A 4-year-old child is brought into the emergency department by ambulance after falling from a swing in the backyard. He landed on his head and his father saw that he hit his head. The child was initially crying but fell unconscious within a few minutes of the fall. On assessing the child’s Glasgow Coma Scale (GCS) score, it is noted that he only opens his eyes to pain, has abnormal flexion to pain and is moaning.
What is the Glasgow Coma Scale (GCS) score for this patient?
A 6-year-old girl is brought to the emergency department by her parents after she was woken up from sleep at night with unilateral jerking movements of the left face and upper limb lasting for 2 minutes. During the episode, she did not lose consciousness. This has only happened once before a few nights ago.
A neurological examination is unremarkable, and her temperature is 37.5ºC and her heart rate is 90 bpm. She is slightly drowsy. Another episode occurs and an EEG is performed, which shows centrotemporal spikes.
She has no past medical history.
What is the most likely diagnosis?
A concerned father brings his 6-year-old daughter to see the GP, worried about her walking and balance. The child learned to walk around 2 years old, much the same as her older brother. However, over the last few months, her dad has noticed that she has become reluctant to walk and often trips or falls when she does.
On examination, the child is of average build but has disproportionately large calves. When asked to walk across the room she does so on her tiptoes. Gowers test is positive.
What investigation is considered most appropriate to confirm the likely diagnosis?
As the F2 in the paediatric clinic, a mother comes in with concerns about her 7-month-old daughter. She shows you a video on her phone of the baby crying, stopping abruptly, drawing her chin into her chest, throwing her arms out, relaxing, and then starting to cry again. This cycle is repeated around 10 times over the course of the minute-long video. The mother also mentions that the child has been referred to the community paediatric clinic due to a slight delay in reaching developmental milestones. What is the most appropriate test for you to order to help confirm your diagnosis?
An emergency call is made for a 10-year-old boy who has collapsed in the waiting room. The receptionists have already called 999. After 10 seconds, there are no signs of respiration and the boy does not respond to stimulation. There is no apparent foreign object in his mouth. What should be the next appropriate action?
A father brings his 20-month-old son to your GP clinic. The child has been experiencing coryzal symptoms for the past 2 days. Yesterday night, he developed a barking cough and a mild fever of 37.8º. Upon examination, there is mild stridor when moving around, but no visible recessions. The chest sounds clear with good air entry on both sides. The temperature remains at 37.8º today, but all other observations are normal. What is the best course of action for management?
A 6-year-old girl is presented to the GP clinic with a flare-up of asthma. Upon examination, she displays bilateral expiratory wheezing but no signs of respiratory distress. Her respiratory rate is 24 breaths per minute and PEF is approximately 60% of normal. What is the recommended course of action for steroid treatment?
The mother of a 7-week-old baby boy born at 33 weeks gestation is seeking guidance on immunisation. What is the recommended course of action for his first round of vaccinations?
The parents of a 7-year-old boy seek your consultation regarding their son’s lifelong bed wetting problem. They are worried that the issue is not improving despite his age. The boy has never had any daytime accidents and has regular bowel movements. He was potty-trained at the age of 3 and has no relevant family history except for hay fever. Physical examination shows no abnormalities, and urinalysis is normal. The parents are particularly concerned as their son is going on a camping trip with his friend’s parents in 2 weeks, and they do not want him to wet the bed. What is the most appropriate management plan?
The neonatal doctor has been requested to assess a woman on the postnatal ward who has a 24-hour old baby. The baby was born at 34 weeks without complications. The midwife informs that the mother is exclusively breastfeeding but also trying to hand express, and the most recent capillary blood glucose is 0.8 mmol/L. The baby is showing no symptoms.
What is the appropriate course of action?