pediatrics

A 2-year-old child is brought to the GP by their parents who are concerned about the appearance of their child's abdomen. The child is asymptomatic, feeding well, and has no history of vomiting or pain. On examination, vital signs are normal. Considering the clinical presentation and the finding shown in the image, what is the most appropriate initial management?

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 7-year-old boy with a history of asthma presents to the clinic with increased wheezing and shortness of breath over the past week. He has been using his salbutamol inhaler more frequently, but his symptoms persist. His mother reports that he has been waking up at night due to coughing. What is the most appropriate next step in managing this child's asthma?

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 intermittent abdominal pain, vomiting, and bloody stools. An ultrasound is performed, the image is shown. What is the MOST appropriate next step in the management of this patient?

A 3-year-old child is brought to the GP by their parents who are worried about the appearance of their child's abdomen, as shown in the image. The child is otherwise well, active, and has no pain, vomiting, or changes in bowel habits. On examination, the finding is soft and easily reducible. Vital signs are normal. Based on this presentation and the image, what is the most appropriate initial management?

A 10-year-old boy presents to his GP with a chronic, intensely itchy rash affecting the flexural areas of his elbows and knees, as well as his neck. His parents report that he has had this condition on and off since infancy, with periods of remission and exacerbation. He also has a history of allergic rhinitis and asthma. On examination, the skin in the affected areas is dry, lichenified, and excoriated. There are also scattered papules and plaques. The patient reports significant sleep disturbance due to the itch. Topical corticosteroids have provided temporary relief in the past, but the rash flares up again soon after stopping treatment. Which of the following is the MOST appropriate next step in managing this patient's atopic dermatitis?

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 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 6-week-old male presents with projectile vomiting after feeds. He is otherwise well-appearing, with normal vital signs and no abdominal distension. An ultrasound was performed, and an image is shown. What is the MOST appropriate next step in management?

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 6-week-old presents with projectile vomiting after feeds. An ultrasound is performed (shown). What is the MOST appropriate next step in management?

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-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 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 4-month-old presents for a well-child visit. The infant is thriving, feeding well, and has no vomiting or respiratory distress. Examination reveals the finding shown. The mass is soft and easily reducible. What is the most appropriate management?

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

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

A 4-year-old child is brought to the emergency department with a 3-week history of increasing abdominal distension, intermittent pain, and decreased activity. Parents also report occasional flushing episodes and unexplained fevers. On examination, a large, firm, irregular mass is palpable in the upper abdomen, extending across the midline. Vital signs are stable, and routine blood tests, including full blood count, electrolytes, and liver function tests, are within normal limits. An abdominal CT scan is performed (image provided). Based on the findings demonstrated in the image and the clinical presentation, which of the following investigations is most critical for accurate staging and risk stratification in this likely diagnosis?

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 neonate, born at 38 weeks gestation, presents with bilious vomiting starting 12 hours after birth. Antenatal ultrasound revealed polyhydramnios. On examination, the baby is active and has a distended upper abdomen but a scaphoid lower abdomen. An abdominal X-ray shows a 'double bubble' sign. Which of the following is the most appropriate next step in the management of this neonate, considering potential associated complications?

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 3-year-old boy presents with a 12-hour history of intermittent, severe abdominal pain, drawing his legs up to his chest. He has vomited several times. His vital signs are stable: HR 110, BP 95/60, RR 24, Temp 37.2°C. On examination, he is irritable but comfortable between episodes of pain. His abdomen is soft but mildly distended. A focused abdominal ultrasound is performed, yielding the image provided. Based on the clinical presentation and the findings shown, which of the following non-surgical interventions is typically attempted first to resolve the underlying issue?

A 4-year-old presents with abdominal distension, pain, and weight loss over several weeks. On examination, a firm, irregular abdominal mass is palpable. Blood tests show mild anaemia. The provided image is an axial CT slice of the abdomen. Considering the clinical presentation and the findings demonstrated in the image, which of the following investigations is the MOST appropriate initial step to establish a definitive diagnosis?

A 5-week-old male infant presents to the emergency department with a 3-day history of non-bilious, projectile vomiting after each feed. He is otherwise well-appearing and afebrile. His mother reports that he is feeding well but seems increasingly hungry after vomiting. On examination, the infant is alert and active, with slightly dry mucous membranes. Abdominal examination is unremarkable, with no palpable masses. An ultrasound of the abdomen is performed, the image of which is shown. What is the most appropriate next step in the management of this patient?

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?

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 5-year-old child with a known history of asthma presents with acute shortness of breath and wheezing after playing outside. What is the most appropriate initial treatment?

A 2-year-old boy presents with abdominal pain and vomiting. An ultrasound is performed, as shown. What is the MOST likely lead point for this condition?

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 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 3-year-old presents with abdominal distension and vague pain. Vitals are stable. An abdominal CT is performed (image attached). Elevated levels of HVA and VMA are noted in the urine. What is the MOST likely origin of the primary lesion?

A 6-week-old male infant presents with a 1-week history of progressively worsening non-bilious vomiting, often projectile, occurring shortly after feeds. His parents report he is constantly hungry and irritable but has had poor weight gain. On examination, he is alert but appears thin. Vital signs are stable. Abdominal examination is soft, non-tender, with no palpable mass. An abdominal ultrasound is performed, the image of which is shown. Considering the clinical presentation and the findings depicted, what is the most appropriate initial management strategy?

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 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 6-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 atopic dermatitis and allergic rhinitis. His parents mention that he was playing outside when the symptoms began. On examination, he is in mild respiratory distress with a respiratory rate of 28 breaths per minute, oxygen saturation of 94% on room air, and bilateral wheezing on auscultation. There is no fever, and his heart rate is 110 bpm. Which of the following is the most likely diagnosis?

A 2-year-old child is evaluated for a 6-week history of increasing abdominal girth, decreased appetite, and occasional bone pain. Physical examination reveals a large, firm, irregular mass in the upper abdomen that appears fixed and crosses the midline. Vital signs are within normal limits for age. Initial investigations show mild anaemia and elevated serum lactate dehydrogenase. An abdominal CT scan is performed (image provided). Given the findings demonstrated in the image and the clinical context, which of the following molecular or genetic analyses is considered a critical determinant of risk stratification and influences treatment intensity for the most likely underlying malignancy?

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 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 14-year-old girl who has been 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 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 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 5-year-old boy is brought to the clinic by his parents due to a 3-day history of fever, irritability, and refusal to eat. On examination, he has a temperature of 39°C, erythematous oropharynx, and tender cervical lymphadenopathy. There are also vesicular lesions on his hands and feet. What is the most likely diagnosis?

A 3-year-old boy presents with sudden onset, intermittent, severe abdominal pain, vomiting, and lethargy. Examination reveals a pale child with a soft abdomen. Vitals are stable. An abdominal ultrasound is performed (image provided). What is the most appropriate next step in management?