Med Student Finals Category: Paediatrics

MSFinals-4682

A 10-year-old girl presents to the Emergency Department with her mother, complaining of right iliac fossa pain for the past 2 days. She has no significant medical history, except for a recent cold and sore throat. She has had a high fever for the past 2 days and has lost her appetite, but denies any other symptoms. On examination, her temperature is 38.9 °C and her heart rate is 130 bpm. She has palpable and slightly tender submandibular and cervical lymph nodes on both sides. Her chest is clear, with transmitted sounds from the upper airways. Abdominal examination reveals marked tenderness in the right iliac fossa without guarding. A urine dipstick shows 2+ ketones and 1+ protein. Her FBC results are as follows: haemoglobin 145 g/l (normal range 135–175 g/l), WCC 14.3 × 109/l (normal range 4–11 × 109/l), and platelets 425 × 109/l (normal range 150–400 × 109/l). What is the most likely clinical diagnosis?

MSFinals-4683

A 3-month-old boy is presented to surgery with vomiting and poor feeding. The mother reports a strong odor in his urine, indicating a possible urinary tract infection. What is the best course of action for management?

MSFinals-4668

A 4-year-old girl is brought to the pediatrician by her mother. The mother is concerned as she has noticed some hair growing in her daughter’s armpits, and although she has not shown any distress or had any other noticeable symptoms, the mother is worried that something is wrong as she is too young to begin going through puberty. On examination, the child has axillary hair growth bilaterally, and her breasts are of appropriate size for her age.

Gonadotrophin assays show the following:
FSH 0.2 IU/L Age 6 months – 10 years old: (1 – 3)
LH 0.1 IU/L Age 6 months – 10 years old: (1 – 5)

What is the most likely cause of this child’s axillary hair growth?

MSFinals-4684

A 10-year-old boy is brought to surgery during an asthma attack. According to the British Thoracic Society guidelines, what finding would classify the asthma attack as life-threatening instead of just severe?

MSFinals-4669

A 4-week-old female neonate is brought to the hospital with a 1-week history of vomiting and regurgitation of non-bilious materials, mostly consisting of ingested milk. The vomiting has lately become projectile. On examination, an olive-shaped mass is palpated in the right upper quadrant, and a periodic wave of peristalsis is visible in the epigastric region. The neonate has puffy hands and feet and redundant skin in the neck. A systolic murmur is noted on the cardiac apex. Laboratory tests reveal hypokalaemic, hypochloraemic metabolic alkalosis.
What is the most likely diagnosis?

MSFinals-4670

A 14-year-old teenage girl comes to the clinic with concerns about delayed puberty and not having started her menstrual cycle. She reports feeling generally well and has no significant medical history. During the examination, it is noted that she has a slender build and underdeveloped breasts. There is no pubic hair present. Upon palpation, marble-sized swellings are felt in both groins. What is the most probable cause of her presentation?

MSFinals-4671

A 6-week old infant is seen by the health visitor. She was born via breech caesarean section at 36+2 weeks gestation due to suspected chorioamnionitis and received antibiotics post-partum. Her hospital newborn physical examination (NIPE) was normal. She is currently thriving and following the 60th centile. What further assessments should the health visitor arrange for this infant based on her medical history?

MSFinals-4672

A General Practitioner (GP) sees a 28-month-old girl who is failing to thrive. The GP carries out some tests and discovers antibody to tissue transglutaminase in the girl’s plasma.
What is the most likely diagnosis?

MSFinals-4673

A 6-month-old female infant is found to have a clicky left hip during a routine check-up. What is the most suitable test to conduct?

MSFinals-4674

A 35-year-old woman attends an ultrasound scan at 36 weeks due to gestational hypertension. This shows a breech presentation. She has a successful external cephalic version (ECV) at 37 weeks and her baby is born vaginally at 40+5 weeks. On the initial postnatal check, both Ortolani’s and Barlow’s tests are negative. Mums’ blood pressure returns to normal after birth.
What investigations will be necessary?