A 14-year-old boy comes to the doctor’s office with his mother. His father passed away two weeks ago. He is feeling very emotional and is hesitant to return to school. He has no known risk factors for depression.
What is the most suitable course of action for managing his situation?
A 16-year-old boy attends the Emergency Department (ED) with his father. They are both heavily intoxicated with alcohol. The boy’s records show that this is the fourth time in eight months that he has attended the ED with alcohol-related problems. The safeguarding lead has advised you to contact social services.
What is the most suitable course of action in this scenario?
A 12-hour-old neonate is evaluated in the neonatal unit after a normal vaginal delivery at 35 weeks’ gestation. The mother reports no issues thus far. During the examination, a continuous ‘machinery-like’ murmur is heard, and a left subclavicular thrill is observed. The neonate has a large-volume collapsing pulse. An echocardiogram is performed, revealing the suspected defect but no other anomalies. What is the most suitable course of action at this point?
A 10-year-old boy with severe haemophilia A is brought to the Emergency Department by his mother due to a nosebleed that has been ongoing for over 30 minutes. He is currently receiving regular injections to manage his condition but is aware that further treatment may be necessary in the event of a significant bleed. What is the most appropriate course of action for managing this patient?
A 10-year-old boy visits his family doctor complaining of a limp that has been bothering him for the past 48 hours. He mentions having a runny nose and cough for a few days, but he feels better today. He reports pain in his left hip.
During the examination, the boy seems to be in good spirits and can bear weight with an antalgic gait.
His blood pressure is 110/70 mmHg, and his heart rate is 90 beats per minute. His respiratory rate is 16 breaths per minute, and his temperature is 38.5ºC.
What is the most appropriate course of action based on this information?
A three-day-old baby who has not passed meconium is presenting with a distended abdomen and vomiting green bile. A congenital condition affecting the rectum is suspected. What test is considered diagnostic in this case?
A 14-year-old boy presents to the emergency department with his parents complaining of sudden onset right-sided groin pain and inability to bear weight after a fall. On examination, he has a decreased range of motion and an antalgic gait. His heart rate is 96 bpm, blood pressure is 118/76 mmHg, BMI is 31 kg/m², and he is afebrile. What is the most probable finding on examination for this diagnosis?
A 7-year-old child is brought to the GP practice for an urgent appointment by their parent. They have a 7 day history of fever and dry cough but in the last 24hrs their parent has become increasingly concerned about their breathing. They also report the child is refusing food and has had very few wet nappies.
The child’s observations are oxygen saturation 93% on air, respiratory rate 58 breaths/min, heart rate 160 bpm, blood pressure 85/45 mmHg and temperature 38.1ºC.
On examination, the child’s breathing appears rapid with marked intercostal recession and use of accessory muscles. They are also making a grunting noise.
Which of these findings would indicate immediate referral to hospital by ambulance?
An 8-year-old is referred to paediatric clinic by a GP due to concerns about an incidental murmur. The child is healthy and shows no symptoms. Upon examination, the paediatrician diagnoses a benign ejection systolic murmur. What is a characteristic of this type of murmur?
The ward doctor is requested to assess a 24-hour-old neonate, born at 35 weeks gestation to a healthy mother via an uncomplicated vaginal delivery. Upon examination, the neonate appears comfortable. Auscultation of the heart reveals a continuous ‘machinery-like’ murmur and a left-sided thrill. The apex beat is palpable and appears to be heaving. A widened pulse pressure is observed, but there is no visible cyanosis. An echocardiogram is performed and confirms the diagnosis while ruling out other cardiac issues.
What is the most appropriate course of action for management at this stage, given the likely diagnosis?