What are the differentials for Fever?
Ottitis Media:
Symptoms:Acute: V Common, every child with a fever needs to have an otoscopy.
Investigations: Otoscopy shows a bright red, bulding tympanic membrane with loss of normal light refelx.
Management: Usually relf resolves, can give Amoxicillin but tell parents to use only if the pain doesn’t go away after 2/3 days. No evidence of benefit in anything else.
Chronic: Can insert venitalation tubes (works for 12 months), gromit is another option.
What are the differentials for Breathing Difficulty and Persistent Cough?
What are the differentials for Diarrhoea and/or vomiting?
What are the differentials for Abdominal Pain?
What are the differentials for Rectal Bleeding?
What are the differentials for Headache?
What are the differentials for Faints/Fits?
Febrile convulsions:
- Symptoms:
- __Provoked by fever, rarely seen in over 5 years olds
- 6 months to 5 years happens to 3% of children
- Occur early in a viral infeciton
- Usually last less than 5 minutes
- Tonic clonic
- Can be SIMPLE (<15 mins), COMPLEX (>15 mins) or FEBRILE STATUS EPELIPTICUS (>30 mins)
- Prognosis and management:
- __Admit if first seizure or compelx
- Overall risk of recurrence is 1 in 3
- Risk factors of another:
- >18 months
- Fever <39 degrees C
- FHx
- Antipyrexics do not prevent further seizures
What are the differentials for Limp/Joint Pain?
Chrondromalacia patellae:
- Softening of the cartilage if the patella
- Common in teenage girls
- Characteristic anterior knee pain on walking up and down stairs and rising from prolonged sitting
- Ususally responds well to psysiotherapy
Osteochondritis dissecans:
- Pain after exercise
- Intermittent swelling and looking
Osgood Schlatter Disesae:
- Seen in sporty teenagers
- Pain, tenderness and swelling over the tibial tubercle
Patellar Subluxation:
- Medial knee pain due to lateral subluxation of the patellar
- Knee may give way
Patellar tendonitis:
- More common in altheltci teenage boys
- Chronic anterior knee pain, worse on running
- Tender below the patella on examination
Perthe’s Disease:
- Due to avascular necrosis of the femoral head
- Usually occurs in children over 5
- A painful limp, on MRI reduced perfusion is seen
- Surgical repare only needed in children over age 6. Below that age observations has a good prognosis
Growing pains:
- Common from 3 to 12 years
- Check there are no “red flags”
Juvenile Idiopathic arthritis
- Occurs when there’s 6 week sof joint pain and other diagnoses have been excluded:
- Management:
- NSAIDS
- Joint injections (initially) of Methotrexate
- Systemic corticosteriods
- avoid if possible to prevent growth supression and osteoporosis
- Cytokine modulators “biologics”
What are the differentials for Persistent Self Harm?
What are the differentials for Non blanching Rash?
What are the differentials for Rashes/Skin lesions?
What are the differentials for Jaundice (beyond the neonatal period)?
1
What are the differentials for Itchy rash/itchy nose?
1
What are the differentials for ENT & eye problems?
What are the differentials for Lumps and bumps and other masses?
What are the differentials for Urinary Problems?
What are the differentials for Obesity?
What are the differentials for Faltering Growth?
What are the differentials for Abnormal Puberty?
What are the differentials for Short Stature?
What are the differentials for Pallor?
What are the differentials for Atypical/recurrent/persistent infection?
What are the differentials for Bone Pain?
