Pediatry-New

A 2-year-old who has a history of repaired biliary atresia presents to your office with fatigue and intermittent dark stools. On physical examination, he is afebrile and pale but active. His heart rate is 110 beats/min, liver and spleen are both enlarged, and abdomen is distended, with prominent abdominal veins. The hematocrit is 22 % (0.22). Of the following, the MOST appropriate next step is to

A 12-month-old boy comes to the emergency department with a 3-day history of intractable vomiting and watery diarrhea. His mother reports decreased urine output for the past 24 hours. His heart rate is 180 beats/min, and his blood pressure is 85/40 mm Hg. He is lethargic but responds to stimulation. His mucous membranes are very dry, his skin turgor is decreased, and his capillary refill is 3 seconds. The remainder of his physical examination findings are unremarkable. Of the following, the laboratory data that are MOST consistent with this patient's clinical presentation are

A 9-year-old girl presents to accident and emergency with fever, vomiting and dysuria. She is wearing a steroid bracelet and has a steroid card stating she is on daily prednisolone for severe asthma and eczema and is therefore at risk of adrenal suppression. She is tachycardic at 140 bpm and you are concerned that her blood pressure is low. Her capillary glucose is 3.0 mmol/L. What is the single most important investigation?

A 15-year-old boy was camping with friends 1 week ago. Over the last 4 days, he has developed fever, worsening headache, increasing sleepiness, and combativeness. You suspect arboviral meningoencephalitis. Of the following, the MOST frequently used method to confirm the diagnosis is

A 14-year-old refugee from Afghanistan who has lived in the UK for 2 years comes to see you complaining of increasing fatigue and breathlessness on exertion. On examination she appears cyanosed and has bilateral basal fine crepitations and a soft pansystolic murmur with a displaced apex beat. She has never been in hospital and has no surgical scars. You urgently refer her for a cardiology review. What is the most likely diagnosis?

A 4-year-old is brought into accident and emergency by very anxious parents. She has had a bad cough which makes her vomit and a fever for 2 days. She has now developed a rash on her face which does not pass the 'glass test', in that the spots are still visible when a glass is pressed against the skin. On examination she is alert and comfortable at rest, with fine petechiae on her cheeks and neck which are non-blanching. She has red, enlarged tonsils without pus and the chest is clear. What is the most likely cause of her rash?

A 3-year-old is brought into accident and emergency on a Monday morning because she has developed several bruises on her buttocks, left leg and right arm. She is seen with her nanny who reports finding the bruises when she was getting her dressed this morning. Recently the girl has not been herself. She has had several colds over the past 2 months and has been more lethargic lately. The nanny is worried she is losing weight. On examination she appears withdrawn, pale and has a bruise on the left buttock which is 5 cm x 8 cm. She has three other bruises on her left leg and right arm which are of varying colours. She also has some fine petechiae on her neck and cheeks. She has a runny nose and a cough but the chest is clear. What is the most likely diagnosis?

You are asked to see a 14-year-old girl who developed pubic hair at age 11 years and breast buds at age 12 years, but has not reached menarche. She is a gymnast who practices 2 hours a day. Breast tissue is Sexual Maturity Rating (SMR) 2 and pubic hair is SMR 4. She is 57 in tall and weighs 86 lb. The results of gonadotropin laboratory studies are a luteinizing hormone concentration of 18 mIU/ml, (18 IU/L) (normal adult female, 2 to 70 mIU/mI, [2 to 70 IU/L]) and a follicle-stimulating hormone concentration of 40 mIU/mL (40 IU/) (normal adult female, 1 to 30 mIU/mL [1 to 30 IU/L]). Of the following, the MOST likely cause of the primary amenorrhea in this patient is

A 12-year-old girl with a history of discitis in her lumbar spine was admitted following investigation at her tertiary centre. She was started on IV benzylpenicillin and clindamycin. She received 24 hours of medication and a rash appeared on her trunk and arms. There were discrete red lesions which outlined a central target lesion. They were non-blanching and itchy. What is the most likely diagnosis?

During a health supervision visit for a 16-year-old boy, you learn that he has experienced chest pain twice with intense exercise during practice for his high school varsity soccer team. Each time the pain felt like pressure, radiated to his left shoulder, and was associated with lightheadedness. He did not seek medical attention after either episode. His father, who is age 49 years, has hypertension and uses lipid-lowering medication. Results of the boy's physical examination are normal, including his blood pressure and cardiovascular examination. Of the following, the BEST management plan is

A 14-year-old girl was diagnosed with idiopathic thrombocytopenic purpura (ITP) last week after she attended the children's assessment unit with recurrent epistaxis. She had a platelet count of 16 x109/L last week and now re-presents to accident and emergency with further episodes of epistaxis, haematemesis and petechiae. She had a heart rate of 110 bpm and her blood pressure is 100/70 mmHg. What is the next best management step?

A mother brings her 6-month-old, formula-fed baby to see the GP complaining that the olive oil she is using is not helping his persistent cradle cap and worsening rash on his face and arms. On examination he has extensive cradle cap and eczematous changes on his cheeks, neck, chest and arms. The neck skin creases are red and oozing with yellow crusts. He is miserable and feels warm to touch. What is the most appropriate management?