A 3-month-old baby was brought to the emergency department three days ago with a purpuric rash, fever, vomiting, and reduced wet nappies. During the assessment, the baby had a seizure which resolved on its own. The baby was admitted and tested for meningitis. A lumbar puncture was done and the laboratory results showed elevated protein levels, increased white cells, and a gram-positive organism. What is the appropriate course of action for managing this infant?
A 10-year-old girl is brought to the Accident and Emergency department by her parents. On a background of high-grade fever and lethargy over the last 12 hours, the child had an episode of jerking of the limbs, frothing at the mouth and incontinence of urine. She has failed to recover full consciousness after the episode. At presentation, she is poorly responsive to name-calling, but responsive to pain. She is however maintaining her airway and oxygen saturation is 95% on air. Limited neurological examination is unremarkable. Non-contrast computerised tomography (CT) scan of the brain is normal. Lumbar puncture is performed and reveals a slightly raised opening pressure, moderately increased cerebrospinal fluid (CSF) protein, CSF lymphocytosis and normal glucose.
What is the most important step in management?
A 10-week-old girl has been brought to the emergency department by her father. He noticed this morning that she was very drowsy and not feeding very much. When he measured her temperature it was 38.5ºC. She was born at 37 weeks gestation with an uncomplicated delivery. There is no past medical history or family history and she does not require any regular medications.
On examination she is lethargic but responds to voice by opening her eyes. She is mildly hypotonic and febrile. There is a non-blanching rash on her torso that her father says was not there this morning.
What is the most appropriate management?
Sarah is a 3-month-old baby who was brought in by her father. He is extremely worried as his baby is generally unwell. Sarah has not been feeding well over the past 24 hours and has been very irritable. Her father had noted a fever of 38.5ºC this morning and this prompted him to seek medical attention. Her nappies continued to appear wet over this time and her father noted she had vomited once at home. No other symptoms were noted without cough.
On examination, Sarah’s general tone is maintained and she does not appear to display any signs of hypotonia. She is moving all 4 limbs equally. The chest remains clear. An area of non-blanching petechiae was noted.
A lumbar puncture was performed with the following results:
Parameter Value Normal range
White cell count 200 cells <3
Neutrophils 180 cells 0
Lymphocytes 20 cells <22
Protein 1.8g/L <1g/L
CSF: serum glucose ratio 0.3 >=0.6
What is the appropriate treatment for Sarah’s likely diagnosis?
Liam, a 3-year-old boy and his father visit a paediatric neurology clinic. Liam’s father is worried about epilepsy, but the consultant explains that Liam has been experiencing reflex anoxic seizures. What characteristics could distinguish between epilepsy and Liam’s condition?
Fragile X is commonly associated with which of the following symptoms, except for:
A 7-year-old girl presents with diffuse lower limb bone pain and tenderness. Her past medical history and family history are mostly unknown, but she is known to have been malnourished and is currently under the care of social services.
During examination, she appears malnourished and pale, with bossing of her forehead, bowing of her legs, and prominent kyphoscoliosis of her spine. She has a waddling gait when walking, and her weight is below the 2nd centile according to a growth chart.
What radiological feature may be observed given the probable diagnosis?
A 25-year-old female arrives at the emergency department complaining of fevers, myalgia, and painful eyes that have been bothering her for the past two days. She recently returned from a trip to the Democratic Republic of the Congo, where she failed to comply with her anti-malarial medication due to gastrointestinal side effects. Upon examination, she has a temperature of 38.8ºC, and she displays clustered white lesions on her buccal mucosa and conjunctivitis. What is the probable diagnosis?
A 4-year-old boy visits his pediatrician complaining of a new rash that has spread all over his body. Upon further inquiry, it is discovered that he had been experiencing a high fever, fatigue, conjunctivitis, and a mild cough for the past four days. During the last week, he had been experiencing these symptoms. Upon examination, the pediatrician notices small white spots on the inside of the boy’s cheeks. What is the probable diagnosis?
A 3-year-old girl is brought to the Emergency Department by her father following a 2-day history of a non-productive cough. Her father denies any recent viral illness.
On examination, the patient has no accessory muscle usage and is afebrile. On auscultation, she is noted to have a left-sided wheeze without crepitations. The patient has been developing normally and has never had any respiratory problems before. She has no significant past medical or family history. Her immunisation records are up to date.
What is the most likely cause of her symptoms?