PRACTICA CASUSSEN KIND 2
Practica super handig om naar te gaan voor het casussen-examen!!!
Learning goals en take home messages (niet van mij, van iemand een paar jaar hoger)
Opmerkingen zijn van mij die erbij zijn gezet met de les
koorts............................................................................................................................................................ 3
Casus 1: Sarah.......................................................................................................................................................3
Casus 2: Ilias..........................................................................................................................................................6
Casus 3: Elisabeth..................................................................................................................................................9
Casus 4: Sam.......................................................................................................................................................11
Casus 5: Stef........................................................................................................................................................14
Casus 6: Maya.....................................................................................................................................................16
Casus 7: Wim.......................................................................................................................................................18
hoesten....................................................................................................................................................... 21
Casus 1................................................................................................................................................................21
Casus 2................................................................................................................................................................23
Casus 3: vervolg op casus 2.................................................................................................................................26
Casus 4................................................................................................................................................................28
Casus 5................................................................................................................................................................30
Casus 6................................................................................................................................................................33
neonaat....................................................................................................................................................... 37
Casus 1................................................................................................................................................................37
Casus 2................................................................................................................................................................39
Casus 3................................................................................................................................................................42
Casus 4................................................................................................................................................................44
Casus 5................................................................................................................................................................47
Casus 6................................................................................................................................................................49
Abdominale pijn en constipatie.................................................................................................................... 56
Casus 1................................................................................................................................................................56
Casus 2................................................................................................................................................................59
Casus 3 (Roxanne)...............................................................................................................................................62
Casus 4................................................................................................................................................................65
, Casus 5................................................................................................................................................................67
Casus 6: Jolien 10y old........................................................................................................................................68
Ledemaatproblemen.................................................................................................................................... 70
Casus 1................................................................................................................................................................70
Casus 2................................................................................................................................................................73
Casus 3................................................................................................................................................................77
Casus 4................................................................................................................................................................78
casus 5.................................................................................................................................................................80
Casus 6................................................................................................................................................................83
Altered awareness....................................................................................................................................... 86
Casus 1................................................................................................................................................................86
Casus 2................................................................................................................................................................89
Casus 3................................................................................................................................................................90
Casus 4................................................................................................................................................................93
Case 5..................................................................................................................................................................95
Casus 6................................................................................................................................................................96
Casus 7..............................................................................................................................................................100
Casus 8..............................................................................................................................................................102
Failure to thrive......................................................................................................................................... 105
Casus 1..............................................................................................................................................................105
Casus 2..............................................................................................................................................................110
Casus 3: Dennis.................................................................................................................................................112
Casus 4..............................................................................................................................................................114
Casus 5..............................................................................................................................................................118
Casus 6..............................................................................................................................................................123
,KOORTS
CASUS 1: SARAH
Sarah is 3 years old. She had a fever since this morning. A few moments ago, she passed out, her lips turned
blue and she was moving her arms and legs in a strange way. In a panic, her mother picked her up and drove
her to the doctor’s office 2 blocks away. When they arrive there, Sarah is sleeping and she feels warm.
Story is not okay: red flags → you need to see a doctor right away: is she sleeping or
unconscious?
Altijd starten met ABCDE: First ABC before asking questions to the mother
- A: thorax movements, abnormal breathing sounds
- B: symmetrical
- C: capillaire refill (on the sternum), limbs usually cold
Temperature 39,7°C, Mother never seen it before
Running nose, fever in the morning, was not crying, was on the couch
It was very symmetrical and short
The child does not want to wake-up
BD stays very long stable in child
RR 42: little bit high → tachycardia, tachypnea
● List at least 3 diagnoses/ conditions you should consider.
○ Koortsstuipen/febrile seizures
○ Meningitis
○ reflex asystolic syncope
○ ○ blue breath holding spells: was not crying
○ ○ epileptic seizure: could be first episode
● Do you include any selflimiting condition in your list? Why?
○ Koortsstuipen: komt bij 3% van de kinderen voor tussen 6 maanden en 6
jaar, zijn een vaak voorkomende oorzaak
● Write a scenario with pivotal elements in the history for eachof the 3 diagnosis.
Highlight arguments pro and con.
○ Koortsstuipen
■ pro: meer dan 38°C koorts, korte aanval, symmetrische, slap,
familiaal VG
■ Con: asymmetrisch, langer dan 15 min, stijfheid, geen koorts
○ Meningitis/encefalitits
■ pro: photophobia lethargy, poor feeding/vomiting, irritability,
hypotonia, drowsiness
■ con:
○ reflex asystolic syncope
■ pro: bleek worden, neervallen, aanleiding: pijn, hevige angst, schrik,
ook tijdens ziekte en koorts, urineverlies, val als begin aanval, first-
degree relative; kort, snel bijgekomen
● Write a scenario with pivotal elements in the physical examination for each of
the 3 diagnosis. Highlight arguments pro and con.
○ koortsstuipen
, ■ pro: weinig te vinden, tijdens aanval: ogen wegdraaien,
symmetrische shocken armen en benen, gezicht bleek, grauw of
blauw, ademhaling oppervlakkig, stotend, kortdurend stoppen
■ con:
○ Meningitis:
■ pro: Brudzinski sign, Kernig sign, purpuric rash, signs of shock,
papilloedame, altered consious levels
○ Reflex asystolic syncope
■ pro: nystagmus
● Do you need further investigations to distinguish? If so,which and why?
○ Throughout clinical examinations: listen to the lungs in between the crying,
check meningeal signs
○ Yes, send to the hospital for a check-up, febrile seizure: menigitis or other
infections uitsluiten (cerebrospinal fluid puncture if you find thinks like neck
stiffness)
○ EEG: geen afwijkingen bij reflex anoxic seizure
○ Urine sample in 3 year old is difficult
Opmerkingen
- Normale waarden van respiratoire rate bij een 3-jarige: 40 te hoog
- Stabiel op dit moment: niet bezorgd om de seizures, maar de koorts. Past perfect bij een febriele
convulsie.
- Reflex asystolische syncope: bleek worden, blauwe lippen, na een seizure valt die in slaap.
- Blijkt een virale infectie met febriele convulsies: geruststellen dat het niets gevaarlijks is, maar
absoluut normaal is.
- Geen medicatie geven, maar elke keer als ze koorts krijgen wel iets gaan geven omdat ze elke keer die
convulsies krijgen. Dan antiepileptica
- Normaal koorts: 10-12x per jaar koorts hebben, dat is normaal voor een 3-jarige.
- Voorkomen met paracetamol? Bij de stijging van temperatuur (niet voorkomen)
Turns out viral infection, child had febrile seizure, tell the mother it may happen again,
self-limiting, not dangerous, for the child not a problem, does not need medication,
valproaat kunnen we eventueel geven om het te voorkomen maar enkel voor diegene die
het echt regelmatig doen: dus bij elke koortspiek
Does paracetamol/NSAID prevent it? No, the febrile seizure will happen during the rise
Take home messages:
Meningitis can present as febrile convulsions
Simple convulsions are harmless, but underlying infection should be excluded
Red flags: >39 degrees fever, reduced consiousness, neck stiffness, seizures, respiratory distress,
dehydration or shock, bile-stained vomiting,
Practica super handig om naar te gaan voor het casussen-examen!!!
Learning goals en take home messages (niet van mij, van iemand een paar jaar hoger)
Opmerkingen zijn van mij die erbij zijn gezet met de les
koorts............................................................................................................................................................ 3
Casus 1: Sarah.......................................................................................................................................................3
Casus 2: Ilias..........................................................................................................................................................6
Casus 3: Elisabeth..................................................................................................................................................9
Casus 4: Sam.......................................................................................................................................................11
Casus 5: Stef........................................................................................................................................................14
Casus 6: Maya.....................................................................................................................................................16
Casus 7: Wim.......................................................................................................................................................18
hoesten....................................................................................................................................................... 21
Casus 1................................................................................................................................................................21
Casus 2................................................................................................................................................................23
Casus 3: vervolg op casus 2.................................................................................................................................26
Casus 4................................................................................................................................................................28
Casus 5................................................................................................................................................................30
Casus 6................................................................................................................................................................33
neonaat....................................................................................................................................................... 37
Casus 1................................................................................................................................................................37
Casus 2................................................................................................................................................................39
Casus 3................................................................................................................................................................42
Casus 4................................................................................................................................................................44
Casus 5................................................................................................................................................................47
Casus 6................................................................................................................................................................49
Abdominale pijn en constipatie.................................................................................................................... 56
Casus 1................................................................................................................................................................56
Casus 2................................................................................................................................................................59
Casus 3 (Roxanne)...............................................................................................................................................62
Casus 4................................................................................................................................................................65
, Casus 5................................................................................................................................................................67
Casus 6: Jolien 10y old........................................................................................................................................68
Ledemaatproblemen.................................................................................................................................... 70
Casus 1................................................................................................................................................................70
Casus 2................................................................................................................................................................73
Casus 3................................................................................................................................................................77
Casus 4................................................................................................................................................................78
casus 5.................................................................................................................................................................80
Casus 6................................................................................................................................................................83
Altered awareness....................................................................................................................................... 86
Casus 1................................................................................................................................................................86
Casus 2................................................................................................................................................................89
Casus 3................................................................................................................................................................90
Casus 4................................................................................................................................................................93
Case 5..................................................................................................................................................................95
Casus 6................................................................................................................................................................96
Casus 7..............................................................................................................................................................100
Casus 8..............................................................................................................................................................102
Failure to thrive......................................................................................................................................... 105
Casus 1..............................................................................................................................................................105
Casus 2..............................................................................................................................................................110
Casus 3: Dennis.................................................................................................................................................112
Casus 4..............................................................................................................................................................114
Casus 5..............................................................................................................................................................118
Casus 6..............................................................................................................................................................123
,KOORTS
CASUS 1: SARAH
Sarah is 3 years old. She had a fever since this morning. A few moments ago, she passed out, her lips turned
blue and she was moving her arms and legs in a strange way. In a panic, her mother picked her up and drove
her to the doctor’s office 2 blocks away. When they arrive there, Sarah is sleeping and she feels warm.
Story is not okay: red flags → you need to see a doctor right away: is she sleeping or
unconscious?
Altijd starten met ABCDE: First ABC before asking questions to the mother
- A: thorax movements, abnormal breathing sounds
- B: symmetrical
- C: capillaire refill (on the sternum), limbs usually cold
Temperature 39,7°C, Mother never seen it before
Running nose, fever in the morning, was not crying, was on the couch
It was very symmetrical and short
The child does not want to wake-up
BD stays very long stable in child
RR 42: little bit high → tachycardia, tachypnea
● List at least 3 diagnoses/ conditions you should consider.
○ Koortsstuipen/febrile seizures
○ Meningitis
○ reflex asystolic syncope
○ ○ blue breath holding spells: was not crying
○ ○ epileptic seizure: could be first episode
● Do you include any selflimiting condition in your list? Why?
○ Koortsstuipen: komt bij 3% van de kinderen voor tussen 6 maanden en 6
jaar, zijn een vaak voorkomende oorzaak
● Write a scenario with pivotal elements in the history for eachof the 3 diagnosis.
Highlight arguments pro and con.
○ Koortsstuipen
■ pro: meer dan 38°C koorts, korte aanval, symmetrische, slap,
familiaal VG
■ Con: asymmetrisch, langer dan 15 min, stijfheid, geen koorts
○ Meningitis/encefalitits
■ pro: photophobia lethargy, poor feeding/vomiting, irritability,
hypotonia, drowsiness
■ con:
○ reflex asystolic syncope
■ pro: bleek worden, neervallen, aanleiding: pijn, hevige angst, schrik,
ook tijdens ziekte en koorts, urineverlies, val als begin aanval, first-
degree relative; kort, snel bijgekomen
● Write a scenario with pivotal elements in the physical examination for each of
the 3 diagnosis. Highlight arguments pro and con.
○ koortsstuipen
, ■ pro: weinig te vinden, tijdens aanval: ogen wegdraaien,
symmetrische shocken armen en benen, gezicht bleek, grauw of
blauw, ademhaling oppervlakkig, stotend, kortdurend stoppen
■ con:
○ Meningitis:
■ pro: Brudzinski sign, Kernig sign, purpuric rash, signs of shock,
papilloedame, altered consious levels
○ Reflex asystolic syncope
■ pro: nystagmus
● Do you need further investigations to distinguish? If so,which and why?
○ Throughout clinical examinations: listen to the lungs in between the crying,
check meningeal signs
○ Yes, send to the hospital for a check-up, febrile seizure: menigitis or other
infections uitsluiten (cerebrospinal fluid puncture if you find thinks like neck
stiffness)
○ EEG: geen afwijkingen bij reflex anoxic seizure
○ Urine sample in 3 year old is difficult
Opmerkingen
- Normale waarden van respiratoire rate bij een 3-jarige: 40 te hoog
- Stabiel op dit moment: niet bezorgd om de seizures, maar de koorts. Past perfect bij een febriele
convulsie.
- Reflex asystolische syncope: bleek worden, blauwe lippen, na een seizure valt die in slaap.
- Blijkt een virale infectie met febriele convulsies: geruststellen dat het niets gevaarlijks is, maar
absoluut normaal is.
- Geen medicatie geven, maar elke keer als ze koorts krijgen wel iets gaan geven omdat ze elke keer die
convulsies krijgen. Dan antiepileptica
- Normaal koorts: 10-12x per jaar koorts hebben, dat is normaal voor een 3-jarige.
- Voorkomen met paracetamol? Bij de stijging van temperatuur (niet voorkomen)
Turns out viral infection, child had febrile seizure, tell the mother it may happen again,
self-limiting, not dangerous, for the child not a problem, does not need medication,
valproaat kunnen we eventueel geven om het te voorkomen maar enkel voor diegene die
het echt regelmatig doen: dus bij elke koortspiek
Does paracetamol/NSAID prevent it? No, the febrile seizure will happen during the rise
Take home messages:
Meningitis can present as febrile convulsions
Simple convulsions are harmless, but underlying infection should be excluded
Red flags: >39 degrees fever, reduced consiousness, neck stiffness, seizures, respiratory distress,
dehydration or shock, bile-stained vomiting,
