pediatrics

A 3-year-old child is brought to the paediatric clinic by their parents due to a 2-month history of increasing abdominal distension, poor appetite, and occasional constipation. On physical examination, a firm, irregular mass is palpable in the upper abdomen, crossing the midline. Vital signs are stable. Initial blood tests, including full blood count and liver function tests, are within normal limits. An abdominal CT scan is performed (image provided). Considering the findings demonstrated in the image, which of the following investigations represents the most appropriate next step in establishing a definitive diagnosis and guiding further management?

A previously healthy 3-year-old boy presents with colicky abdominal pain and non-bilious vomiting. Physical exam reveals a palpable abdominal mass in the RUQ. An ultrasound is performed, revealing the finding shown. What is the MOST likely lead point?

A 10-year-old boy presents to the pediatric clinic with a history of fever, a rash characterized by erythema marginatum, and migratory arthralgia. His mother reports that he had a sore throat about three weeks ago, which resolved without treatment. On examination, he has a temperature of 38.5°C, a heart rate of 110 bpm, and a faint erythematous rash on his trunk. His joints are tender but not swollen. Given the suspicion of acute rheumatic fever, which of the following is the most appropriate next step in management?

A 10-year-old boy is brought to the GP by his parents, who report difficulties with attention and hyperactivity at school and home for the past 6 months. Which of the following is the MOST appropriate initial step in managing this child?

A 10-year-old presents with a sore throat, fever, and fatigue for 2 days. Examination reveals tonsillar exudates and tender anterior cervical lymph nodes. What is the most appropriate next step in management?

A 1-year-old child is presented to the general practitioner by their parents who are concerned about the appearance of their child's umbilicus, as depicted in the accompanying image. The parents report the bulge is more prominent with crying but is easily reducible. The child is otherwise well, feeding normally, and has no history of pain, vomiting, or constipation. Physical examination reveals normal vital signs and a soft, non-tender abdomen. Considering the clinical presentation and the finding shown, what is the most appropriate advice to give the parents regarding initial management?

A 1-month-old baby has a palpable mass in the right flank and abdominal swelling. An ultrasound reveals a solid mass in the kidney. What is the most likely diagnosis?

A previously well 3-year-old boy presents to the emergency department with a 12-hour history of sudden onset, intermittent, severe, colicky abdominal pain, associated with non-bilious vomiting. Between episodes, he appears lethargic and pale. His vital signs are stable: HR 110, BP 90/60, RR 24, Temp 37.2. Abdominal examination reveals mild distension and tenderness, but no guarding or rebound. Bowel sounds are present. A point-of-care ultrasound is performed by the emergency physician. Considering the clinical presentation, the patient's current stable vital signs, and the specific findings demonstrated in the provided ultrasound image, which of the following represents the single most appropriate immediate next step in the management of this patient in an Australian tertiary paediatric centre?

A 3-week-old male infant is brought to the emergency department by his parents due to persistent, non-bilious vomiting after each feeding for the past week. The vomiting has become increasingly forceful. The infant appears mildly dehydrated, and his weight has remained stable since birth. On examination, an olive-shaped mass is palpated in the epigastric region when the infant is not actively vomiting. An upper GI series is performed, and the image is shown. What is the most appropriate next step in the management of this patient?

A 3-year-old child is presented to the general practitioner by their parents who are concerned about the appearance of their child's umbilicus, as depicted in the accompanying image. The child is reported to be entirely asymptomatic, feeding and playing normally, with no history of pain, discomfort, or vomiting. Physical examination reveals normal vital signs and a soft, non-tender abdomen with no signs of obstruction. Considering the clinical presentation and the finding shown, what is the most appropriate initial management plan for this child?

A 1-year-old presents with the abdominal exam shown. It is easily reducible. What is the most appropriate management?

A 3-year-old boy presents to the emergency department with a 12-hour history of sudden onset, severe, colicky abdominal pain, drawing his legs up, and non-bilious vomiting. His parents report he has been listless between episodes and had a small amount of red jelly-like stool earlier. Vitals: T 37.2°C, HR 110, RR 24, BP 95/60, Sats 98% on air. Abdominal examination reveals tenderness in the right upper quadrant and a palpable mass. Bowel sounds are diminished. A point-of-care ultrasound is performed. Based on the clinical presentation and the findings demonstrated in the provided ultrasound image, what is the most appropriate initial management step for this patient?

A 3-year-old boy presents with intermittent abdominal pain and vomiting. Stool examination reveals a positive occult blood test. An ultrasound is performed, as shown. What is the MOST appropriate next step in management?

A 7-year-old boy is brought to his GP by his parents, who are concerned about his behaviour at school and at home. They report that he has difficulty paying attention in class, often fidgets and squirms in his seat, and frequently interrupts others. At home, he struggles to follow instructions, loses things easily, and seems forgetful. The teacher has also noted that he has difficulty staying on task and often blurts out answers before the question is finished. The parents deny any history of significant medical illness or developmental delay. On examination, the boy appears energetic and talkative, but is cooperative with the assessment. Which of the following is the most appropriate next step in the evaluation of this child?

A 4-year-old boy presents with left flank pain and a palpable abdominal mass. His mother reports decreased appetite and recent weight loss. A CT scan of the abdomen is performed (image attached). What is the MOST likely diagnosis?

A 3-year-old child presents to the clinic with a history of recurrent wheezing episodes, especially during viral infections. What is the most common cause of wheezing in children under 5 years of age?

A 4-year-old child presents with a history of recurrent wheezing and cough, particularly at night and with exercise. What is the most appropriate long-term management strategy?

A 3-week-old male presents with projectile vomiting after feeds. An upper GI series is performed (image shown). What is the MOST appropriate next step in management?

A 2-week-old baby is brought to the clinic with abdominal distension and bilious vomiting. On examination, the abdomen is tense and tender. What is the most likely diagnosis?

A 4-year-old presents with abdominal distension and back pain for 2 months. Exam reveals a firm, fixed abdominal mass. Vitals are normal. An abdominal CT is performed (axial view shown). Which lab finding would MOST strongly support the suspected diagnosis?

A 9-year-old, diagnosed with ADHD, struggles with homework completion despite medication. His parents report significant family stress. What's the MOST appropriate next step?

A 10-year-old presents with a sore throat, fever, and tonsillar exudates. Rapid strep test is negative. What is the most appropriate next step?

A 4-year-old with abdominal pain and hypertension has this CT. What is the MOST appropriate next step in management?

A 10-year-old child with ADHD is started on stimulant medication. His parents report that he has lost weight and is not eating well. What is the most likely side effect of the medication?

A 6-month-old male infant is brought to the emergency department by his parents. They report that they have noticed a bulge on his abdomen that seems to get larger when he cries. The infant is otherwise healthy, feeding well, and has normal bowel movements. On examination, the infant is afebrile, and his vital signs are within normal limits. The abdomen is soft and non-tender. Palpation reveals a soft, reducible mass at the umbilicus, as shown in the image. What is the MOST appropriate next step in the management of this patient?

A 4-week-old male presents with projectile vomiting after feeding. He is irritable and appears mildly dehydrated. An abdominal exam reveals a palpable, olive-shaped mass in the epigastrium. An upper GI contrast study is performed, and relevant images are shown. What is the MOST appropriate initial step in managing this patient's electrolyte imbalance?

A 6-month-old infant presents for a routine check-up. The mother reports the infant is feeding well and has normal bowel movements. On examination, the infant is active and alert with normal vital signs. The abdomen is soft and non-tender. The image shows a finding on abdominal examination. What is the most appropriate next step in management?

A 3-year-old boy presents with a 12-hour history of intermittent, severe abdominal pain, non-bilious vomiting, and decreased activity. Parents report redcurrant jelly stool. On exam, a palpable mass is noted. Vitals are stable. An ultrasound is performed (shown above). Considering the clinical picture and the image findings, which non-surgical intervention is indicated?

A 14-month-old child is presented to the general practitioner by their parents, who are concerned about a noticeable protrusion around the navel. They report this bulge is more prominent when the child cries or strains but easily disappears when the child is relaxed or sleeping. There are no reports of pain, discomfort, changes in bowel habits, or feeding difficulties. The child is meeting all developmental milestones and appears well. On examination, vital signs are stable and within age-appropriate ranges. The abdomen is soft and non-tender, with no distension. The finding illustrated in the accompanying image is observed. Based on this clinical presentation and examination, what is the most appropriate initial management plan?

An 8-year-old girl presents with chronic night cough and wheezing, with possible asthma. What is the minimum age for spirometry?

A 4-year-old boy is brought to the clinic by his parents due to a persistent itchy rash on his arms and legs. The rash has been present for several weeks and seems to worsen at night. The child has a history of asthma and allergic rhinitis. On examination, there are erythematous, scaly patches with excoriations on the flexural surfaces of his arms and legs. What is the most likely diagnosis?

A 6-month-old infant presents for a routine check-up. The mother reports the infant is feeding well and has normal bowel movements. On examination, the infant is active and alert with normal vital signs. The abdomen is soft and non-tender. The image shows a finding on the abdominal exam. What is the most appropriate next step in management?

A 1-year-old child presents to the GP with parental concern about a bulge on the abdomen, as shown in the image. The child is asymptomatic, feeding well, and has normal bowel movements. Examination reveals a soft, reducible finding at the umbilicus; the abdomen is non-tender with normal bowel sounds. Based on this presentation and the image, what is the most appropriate initial management?

A 14-year-old girl living alone presents with a positive urine pregnancy test. She states she was raped 6 months ago and wishes to terminate the pregnancy. What is the next appropriate step?

A 10-year-old boy with a history of asthma presents to the emergency department with wheezing and shortness of breath. His mother reports that he has been using his salbutamol inhaler more frequently over the past two days. On examination, he has a respiratory rate of 28 breaths per minute, and his oxygen saturation is 92% on room air. What is the most appropriate initial management step?

A 5-week-old male presents with non-bilious projectile vomiting. An ultrasound is performed (shown). What acid-base disturbance is MOST likely?

A 3-year-old boy presents with sudden onset intermittent severe abdominal pain, vomiting, and lethargy. On examination, he is pale but haemodynamically stable. Abdominal examination reveals a palpable mass in the right upper quadrant. An ultrasound is performed (image provided). What is the most appropriate next step in management?

A 3-year-old presents with abdominal distension and bone pain. The provided image was obtained. What is the MOST likely source of the elevated urine HVA and VMA?

A 5-week-old male presents with projectile vomiting after feeds. He is irritable and appears dehydrated. An upper GI contrast study is performed, with relevant images attached. What is the MOST likely underlying cause?

A 5-week-old male infant presents with a 10-day history of non-bilious, forceful vomiting after every feed. His parents report decreased wet nappies and lethargy. On examination, he is pale, weighs 3.2 kg (birth weight 3.5 kg), has sunken eyes, and poor skin turgor. Vital signs: HR 170, RR 45, Temp 37.0, BP 80/50. Initial bloods show Na 132, K 3.1, Cl 88, HCO3 30. An imaging study is performed, shown in the image. Considering the clinical presentation and the findings demonstrated in the imaging study, what is the most appropriate immediate management priority for this infant?

A 6-month-old presents for a well-child check. The image shows the abdominal exam. Parents report it enlarges when crying. What is the most appropriate next step?

A 6-month-old infant presents for a routine check-up. The mother reports the infant is feeding well and has normal bowel movements. On examination, you observe the finding in the image. The mass is soft and easily reducible. What is the MOST appropriate next step in management?

A 4-week-old male presents with persistent projectile vomiting after feeding. He is otherwise well-appearing. An upper GI series is performed, with relevant images attached. What acid-base disturbance is MOST likely present?

A 6-year-old child presents with intensely itchy, small, fluid-filled blisters on their hands and feet, especially between the fingers and toes. The lesions are linear and excoriated. Multiple family members have similar symptoms. What is the most likely diagnosis?

A 4-year-old boy is brought to the pediatrician by his parents due to a persistent cough and wheezing for the past two weeks. The symptoms started after he had a cold. He has no significant past medical history and is up to date with his vaccinations. On examination, he is afebrile, with mild respiratory distress and bilateral wheezing on auscultation. What is the most appropriate initial treatment?

A 5-year-old girl presents with an itchy bottom at night, worse at night, suggestive of threadworm infection. What is the best treatment for her infection in the Australian context?

A 14-month-old child is brought to the general practitioner for a routine check-up and immunisations. The parents express mild concern about a bulge they have noticed around the child's navel, which seems more prominent when the child is crying or straining. They report it is easily pushed back in and does not appear to cause the child any pain or discomfort. The child is otherwise thriving, with normal feeding, bowel movements, and developmental progress. On physical examination, the child is alert and interactive. Vital signs are within normal limits for age. Abdominal examination reveals no distension or tenderness. The finding shown in the image is noted. Based on this clinical presentation and examination finding, what is the most appropriate initial management plan?

A 3-year-old presents with abdominal distension, irritability, and periorbital ecchymosis. Examination reveals a firm, irregular abdominal mass. The provided image is an axial CT slice. Considering the clinical presentation and the findings demonstrated in the image, which of the following biochemical markers is MOST likely to be significantly elevated?

A 10-year-old boy struggles with inattention at school, often daydreaming and losing focus. His grades are declining, and he forgets homework. Parents report similar issues at home. What's the most appropriate initial step?

A 3-year-old boy presents with intermittent abdominal pain, vomiting, and currant jelly stools. An ultrasound is performed, revealing the image shown. What is the MOST appropriate next step in management?