A 4-year-old girl comes to the doctor’s office with a diffuse, blanching, erythematosus rash all over her trunk, arms, and legs. She has been running a fever and feeling generally cranky and tired for about a week. Additionally, she has been experiencing abdominal discomfort for the past few days. During the examination, the doctor notices that the skin on her palms and soles is peeling, and her tongue is red with a white coating. What is the probable diagnosis?
An 8-year-old boy comes to the paediatric department with a 5-day history of epistaxis and mucosal bleeding during tooth brushing. He has no significant medical history except for a cold he had 3 weeks ago. Upon examination, his vital signs are normal, but he has multiple bruises and petechiae on his upper and lower limbs. The following laboratory tests were ordered: Hb 140 g/L (135-180), Platelets 33 * 109/L (150 – 400), WBC 7.3 * 109/L (4.0 – 11.0), Na+ 138 mmol/L (135 – 145), K+ 4.1 mmol/L (3.5 – 5.0), Urea 5.1 mmol/L (2.0 – 7.0), Creatinine 110 µmol/L (55 – 120). What is the most probable diagnosis?
A 7-year-old boy is brought into the Emergency Department by his worried parents, who have noticed he is covered in a rash and has developed numerous bruises on his legs. This has come on suddenly and he has been well, apart from a ‘cold’ that he got over around 2 weeks previously. He has no past medical history of note, apart from undergoing an uncomplicated tonsillectomy aged 5 years following recurrent tonsillitis. There is no family history of any bleeding disorders. There is no history of fever within the last 24 hours.
On examination, vital signs are normal. There is a purpuric rash to all four limbs and his trunk. A few red spots are noted on the oral mucosa. Physical examination is otherwise unremarkable, without lymphadenopathy and no hepatosplenomegaly. Fundi are normal.
A full blood count and urine dipstick are performed and yield the following results:
Investigation Result Normal value
Haemoglobin 132 g/l 115–140 g/l
White cell count 4.8 × 109/l 4–11 × 109/l
Platelets 25 × 109/l 150–400 × 109/l
Blood film thrombocytopenia
Urine dipstick no abnormality detected
What is the most likely diagnosis?
A 7-year-old girl is brought to the pediatrician by her father. She has been experiencing coryza and a fever of 38C for the past 3 days. This morning her father noticed a red rash on both cheeks and pallor surrounding her mouth. What is the most probable organism responsible for these symptoms?
You are requested to assess a 35-year-old man who has presented to the emergency department complaining of shortness of breath, fever, and unusual breathing sounds for the past twelve hours. He reports having a sore throat for the past few days, which has rapidly worsened. He has no significant medical history.
Upon examination, his vital signs are as follows: respiratory rate 30/min, pulse 120 bpm, oxygen saturation 96%, temperature 39.0ºC, blood pressure 110/60 mmHg. From the end of the bed, you can observe that he is visibly struggling to breathe, has a hoarse voice, and is drooling into a container. You can hear a high-pitched wheeze during inspiration.
What would be the most appropriate course of action at this point?
A 24-hour-old newborn, born at 35 weeks to a healthy mother, is currently being examined on the ward. The baby appears to be in good health on initial inspection and the mother has not reported any concerns thus far. During the examination, the doctor observes a large volume, collapsing pulse, a heaving apex beat, and a left subclavicular thrill. On auscultation of heart sounds, the doctor detects a continuous ‘machinery-like’ murmur. An urgent echocardiogram is ordered by the doctor, which confirms their suspected diagnosis. No other abnormalities or defects are detected on the echo.
What would be the most appropriate initial management, given the findings and likely diagnosis?
A concerned mother brings her 4-year-old child to the Emergency Department with a ‘barking cough’. The child has been experiencing ‘noisy breathing’ and a fever for the past 48 hours. The child is eating and drinking, but not as much as usual. The child is urinating regularly and has no significant medical history. Upon examination, the child is alert, well, and smiling. The child is clearly suffering from a cold. There is no stridor, and vital signs are normal. The chest is clear, without signs of recession. The diagnosis is croup.
What is the most appropriate course of action?
A diabetic mother gives birth at term to a healthy infant, without complications during pregnancy, nor the birth. A blood test at approximately 3 hours after birth yields the following result:
Blood glucose 2.2 mmol/L
On examination, the infant appears well, with expected behaviour and no abnormal findings. The mother reported no problems with the first breastfeed.
What would be the most appropriate management plan based on these findings?
After an emergency Caesarian-section for foetal distress, the consultant obstetrician hands the paediatrician a normal term female infant. You observe that the infant is apnoeic, floppy and blue in colour.
What would be your initial step?
As a junior doctor in the emergency department, you are asked by a senior doctor to examine a child with a persistent cough. However, they caution you against examining the child’s throat as it may lead to airway obstruction. What could be the possible diagnosis for this case?