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 3-year-old boy presents with sudden onset intermittent severe abdominal pain, vomiting, and lethargy. On examination, he is pale and has a palpable mass in the right upper quadrant. An ultrasound is performed (image provided). Based on this finding, what is the most appropriate next step in 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 28-year-old woman, 18 weeks pregnant, presents to her GP two days after her 5-year-old son developed varicella. She is unsure of her immunity status and is asymptomatic. Which of the following is the most appropriate initial management step?

A 3-year-old boy presents to the emergency department with a 24-hour history of intermittent, severe abdominal pain. His mother reports episodes where he cries inconsolably, draws his knees to his chest, and then seems to recover briefly before the pain returns. He has also passed a stool mixed with mucus and blood, described as 'red currant jelly'. On examination, the child is afebrile, but appears pale and lethargic. Abdominal palpation reveals a sausage-shaped mass in the right upper quadrant. An ultrasound is performed, and a representative image is shown. Assuming the diagnosis is confirmed, what is the MOST appropriate next step in management?

A 7-year-old boy is brought to the emergency department by his parents due to sudden onset wheezing and difficulty breathing. He has a history of asthma, for which he uses a salbutamol inhaler as needed. His parents report that he had a cold over the past few days, and today he started wheezing and became short of breath. On examination, he is in moderate respiratory distress, with a respiratory rate of 30 breaths per minute, oxygen saturation of 92% on room air, and widespread wheezing on auscultation. What is the most appropriate initial management step for this child?

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 3-year-old boy presents with sudden onset, intermittent, severe abdominal pain, vomiting, and lethargy. On examination, he is pale and has a palpable mass in the right upper quadrant. Vitals are stable. An ultrasound is performed, shown above. Based on the clinical presentation and the provided image, what is the most appropriate next step in the management of this patient?

A 3-year-old boy is brought to the emergency department by his parents due to a high fever and irritability. He has had a runny nose and cough for the past two days. On examination, he is lethargic and has a bulging fontanelle. A lumbar puncture is performed, and the cerebrospinal fluid (CSF) analysis shows elevated protein, low glucose, and a high white cell count with a predominance of neutrophils. What is the most likely diagnosis?

A 6-week-old male infant presents to the emergency department with a 2-week history of progressively worsening non-bilious vomiting, which has become projectile over the past few days. His parents report he is feeding eagerly but vomits most feeds shortly after completion. He has had fewer wet nappies than usual and appears more lethargic. On examination, he is irritable but consolable. His weight is below the 3rd percentile, having dropped from the 10th percentile at birth. Vital signs are: Temperature 36.8°C, Heart Rate 155 bpm, Respiratory Rate 40 bpm, Blood Pressure 85/50 mmHg, Oxygen Saturation 98% on room air. Capillary refill time is 3 seconds. Abdominal examination reveals a soft, non-distended abdomen with active bowel sounds; no palpable masses are appreciated. Initial blood gas shows pH 7.52, pCO2 40 mmHg, Bicarbonate 32 mmol/L, Na+ 132 mmol/L, K+ 3.0 mmol/L, Cl- 88 mmol/L. A point-of-care ultrasound was performed, and the image provided was obtained. Considering the clinical presentation, the laboratory results, and the findings demonstrated in the image, which of the following represents the most appropriate immediate therapeutic intervention?

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

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 5-week-old male presents with projectile vomiting. Ultrasound (shown). What electrolyte abnormality is MOST likely?

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 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 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-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, with slightly decreased skin turgor. His weight is below the 5th percentile for his age. An abdominal X-ray is unremarkable. Given the clinical presentation, the physician orders further imaging, the results of which are shown. What is the MOST appropriate next step in the management of this patient?

A 2-year-old with a palpable abdominal mass and periorbital ecchymoses has the shown CT. What is the MOST likely diagnosis?

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 3-week-old male presents with projectile vomiting. Upper GI series (image shown). What electrolyte abnormality is MOST likely?

A 4-week-old male presents with persistent non-bilious vomiting after feeding. He is mildly dehydrated, but otherwise active. An ultrasound is performed, as shown. What is the MOST likely acid-base disturbance?

A 6-month-old baby has abdominal swelling and vomiting. An abdominal X-ray shows a 'double bubble' sign. What is the most likely diagnosis?

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 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-week-old male infant presents with persistent, non-bilious projectile vomiting after each feed. He appears hungry and eagerly accepts the bottle, but vomits shortly after. On examination, mild dehydration is noted. An abdominal X-ray is ordered, the relevant image is attached. 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 3-year-old child presents to the emergency department with a sudden onset of cough, wheezing, and difficulty breathing after playing with small toys. The child is in mild respiratory distress, with a respiratory rate of 40 breaths per minute and oxygen saturation of 92% on room air. On auscultation, there are decreased breath sounds on the right side with wheezing. The child has no fever, and there is no history of recent illness. What is the most likely cause of these symptoms?

A 2-year-old child is brought to the emergency department by their parents due to a persistent cough, wheezing, and difficulty breathing that has worsened over the past two days. The child has a known history of eczema and multiple food allergies, including peanuts and eggs. On examination, the child appears in mild respiratory distress with nasal flaring and intercostal retractions. Auscultation of the chest reveals bilateral wheezing. The child is afebrile, with a respiratory rate of 40 breaths per minute, heart rate of 120 bpm, and oxygen saturation of 94% on room air. A chest X-ray shows hyperinflation but no focal consolidation. Which of the following is the most likely diagnosis?

A 3-year-old presents with abdominal distension and bone pain. An abdominal CT is performed (image attached). Which of the following is the MOST appropriate initial investigation to confirm the suspected diagnosis?

A neonate is born at term following an uneventful pregnancy. Immediately after birth, the baby develops bilious vomiting. Abdominal examination reveals epigastric distension, but the rest of the abdomen is scaphoid. An abdominal X-ray is performed. Which of the following findings on the abdominal X-ray would be most consistent with the likely diagnosis?

A 3-year-old boy is brought to the emergency department with a high fever, irritability, and a rash. The rash started on his face and has now spread to his trunk and limbs. On examination, he has conjunctivitis and Koplik spots are noted on the buccal mucosa. What is the most likely diagnosis?

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 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 illustrated in the image is noted. Based on this clinical presentation and examination finding, what is the most appropriate initial management plan?

A 10-year-old girl with a 3-day history of shortness of breath, fever, and headache has been diagnosed with pneumonia. What signs might be seen in severe pneumonia?

A 6-week-old male infant presents to the emergency department with a 2-week history of progressively worsening non-bilious vomiting, which has become projectile over the past few days. His parents report he is feeding eagerly but vomits most feeds shortly after completion. He has had fewer wet nappies than usual and appears more lethargic. On examination, he is irritable but consolable. His weight is below the 3rd percentile, having dropped from the 10th percentile at birth. Vital signs are: Temperature 36.8°C, Heart Rate 155 bpm, Respiratory Rate 40 bpm, Blood Pressure 85/50 mmHg, Oxygen Saturation 98% on room air. Capillary refill time is 3 seconds. Abdominal examination reveals a soft, non-distended abdomen with active bowel sounds; no palpable masses are appreciated. Initial blood gas shows pH 7.52, pCO2 40 mmHg, Bicarbonate 32 mmol/L, Na+ 132 mmol/L, K+ 3.0 mmol/L, Cl- 88 mmol/L. A point-of-care ultrasound was performed, and the image provided was obtained. Considering the clinical presentation, the laboratory findings, and the abnormality demonstrated in the provided image, which of the following best explains the mechanism leading to the observed electrolyte and acid-base derangements?

A 5-week-old male presents with non-bilious projectile vomiting after each feed for the past week. He is alert but appears dehydrated. An ultrasound is performed, as shown. What electrolyte abnormality is MOST likely present?

A 16-year-old boy is diagnosed with Type 1 diabetes mellitus after presenting with polyuria, polydipsia, and weight loss. His blood tests show elevated blood glucose levels and the presence of autoantibodies against pancreatic beta cells. In contrast, a 55-year-old woman is diagnosed with Type 2 diabetes mellitus, characterized by insulin resistance and obesity. Which of the following best describes the pathophysiological differences between Type 1 and Type 2 diabetes?

A 10-year-old boy with a known history of asthma presents to the emergency department. He developed symptoms three days after a viral upper respiratory tract infection. On examination, he is tachypnoeic (respiratory rate 48 breaths/min), tachycardic (heart rate 130 bpm), and hypoxic with an oxygen saturation of 91% on room air. He is speaking only in short phrases but remains alert and is afebrile. Auscultation reveals a widespread wheeze throughout his chest. A COVID swab performed yesterday was negative. Which investigation is the most appropriate next step in the immediate management of this patient?

A 9-month-old presents with a noticeable abdominal protrusion, more prominent when crying. The child is feeding well and has regular bowel movements. Examination reveals a soft, easily reducible bulge at the umbilicus, as shown. Parents are concerned about potential complications. What is the MOST appropriate parental advice?

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-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-week-old male presents with persistent projectile vomiting after each feed. He appears hungry and eagerly feeds, but vomits shortly after. An abdominal X-ray is ordered, the result of which is shown. What is the most appropriate next step in management?

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 3-year-old boy presents with intermittent severe abdominal pain, vomiting, and lethargy. On examination, he is afebrile with a soft but slightly distended abdomen. An ultrasound is performed (image provided). Based on the clinical presentation and the image findings, what is the most appropriate next step in the management of this patient?

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 1-year-old child is brought to the emergency department with a 3-day history of cough, wheezing, and difficulty breathing. The child has a fever of 38.5°C and a runny nose. On examination, the child appears in mild respiratory distress with nasal flaring and intercostal retractions. Auscultation reveals diffuse wheezing and crackles throughout the lung fields. The child has no significant past medical history and is up to date with vaccinations. A chest X-ray shows hyperinflation but no focal consolidation. Which of the following is the most likely diagnosis?

A 3-year-old boy presents with sudden onset intermittent severe abdominal pain, vomiting, and lethargy. On examination, he is pale and has a palpable mass in the right upper quadrant. An ultrasound is performed (image provided). Based on this finding, what is the most appropriate next step in management?