pediatrics

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 4-year-old boy presents with a 3-week history of decreased appetite, lethargy, and intermittent abdominal pain. His parents note his abdomen seems larger. Vitals are stable. On examination, a firm, irregular mass is palpable in the upper abdomen. Blood work shows 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 support the suspected diagnosis?

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 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?

For which condition is predictive genetic testing in an asymptomatic minor generally *not* recommended?

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 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 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-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 6-year-old child presents with intensely itchy, small, fluid-filled blisters on their hands and feet. The blisters are most prominent on the palms and soles. The child has a history of atopic dermatitis. What is the most likely diagnosis?

A 3-year-old child presents with a 2-month history of increasing abdominal distension and intermittent pain. On examination, a firm, non-tender mass is palpable in the upper abdomen. Initial blood tests reveal mild anaemia. Vital signs are stable. The provided image was obtained as part of the diagnostic evaluation. Based on the findings in the image and the clinical context, which of the following imaging modalities is most likely to provide critical information regarding potential metastatic disease, which is essential for accurate staging and treatment planning in this paediatric patient?

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 6-week-old male infant presents with increasing frequency of non-bilious vomiting after feeds for the past week. He is otherwise well, afebrile, and has wet nappies. On examination, he is alert and interactive. Abdominal examination is unremarkable. Vitals are stable. You order an ultrasound, which is shown. Based on the clinical presentation and the provided image, what is the most appropriate immediate 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-week-old male presents with projectile vomiting. Upper GI series (image shown). What electrolyte abnormality is MOST likely?

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 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 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 6-week-old male infant presents with a 2-week history of progressively worsening projectile non-bilious vomiting after feeds. He has lost weight and appears lethargic. Initial bloods show a hypochloremic, hypokalaemic metabolic alkalosis. After fluid resuscitation, the image is obtained. What is the most appropriate definitive management for this patient?

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 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 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 3-year-old boy presents to the emergency department with a one-week history of abdominal pain, decreased appetite, and irritability. His parents also report that he has been increasingly tired and pale. On examination, the child is noted to have a palpable abdominal mass. A CT scan of the abdomen is performed, the axial view is shown. Based on the image and clinical presentation, which of the following is the MOST appropriate next step in management?

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 3-year-old boy presents with sudden onset, intermittent, severe abdominal pain, vomiting, and lethargy. Examination reveals a palpable mass. Vitals stable. Ultrasound performed. Based on the clinical presentation and the provided image, what is the most appropriate next step in management?

A newborn has abdominal swelling and scrotal swelling. On examination, the swelling is soft and reducible. What is the most likely diagnosis?

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

A 6-week-old infant presents with a 1-week history of increasing frequency of non-bilious, projectile vomiting occurring shortly after feeds. He has lost some weight since his last check-up. Examination is otherwise unremarkable. An ultrasound is performed, shown in the image. Based on the clinical presentation and the provided image, which of the following electrolyte abnormalities is the most likely consequence if this condition remains untreated?

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 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 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 9-month-old presents with a noticeable abdominal protrusion, accentuated during crying. The infant 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 6-week-old infant presents with a 1-week history of increasing non-bilious projectile vomiting after feeds. He is otherwise well, afebrile, and has wet nappies. Examination is unremarkable. An ultrasound is performed, shown in the image. Considering the clinical presentation and the findings in the provided image, what is the most appropriate definitive surgical intervention for this condition?

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 previously healthy 2-year-old boy presents to the emergency department with a 1-day history of colicky abdominal pain. His parents report that the pain occurs in episodes, during which he cries intensely and pulls his legs up to his chest. Between episodes, he appears relatively comfortable. He has had one episode of vomiting. His parents also noticed a small amount of blood in his stool this morning. On examination, the child is alert but irritable. His abdomen is soft, but a palpable mass is noted in the right upper quadrant. An ultrasound is performed, with a representative image shown. What is the MOST appropriate initial management strategy?

A 4-week-old male presents with projectile vomiting after feeding. He is irritable and appears dehydrated. An upper GI series is performed, as shown. After addressing immediate concerns, what is the MOST appropriate next step?

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 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 boy presents to the emergency department 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, what is the most appropriate next step in the management of this patient?

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 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 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?