You see a 3-year-old boy who presents with fever, irritability and offensive smelling urine. You suspect a urinary tract infection, but his mother is unable to obtain a clean catch urine sample.
What is the recommended method of obtaining a urine sample if a clean catch is not possible in a 3-year-old boy with suspected urinary tract infection?
A father brings his 4-year-old son to see you in the surgery. He has had a fever for 24 hours, vomited once and complains of abdominal discomfort and pain when passing urine. He is drinking plenty of fluids. He has been potty trained for one year, but had several urinary accidents in the past couple of days. There is nothing of note in his past medical history.
On examination there are no recessions, his chest is clear, abdomen is soft with mild lower abdominal tenderness and no loin tenderness. He has a normal ENT examination. He is well hydrated and has no rash. His urine dipstick is positive for leukocytes and protein, but negative for nitrate and blood. His temperature is 38°C, HR 120, RR 28, and CR <2 sec. According to the NICE ‘traffic light’ system what is the most appropriate management?
A 16-year-old student presents with a three week history of a flu-like illness, which progressed after a week to paroxysms of coughing.
He was previously healthy and believes he received all the recommended childhood vaccinations.
Upon examination, he has no fever and his chest sounds clear. You suspect he may have pertussis.
What is the most suitable test to confirm the diagnosis?
A mother has brought her 7-year-old son to see you as she is worried about a lump in his neck. She says that the lump is painless and has been present for several months.
On examination you find a 3 cm, non-tender cervical lymph node. You can also see some scratch marks over his trunk.
What is the most likely diagnosis?
A 5-year-old girl presents with fever, sore throat and reluctance to eat for the last 48 h. On examination, you note small erosions on the buccal mucosa and tongue. Examining her body, you also find erythematous macules, some with vesicles, on the hands and feet.
What is the most likely cause of these symptoms?
A previously healthy 6-month-old baby boy is brought to the General Practitioner with a 3-day history of coughing. He has now started to go off his feeds and his mother is getting rather concerned. On examination, he is tachypnoeic, with fine crepitations heard all over his lungs, with some wheeze in both lung fields.
What is the most likely diagnosis?
A 3-year-old girl presents with weight loss at her health check, having dropped from the 75th centile weight at birth to the 9th. She was born abroad; the results of any neonatal screening are unavailable. Since her arrival in this country, she has been prescribed antibiotics for several chest infections. Between attacks, she is well. The mother worries that she might have asthma. There is no family history of note.
What is the most likely diagnosis?
A 5-year-old girl presents with a three-day history of paroxysms of colicky central abdominal pain and bile-stained vomiting. The abdomen feels full and tender. Some red mucous has been passed from the rectum.
What is the most likely diagnosis?
A 7-year-old child comes to the clinic after visiting a petting zoo about 2 weeks ago. The child complains of watery diarrhea, abdominal cramps, and a low-grade fever. The mother reports that the child is still able to eat and drink normally and is urinating normally. Upon examination, the child appears pale, and the abdomen is slightly tender but soft. What is the most probable diagnosis?
The parents of a 6-month-old baby have brought their child to see you due to ongoing problems with reflux.
The baby has been seen in paediatric outpatients and was started on ranitidine. You can see from the clinic letters that this was started at an initial dose of 1 mg/kg three times a day but to achieve symptom control it has been titrated to 3 mg/kg TDS. The higher dose seems to be controlling symptoms well.
The paediatricians have asked you to continue to prescribe the ranitidine at a dose of 3 mg/kg until they review the child again in four weeks time.
You weigh the child today and the current weight is 6 kg. Ranitidine oral solution is dispensed at a concentration of 75 mg/5 ml.
What is the correct dosage in millilitres to prescribe?