pediatrics

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 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 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 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 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 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 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 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-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 4-week-old male presents with non-bilious emesis. An upper GI series is performed (image shown). What acid-base abnormality is MOST likely?

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 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 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 the infant's abdomen. What is the most appropriate next step in management?

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-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 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 the clinical presentation and the image, what is the most appropriate next step in management?

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 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 3-year-old boy presents with intermittent abdominal pain and bloody stools. An ultrasound is performed. What is the MOST appropriate next step in management?

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 presents with a sore throat, fever, and tonsillar exudates. Rapid strep test is negative. What is the MOST appropriate next step?

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 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 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-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-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 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 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 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 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 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 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-month-old baby presents with abdominal swelling and constipation. A rectal biopsy shows the absence of ganglion cells. What is the most likely diagnosis?

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?

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?

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?