vaginal discharge.

Question 6

What sign might a baby have to indicate pain?

Answer 6

Abnormal facial expression

Question 7

What are we testing when we ask a child to suck their abdomen in and blow it out?

Answer 7

To check for the level of the pain and exclude peritonitis if they do it without pain.

Question 8

What are the medical causes of acute abdominal pain for infants?

Answer 8

Gastroenteritis, UTI, constipation.

Question 9

What are the medical causes of acute abdominal pain for children aged 2-5?

Answer 9

Gastroenteritis, UTI, and constipation.

Question 10

What are the medical causes of acute abdominal pain for children aged 6-11?

Answer 10

Gastroenteritis, UTI, and constipation.

Question 11

What are the medical causes of acute abdominal pain for children aged 12-18?

Answer 11

Gastroenteritis, UTI, and constipation.

Question 12

What are the surgical causes of acute abdominal pain for infants?

Answer 12

Intussusception, volvulus, incarcerated hernia, Hirschsprung’s

Question 13

What tool can be used to assess the need for further investigation of abdominal pain?

Answer 13

Paediatric appendicitis score (PAS)

Question 14

What are the other non-surgical causes of acute abdominal pain for children aged 12-18?

Answer 14

Dysmenorrhoea, DKA, mittelschmerz, threatened abortion, ectopic pregnancy, IBD, adrenal crisis, PID

Question 15

What are the surgical causes of acute abdominal pain for children aged 2-5?

Answer 15

Appendicitis, intussusception, volvulus, trauma

Question 16

What are the surgical causes of acute abdominal pain for children aged 6-11?

Answer 16

Appendicitis, trauma

Question 17

What are the surgical causes of acute abdominal pain for children aged 12-18?

Answer 17

Appendicitis, trauma, ovarian torsion, testicular torsion

Question 18

What are the other non-surgical causes of acute abdominal pain for infants?

Answer 18

Infantile colic

Question 19

What are the other non-surgical causes of acute abdominal pain for children aged 2-5?

Answer 19

Mesenteric lymphadenitis, HSP, DKA, Sickle cell crisis

Question 20

What are the other non-surgical causes of acute abdominal pain for children aged 6-11?

Answer 20

Mesenteric lymphadenitis, HSP, DKA, Sickle cell crisis, pneumonia, functional pain, abdominal migraine.

Question 21

What is the PAS?

Answer 21

Score designed to show if abdominal pain needs further assessment in children.

Question 22

What scores points on the PAS?

Answer 22

Migration of pain (1), anorexia (1), N+/or vomiting (1), RLQ pain (2), cough/percussion/hopping tenderness (2), fever (1), leukocytosis or neutrophilia (1 each)

Question 23

What 2 socially concerning things would make the differential list for an acute abdomen?

Answer 23

Drug use and child abuse.

Question 24

A child is brought to A+E with a high pitched whistling sound when they breath out. What 4 ways can this occur?

Answer 24

Bronchospasm, mucosal lining swelling, excessive secretions, or inhaled foreign body.

Question 25

A child is brought to A+E with a high pitched whistling sound when they breath out. They were previously playing with some lego, and then all of a sudden this noise started. What is your top differential?

Answer 25

Inhaled foreign body, probably a bit of lego

Question 26

When in wheezing least common in childhood?

Answer 26

In the immediate neonatal period

Question 27

A child is brought to A+E with a high pitched whistling sound when they breath out. This occurred after a P.E lesson in which they did the beep test. What is your top differential?

Answer 27

Exercise induced wheeze ?asthma

Question 28

What is a frequent cause of wheeze in pre-school children?

Answer 28

Viral/bacterial URTIs e.g. croup, bronchiolitis, cold/flu

Question 29

What GI problem could cause a wheeze in a child?

Answer 29

Gastro-oesophageal reflux

Question 30

A child with a wheeze comes to A+E. What red flags would indicate the need for immediate assessment and care?

Answer 30

Poor feeding, cyanosis, respiratory distress, drowsiness, poor response to treatment

Question 31

What does a wheeze starting perinatally suggest?

Answer 31

A structural abnormality

Question 32

What kind of structural abnormality might cause a perinatal wheeze?

Answer 32

Tracheo-oesophageal fistula, heart failure/congenital heart disease, extrinsic airway compression, tracheobronchomalacia

Question 33

How is a transient wheeze in infancy managed?

Answer 33

Short term inhaled bronchodilators, treat the cause if possible.

Question 34

What investigations might be necessary for a child presenting with a wheeze?

Answer 34

CXR if foreign body, structural abnormality, or pulmonary mass/infiltrate suspected, swaet test for CF, allergy test, Barium swallow, spirometry if over 6 years old.

Question 35

What are the main priorities when first assessing a pt with vomiting or diarrhoea?

Answer 35

Presence and degree of dehydration, and underlying cause especially if life-threatening

Question 36

What are some of the more sinister causes of vomiting?

Answer 36

DKA, meningitis, subarachnoid, RICP, bowel obstruction, malignancy, peritonitis, torsion (test/ovarian)

Question 37

What are the consequences of untreated vomiting?

Answer 37

Dehydration, metabolic alkalaemia, hyponatraemia, hypokalaemia, haematemesis

Question 38

What are the consequences of untreated diarrhoea?

Answer 38

Dehydration, hypokalaemia

Question 39

A child comes to the GP with it's mother because they have been having back pain. How common is nonspecific back pain in children?

Answer 39

Depends on population, but can be up to 2/3s of children at some point.

Question 40

When is back pain most common in children?

Answer 40

Times of rapid growth, so more common with increasing age

Question 41

Which sports is back pain most associated with?

Answer 41

Gymnastics, dancing, american football, diving, wrestling, rowing, rugby