Paeds SBA Lecture
Henry Taylor
Alex Nesbitt
Question 1
A two year old boy is brought into A&E following
2 days of cough, coryza and a fever. Today the
cough changed and he developed stridor. He is
currently sitting on his mother’s lap and has no
signs of respiratory distress. He is active and has
a temperature of 37.8.
Question 1
What is the single most appropriate treatment
for James?
A Oral dexamethasone
B Nebulised adrenaline
C Nebulised salbutamol
D Humidified oxygen
E Amoxicillin
Croup
Mild
Active child, audible stridor but no
signs of respiratory distress
Moderate
Stridor with retractions/recession
and decreased air entry
Severe
Stridor at rest with expiratory
component, increased resp effort,
retractions/recession, tachypnoea
and pallor
Other respiratory conditions
What key features of each of these might be
mentioned in a SBA stem?
Bronchiolitis
Viral induced wheeze/asthma
Pneumonia
Pertussis
Cystic fibrosis
Epiglottitis
Diphtheria
Question 2
Horatio (aged 3) has been brought into the GP
surgery by his mother. He began coughing lest
week and was “a bit hot” and lethargic. Since
then, his eyes have become red and sore. He has
now developed a rash (next slide). You check his
notes and find that he has not received any
immunisations since he was 6 months old.
Question 2
Question 2
What is the single most likely complication of
this condition?
A Acute otitis media
B Cellulitis
C Pneumonia
D Meningitis
E Status epilepticus
Question 2
What is the single most likely complication of
this condition?
A Acute otitis media
B Cellulitis
C Pneumonia
D Meningitis
E Status epilepticus
Koplik Spots
Viral Exanthems
Name
Cause
Pattern of illness
Complications
Measles
Measles
paramyxovirus
Cough, coryza &
conjunctivitis. (Koplik spots)
Acute otitis media,
Bronchopneumonia,
Encephalitis, SSPE
Scarlet fever
S.Pyogenes
(toxin)
Fever, rash, strawberry
tongue, (Forcheimer spots)
Infective (URTI, Sepsis)
& Immune (GN, Rh
Fever)
Rubella
Rubella
togavirus
Rash: starts on face & spreads
to body. Sub-occipital
lymphadenopathy
Caution: Pregnant
mothers
Mumps
Mumps
paramyxovirus
Fever & headache ->
Parotidomegaly +/- rash
Orchitis/Oophoritis,
Pancreatitis, Meningitis
Fifth disease/Erythema
infectiosum
Parvovirus B19
Low grade fever & rash:
slapped cheek/lacelike
Aplastic crisis, Caution:
Pregnant mothers
Roseola infantum
HHV6 & 7
Sudden high fever for 3 days
then rash
Febrile convulsions
Kawasaki disease
Vasculitis
Persistent fever (7d), followed Coronary artery
by rash, conjunctivitis,
aneurysms
lymphadenopathy, skin
desquamation
Question 3
A 6 week old boy has been jaundiced for the past 5
weeks. His serum bilirubin is 140µmol/L (unconjugated
80µmol/L; conjugated 60µmol/L). He is clinically well,
exclusively breast fed, and has pale yellow stools.
What is the most likely diagnosis?
A.
B.
C.
D.
E.
Physiological jaundice
Hereditary Spherocytosis
Breast milk jaundice
Congenital toxoplasmosis
Biliary atresia
Neonatal Jaundice
Total serum
bilirubin
(µmol/L)
200
Early
Severe hyperbilirubinaemia
Prolonged
Jaundice
presenting <24
hours
•
•
Jaundice persisting after 2
weeks
•
•
Due to increased RBC breakdown + immature
liver function; occurs in 60% of neonates.
Present from 24 hrs to 2 weeks, bilirubin
levels <200µmol/L.
•
Cephalohaematoma, prematurity
+ early and late causes
Physiological
Haemolytic,
Infections
(TORCH),
Congenital
(CN, Gilbert)
•
•
•
•
•
24 hrs
Breast-milk jaundice
Infections (UTI)
Cholestasis (Biliary
atresia, choledochal
cyst)
Metabolic
(galactosemia, α1-AT)
Endocrine
(hypothyroid)
2 weeks
time
Unconjugated
Conjugated
Early Neonatal Jaundice
Haemolytic disorders
Present early (first 1-3 days of life)
Cause an unconjugated hyperbilirubinaemia
•
Haemolytic disease of the newborn (HDN)
–
–
–
•
Glucose 6-phosphate dehydrogenase deficiency (G6PD)
–
•
Aetiology: X linked enzyme deficiency -> no glutathione production in RBCs -> vulnerable to oxidative
stress; also impaired bilirubin conjugation in hepatocytes.
Hereditary Spherocytosis
–
–
•
Aetiology: rhesus incompatibility or ABO incompatibility
ABO incompatibility is more common, but produces a much milder, self-limiting disease
Ix: Coombs test (DAT)
Aetiology: AD>AR; RBC cytoskeletal genes
Ix: osmotic fragility test, blood film, PCR
℞ - phototherapy -> exchange transfusion
Prolonged Neonatal Jaundice
Unconjugated hyperbilirubinaemia
• Breast milk jaundice
– Presents >24 hours, usually resolves by 5-6
weeks
– Aetiology: incompletely understood; breast
feeding:
• Inhibits conjugation in liver
• Increases enterohepatic circulation
– Ix: monitor bilirubin levels – transcutaneous,
capillary, or venous sample.
– ℞: usually none needed, phototherapy
Prolonged Neonatal Jaundice
Conjugated hyperbilirubinaemia
• Biliary atresia
– Presents >24 hours, persists >2 weeks.
– Aetiology: inflammatory obliteration of biliary
tree causes cholestasis
– Moderately elevated total serum bilirubin
Conjugated bilirubin >20µmol/L or >20% total
bilirubin.
– Pale stools, dark urine
– Ix: Abdo US, HIDA scan, biopsy, intraoperative
cholangiography
– ℞: Kasai procedure (hepatoportoenterostomy)
-> liver transplant
Question 3
A 6 week old boy has been jaundiced for the past 5
weeks. His serum bilirubin is 140µmol/L (unconjugated
80µmol/L; conjugated 60µmol/L). He is clinically well,
exclusively breast fed, and has pale yellow stools.
What is the most likely diagnosis?
A.
B.
C.
D.
E.
Physiological jaundice
Hereditary Spherocytosis
Breast milk jaundice
Congenital toxoplasmosis
Biliary atresia
Question 3
A 6 week old boy has been jaundiced for the past 5
weeks. His serum bilirubin is 140µmol/L (unconjugated
80µmol/L; conjugated 60µmol/L). He is clinically well,
exclusively breast fed, and has pale yellow stools.
What is the most likely diagnosis?
A.
B.
C.
D.
E.
Physiological jaundice
Hereditary Spherocytosis
Breast milk jaundice
Congenital toxoplasmosis
Biliary atresia
Question 4
A 4 week old girl with Down’s syndrome has nonbilious, non-bloody vomiting occurring shortly after
most feeds. She is formula fed, gaining weight, and
passing normal stool. What is the most likely diagnosis?
A.
B.
C.
D.
E.
Duodenal atresia
Gastro-oesophageal reflux
Pyloric stenosis
Cow’s milk protein allergy
Intestinal volvulus
Infantile Vomiting
Disorder
Typical Age Features
Incidence
Ix
℞
Gastrooesophageal
reflux
<6 months
40%
Postprandial, often small volume,
effortless. non-bilious
± fussiness, feed refusal
If feeding +
growing none
indicated.
Thicken feeds,
position head up
after feeds.
± H2 receptor
blocker/PPI
Pyloric stenosis
2-7 weeks
(4M:F),
0.1%
Projectile non-bilious vomiting. +
hungry, wt loss. + RUQ mass.
hypochloraemic alkalosis, low K+
Test feed,
US
Correct fluid
balance,
Pyloromyotomy
Volvulus
0-3 weeks,
Malrotation
in 0.5%
Recurrent bilious vomiting/acute
obstruction
Upper GI series, Resect necrotic
Surgical
bowel, Ladd’s
exploration
procedure
Duodenal
atresia
1st week
1 in 5000
(25%
Down’s)
Scaphoid abdomen, bilious
vomiting from birth, obstruction
AXR – ‘double
bubble’
Surgical
Cow’s milk
protein allergy
<12 months
Vomiting, diarrhoea, blood in
stool, anaemia ± FTT, ± atopy
Trial of dietary
elimination
Maternal diet /
hydrolysed
formulas
Question 4
A 4 week old girl with Down’s syndrome has nonbilious, non-bloody vomiting occurring shortly after
most feeds. She is formula fed, gaining weight, and
passing normal stool. What is the most likely diagnosis?
A.
B.
C.
D.
E.
Duodenal atresia
Gastro-oesophageal reflux
Pyloric stenosis
Cow’s milk protein allergy
Intestinal volvulus
Question 4
A 4 week old girl with Down’s syndrome has nonbilious, non-bloody vomiting occurring shortly after
most feeds. She is formula fed, gaining weight, and
passing normal stool. What is the most likely diagnosis?
A.
B.
C.
D.
E.
Duodenal atresia
Gastro-oesophageal reflux
Pyloric stenosis
Cow’s milk protein allergy
Intestinal volvulus
Question 5
An 11 year old boy has had intermittent, severe, periumbilical abdominal pain for four months. It has caused
him to miss 10 days of school.
He weighs 32kg and his height is on the 50th centile. He
reports occasional vomiting, but no weight loss or
diarrhoea.
Question 5
• Is 32kg an appropriate weight for an 11 year
old boy?
For a pre-pubertal child
Approximate weight = (age + 4) x 2
• An 11 year old should weight (11+4) x 2 = 30kg
• A 6 year old should weigh 20kg etc.
Question 5
An 11 year old boy has had intermittent, severe, periumbilical abdominal pain for four months. It has caused
him to miss 10 days of school.
He weighs 32kg and his height is on the 50th centile. He
reports occasional vomiting, but no weight loss or
diarrhoea. What is the most likely diagnosis?
A.
B.
C.
D.
E.
Functional abdominal pain
Coeliac disease
Crohn’s disease
Intussusception
Lactose intolerance
Abdominal Pain
Disorder
Typical Age Features
Incidence
• Table School
of comparison
age
Peri-umbilical, intermittent for
Functional
/Recurrent
Ix
℞
Education and
reassurance,
attend school
30%
>3/12; + vomiting in 30%
ºdiarrhoea, fever, FTT
Bloods,
Endoscopy if
?coeliac
Coeliac disease
Esp. 1-3 yrs
1% in UK
FTT, lethargy, diarrhoea (large
pasty stools).
± vomiting, distension,
TTG, total IgA;
HLA typing
Endoscopy
Gluten free diet
Crohn’s disease
Esp.
Adolescence
0.1%
FTT, weight loss, anaemia,
lethargy, peripheral stigmata
Endoscopy +
colonoscopy
steroids,
elemental diet,
biologics.
ASA, azathioprine.
Surgical
Lactose
intolerance
any age
5% in N
Europeans
Bloating, flatus, and diarrhoea
occur 1-3 hrs after dairy
consumption
Diet trial,
H breath test,
reducing
substances in
stool
Lactose free diet
Intussusception
3/12 – 2 yrs
2M:F. 0.4%
Intermittent colicky abdo pain,
obstruction, redcurrant jelly stool
AXR
US
Air insufflation
Surgical
Question 5
An 11 year old boy has had intermittent, severe, periumbilical abdominal pain for four months. It has caused
him to miss 10 days of school.
He weighs 32kg and his height is on the 50th centile. He
reports occasional vomiting, but no weight loss or
diarrhoea. What is the most likely diagnosis?
A.
B.
C.
D.
E.
Functional abdominal pain
Coeliac disease
Crohn’s disease
Intussusception
Lactose intolerance
FTT
“insufficient usable nutrition resulting in failure to gain weight appropriately
•
No universally accepted diagnostic criteria, examples:
– Child < 3rd-5th percentile for weight
– Fall of 2 percentile lines on growth chart
•
Consider Height (HT), Weight (WT), Head Circumference (HC)
– Type I – WT low, HT + HC relatively preserved
• Malnutrition – neglect, poverty, feeding difficulties, anorexia
• Malabsorption – Coeliac, Crohn’s, etc.
• Increased caloric demand – Cystic fibrosis, CHD, metabolic
– Type II – WT + HT low, HC preserved
• Dwarfism, endocrine growth abnormalities
• Severe malnutrition
– Type III – WT, HT + HC low
• Prenatal infection, congenital abnormalities
• Severe malnutrition
• Constitutionally small child
• Note these patterns may suggest an aetiology, but are not diagnostic.
Any child with FTT requires a full work up
FTT
• Red flags for organic cause
– Abnormal cardio examination
– Developmental delay
– Dysmorphic features
– Recurrent infections
– Organomegaly/lymphadenopathy
– Vomiting, diarrhoea, dehydration
– Adequate caloric intake
4 common causes of organic FTT = the 4 C’s
Coeliac
Cardiac
Cystic fibrosis
Cerebral palsy
if present require
extensive Ix
if not evaluate +
manage caloric
intake
Question 6
Emma is a 4 year old who has come in to A&E
with abdominal pains and vomiting. She recently
had a coryzal illness.
Her blood gas shows a metabolic acidosis with
partial respiratory compensation. She has
glycosuria and ketonuria. You diagnose and treat
her for diabetic ketoacidosis (DKA) according to
your trust guidelines.
Question 6
You have calculated that Emma is 10% dehydrated (she
normally weighs 15kg). You treat her with an appropriate
insulin infusion and now calculate her fluid replacement.
What is the correct fluid replacement regimen for her?
A 2500ml over 48 hours
B 4000ml over 48 hours
C 2750ml over 24 hours
D 1250ml over 24 hours
E 5250ml over 72 hours
Question 6
You have calculated that Emma is 10% dehydrated (she
normally weighs 15kg). You treat her with an appropriate
insulin infusion and now calculate her fluid replacement.
What is the correct fluid replacement regimen for her?
A 2500ml over 48 hours
B 4000ml over 48 hours
C 2750ml over 24 hours
D 1250ml over 24 hours
E 5250ml over 72 hours
Fluid replacement in DKA
Replacement should be more cautious than in
adults and takes place over 48h. Why?
Daily fluid requirement in children:
100mls each kg for first 10kg
50mls each kg for next 10kg
20mls each kg for each additional kg
Question 6
You have calculated that Emma is 10%
dehydrated (she normally weighs 15kg). You
treat her with an appropriate insulin infusion and
now calculate her fluid replacement.
Daily requirement = 10 x 100 + 5 x 50 = 1250ml
Therefore, requirement for 48h = 2500ml
Deficit = 10% of 15kg = 1.5kg = 1500ml
Total Replacement = 2500ml + 1500ml = 4000ml
Managing DKA
Protocols vary slightly between centres, find one at
your hospital or from the CATS website to learn.
Management strategy:
1. Stop ketone production
2. Rehydrate/resuscitate & normalise electrolytes
3. Identify and treat underlying cause
Question 7
Amy is a 9 month old who has being crying more
than usual over the last 24 hours and has a fever
of 38.5. A urine dip is positive for nitrites and
leucocytes and she is successfully treated with a
short course of trimethoprim.
Question 7
What is the most appropriate follow up for this
episode?
A Reassure Amy’s parents that no further follow-up
is necessary
B An ultrasound in the next 6 weeks and DMSA scan
C An ultrasound in the next 6 weeks and a MCUG
(micturating cysturethrogram)
D An ultrasound in the next 24 hours
E An ultrasound in the next 6 weeks
Question 7
What is the most appropriate follow up for this
episode?
A Reassure Amy’s parents that no further followup is necessary
B An ultrasound in the next 6 weeks and DMSA scan
C An ultrasound in the next 6 weeks and a MCUG
(micturating cysturethrogram)
D An ultrasound in the next 24 hours
E An ultrasound in the next 6 weeks
NICE Guidelines
Acute USS
USS within 6
weeks
DMSA 4-6
months later
MCUG
If atypical /
recurrent
All others
If atypical /
recurrent
If atypical/
recurrent
6 months – 3 yrs If atypical
If recurrent
If atypical /
Recurrent
X
3 yrs
If recurrent
If recurrent
X
0-6 months
If atypical
Question 8
A father brings his 3 year old son to the GP’s with
worsening fever, diarrhoea, and vomiting. The GP feels
a large mass in the left flank which crosses the midline.
Urine analysis reveals elevated HVA levels. What is the
mass most likely to be?
A.
B.
C.
D.
E.
Wilms’ tumour
Spleen
Neuroblastoma
Intussusception
Carcinoid tumour
Wilms’ Tumour
aniridia
Wilms’ tumour,
firm smooth
grey/tan mass
Triphasic histology
– blastema,
mesenchyme,
epithelium
Neuroblastoma
Large
adrenal
mass
Small round
blue cell
tumour
Distribution of
neuroblastoma
Abdominal Mass
Disorder
Typical
Age
Incidence
Cause
History
Exam and Ix
Wilms’ tumour
<5
(peak 3-4)
0.1/1000
Malignancy of
embryonic renal
tissue. ± genetic
predisposition (e.g.
WAGR)
Abdominal mass.
Often otherwise
asymptomatic
Large smooth firm
renal mass, doesn’t
usually cross midline.
Biopsy = triphasic
Neuroblastoma
<5
(peak 0-2)
0.1-0.2
/1000
Malignancy of
Fever, fatigue, wt
neural crest cells in loss, diarrhoea,
adrenal
vomiting
medulla/sympatheti
c chain.
Abdominal mass, can
cross midline. +urine
HVA/VMA. ±calcified.
Biopsy: small blue cell
Splenomegaly
any
Infections, RBC and Hb disorders,
lymphoma, leukaemia, SLE
LUQ/left sided mass,
notch, can’t get above
Hepatomegaly
any
Biliary atresia, viral hepatitis, heart
failure
RUQ mass, ±pulsatile,
±tender
Hepatosplenom
egaly
any
Leukaemia, thalassemia, MPS, liver
Question 8
A father brings his 3 year old son to the GP’s with
worsening fever, diarrhoea, and vomiting. The GP feels
a large mass in the left flank which crosses the midline.
Urine analysis reveals elevated HVA levels. What is the
mass most likely to be?
A.
B.
C.
D.
E.
Wilms’ tumour
Spleen
Neuroblastoma
Intussusception
Carcinoid tumour
Question 8
A father brings his 3 year old son to the GP’s with
worsening fever, diarrhoea, and vomiting. The GP feels
a large mass in the left flank which crosses the midline.
Urine analysis reveals elevated HVA levels. What is the
mass most likely to be?
A.
B.
C.
D.
E.
Wilms’ tumour
Spleen
Neuroblastoma
Intussusception
Carcinoid tumour
Question 9
A 3 day old baby girl collapses on the way to A&E, she
had become progressively blue and breathless over the
last few hours. High flow oxygen has been administered
for the past 20 minutes but has had little effect on the
PaO2. What is the most likely diagnosis?
A.
B.
C.
D.
E.
Transposition of the great arteries
IRDS
Ventricular septal defect
Patent Ductus Arteriosus
Eisenmenger’s syndrome
Congenital Cyanotic Heart diseases
• Cyanosis is due to a Right-to-Left shunt
• 3 causes:
1.
2.
3.
Congenital Cyanotic Heart diseases
• Cyanosis is due to a Right-to-Left shunt
• 3 causes:
ToF
Pathophysiology 1. Overriding Aorta
2. RV outflow obstruction
3. Large VSD
4. RV hypertrophy
Together = venous mixing,
reduced pulmonary
circulation.
DA provides L->R shunt.
Presentation
Variable RV outflow
obstruction = range of
severity.
Exertional cyanotic spells
(tet spells),
breathlessness, FTT.
CXR – boot shaped heart
TGA
Eisenmenger’s
Transposition of aorta
and pulmonary artery.
Chronic L->R shunt
results in increased
pulmonary vascular
resistance and
pulmonary HTN.
Increased right sided
pressure reverses
shunt, becomes R->L
shunt & get cyanosis.
Co-exists with VSD,
ASD, or PDA. Allows
partial pulmonary
circulation
Severe cyanotic
episode often at day 3
of life (when DA
closure occurs).
L->R shunt causes
breathlessness, FTT,
chest pain,
haemoptysis.
Cyanosis onset around
2 years.
Question 9
A 3 day old baby girl collapses on the way to A&E, she
had become progressively blue and breathless over the
last few hours. High flow oxygen has been administered
for the past 20 minutes but has had no effect on the
PaO2. What is the diagnosis?
A.
B.
C.
D.
E.
Transposition of the great arteries
IRDS
Ventricular septal defect
Patent Ductus Arteriosus
Eisenmenger’s syndrome
Question 9
5
A 3 day old baby girl collapses on the way to A&E, she
had become progressively blue and breathless over the
last few hours. High flow oxygen has been administered
for the past 20 minutes but has had no effect on the
PaO2. What is the diagnosis?
A.
B.
C.
D.
E.
Transposition of the great arteries
IRDS
Ventricular septal defect
Patent Ductus Arteriosus
Eisenmenger’s syndrome
Congenital Non-Cyanotic Heart diseases
• Non-cyanotic heart disease is due to Left-to-Right shunt
– ASD
• Presentation – asymptomatic, recurrent chest infections, arrhythmia (as adult)
• O/E: ESM at L sternal edge – wide S2
• ℞: monitor, if large enough to cause RV dilatation -> surgical correction
– VSD
• Most common congenital heart disease
• Small = <3mm, asymptomatic, most resolve spontaneously. Loud pansystolic
murmur at left sternal edge
– ℞ await closure – usually at 1-2 years
• Large = >3mm, breathlessness, heart failure, FTT, recurrent chest infections.
Quiet murmur.
– ℞ – surgery at 3-6/12
– PDA
•
•
•
•
Failure of DA closure 2/12 after expected date of delivery
Presentation: usually asymptomatic. O/E: continuous murmur under L clavicle
℞: indomethacin, coil/occlusion device.
NB: PGE infusion keeps open, e.g. in TGA.
Innocent Murmurs
• Present in 30% of children
• Resolve spontaneously
• Features
– Systolic
– Soft blowing murmur
– Asymptomatic
– Left sternal edge
No radiation, added sounds, fever, or anaemia
• Ddx: ESM (location), PDA (continuous), VSD (harsh, symptoms)
Question 10
Mary is a four year old who has been brought
into A&E by ambulance. She has been having
continuous tonic-clonic seizures for the last 8
minutes. She has been given a dose of buccal
midazolam by LAS and her BM is 5.4.
Question 10
What is the next most appropriate intervention?
A Phenytoin infusion
B Buccal midazolam
C IV lorazepam
D PR paraldehyde
E Rapid sequence induction with thiopental
Question 10
What is the next most appropriate intervention?
A Phenytoin infusion
B Buccal midazolam
C IV lorazepam
D PR paraldehyde
E Rapid sequence induction with thiopental
Question 10 (Part two)
You successfully terminate Mary’s seizure and
continue your ABCDE assessment. On exposure,
you find the following:
Question 10 (Part two)
What is the single most likely underlying cause
of Mary’s seizure?
A Neurofibromatosis type I
B Neurofibromatosis type II
C Pneumococcal meningitis
D Tuberous sclerosis
E West syndrome
Question 10 (Part two)
What is the single most likely underlying cause
of Mary’s seizure?
A Neurofibromatosis type I
B Neurofibromatosis type II
C Pneumococcal meningitis
D Tuberous sclerosis
E West syndrome
Tuberous sclerosis
Multi system disorder:
CNS – Cortical tubers, giant cell astrocytoma & subependymal nodules. Learning disabilities and
autistic spectrum disorders.
Skin - Multiple manifestations
Kidneys – Angiomyolipomas
Eyes – Coloboma, papilloedema
Heart – Rhabdomyomas
Lungs – Cystic replacement of parenchyma
Tuberous sclerosis
Multi system disorder:
Neurofibromatosis type I
Sturge-Weber Syndrome
Question 11
Sarah is an 11 year old who has developed left sided hip pain
and a limp over the last few days. Her BMI is 34, she is afebrile
and her observations are stable.
What is the single most likely cause of her presentation?
A Avascular necrosis
B Perthe’s disease
C Septic arthritis
D Slipped upper femoral epiphysis
E Transient synovitis
Question 11
8
Sarah is an 11 year old who has developed left sided hip pain
and a limp over the last few days. Her BMI is 34, she is afebrile
and her observations are stable.
What is the single most likely cause of her presentation?
A Avascular necrosis
B Perthe’s disease
C Septic arthritis
D Slipped upper femoral epiphysis
E Transient synovitis
The Limping Child
Condition
Presentation
Minor injury
Post-traumatic
Septic
arthritis/osteomyelitis
Fever, excruciating inability to weight bear/to mobilise a limb.
Red hot joint
Neoplasia
Insidious onset, increasing bone pain +/- fractures & weight
loss.
CNS
Present from birth/acute. Other neurological signs (eg: high
arched feet)
Juvenile Idiopathic
Arthritis
Oligo/polyarthritis lasting longer than 6 weeks
Transient synovitis
Aged 3-8, preceding URTI, dx of exclusion
DDH
Aged 0-4, dx on delivery/baby check. Risk factors: First born,
FH, female, breech delivery, macrosomia
Perthes
Aged 5-9, idiopathic avascular necrosis fem head, intermittent
limp & groin/hip/knee pain Rx: Analgesia & bed rest
SUFE
Aged 10+, Risk factors: Male, Obese, Pubertal, Afro-Caribbean
Summary
•
•
•
•
•
•
•
•
•
•
•
Respiratory infections
Viral exanthems
Neonatal Jaundice
Infantile Vomiting
Abdominal Pain and FTT
DKA
Abdominal Mass
UTI
Congenital heart disease
Neurocutaneous syndromes
Childhood orthopaedic conditions