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Flashcards in Spot Diagnosis Deck (42):
1


I am a condition that arises from damage to the immature brain.

Cerebral Palsy

2

I am a condition arising from damage to the immature brain. You are the doctor what is the condition given that there are 4 main forms of this condition

spastic (70%): hemiplegia, diplegia or quadriplegia
dyskinetic
ataxic
mixed

which condition am I?

Cerebral Palsy

3

I am a condition arising from damage to the immature brain. You have finished the history and examination and go on to make a diagnosis.

The medical management for my condition includes
spasticity medication such as
oral diazepam,
oral and intrathecal baclofen,
botulinum toxin type A,
orthopaedic surgery
selective dorsal rhizotomy

Which condition am I?

Cerebral Palsy

4

• M>F

• 5-10% Family history of parents

• Projectile vomiting at 4-6 weeks of life

• Diagnosis is made by test feed or USS

• Treatment: Ramstedt pyloromyotomy (open or laparoscopic)

• Hypochloremic Hypokalaemic metabolic alkalosis

which condition am I?

Pyloric stenosis

5

• Proximal to or at the level of, ileocaecal valve

• 6-9 months age

• Colicky pain, diarrhoea and vomiting, sausage shaped mass, red jelly stool.

• Treatment: reduction with air insufflation

Which Condition am I?

Intussusception

6

Jaundice > 14 days
Increased conjugated bilirubin
Urgent Kasai procedure

Which condition am I?

Biliary atresia

7


emergency department
4-year-old child
sore throat which has rapidly become worse over the last 3 hours,
a high fever and has begun drooling from the sides of his mouth. His mother admits he has missed some of his vaccinations
soft high pitched sound is just audible on inspiration

Which condition am I?

acute epiglottitis
Haemophilus influenza type B

8


18-month-old
Three days ago he started with fever, cough and rhinorrhoea
wheezy
On examination his temperature is 37.9ºC, heart rate 126/min, respiratory rate 42/min and a bilateral expiratory wheeze
inhaler has made little difference to the wheeze

viral-induced wheeze

9

a degenerative condition affecting the hip joints of children, typically between the ages of 4-8 years
5 times more common in boys
hip pain: develops progressively over a few weeks
x-ray: early changes include widening of joint space, later changes include decreased femoral head size/flattening

Perthes' disease

10

Microcephalic, small eyes
Cleft lip/palate
Polydactyly
Scalp lesions

Patau syndrome (trisomy 13)

11

Micrognathia
Low-set ears
Rocker bottom feet
Overlapping of fingers

Edward's syndrome (trisomy 18)

12

Hypotonia
Hypogonadism
Obesity
syndrome has no cure

Prader-Willi syndrome

13

NICE issued guidance in 2010. Management:
look for possible underlying causes/triggers (e.g. Constipation, diabetes mellitus, UTI if recent onset)
advise on fluid intake, diet and toileting behaviour
reward systems (e.g. Star charts). NICE recommend these 'should be given for agreed behaviour rather than dry nights' e.g. Using the toilet to pass urine before sleep

Nocturnal Enuresis

14

The commonest murmur heard in children

• Soft
• Systolic
• Asymptomatic
• Left sternal edge

and no added heart sounds

Innocent murmur

(Example:Increased flow across branch pulmonary artery, Stills murmur, Venous hum)

15

Long Systolic Murmur

VSD
Overriding Aorta
Right Ventricular Hypertrophy
Pulmonary Stenosis (right ventricle blood vessel narrowing)

Tetralogy of Fallot

16

Right Lateral thoracotomy scar
right modified Blalock Taussig Shunt (RMBTS)

Tetralogy of Fallot

17

Differentials for a left lateral thoracotomy scar

Tetralogy of Fallot (RMBTS / LMBTS)

Coarctation of the aorta repaired

Pulmonary artery band

Persistent arterial duct ligation

18

The child with Down’s Syndrome who has a murmur at the left lower sternal edge and a median sternotomy scar

AVSD / VSD

19

A child with median sternotomy scar and lateral thoracotomy scar with a systolic and diastolic murmur at the left sternal edge

Blalock Taussig Shunt, and then complete repair for Tetralogy of Fallot

20

15 month old girl
Upper respiratory tract symptoms for 2 days
crying ++
generalised convulsion lasting 2 minutes
Temperature 39ºC
Drowsy initially but soon started to respond
Red left tympanic membrane
Rest of examination normal

Febrile Convulsion and Otitis Media


FEBRILE CONVULSION
6 months to 6 years
3-5% of children
Often familial
Convulsion is generalised,<15 minutes

OTITIS MEDIA
red tympanic membrane

21

whining and crying, to screaming, kicking, hitting, falling down and breath holding

temper tantrum

22



is the commonest cause of death in the first year of life. It is most common at 3 months of age. Major risk factor is putting the baby to sleep prone

Sudden Infant Death Syndrome

23

Webbed neck, widely spaced nipples and wide carrying angle with aortic ejection systolic murmur

turners syndrome

24

turners syndrome examination findings on general inspection and auscultation of the heart

Webbed neck, widely spaced nipples and wide carrying angle with aortic ejection systolic murmur

25

Loose stools most likely diagnosis in the absence of other signs

lactose intolerance

26

Most common causative organism for this ear problem is haemophilus influenzae

otitis media

27

bilious vomiting

intussusception

28

haemophilia in teenage girls should lead you to suspect which genetic condition

turners syndrome

29

Right iliac fossa pain following a recent viral infection in children

Mesenteric adenitis

30

Viral exanthem of the Human herpes virus 6 Roseola infantum

fever followed by rash

31

Extra digits a cleft palate microcephaly and congenital abnormatlities form part of the presentation of which chromosomal abnormality

Patau 13

32

An 18 year old boy presents to the GP and it is obvious from when he works in that he has no physical evidence of puberty name a cause of delayed puberty associated with hypogonadotropic hypogonadism

Kallmann syndrome

33

You are the GP

A concerned mum tells you about her son who has not been feeling well recently has a swollen tummy and mum has also noticed blood in his nappies

Which conditions should you be worried about that is treated with empirical antibiotics

Necrotising enterocolitis

34

you are looking at the child's eyes but you'll notice that the left eye is looking inwards why has the right eyes looking straight at you what is this sign called

Esotropic strabismus

35

You are examining a child and noticed that the left eyes looking straight at you but the right eye is looking upwards what is this sign called

Hypertropic strabismus

36

You are looking at a child's eyes and noticed that the right eye is looking straight at you but the last eyes looking down what is the name of this sign

Hypotropic strabismus

37

Whilst doing the Top To Toe baby check you notice that the baby doesn't have a red reflex and in fact the pupil looks white whilst not pathognomonic this presentation is commonly seen in which type of Childhood cancer

Retinoblastoma

38

The doctor has just told me that my child has a condition called retinoblastoma does that mean she will die

No the prognosis is really good

39

Coxsackie A16 virus typically presenters which can the condition affecting the hands feet and mouth

Hand foot and mouth disease

40

Hi Dr I first noticed a rash on my child's face that over the past couple of weeks has been spreading over his chest and back.
Whilst not a pathognomonic feature this type of presentation is typical for which virus

Rubella

41

Which virus causes slapped cheek syndrome

Parvovirus B19

42

Patent ductus arteriosus

collapsing pulse