pediatrics

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 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 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 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 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 3-year-old presents with a 2-month history of increasing abdominal distension and intermittent pain. Physical examination reveals a firm, non-tender mass in the upper abdomen. Blood tests show mild anaemia. Vitals are stable. This CT scan was performed as part of the initial workup. Considering the clinical presentation and the findings demonstrated in the provided image, which of the following investigations is the most critical next step for accurate staging and risk stratification to guide appropriate management in this paediatric 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 15yo boy has no puberty signs. Initial tests show low LH/FSH. What is the most likely next step in investigation?

A 4-year-old boy presents to the emergency department with a 12-hour history of intermittent abdominal pain. His mother reports that the pain seems to come in waves, during which he cries and pulls his legs towards his chest. Between episodes, he appears relatively comfortable and plays normally. He has vomited once. His bowel movements have been normal, but his mother noticed a small streak of blood in his diaper this morning. On examination, the child is alert and playful. His abdomen is soft and non-tender to palpation. Bowel sounds are present. Given the history, the physician orders an abdominal ultrasound, the image is shown. What is the MOST likely underlying cause of this patient's condition?

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 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 6-month-old infant is brought to the general practitioner by his parents, who are concerned about a persistent, itchy rash. The rash initially appeared on his cheeks and scalp a few weeks ago and has now spread to his trunk and extensor surfaces of his arms and legs. The parents report that the infant is constantly scratching, which disrupts his sleep. He has no known allergies, and there is no family history of asthma or allergic rhinitis. On examination, the infant is alert and active. There are erythematous, papular lesions with areas of weeping and crusting on his cheeks, scalp, trunk, and extensor surfaces. The skin is dry and flaky in other areas. Which of the following is the MOST appropriate initial management strategy for this infant's condition?

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 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 9-month-old presents with the abdominal finding shown. It is soft and reducible. Parents are concerned. What counseling is most appropriate?

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. Considering the clinical presentation and the findings in the image, what is the most appropriate initial management step?

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 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-week-old male presents with persistent non-bilious vomiting after feeding. He appears hungry and has lost weight since birth. Examination reveals visible peristaltic waves across the abdomen. An abdominal ultrasound is performed, as shown. What is the most likely acid-base disturbance seen in this patient?

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?

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

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 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 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 6-year-old child with a history of asthma presents with increased wheezing and difficulty breathing after exposure to cold air. What is the most appropriate immediate 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 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 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 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 6-week-old male infant presents to the emergency department with a 5-day history of progressively worsening non-bilious vomiting, which has become projectile over the past 48 hours. He is exclusively formula-fed and his parents report decreased wet nappies and increased irritability. On examination, he is alert but appears slightly lethargic. His weight is below his birth weight. Capillary refill time is 3 seconds. Vitals are: HR 150 bpm, RR 40 bpm, T 37.2°C, BP 85/50 mmHg. Abdominal examination is soft, non-distended, and no masses are definitely palpable. Initial blood gas shows pH 7.52, pCO2 40 mmHg, HCO3 32 mmol/L, Na+ 130 mmol/L, K+ 3.0 mmol/L, Cl- 85 mmol/L. Urea and creatinine are mildly elevated. An imaging study was performed, shown above. Considering the clinical presentation and the findings on the imaging study, which of the following is the most critical immediate 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 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 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-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 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 couple with a 4-year-old daughter who has cystic fibrosis (CF), and both are CFTR gene carriers, want to try for another baby. What is the likelihood of having a second baby with cystic fibrosis?

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 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 child has a sore throat and fever. Centor criteria are 3/4. What's the next step?

A 5-year-old boy presents with wheezing, shortness of breath, and a history of recurrent respiratory infections. His symptoms worsen with exercise and during the night. What is the most likely diagnosis?

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 child is brought to the general practice clinic by his parents due to recurrent episodes of wheezing and cough, particularly following viral upper respiratory tract infections. The child has had multiple similar episodes over the past year, each resolving with bronchodilator therapy. There is no history of eczema or allergic rhinitis, and the family history is unremarkable for atopic conditions. On examination, the child appears well between episodes, with normal growth parameters and no signs of respiratory distress. Auscultation of the chest reveals clear lung fields without wheezes or crackles. Which of the following is the most likely underlying condition?

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 7-year-old boy is brought to the GP by his parents due to poor performance at school. Teachers report that he is inattentive, easily distracted, and frequently interrupts others. What is the most appropriate first-line treatment?

A 6-week-old male presents with projectile vomiting after feeds. He is otherwise well-appearing, with normal vital signs. An abdominal ultrasound is performed (image attached). What is the MOST appropriate next step in management?