Paediatrics 👶

A 4 year old boy is brought to the GP clinic by his worried mother, complaining that he is still unable to keep dry at night. He wets his bed in the middle of the night and has daytime wetting as well. There was no period where he managed to stay dry during the night. The child is aware of his toileting needs but struggles not to wet himself during the day and night. Rewards are given for agreed behaviours, such as using the toilet regularly and using it before going to sleep. His urine dipstick shows no abnormalities. He does not suffer from constipation. The mother wants to know if anything can be done to resolve this issue. What is the SINGLE most appropriate management?

A 13 month old child is brought the Paediatric Accidents & Emergency by his parents as they are worried about the possibility of their son having a seizure. Earlier in the day, the child hit his head on the table while he was running. He cried, became pale and immediately collapsed onto the ground falling unconscious. He had frath in his mouth, his eyes rolled upwards and his limbs went stiff. His left leg was jerking during the episode. He regained full consciousness two minutes later. He had a similar episode a week ago when he lacerated his finger. What is the SINGLE most likely diagnosis?

A 12 month old male infant presents to clinic because his mother is concerned that the child cannot sit on his own. He can crawl but cannot stand with support. He is able to pick up small items. He is not socially interactive with his older sibling. What is the SINGLE best management?

A 16 year old boy obtained a penetrating wound on his right foot during a hiking trip. The wound developed into an ulcer a few days later. He is limping and refusing to weight bear with worsening pain on his foot. He has recently developed a fever and feels very lethargic. His medical history includes type 1 diabetes which he takes insulin for. On examination, there is redness and increased warmth over the plantar aspect of the 1st metatarsal. He has a temperature of 39.1°C and a heart rate of 108 beats/minute. What is the SINGLE most likely causative organism?

A 28 year old woman has a delivery of a term baby girl 8 hours ago. She was admitted initially for prolonged rupture of the membranes. The neonate develops a temperature of 38.5°C and has problems breathing. What is the SINGLE most likely causative organism?

A 13 year old girl with several years of elevated liver enzymes of unknown aetiology attends the clinic with slow deterioration in her school performance. On examination, there is hepatosplenomegaly, intention tremor, dysarthria, and dystonia. Her urinalysis has elevated levels of glucose, protein, and uric acid. What is the SINGLE most likely diagnosis?

A 2 year old child was brought by his mother with swelling on the right side of his neck extending from the angle of the mouth to the middle one third of the sternocleidomastoid muscle. The swelling is on the anterolateral side of the sternocleidomastoid muscle. On examination, the mass is partially compressible. when subjected to light test is brilliantly translucent. What is the SINGLE most likely diagnosis?

An 8 year old child has recurrent throat infections. He feels tired and lethargic all the time. Petechiae is noticed on his lower limbs. On examination, splenomegaly and gum hypertrophy was noted. Blood results show:

Haemoglobin 68 g/L ((130-180)

White cell count 7 x 10^9/L (4-11)

Platelets 75 x 10^9/L (150-400)

What is the SINGLE most likely diagnosis?

A 4 year old child presents to A&E with fever and stridor. He is unable to swallow his saliva. He has a respiratory rate of 45 breaths/minute. What is the SINGLE most appropriate next step in management?

A 9 year old girl presents with arthralgia and purpura over her buttocks and extensor surfaces of the legs bilaterally. Laboratory results showed elevated IgA levels and creatinine. What is the SINGLE most likely diagnosis?

Following an emergency caesarean section for fetal distress, a baby is in poor condition. His heart rate is 90 beats/minute. He is blue at extremities but his body is pink. He has some limb flexion and muscle tone. He is gasping for air irregularly and grimaces an aggressive stimulation. What Apgar score does this newborn infant have?

A 9 month old infant is brought in by his mother to the paediatric clinic for a review as he is having worsening abdominal distention and a cough. His cough has been present for the past 3 weeks and it is associated with mild shortness of breath. On examination, there is an expiratory wheeze and inspiratory crackles. It is noted that he has a faltering growth and he now sits on below the 5th centile for weight his age. His oxygen saturation is 97%. His childhood immunisations are up to date. What is the SINGLE most likely diagnosis?

A 9 year old boy is admitted with an acute exacerbation of asthma. He is treated initiated with 100% oxygen, nebulised salbutamol, and oral prednisolone. Ipratropium bromide was also added to the nebulisers. Despite the initial treatment, he continues to deteriorate. His oxygen saturation is 93% and his respiratory rate is 25 breaths/minute. He is able to talk in full sentences. What is the SINGLE most appropriate next step in management?

A 5 month old child is unable to speak but makes sounds. She can hold things with her palm, but not small objects using her fingers. She smiles and laughs and is not shy with strangers. She does not wave or clap. She cannot sit independently but can hold her hand and sit when propped up against pillows. What is the SINGLE best development stage to describe this child?

A 3 year old child is brought to the Emergency Department by his grandmother with bruises and swelling over the medial aspect of the left arm. The grandmother gives a history of her grandson falling down the stairs a few hours ago. Bruises on the child’s back and left chest are seen on examination. X-ray of the chest shows multiple callus formation in the ribs. Analgesia has been given. What is the SINGLE most appropriate next step?

A 4 year old boy, who recently immigrated from Kenya with his parents a week ago, presents to clinic with intermittent watery diarrhoea, foul-smelling flatulence, nausea, and abdominal pain. His weight is less than the fifth percentile for his age. On examination, he has a fever of 38°C and is dehydrated. Which of the following is the most likely to confirm his diagnosis?

A 10 month old male infant presents with a 6 hour history of crying and passage of loose, bloody stool. On examination, the infant is irritable, with intermittent drawing up of his knees to his chest, and a temperature of 38.8°C. A currant jelly-coloured blood is seen in his stools. What is the SINGLE most likely diagnosis?

A 9 year old has just been diagnosed with insulin dependent diabetes mellitus. He refuses to take his insulin or to stick to the dietitian’s advice. He is often sullen and withdrawn at home and his teacher complains that he has stopped associating with his friends at school. What is the SINGLE most appropriate referral for this patient?

A 6 year old boy presented to the Emergency Department with his father following a burn injury to his left hand. His father mentioned that he pulled the card of a hot iron which fell and burned his hand. On examination, you noticed a burn area with partial thickness of around 10%. He is crying and is in severe pain. What is the SINGLE most appropriate medication to offer to this child?

A 3 month old baby is seen in the Emergency Department with his mom because of a high fever. The mom says that he has been refusing to feed. He had a history of a recent respiratory tract infection which he was treated a week ago. On examination, there was a bruise on the child’s forehead. On asking the mother what happened, she said that the baby had rolled over from the sofa while she was changing his diapers. The child looks ill-looking and lethargic. There is some evidence of weight loss when compared to his weight a month ago. His temperature is 39°C. His blood results show:

Haemoglobin 10.9 g/dL (14.0-220)

White cell count 9 x 10^9 (9-30)

Platelets 132 x 10^9 (150-400)

What is the SINGLE most appropriate initial management?

A 4 month old, healthy female infant presents to clinic for her routine immunizations of DTP, Hib, polio, Menẞ, and pneumococcal vaccines. At her 3 month immunization, she cried and was irritable for 3 hours followed by a fever that lasted for 2 days. Which of the following is the SINGLE most appropriate action now?

A mother who delivered a term male infant 9 days ago is now diagnosed with varicella zaster. She developed the rash on her torso 12 hours ago. Her infant is currently afebrile, feeding well, passing stool and urinating without difficulty. Which of the following is the SINGLE most appropriate step in management?

A 7 year old girl is brought by her mother with bright red staining of her underpants. She gives a history that her daughter recently started taking horse riding lessons. What is the SINGLE next most appropriate action?

A 2 year old boy was separated from his mother in a shopping mall. He got very upset and then fell down and became unconscious. He looked blue. He became conscious after 2 minutes and was back to his active self after an hour. His mother is extremely concerned. What is the SINGLE most appropriate next step?

A 7 year old child is brought to his GP accompanied by his mother with concerns of difficulty in writing. His mother complains that he has great trouble with handwriting and spelling compared to the other students in his class. He has the ability to form letters using a pencil but requires extreme effort and an unjustifiable amount of time to accomplish. Which is the SINGLE most appropriate team to refer this patient to?

A 4 year old girl is taken by her mother to the emergency department and complains of pain during urination and feeling generally unwell. She has a temperature of 38.5°C. What is the SINGLE most appropriate initial action?

A 6 week old child is brought to A&E with persistent non-bilious vomiting. The child feels hungry and wants to feed despite constant vomiting. Biochemistry shows K+ of 3.1 mmol/L. What is the SINGLE most likely diagnosis?

A 15 year old boy has been brought to his GP by his parents as they are concerned about his short stature. His gestation and birth were without incident. According to his growth chart, the boy has a long history of hovering consistently around the 15th percentile for height. Both of the boy’s parents have a mean adulthood height for their respective sex. His brother who is 2 years older has a normal height for his age. Physical examination reveals the absence of testicular development and no pubic hair. His mother is concerned about a hormonal problem. What is the most likely diagnosis?

A 7 year old boy is taken to his general practitioner by his mother with the complaint of a two-day history of weight gain and bodily swelling. He has no other complaints and, other than the swelling, appears happy and healthy. The patient’s mother reports an uneventful pregnancy and says that he was delivered vaginally at term. He has no medical problems and has normal growth and development. Physical examination reveals bilateral lower limb oedema and periorbital oedema. A urinalysis was done for this patient. What is the SINGLE most likely result that you will see on this patient’s urine dipstick?

A 4 year old boy is brought to clinic by his worried mother, complaining that he is still unable to keep dry at night. There was no period where he managed to stay dry during the night. The mother wants to know if anything can be done to resolve this issue. He is dry during the day. His medical history is insignificant, and there is no history of recurrent urinary tract infections. What is the SINGLE most appropriate management?

An 8 year old girl presents to the GP surgery with her mother with ongoing abdominal pain that has been present for a month. The abdominal pain is episodic and occurs in the periumbilical region. It occurs with features of a migraine which can last more than an hour. The episodes interfere with her normal activities and so she has to miss school when these episodes occur. The episodes only occur mainly on weekdays. She maintains a good weight and has a good appetite. Full blood count, urea and electrolytes are found to be normal. Her mother is going through a rough time with a recent diagnosis of breast cancer which has shocked the family. What is the SINGLE most appropriate management?

A 4 week old female infant presents to the Emergency Department with vomiting after every feed. The child is also constipated. On examination, there is a right-sided epigastric mass on palpation. What is the SINGLE most likely diagnosis?

During the afternoon shift, a mother calls the postnatal ward with concerns of her newborn. Her baby was born at term by an uncomplicated vaginal delivery in the birthing centre yesterday evening. The baby is feeding well and not irritable. This is the parents’ first child and the parents are especially concerned as the baby has a yellowish colour to his skin and eyes. What is the SINGLE most appropriate management?

A 3 year old girl ingested 10 tablets from her grandmother’s medication bottle, thinking it was candy. By the time the child is in the Emergency Department, she is drowsy and lethargic. Paramedics nated myoclonic twitching. ECG reveals tachycardia and widened QRS. Potassium is elevated. What is the SINGLE most likely medication did the child ingest?

A 4 week old infant is rushed to Accident & Emergency (A&E) by his parents with the complaint of difficulty breathing, cough and wheeze. His cough started 2 days ago and has since then been difficult to feed. His respiratory rate is 80 breaths/minute and he appears to be working hard to breathe with marked chest recessions. His temperature is 38.4°C. His oxygen saturation is 85% on room air. Auscultation of his chest is significant for widespread bibasal crepitations. What is the SINGLE most likely diagnosis?

A 5 year old boy is seen in secondary care for a history of persistent nighttime bedwetting several incidences of day time urinary leak. His mother is very worried about his symptoms since he is about to start school. There has never been a period where he was able to keep dry. The child is otherwise well without any complications at birth. His urine dipstick results are within normal limits. What is the SINGLE most appropriate management for this boy?

A 14 week baby attends the GP surgery as he is unsettled after every feed. He vomits his feeds and cries in discomfort right after his feeds irrespective of the amount of milk given to him. On occasion, he would refuse feeds. He is bottle-fed. He was delivered as a term baby without any concerns. He has been growing well and has a normal weight. There is no blood in his stool. He does not have a fever or any rashes. His mother has tried a course of feed thickeners. What is the SINGLE most appropriate next step in management?

After several episodes of urinary tract infections, a 2 year old girl undergoes a micturating cystourethrogram which reveals mild dilation of the renal pelvis and reflux into the ureters and kidney. She is currently not on any medication. Which of the following is the SINGLE most appropriate next step in treatment?

A 24 month old child has been having smelly, loose stools and abdominal distention over a period of months. He has not gained sufficient weight over the past few months. His mother describes him as miserable. He eats the same foods as the rest of the family. He weighs 12.5 kg. His weight has dropped two pre-drawn centiles from the last time he was weighed 6 months ago. He has no other health issues reported. On examination, he is pale-looking and thin. His abdomen is distended. What condition should be investigated first?

A 5 week old baby is brought into the GP surgery. His mother has concerns that he has a sticky discharge on his left eye over the past 5 days. The eye is not red and there is no lid swelling observed. What is the SINGLE most appropriate management?

A 7 year old child presented with chronic cough and is also found to be jaundiced on examination. What is the SINGLE most likely diagnosis?

An 8 year old child is brought into A&E with a fractured leg. The parents are unable to explain how the leg fractured. X-rays reveal several other fractures in various stages of healing. The parents cannot explain what might have caused them. On examination, the child has a blue sclerae and difficulty hearing. What is the SINGLE most likely diagnosis?

A 2 year old boy has been having stridor and cough at night for the past 3 days. He has a temperature of 38.1°C, respiratory rate of 31 breaths/minute, pulse rate of 140 beats/minute and his oxygen saturation on air is 99%. On examination, there are no chest wall recessions. Percussion of his chest is found to be resonant. What is the SINGLE likely outcome if his condition is left untreated?

An 8 year old boy presents with severe crushing chest pain. He is tall for his age and has a refractive error for which he wears thick glasses for. What is the SINGLE most likely syndrome?

A four year old girl is brought into her GP surgery with her father who reports a two day history of a rash that started on the face and has now spread to the rest of her body. She has swollen neck glands which preceded the rash. She had a fever that developed before the rash but went away on the first day of the rash. Her highest recorded temperature over the past few days is 38.4°C. She denies any sore throat. She has a mild cough. She is eating and drinking well. Her father is uncertain of her immunisation status. Examination reveals red petechiae in her mouth and a pink widespread erythematous maculopapular rash. What is the most likely diagnosis?

A mother and her 4 year old boy attended the Emergency Department with complaints of her child having a runny nose and sore throat which had rapidly become worse over the last three days. She mentioned that he has a fever and has been refusing to eat. She noticed a type of red rash which first started on her son’s face which spread all over his body. She admits that he had missed some of his vaccinations as she had read an article online that vaccinations cause autism in children but is unsure which vaccinations were omitted and when they were originally scheduled for. There is no history of any known drug allergies in the child. The boy recently started nursery and is happy and enjoying the new environment. There is no significant history based on the patient’s past medical records. On examination, the child is alert but irritable. His temperature is 38°C and his chest is clinically clear. Examination of his throat reveals small, red spots, each with bluish-white specks in the centre. There is no cervical lymph node enlargement. On further examination, there is a widespread maculopapular rash all over his body, causing discomfort and itchiness to the patient. What is the SINGLE most likely treatment option for this patient?

A 3 year old boy has developed severe abdominal pain over the past several hours associated with rectal bleeding. He started having purpura on his buttocks and lower legs 5 days ago. He also describes pains in the joints of his knees and ankles. He has a temperature of 38.1°C. On examination, he is irritable. There is decreased skin turgor. What is the SINGLE most likely diagnosis?

A five day old infant was born at 30 weeks gestation with respiratory distress. He weighed in at 1050 grams and was intubated immediately after delivery due to poor respiratory efforts, however, his condition has improved over the past four days. Today, his condition has suddenly worsened and the neonatal ward nurse has bleeped you to urgently assess him. Auscultation of his chest reveals a continuous murmur best audible at the left infraclavicular area. What is the SINGLE best descriptor of the murmur?

A 2 month old girl presents with jaundice and failure to thrive. She was delivered at term with a birth weight of 3 kg. The jaundice was first noticed in the first few weeks of life but her parents were not able to seek medical care. She has pale stools and dark urine. Her spleen is palpable and her liver is enlarged and hard. What is the SINGLE most likely diagnosis?

A 6 year old child is brought in by her mother with complaints of having a fever and a sore throat. She developed a rash that started on her torso and had spread to her extremities. A picture of her tongue can be seen below:

She has a temperature of 39°C. What is the SINGLE most likely organism causing her symptoms?

A 20 month old girl is brought by her mother to the clinic as she has recently developed blisters on her hands and feet. She has a temperature of 37.6°C. Below is a picture of the rash:

What is the SINGLE most appropriate advice to give her?

A 7 day baby whose birth weight was initially 3.5 kg, has a weight of 3.3 kg currently. What is the SINGLE most appropriate next action?

A 6 week old male infant presents to the Accident & Emergency Department with vomiting after every feed. The mother describes the vomiting as projectile and non- bilicus in nature. The child is also constipated and has not passed stool or flatus for 3 days. On examination, there is a palpable epigastric mass with visible peristalsis from left to right on the upper abdomen. What is the SINGLE most appropriate next step of action to diagnose the condition?

A 3 year old girl is brought to the Emergency Department because of high fevers. Her temperature has been at 40°C over the past several hours and she has not been eating or drinking well. She is uncomfortable and has abdominal pain. She has no relevant medical history. An intravenous line was inserted to administer fluids. She started having a seizure in the department which has been ongoing for the past 7 minutes. What is the SINGLE most appropriate medication to administer?

A 13 year old boy has a deformity of his chest. The deformity was seen at birth. The sternum is pressed inwards. He does not have any chest pain or shortness of breath. A picture of this is seen below:

What is the SINGLE most likely diagnosis?

A 7 day old infant is referred by his midwife to the paediatric day unit because of worsening jaundice. The jaundice started on the second day of life. The newborn has been more sleepy. He is exclusively breast fed. He has a birth weight of 3.60 kg and was born at term. There is no family history of jaundice and this is her first pregnancy. On examination, the sclera is yellow and the infant is seen to be drowsy. He has a palpable mass thought to be the liver 2 cm below the right castal margin and a palpable mass on the left upper quadrant thought to be the tip of the spleen. He is well perfused and has a temperature of 36.5°C. He weighs 3.61 kg. A blood test was performed which shows

Haemoglobin 119 g/L (140-220)

White cell count 11 x 10^9 (9-30)

Reticulocytes 14% (<2%)

Bilirubin 330 μmol/L (<205)

Direct antiglobulin test (DAT) positive

What is the SINGLE most likely diagnosis?

A 14 year old child is brought the the GP surgery by his mother with the complaint of mild dyspnoea. He also complains of coughing up about two tablespoons of mucopurulent sputum per day for about two years now. His past medical history is significant for cystic fibrosis. He has a history of repeated chest infections over the past few years which he was treated with antibiotics. He has an oxygen saturation of 96% and his observations are within normal limits. What is the SINGLE most appropriate management for this patient?

A 4 year old boy is referred by the GP to the paediatrician with a cervical lymphadenopathy that is 2 cm in size. His mother says that she thinks the lymph node is growing. It was first noticed 6 weeks ago. The child is generally well with no complains of tiredness. He has no history of fever. On examination, the spleen is not palpable and there are no other palpable lymph nodes around the body. The cervical lymph node is firm, non-tender and immobile. His throat is clear with no signs of infection. What is the SINGLE most appropriate initial investigation to perform?

A 24 month old child is assessed for developmental milestones. She can climb stairs and climb chairs. She eats with a spoon by herself. She is unable to use a knife to cut her food. When she wets her pants, she is able to point to her pants to indicate that she wet herself. She can say dada and mama but is unable to say anything beyond that. She can draw a line but cannot draw a circle. She can wave and copy the actions of others. What is the SINGLE best development stage to describe this child?

A 6 week old infant is brought into the Paediatric Emergency Department as he has a high fever. His mother recorded his temperature at home as 39°C a few hours ago. His mother says that his nappies have been dry over the past 24 hours and he has not been feeding as much. He has a persistent cough and a slight wheeze. He was born at 37 weeks gestation. He is breastfed and has been gaining weight appropriately. His temperature recorded in the department is 38.1°C. He has a heart rate of 130 beats/minute. His oxygen saturation is 96% and respiratory rate is 50 breaths/minute. On auscultation, there are widespread fine crackles and expiratory wheeze. What is the SINGLE most appropriate action?

A 1 week old male infant, born at 32 weeks gestation, is currently in neonatal ICU and was doing well on increasing nasogastric feedings. The nurse now notes that the infant has been vomiting during the last 2 feeds, is less active, and has blood in his stool. On examination, the abdomen was tense, distended with decreased bowel sounds. Abdominal X-ray reveals distended loops of bowel with air in the bowel wall. What is the SINGLE most appropriate next step in management?

A 3 year old boy was brought to the GP surgery with his mother with a 4 day history of fever and a widespread rash. He was given a diagnosis of a viral exanthem, reassured and advice to take paracetamol. The following day his mother notices he has become more lethargic and unwell and was brought in to the Paediatric Emergency Department. His rash continues to spread. On examination, he has cracked red lips, red sore eyes, and cervical lymphadenopathy. His temperature was 39.1°C. He was admitted for further a full septic screen, investigations and management. 2 weeks later, his skin on his fingers and toes begin to peel. What is the SINGLE most likely diagnosis?

An 8 month old boy attends the Emergency Department with his mother complaining of a fever and a cough. His symptoms started one day ago. The mother reports a slightly reduced food intake. On examination, his temperature is 38°C, his respiratory rate is 50 breaths/minute, and his saturations are 97%. He has crackles throughout his chest. His capillary refill is 2 seconds. There are no grunting or marked recessions. What is the SINGLE most appropriate management?

A 14 year old boy has a rash that started 2 days ago on his back and torso. He has been coughing and having symptoms of rhinorrhoea which started a week ago. He has a 4 day history of fever. On examination, there is a rash on his torso and back of which the image of the back is shown below:

He has signs of conjunctivitis. What is the SINGLE most likely diagnosis?

A 15 year old boy presents with a lump on his neck. The mother states that the lump has been there for a few months. He is asymptomatic and denies weight loss or night sweats. His temperature is 37.2°C. Examination reveals a firm, nontender lymphadenopathy in the left cervical chain. Full blood count and chemistry studies are normal. What is the most appropriate investigation?

A 5 month old girl was admitted with fever and lethargy. Her mother reports poor feeding and offensive-smelling urine. A urine analysis at the time of admission showed leukocyte esterase negative and nitrites positive. The urine sample was sent for microscopy and culture and she was started on antibiotics. 2 days later, she is still febrile at 38.9°C and her symptoms have not improved. What is the SINGLE most appropriate investigation?

A mother of a 15 months old baby complains that her infant does not respond to loud noise. He shows no response to familiar words or his name. He is able to say, “mama” and “papa”. Background of the delivery reveals that he was born at 28 weeks and had been an inpatient in the neonatal ICU for 20 days. A hearing test was performed which revealed bilateral conductive hearing loss. What is the SINGLE most likely reason for his hearing loss?

A 15 month old male infant arrives at the clinic for his measles, mumps, rubella (MMR) vaccine. On examination, he has a temperature of 38.1°C and has acute otitis media. There is also a family history of egg allergy. What is the SINGLE most appropriate action?

A 4 month old girl is due for her routine immunisation for diphtheria, tetanus, acellular pertussis, Haemophilus influenzae type b, polio, pneumococcal conjugate, hepatitis B and MenB vaccines. Which of the following is a contraindication for her vaccination?

An 18 month old child is assessed for developmental milestones. He is unable to walk but is able to stand on support. He can crawl and pull himself up to stand. He is able to transfer objects from hand to hand and is able to scribble but is unable to draw circles. He shows an understanding of nouns such as “where’s mommy?” and has a vocabulary of around 4 to 6 different words but unable to form a sentence. He can wave, clap and imitate others. What is the SINGLE best development stage to describe this child?

An 18 month old female child is able to walk. She plays well with others in daycare, builds blocks, and is able to hold crayons scribbling on paper. Her mother is concerned because despite her daughter having a vocabulary of more than 10 words, she is nat able to speak in sentences nor is she able to run or climb stairs. What is the SINGLE best management strategy?

A 6 year old boy is seen in secondary care for a history of day time urinary leak. His mother is very worried about his symptoms since he is about to start school. The urinary incontinence is sudden and he gets an uncontrollable sensation to void. He voids without meaning to. There has never been a period where he was able to keep dry. The child is otherwise well without any complications at birth. He does not suffer from any constipation. His urine dipstick results are within normal limits. What is the SINGLE most appropriate management for this bay?

A 5 week old male infant presents to clinic with jaundice during routine check-up. His mother reports a normal vaginal delivery at term with a birth weight of 3.5 kg. On examination, the baby is irritable, below average centiles for weight, and the liver is enlarged. Pale stools and dark urine on diaper were observed. The mother is currently not breastfeeding and had placed him on formula. What is the SINGLE most likely diagnosis?

A 13 month old child is assessed for developmental milestones. He holds on to furniture to help him stand but finds it difficult to walk independently. He can say ‘mama’ and ‘papa’ but is unable to join two or three words in sentences. He makes eye contact and smiles at his mum but he is very shy around strangers. He can wave and clap. He does not play with other babies but plays with his parents. He can transfer objects from one hand to another and use a pincer grasp. He responds to his name. What is the SINGLE best development stage to describe this child?

A 35 day infant has not been putting on weight as expected. He is irritable and vomits after most feeds. On examination, there are red patches on his face and cheeks. His skin feels dry and rough. He is exclusively breast fed. A cow’s milk protein allergy is suspected. The mother describes an uneventful pregnancy and delivery. What is the SINGLE most appropriate management?

A 6 year old child is brought into the Emergency Department with severe burns on his chest and limbs from a house fire. The paediatric doctors have failed to insert a peripheral intravenous line due to the significant burns. What would be the next most appropriate method to deliver fluids for fluid resuscitation?

An eight day old male neonate presents with vomiting, weight loss and lethargy. Urea and electrolyte blood test has been done and shows his serum potassium level to be 5.2 mmol/L. An ultrasound scan of his abdomen reveals bilaterally enlarged adrenal glands. What is the SINGLE most likely feature to be seen in this patient?

A 5 year old boy is brought by his mother to the GP surgery with a 3-day history of a cough and fever. He has no medical history of relevance and his birth was uncomplicated. During the examination, a soft cardiac murmur is heard upon auscultation of his chest. The murmur can only be heard during systole and is 2/6 in intensity. It can be heard clearly when the patient is supine but disappears completely when he stands upright. What is the SINGLE most likely type of murmur in this patient?

A 4 year old boy has a fever that has ranged between 39°C and 40°C for the past 5 days. He has a polymorphous rash that developed shortly after the fever. On examination, cervical lymphadenopathy is palpable. He has fissured lips. An image of his face is seen below:

Which long term complication is most associated with this condition?

A 6 year old boy is brought into the Paediatric Accidents and Emergency by his parents with shortness of breath. He was given the diagnosis of asthma a year ago. His symptoms have been worsening despite use of salbutamol inhalers. On examination, he has a widespread wheeze on auscultation. There are intercostal recessions seen. His oxygen saturation were 95% and respiratory rate was 40 breaths/minute. He was given back to back nebulizers with salbutamol and ipratropium bromide. What would be the next most appropriate medication to be administered?

A 12 year old boy attends the Emergency Department with difficulty breathing and a whole-body rash. He is asthmatic and uses his inhalers regularly. He was staying at his uncle’s house and missed a few doses of his inhaler. His medical history includes eczema as a child. He has had multiple food allergies also as a child and was eating different types of cuisines with his uncle. On examination, he has an inspiratory stridor and looks drowsy. His heart rate is 115 beats/minute and his respiratory rate is 30 breaths/minute. What is the SINGLE most appropriate management?

An 18 month old child is seen has been having loose stools and abdominal distention over a period of months. He has not gained sufficient weight over the past few months. His mother describes him as miserable. His stools are smelly and greasy. He eats the same foods as the rest of the family do. He weighs 10.5 kg. His weight has dropped two pre-drawn centiles from the last time he was weighed 8 months ago. On examination, he is pale-looking and thin. He has loose skin over his buttocks. His abdomen is distended. There are no abnormal palpable masses abdominally. The oral cavity and perianal area are seen to be normal. What is the SINGLE most likely diagnosis?

A 12 year old boy presents with severe watery diarrhoea for the past 7 days. He feels nauseous and has vomited twice in the past 24 hours. His urine output is low, mucous membranes are dry, and skin turgor is decreased. He has a pulse rate of 120 beats/minute, a temperature of 40°C and blood pressure of 90/60 mmHg. What is the SINGLE most appropriate initial management?

An 8 month old baby presented to the Emergency Department with her mother. Her mother mentioned that over the last three days, she has been feeding a lot less and had been refusing solids and milk the whole of yesterday. The baby was born at term and is still fully breastfed. She has no significant past medical history. Her weight is 8 kg, her blood pressure is 70/40 mmHg and her heart rate is 180 beats/minute. On examination, she appeared pale with dry lips and sunken eyes. Her capillary refill time is 4 seconds. What is the most suitable IV bolus amount of fluid required to be given?

A 5 year old boy is brought to the clinic by his mother. The young boy has a distinct nasal speech and snores heavily at night. He is hyperactive during the day but has poor concentration. He is noted to be constantly breathing through his mouth. What is the SINGLE most appropriate action?

A 6 year old boy is brought into the Emergency Department by his mother’s boyfriend with a fever of 37.8°C of 3 days duration. On examination, there are purple spots on his lower back and brownish discolouration on his left forearm with left shoulder dislocation. The child is quiet and makes no eye contact while in conversation. What is the SINGLE most appropriate action to be taken after attending his fever?

A 5 year old girl has been treated successfully with antibiotics for dysuria 6 weeks ago. The organism that was initially cultured was E.coli. She has had 4 episodes of lower urinary infection which was treated with antibiotics in the past one year. An ultrasound scan was organised which was seen to be normal. What further investigations should be organised?

A 4 year old is brought to the emergency department by ambulance. His mother reports that he has been unwell with a sore throat. He is sitting on his mother’s knee and is tolerating an oxygen mask but looks unwell. He has constant noisy breathing and he is drooling saliva. He has a temperature of 39.0°C. What is the SINGLE most likely diagnosis?

A 5 year old boy suffers from recurrent urinary tract infections. He has had 4 urinary tract infections over the past 6 months. His previous mid-stream urine shows evidence of E.coli growth which he was treated appropriately for. His ultrasound scan shows thickening of the bladder wall and dilatation of the ureters. What is the SINGLE most appropriate investigation to follow?

A 2 year old girl is brought to the Emergency Department by her mother after having witnessed her child’s hands twitch for a few minutes. The child has been having coryza symptoms. She is uncomfortable and distressed. She is restless and crying when being examined. There is no rash on the child’s body. The temperature on admission was 39.5°C. She has no relevant medical history. What is the SINGLE next appropriate management?

A 3 year old boy is brought to the Emergency Department by his mother as he started having a nosebleed one hour ago which has not stopped. He also developed a purpuric rash with some bruises on his trunk and legs a day ago. He remembers having an upper respiratory tract infection one week ago. There is no lymphadenopathy or hepatosplenomegaly on examination. His observations are within normal limits. His blood results show the following:

Haemoglobin 132 g/L (130-180)

White cell count 7.8 x 10^9/L (4-11)

Platelets 10 x 10^9/L (150-400)

Prothrombin time 13 seconds (10-14)

Activated partial thromboplastin time 37 seconds (35-45)

What is the SINGLE most appropriate management?

A 4 month old infant is rushed to Accident & Emergency (A&E) with the complaint of difficulty breathing and a cough. According to his mother, the trouble in breathing began two hours ago. He has had a cough for around three days now but his mother was unconcerned as a neighbour had told her that it was probably just croup. The mother had an uneventful pregnancy. His feeding has been poor over the preceding week although he has not lost any weight. Examination reveals a male infant who is tachypnoeic. His respiratory rate is 70 breaths/minute and he appears to be working hard to breathe. His temperature is 38.4°C. He has slight abdominal distention with no other abdominal abnormalities on physical examination. Auscultation of his chest is significant for widespread bibasal crepitations. What is the SINGLE most likely diagnosis?

A 9 year old boy has long arms, legs, fingers and toes. He is tall for his age and is noted to have scoliosis when examining his back. He started wearing glasses at a young age as he was not able to see distance. What is the SINGLE most likely syndrome?

A 7 year old boy presents to Accident & Emergency (A&E) after an injury to his right leg while playing football. His parents give a history of his friend unintentionally kicking the boy’s shin instead of the ball. X-ray imaging reveals a fracture of the tibia. The boy’s past medical history is significant for multiple fractures sustained over the past few years. His growth chart demonstrates that he is below the 50th centile for height despite appearing well nourished. Inspection reveals noticeably blue sclera. His fracture was surgically managed by the orthopaedic team and he was discharged pending further investigations for his condition. Which SINGLE medication, if any, is used in the long term management of this patient’s condition?

A new mother brings her 6 week old infant visit the GP surgery for their postnatal check. She is currently breastfeeding but has sore, itchy nipples especially after feeding. Bath her nipples look pale with shiny skin on examination. Her child has white spots on his tongue and mouth. She has recently finished a course of co-amoxiclav for a perineal infection. What is the SINGLE most appropriate action?

A 4 year old boy presents to the Emergency Department with fever, abdominal pain, bloody diarrhoea, decreased urine output after a school field trip at a farm. On examination, the boy is pale, tired, and his face is swollen.

Investigations:

Haematocrit 28%

Platelets 72 x 10^9/L (150-400)

There is blood and protein in the urine. What is the SINGLE most likely diagnosis?

A 17 day old female infant born at 38 weeks gestation has gradually become jaundiced over the past 10 days. Both mother and newborn were visited at home by her midwife who decided to refer the newborn back to the paediatric team in the hospital due to prolonged jaundice. Her mother has breastfed her exclusively since she was born. Besides the symptoms of jaundice, the newborn has been growing well. The newborn has wet nappies. Blood test reveals:

Total bilirubin 155 μmol/L (high)

Conjugated bilirubin 30 μmol/L (high)

Unconjugated bilirubin 125 μmol/L (high)

What is the SINGLE most likely diagnosis?

A 24 month old child is assessed for developmental milestones. He can build 6-block towers but cannot draw squares. He can wave goodbye. He uses a spoon to feed himself. He cannot button his shirts although he tries to dress himself. He is not potty trained. He copies actions and activities he sees around him such as cooking with toy pans. He has a vocabulary of around 10 words and can demonstrate some parts of his body. He is unable to combine 2 or more words in a sentence. What is the SINGLE best development stage to describe this child?

A 5 year old boy presents with drooling of saliva and severe stridor. He has a temperature of 39.0°C and is sick looking. He has difficulty speaking and has muffled voice. A lateral radiograph demonstrates a “thumb sign”. What is the SINGLE most likely diagnosis?

A 9 year old boy is brought into the Paediatric Accident and Emergency by his parents with severe shortness of breath. He has a history of asthma and has become unwell over the past few days with a productive cough. His symptoms are worsening and he feels the salbutamol inhalers are no longer effective in helping him breathe. On examination, he has a widespread wheeze on auscultation. There are intercostal recessions and the use of accessory muscles. His oxygen saturation was 88% and respiratory rate was 45 breaths/minute. Oxygen was immediately commenced. He was given back to back nebulisers with salbutamol and ipratropium bromide. Intravenous hydrocortisone was administered. Due to poor response, he was given intravenous salbutamol and intravenous aminophylline. His symptoms continue to deteriorate with signs of exhaustion and poor respiratory effort. What is the SINGLE next most appropriate medication to be considered?

A 4 month old child is brought to Accident & Emergency by her parents. She is found to weigh 4.1 kg. She presents with multiple bruises on her left and right lower leg. Her left ankle is swollen and she refuses to move it. She appears irritable and she also has a runny nose. What is the SINGLE most likely diagnosis?

A 15 year old boy is admitted with acute shortness of breath that started 12 hours ago. He has a history of asthma which last exacerbation required admission to the hospital 3 months ago. He denies any fever. He has no rash or swelling. He is treated initiated with 100% oxygen, nebulised salbutamol, and intravenous hydrocortisone. Ipratropium bromide was also added to the nebulisers. Despite the initial treatment, he continues to deteriorate. His oxygen saturation is 88% and his respiratory rate is 31 breaths/minute. He is able to talk in full sentences. What is the SINGLE most appropriate next step in management?

A 4 year old boy was admitted into hospital for bloody diarrhoea, abdominal pain and vomiting. On day 4 of his admission, he continues to look pale and lethargic. His stool cultures show growth of an Escherichia coli strain 0157. He is febrile, tachycardic and tachypnoeic. His recent blood test shows:

Sadium 131 mmol/L (135-145 mmol/L)

Potassium 5.8 mmol/L (3.5-5.0 mmol/L)

Urea 11.1 mmol/L (2.0-7 mmol/L)

Creatinine 219 μmol/L (70-150 μmol/L)

Calcium (Total) 2.4 mmol/L (2.1-2.6 mmol/L)

Bicarbonate 20 mmol/L (22-26 mmol/L)

What is the SINGLE most likely diagnosis?

A 8 month old boy presents to the Paediatric Emergency Department with a high temperature, cough and shortness of breath. His mother is concerned as he has not been eating or drinking well for the past 24 hours. Over the past few hours, he has been responding less to social cues. On examination, his mucous membranes are dry and he is noted to have nasal flaring. He is seen grunting with a respiratory rate of 70 breaths/minute. His temperature is 38.9°C. Which is the SINGLE most worrying clinical feature?

A 6 year old boy is brought to clinic by his mother. She says that he is still unable to keep dry at night and will be attending a sleepover party at a friends house. She says that it would be embarrassing if he wets himself during the sleepover and she wants to know if anything can be done. The child does not wet himself during the day. What is the SINGLE most appropriate management?

A 10 month old boy is brought to the Emergency Department by mother with the complaint of a cough which has worsened over the past 2 days. His mother explains that his cough began 8 days ago and has progressed quite rapidly. She also reports that she was alarmed by the bluish discolouration of his lips after a bout of coughing. He was born at term and does not have any significant past medical history. However, he was not immunised as his parents are against vaccinating their child. On examination, he appears grossly unwell with a heart rate of 160 beats/minute. On the assessment of his pharynx, he develops a bout of cough which continues for 2 minutes. After every few coughs, he draws in a large amount of air in and his lips appear cyanosed during the latter part of the episode. Which is the SINGLE best investigation to yield a diagnosis?

A 2 year old boy is brought by his parents to the Paediatric Department as he swallowed a small coin a few hours ago. The parents are confident that it was a coin as they saw him putting it in his mouth but could not react fast enough to prevent him from swallowing it. He does not have any shortness of breath and he does not have any abdominal pain. He has not vomited since the ingestion of the coin. His observations are normal. An X-ray shows a round object in the stomach. What is the SINGLE most appropriate action?

Parents of a 15 month old baby are concerned as their child can only babble and cannot say any discernible words. He is able to say monosyllabic words but without any meaning. His parents usually send him to a nursery and they are especially worried as all the other children around his age are able to say “dada” and “mama” and can follow simple directions but their child cannot. He makes no effort to say words that his parents are saying. He was born at term with no complications during pregnancy or after birth. What is the SINGLE most appropriate action?

An infant born at term, started to have jaundice when he was 2 days old. He is now 9 days old and the symptoms of jaundice has improved for the past 7 days. He is breastfed and is gaining weight within normal limits. What is the SINGLE most likely diagnosis?

An 12 month old child presents to the Emergency Department with her parents. Her parents mentioned that she has been having diarrhoea and vomiting over the past 5 days. Her oral intake has been reduced. She has been born at term and is still breastfed. She has no significant past medical history. Her weight is 10 kg, her blood pressure is 70/40 mmHg and her heart rate is 180 beats/minute. On examination, she appeared pale with dry lips and sunken eyes. Her skin turgor is reduced. What is the SINGLE most appropriate initial action?

A 2 year old boy is brought by his parents to the Paediatric Department as he swallowed a small coin a few hours ago. He does not have any shortness of breath and he does not have any abdominal pain. He has not vomited since the ingestion of the coin. His observations are normal. An X-ray shows the following:

What is the SINGLE most appropriate action?

A 5 year old boy presents with bilateral swelling in his lower extremities. His mother reports that he has recently had a bout of abdominal pain and diarrhoea and in the mornings his eyes appear puffy. On examination, you note pitting oedema in the lower extremities. What is the most important next investigation?

A 6 month old boy is admitted with persistent irritability. He is lethargic and is not feeding well. He has a temperature of 38.2°C, a capillary refill time of 2 seconds and a respiratory rate of 34 breaths/minute. A urinalysis reveals leukocyte esterase positive and nitrite negative. What is the SINGLE investigation most likely to lead to a diagnosis?

A 12 year old girl is brought to the Emergency Department. She has been passing loose, watery stools at least 6 times a day for the past 5 days. Her mother reports that she has not been feeding or drinking well since yesterday and passed urine just once in the past 12 hours. On examination, she is lethargic, and her mucus membranes are dry. Her pulse is feeble at a 120 beats/minute, and blood pressure is 86/64mmHg. Which of the following is the SINGLE most appropriate investigation to perform initially?

A 2 year old child is brought to the hospital by his mother with a barking cough. A few days ago he had a runny nose, cough and a sore throat. His chest sounds are normal and there are no signs of intercostal recession. He has a temperature of 38.7°C, respiratory rate of 34 breaths/minute, pulse rate of 150 beats/minute and his oxygen saturation on air is 98%. What is the SINGLE most appropriate management?

A 24 month old girl is seen in the paediatric clinic with milestone concerns. She was able to walk at 18 months of age without support but has regressed over the past 2 months. She has to use her hands and arms to walk up her body to achieve an erect position. She has difficulties standing unaided. There is marked unsteadiness and awkwardness when walking. She has a delay with the development of speech and fine motor skills. Her mother describes her as been developing normally up to about 18 months of age. She was born at term and had no complications during birth. What is the SINGLE most appropriate action?

A 3 year old boy has had symptoms of a viral upper respiratory tract infection for the past 3 days. His temperature recorded by his mother at home ranges from 38°C to 39°C He has been brought to the Paediatric Accidents & Emergency with a history of a fit lasting for 3 minutes. Further clinical examinations and investigations for infection were performed in the hospital and meningitis was excluded. There is no history of febrile seizures or epilepsy in the family. At discharge, he was given the diagnosis of febrile seizures. His mother has concerns regarding the prognosis of febrile seizures. What is the SINGLE most appropriate advice to give to the mother?

A 4 year old girl has been treated with antibiotics for dysuria 4 weeks ago. The organism that was initially cultured was E.coli. She has had 3 episodes of lower urinary infection which was treated with antibiotics in the past one year. Her symptoms resolved within 2 days of starting antibiotic therapy and she is no longer symptomatic. Which is the first scan to be organised?

A mother of a 3 year old healthy Caucasian boy attends the GP surgery for advice regarding vitamin D supplements for her toddler. What is the most appropriate advice?

A 2 year old boy presents to the Emergency Department with bruising and generalised petechiae that is more prominent over his legs bilaterally. The mather states the child recovered from the flu 2 weeks ago. On examination, there was no hepatosplenomegaly, no lymph node enlargement. A full blood count was done and reveals:

Haemoglobin 133 g/L (130-180)

White cell count 9 x 10^9/L (4-11)

Neutrophils 3.1 x 10^9/L (2-7.5)

Platelets 15 x 10^9/L (150-400)

What is the SINGLE most likely diagnosis?

A 5 week old baby is admitted with persistent vomiting. Her mother describes the vomiting as projectile and non-bilious. The vomiting occurs soon after feeding. He was born at term. The infant weighed 3.6 kg last week. His weight today is 3.3 kg. On examination, there is a right-sided abdominal mass. Blood tests were performed. What is the SINGLE most likely result?

A 33 year old woman who had a primary infection of cytomegalovirus during pregnancy has given birth 2 days ago to a baby girl who is currently without symptoms. She had serial antenatal ultrasound scans which showed no fetal abnormality. Which of the following is regarded as the most common long-term health problem in babies born with congenital cytomegalovirus infection?

A 3 month old term female infant presents to clinic with frequent episodes of non- projectile vomiting after feeds. She is exclusively breastfed. The mother complains it is difficult to breastfeed her child as she often gags, and chokes during feeds. Shortly after feeding, she occasionally would display signs of distress, cries and refuses feeds. On examination, the infant is irritable and she is below centiles on the growth chart in terms of weight. What is the SINGLE most likely diagnosis?

A 5 year old girl was brought to the Emergency Department following a burn to her right arm. Her mother mentioned that she looked away for a ‘split second’ when the girl reached for her coffee mug on the table which has just been made. On examination, you noticed partial thickness burns over 10%. The girl appears well but is crying in pain. What is the SINGLE most appropriate initial medication to offer?

A 4 year old girl is brought to the Emergency Department because of high fevers. Her temperature has been over 40°C over the past several hours and she has not been eating or drinking well. She started having a seizure in the department which has been ongoing for the past 2 minutes. His blood glucose is 4 mmol/L. What is the SINGLE most appropriate medication to administer to stop the seizure?

A 4 year old boy has had three urinary tract infections over the past 2 years requiring antibiotics. What is the SINGLE most likely anatomical abnormality resulting in his symptoms?

A 14 year old boy presents to the emergency department after he fell and hit his head in the playground at school. He did not lose consciousness but has swelling and tenderness of the right cheek with a subconjunctival haemorrhage on his right eye. His observations are stable and he is alert and conscious. You are the foundation year two doctor who first sees him. What SINGLE initial investigation would be helpful in this case?

A 2 year old boy is accompanied to the Emergency Department by his parents. He complains of abdominal pain which started 5 hours ago and is intermittent. He cries uncontrollably and draws his knees to his chest when in pain and appears fine in between episodes. He had two episodes of vomiting at home, which was nonbilious. On examination, his heart rate is 150 beats/minute, and his temperature is 37.8°C. A sausage-shaped mass is palpable on the right upper quadrant of the abdomen. Additionally, he passed stool on his way to the hospital, which appears like redcurrant jelly on his diaper. Which of the following is the most appropriate investigation?

A 30 day infant has been losing weight over the past 10 days. He now weighs the same weight as his birth weight. He is irritable and vomits after most feeds. He is exclusively formula fed. A cow’s milk protein allergy is suspected. The mather describes an uneventful pregnancy and delivery. What is the SINGLE most appropriate management?

A young anxious mother of a 1 year old boy comes to you requesting a test for cystic fibrosis as her brother died from cystic fibrosis. What is the SINGLE most appropriate investigation?

A 4 year old male child is brought to the GP by his mother with the complaint that he has started wetting the bed again. He had previously been dry for a period of seven months but had recently started wetting the bed again at night. This has been occurring regularly, at least once a night, for the past week now. He has no daytime symptoms. The mother describes her son’s birth as uncomplicated. The patient has an older sister who is currently seven years old. She has never wet the bed. The patient is within the 50th centile for height and weight for his age. He has no past medical history of note. A urinalysis was performed in clinic with normal results. What is the SINGLE appropriate action?

A 10 year old girl attends the paediatric neurology clinic for a follow up of her migraines. She has been started on propranolol for prophylaxis 4 months ago. Her intermittent headaches continue despite taking her medications regularly. She has developed a convergent deviation of her right eye with symptoms of diplopia which was noticed 3 days ago. What is the SINGLE most appropriate management?

A 13 month old girl presents to the Emergency Department with difficulty in breathing. On examination, she has intercostal recessions and a bilateral widespread expiratory wheeze. She has been eating less over the past few days. She was born at term. Her temperature is 37.9°C and respiratory rate is 35 breaths/minute. Her oxygen saturation is 97%. What is the SINGLE most likely diagnosis?

A 12 month old toddler is seen in the paediatric outpatient clinic by his mother with concerns of his growth. 6 months ago his weight was on the 75th centile. His weight has now dropped to the 25th centile. He was born at term and there were no complications during his birth or during pregnancy. His birth weight was 4.1 kg. He was completely breastfed until 6 months of age. He was weaned at 6 months of age. His appetite has been poor over the past few months. He has no vomiting. He opens his bowels three times a day. There are no heart murmurs heard. He is not clinically jaundiced or cyanosed. His last full blood count is seen below.

Haemoglobin 85 g/L (130-180)

White cell count 9 x 10^9/L (4-11)

Platelets 250 x 10^9/L (150-400)

Mean cell volume 65 fL (76-96)

Mean cell haemoglobin concentration 289 g/L (300-360)

What is the SINGLE most appropriate test to request?

An 18 month old male child is being assessed for his developmental milestones. His mother describes him as being very sociable. He smiles around family members but does not make any eye contact. He can walk and kick a ball but he cannot run. He cannot speak any decipherable words but can speak up to two meaningless words at a time. He can scribble on paper but cannot write or draw. He does not exhibit any particular hand dominance. What is the SINGLE most concerning symptom in this child?

A 2 year old boy presents to the Emergency Department with painless rectal bleeding for the past 2 days. On examination, the child is afebrile, tachycardic, alert, playful, and feeding well. Abdominal examination was normal. Which of the following is the SINGLE most likely diagnosis?

A 3 month old infant presents with recurrent infections and feeding difficulties. His face looks dysmorphic and has a cleft palate. A chest X-ray shows absent thymic shadow. What is the SINGLE most likely diagnosis?

A 1 year old girl attends the clinic with her mother. Her mother complains that her baby has diarrhoea, bloating and abdominal pain. She is failing to thrive. A blood test reveals a hypochromic microcytic anaemia. Alpha-gliadin antibodies are positive. What is the SINGLE most likely diagnosis?

A 6 year old boy is brought to the clinic by his worried mother complaining that he is still unable to keep dry at night. He wets his bed in the middle of the night at least three times a week but he is without daytime symptoms. There was no period in the past where he managed to stay dry during the night. The mother has tried a star chart and awarded the child a star when the child gets up to change the sheets. She has previously visited another GP who has discussed that adequate fluid intake is important and not to restrict fluids for the child. She would like to know if there is any other method that can be done to resolve this issue. His medical history is insignificant and there is no history of recurrent urinary tract infections. What is the SINGLE most appropriate management?

A 4 week old female infant presents to the Emergency Department with vomiting after every feed. The mother describes the vomiting as projectile and non-bilious. The child is also constipated. On examination, there is a right-sided olive-sized abdominal mass on palpation. What is the most urgent investigation?

A previously healthy 2 year old girl is brought to the Emergency Department by her mother after having witnessed the child’s body suddenly going stiff followed by uncontrolled twitching of the arms and legs for about 5 minutes. There was frothing at the mouth and on examination now the child is drowsy, irritable and distressed. The temperature on admission was 38°C. This was a first-time event. There is no rash observed. What is the SINGLE next appropriate management?

A 3 year old child presents with cough, a rash on his face and a high temperature which began 2 days ago. A rash is also seen on his buccal mucosa. His parents state that he was not given routine immunization as the parents were concerned about the adverse effects. The rash is erythematous and maculopapular and has spread to his body. He has a temperature of 38.9°C Below is a picture of his trunk and back

What is the SINGLE most appropriate diagnosis?

A 2 week old baby is brought to the GP surgery by his mother. He has a purulent discharge from his right eye that started two days ago. His eye shows an injected conjunctiva. The neonates vitals are within normal limits. He has a temperature of 36.4°C. What is the SINGLE most appropriate management?

A 4 year old boy has a fever that has ranged between 39°C and 40°C for the past 6 days. He has a widespread maculopapular rash that developed shortly after the fever. He developed bilateral conjunctivitis. He was started on phenoxymethylpenicillin 2 days ago but his parents have not reported any improvement. On examination, cervical lymphadenopathy is palpable. He has fissured lips and a strawberry tongue. What is the SINGLE most likely diagnosis?

A 12 year old girl presents to clinic with sudden onset of pallor, palpitations, and difficulty breathing while running on the school track. After 30 minutes, her symptoms resolved. This is a first time event and she has never been cyanotic Cardiac examination was normal. Chest x-ray and echocardiogram were normal. ECG reveals evidence of pre- excitation, delta waves, and prolonged QRS. What is the SINGLE most likely diagnosis?

A fully immunised 10 month old baby was brought into the GP surgery by her parents. The baby recently started attending nursery. She developed a sudden high fever (ranging from 39°C to 40.5°C) which lasted for two days. 5 days after the fever started, she developed a rose-pink maculopapular rash on her trunk. Her face and neck are not affected by the rash. The baby is drinking and eating well. Which is the SINGLE most likely diagnosis?

Parents of a 5 month infant attend the GP surgery with concerns for a deformity on the infant’s head. His head appears to be flattened on the left side. His parents report that he has been developing normally and his milestones are appropriate for his age. He was born at 39 weeks gestation and had a normal looking skull during the two months of life. There is no restriction in the infant’s neck movements. The parents have been advised to continue to change the baby’s position when sleeping. An X-ray of the skull was performed which the radiology report shows evidence of plagiocephaly with no premature fusion of the cranial sutures. What is the SINGLE most appropriate action?

A 2 week old female infant born at term has gradually become jaundiced over the past few days. Both mother and newborn were visited at home by her midwife who decided to refer the newborn back to the paediatric team in the hospital due to prolonged jaundice. Her mother has breastfed her exclusively since she was born. Besides the symptoms of jaundice, the newborn has been growing well and has normal yellow coloured stool. A split bilirubin test was performed which shows elevated levels of unconjugated bilirubin. What is the SINGLE most appropriate management?

A 2 year old child is brought to the Paediatric Emergency Department by his mother following a 4 minute seizure. The mother says she was playing with his elder brother when he suddenly sat down and started seizing. There was no injury to his head. His mother reports no concerns in regards to his developmental milestones. He has had all his childhood immunisations. He was eating and drinking normally throughout the day. He has a temperature of 36.2°C. His respiratory rate and heart rate are within normal limits. What is the SINGLE next most appropriate investigation?

A 9 year old girl, known case of asthma, presents to the Emergency Department with a 1 day history of shortness of breath that is increasing in severity. She had a previous upper respiratory tract infection 1 week prior which had resolved. Chest x-ray reveals bilateral hyperinflation. On arrival, she was given oxygen, nebulized beta-2 agonist, and oral prednisolone. She is now drowsy, respiratory rate is 30 and her SpO2 is 90%. Which of the following is the SINGLE most appropriate investigation?

A 7 year old child is brought in by her mother with complaints of having a fever, sore throat and feeling unwell. She has a maculopapular rash on her trunk and back which appeared a few hours ago. On examination of the throat, there is a white coating on the tongue and the tonsils have pale exudates. She has a temperature of 39°C. What is the SINGLE most likely diagnosis?

A 15 month old child is assessed for developmental milestones. He holds on to furniture to help him stand and walk. He cannot walk independently and makes no attempt to walk without support. He can say ‘mama’ and ‘papa’. He responds and understands familiar words like “bottle”. He cannot put 2 or more words in a sentence. He makes eye contact, smiles and waves at his parents. He can transfer objects from one hand to another. He tends to bang and throw toys rather than use them for their intended purpose when playing with toys. He does not attempt to dress. What is the SINGLE best development stage to describe this child?

A 2 year old has atrophy of the buttocks. He has occasional bloating of his abdomen with frequent offensive, smelly stools that are difficult to flush. His symptoms have been ongoing for the past 3 months. He looks pale on examination and his mother reports that he is more fatigue over the past month. What is the SINGLE most appropriate initial investigation?

An 18 month old boy has been brought to the Emergency Department by his mother because he has been refusing to move his left arm and crying more than usual for the past 24 hours. He has recently been looked after by his mother’s new partner while she attends college. An assessment of the child shows multiple bruises on his body and the medial aspect of his left upper arm. What is the SINGLE most appropriate next step?

A six week old baby presents with noisy respiration and stridor, which is worse on crying. Her mother has been reassured that the condition will resolve within 1 year. She was told that is due to a congenital abnormality. Which structure is not fully developed at birth in this child?

A 6 year old boy presents with abdominal pain and a mild fever. He also has pain in both knees and a swollen right knee. Yesterday, he developed flat, red spots which evolved and merged into elevated purple patches. These patches cover his buttock and the back of both legs. His mother mentions that he had a cough and runny nose 10 days ago. Apart from a temperature of 38°C, his vitals are within normal limits. On applying pressure with a glass slide, the purple patches do not blanch. A urinalysis shows microscopic haematuria and mild proteinuria.

Investigations:

Platelets 260 x 10^9/L (150-400)

White cell count (total) 12 x 10^9/L (4-11)

ESR 15mm/hr

Serum IgA levels elevated

What is the SINGLE most likely diagnosis?

A 2 year old boy fell off his tricycle and hurt his arm. He got up and was about to start crying but before there was any sound, he went pale, and unconscious. He recovered after 2 minutes but remained pale. His colour came back after a few minutes. His mother was concerned at that time that he was going to die. She is very worried and mentions that he had a similar episode 2 months ago after falling down some steps. What is the SINGLE most appropriate next step?

A 6 year old boy presents to clinic with obesity. He has a history of failure to thrive as an infant. He is now behind in school, has difficulty interacting with friends, and feeds constantly. His mother says he cannot stop eating. What is the SINGLE most likely diagnosis?

An 11 month old boy was referred to the outpatient paediatric clinic with failure to thrive, and persistent diarrhoea. He has a birth weight of 3.5 kg and initially gained weight. He was breast-fed for the first six months and then was weaned. His appetite has been low for the past few months. He has loose stools and opens his bowels 3 to 4 times a day. He currently has a few battles of cow’s milk a day. On examination, his abdomen is mildly distended with no palpable masses. His growth chart is seen below:

Coeliac disease was suspected and serology was requested. The serology results are as follows:

Tissue transglutaminase (TTG) antibodies (IgA) negative

IgA deficiency present

What is the SINGLE most appropriate action?

A 17 year old girl presents with complaints of not having started her menstrual period. She has a short stature. Her chromosomes were checked which confirmed Turner syndrome. What is the SINGLE most likely finding in Turner’s syndrome?

A 7 year old boy with a background of cerebral palsy suffers from chronic severe spasticity and functional disability of his arms, hands and legs. He has flexion at the elbow and wrist which leads to difficulty with tasks such as getting dressed, eating and drinking. Spasticity of the muscles in his legs affects his ability to walk. His limb tone is persistently increased. He has increased deep tendon reflexes. He has regular appointments with the physiotherapist. He uses a wheelchair for mobility. Which medication would benefit this child?

A 15 year old boy attended the emergency department with shortness of breath. A diagnosis of spontaneous unilateral pneumothorax was made. He is noted to be tall for his age with long arms and fingers. He also has severe scoliosis. What is the SINGLE most likely syndrome?

A 10 day old baby is brought into the GP surgery. His mother has concerns that he has a two day history of clear bilateral eye discharge. The discharge is described as sticky. There is no redness or injection of the conjunctiva. There is no eye lid swelling. His temperature is 36.9°C. His observations are within normal limits. What is the SINGLE most appropriate step?

A 3 week old infant’s mother is concerned about the infants intake of milk and cows milk protein allergy. She is breastfeeding exclusively. The infant’s birth weight was 3.4 kg. The infant has loss around 5% of weight in the early days of life which has returned by week 3. She had a vaginal delivery without complications. Her pregnancy was uneventful. What is the SINGLE most appropriate advice?

A 19 day old infant is brought by his mother to the GP surgery with concerns of a lump on his umbilicus. On examination, there is a pink soft swelling at the umbilicus. He has a temperature of 37.2°C. There is no offensive smell or discharge. A picture of the mass is seen below:

What is the SINGLE most appropriate management?

A 9 year old girl with cystic fibrosis is discussing her problems with you and wishes to know the reason for her repeated pulmonary problems. What is the SINGLE most likely cause of her pulmonary symptoms?

A 3 year old boy is brought to A&E after having a generalized tonic-clonic seizure that lasted approximately 5 minutes. The parents say that he was previously well but started developing symptoms of a cold earlier in the morning. He is noted to have a fever of 39°C. What is the SINGLE most likely diagnosis?

A 5 year old boy is brought to the Emergency Department by his father as he started having large bruises around his body. On examination, he has petechiae on his arms and legs with bruising on the trunk. Palatal petechiae is seen. He has blood crusted in his nares but without any active bleeding. There are no fundal haemorrhages. There are no signs of lymphadenopathy or hepatosplenomegaly. The child has had an upper respiratory tract infection 6 days ago. The child is active. His observations are within normal limits. His blood results show the following:

Haemoglobin 139 g/L (130-180)

White cell count 8.8 x 10^9/L (4-11)

Platelets 44 x 10^9/L (150-400)

Prothrombin time 12 seconds (10-14)

Activated partial thromboplastin time 39 seconds (35-45)

What is the SINGLE most appropriate management?

A 7 year old child with meningitis is an his last day of intravenous antibiotic treatment. He was brought to the hospital by his parents as soon as he began to complain of feeling ill. A lumbar puncture showed infection with Haemophilus influenzae type B. He did not need resuscitation on admission and the course of his illness was relatively mild. The patient appears to be recovering well and has no complaints. He has no prior medical conditions and his gestation and birth were uneventful. The patient appears healthy, is doing well at school, is sociable and is around the 50th centile on all his growth charts. The patient’s parents ask to speak to you and say that they are concerned about the implications of meningitis on their son’s future health. What is the SINGLE most likely outcome for this patient?

A 6 year old boy presents to the clinic with obesity and short stature. On examination, his BMI is above the 95th percentile. His past medical history is significant for a renal transplant. What is the SINGLE most likely diagnosis?

A 3 year old child is admitted to the hospital for a very high fever. He is discovered to be below the 25 th percentile for weight. After a week in the hospital, his weight improves from 10 kg to 11 kg upon discharge. A week later, he is readmitted with pneumonia. His weight upon admission is back to 10kg and improved to 11.5 kg at the end of 10 days upon discharge. What is the SINGLE most likely cause of his fluctuating weight?

An 8 year old boy is seen in secondary care for a history of nighttime bedwetting and a few incidences of day time urinary leak a week. His mother is very worried about his symptoms since it can be very embarrassing for him to wet himself in school. The child is otherwise well without any complications at birth. His urine dipstick results are within normal limits. He does not suffer from any constipation. He has not been able to sustain continence during the day or at night. What is the SINGLE most appropriate management for this boy?

PLABABLE

A 15 year old boy is concerned that he is shorter than his peers. He often gets teased in school because of his height. His growth chart reveals that he was on the 9th centile when he was 10 years old. He is now on the 2nd centile. His mother had menarchy when she was 13 years old. His father was also short around that age but had a growth spurt once he reached 16 years of age. His blood tests which include a growth hormone provocation test are within normal levels. What is the most appropriate action?

A 2 year old male presents to the Emergency Department with a left-sided reducible firm swelling near the groin. The swelling descends when the child cries. On examination, both testicles are palpable in the scrotum. What is the SINGLE most appropriate management?

A 14 year old girl attends a paediatric neurology clinic with her mother for ongoing seizures. She was diagnosed with epilepsy when she was 8 years old. Over the past two months, she has had 5 epileptic seizures. Rectal diazepam terminates the attack. She has been using sodium valproate and lamotrigine to control her seizures for the past few years. She is on the maximum dose of sodium valproate. What is the SINGLE most appropriate investigation?

A 9 month old baby is admitted with a 3 day history of a persistent dry cough and difficulty breathing. He has a temperature of 38.5°C. His mother says that he has been having difficulty breathing throughout the night. He has been eating and drinking less than usual. On examination, there are nasal flares and a high-pitched widespread wheeze bilaterally. He has reduced skin turgor and a capillary refill time of 4 seconds. His respiratory rate is 70 breaths/minute and oxygen saturation is 91%. What is the most likely aetiology?