who harms themselves Sarah, a 15 year old girl, is brought to the emergency department after telling a teacher that she had taken paracetamol 3 hours earlier after an argument with her boyfriend. She ...
who harms themselves Sarah, a 15 year old girl, is brought to the emergency department after telling a teacher that she had taken paracetamol 3 hours earlier after an argument with her boyfriend. She ...
with a cough and TB contact A15 month old boy has a 3 week history of cough. He was born in Slovakia and received a Bacille Calmette-Guérin (BCG) vaccination at birth. His maternal grandfather, who li...
with a cough and TB contact A15 month old boy has a 3 week history of cough. He was born in Slovakia and received a Bacille Calmette-Guérin (BCG) vaccination at birth. His maternal grandfather, who li...
with a cough and TB contact A15 month old boy has a 3 week history of cough. He was born in Slovakia and received a Bacille Calmette-Guérin (BCG) vaccination at birth. His maternal grandfather, who li...
with status epilepticus A previously fit and healthy 9 year old Caucasian girl presents to the emergency department in status epilepticus. She is reported to have had paranoid behaviour, a low-grade t...
Amy is an 11 year old girl who is known to have drug resistant epilepsy. She attends the epilepsy clinic with her mother, who is worried about the recent worsening of her tonic seizures. She had her f...
Amy is an 11 year old girl who is known to have drug resistant epilepsy. She attends the epilepsy clinic with her mother, who is worried about the recent worsening of her tonic seizures. She had her f...
and an abnormal blood result A lyear old Caucasian boy presents to the emergency department with fever, vomiting and a skin rash of 2 days’ duration. Examination suggests a viral illness. However, in ...
and an abnormal blood result A lyear old Caucasian boy presents to the emergency department with fever, vomiting and a skin rash of 2 days’ duration. Examination suggests a viral illness. However, in ...
who requires palliative care analgesia A 4 year old boy with a stage IV neuroblastoma has relapsed for the second time after receiving treatment with systemic chemotherapy, surgical resection of the a...
who requires palliative care analgesia A 4 year old boy with a stage IV neuroblastoma has relapsed for the second time after receiving treatment with systemic chemotherapy, surgical resection of the a...
with concerns about her weight Sophie is a 15 year old girl who is reviewed in an outpatient clinic as her parents have become concerned about her weight. She has always been active, competing in swim...
with concerns about her weight Sophie is a 15 year old girl who is reviewed in an outpatient clinic as her parents have become concerned about her weight. She has always been active, competing in swim...
A7 year old boy presents with difficulties at school. He has a very short concentration span and is falling behind in his schoolwork. He is excitable, sometimes disruptive in class, and frequently dis...
A7 year old boy presents with difficulties at school. He has a very short concentration span and is falling behind in his schoolwork. He is excitable, sometimes disruptive in class, and frequently dis...
A 14 year old girl is referred due to emotional lability and deteriorating school performance. Her parents say that, over the past few weeks, she has “lost interest” in her normal daily activities. Sh...
A 14 year old girl is referred due to emotional lability and deteriorating school performance. Her parents say that, over the past few weeks, she has “lost interest” in her normal daily activities. Sh...
A baby boy, born at term, presents at the age of 6 hours with tachypnoea, persistent cyanosis, lethargy and poor feeding. On examination, his respiratory rate is 60/minute, the chest is clear, and the...
A baby boy, born at term, presents at the age of 6 hours with tachypnoea, persistent cyanosis, lethargy and poor feeding. On examination, his respiratory rate is 60/minute, the chest is clear, and the...
A 2 year old boy presents to the emergency department with breathing difficulties. His mother says the child was well when dropped off at nursery that morning but when she collected him later that day...
A 2 year old boy presents to the emergency department with breathing difficulties. His mother says the child was well when dropped off at nursery that morning but when she collected him later that day...
A 3 month old girl presents with a history of irritability, vomiting and recurrent, occasionally blood-stained, loose stools. She was born at term, with a birthweight of 3.5 kg. She has been largely b...
A 3 month old girl presents with a history of irritability, vomiting and recurrent, occasionally blood-stained, loose stools. She was born at term, with a birthweight of 3.5 kg. She has been largely b...
A previously well 6 month old boy presents with generalised fits intermittently for the last 1 hour. He received buccal midazolam twice in the ambulance without relief. On arrival in hospital, he has ...
A previously well 6 month old boy presents with generalised fits intermittently for the last 1 hour. Blood investigations show severely low calcium (1.2 mmol/l). The fits recur as soon as he is transf...
presenting with pallor A 6 year old boy is admitted with pallor and tiredness and ongoing diarrhoea. He was sleeping more than usual and his appetite and drinking had diminished. His urinary output ha...
A 10 year old boy, who had been previously well, presents with tiredness and lethargy for the last 6 months. Clinical examination shows no pallor, clubbing or lymphadenopathy, and systemic examination...
A 10 year old obese boy (BMI 35) with tiredness and lethargy for 6 months. Systemic examination is unremarkable. What is the most important investigation at this stage?
with an irregular pupil and white reflex A 2 year old Asian girl, the daughter of non-consanguineous parents, had been born at full term by normal vaginal delivery after an uncomplicated pregnancy. Sh...
who took some tablets A 15 year old girl presents to the emergency department at 4 pm with nausea and vomiting. She says that, at 8 am that morning, she had taken 20 adult paracetamol tablets. She is ...
who took some tablets A 15 year old girl presents to the emergency department at 4 pm with nausea and vomiting. She says that, at 8 am that morning, she had taken 20 adult paracetamol tablets. She is ...
and haemoptysis AQ year old girl presents with a 6 month history of a tickly cough, sometimes productive of clear sputum, and 2 episodes of haemoptysis in the previous 24 hours. She has a history of a...
A baby boy was born at term by normal delivery after an uneventful pregnancy. His birthweight was 3.5 kg. His appearance at birth was normal and he was sent to the postnatal ward with his mother to es...
A baby boy was born at term by normal delivery after an uneventful pregnancy. His birthweight was 3.5 kg. His appearance at birth was normal and he was sent to the postnatal ward with his mother to es...
A 7 year old boy is referred to the paediatric outpatient clinic after a murmur was heard during a routine school medical examination. He is asymptomatic and has no history of cardiac problems. On exa...
A 7 year old boy is referred to the paediatric outpatient clinic after a murmur was heard during a routine school medical examination. He is asymptomatic and has no history of cardiac problems. Which...
A 6 week old male infant is referred with poor feeding and generalised hypotonia. His reflexes are all present but weak. He is noted to have dysmorphic features, including almond-shaped eyes, a thin u...
A 6 week old male infant is referred with poor feeding and generalised hypotonia. Clinical features suggest Prader-Willi syndrome. Which investigation would confirm the diagnosis?
with delayed puberty An 11 year old girl is referred with short stature and delayed puberty. Over the previous year, it was noted that her height velocity was not keeping pace with her peers’ despite ...
with delayed puberty An 11 year old girl is referred with short stature and delayed puberty. Over the previous year, it was noted that her height velocity was not keeping pace with her peers’ despite ...
with delayed puberty An 11 year old girl is referred with short stature and delayed puberty. Over the previous year, it was noted that her height velocity was not keeping pace with her peers’ despite ...
an abdominal mass A 4 year old girl presents with a 3 week history of lethargy and abdominal pain. She has had episodic high temperatures and was not eating. She is passing small amounts of urine and ...
an abdominal mass A 4 year old girl presents with a 3 week history of lethargy and abdominal pain. She has had episodic high temperatures and was not eating. She is passing small amounts of urine and ...
who presents with bleeding gums A 12 year old boy presents to the emergency department after having 2 teeth extracted so a brace could be fitted. He has had persistent oozing of blood from the teeth s...
who presents with bleeding gums A 12 year old boy presents to the emergency department after having 2 teeth extracted so a brace could be fitted. He has had persistent oozing of blood from the teeth s...
with abdominal pain, wheeze and a rash A7 year old asthmatic boy is admitted after becoming unwell at a Christmas party. At the party, he had abdominal pain, vomited, started to wheeze and developed a...
with abdominal pain, wheeze and a rash A7 year old asthmatic boy is admitted after becoming unwell at a Christmas party. At the party, he had abdominal pain, vomited, started to wheeze and developed a...
A5 year old girl is seen in a general paediatric clinic with a 6 week history of episodic pain and stiffness affecting her wrists, ankles and right knee. In her detailed history, she had a swollen and...
A5 year old girl is seen in a general paediatric clinic with a 6 week history of episodic pain and stiffness affecting her wrists, ankles and right knee. In her detailed history, she had a swollen and...
with generalised oedema A male infant born at 34 weeks of gestation is noted to be oedematous and pale, with poor respiratory effort and shallow breathing soon after birth. His birthweight is 2.9 kg. ...
with generalised oedema A male infant born at 34 weeks of gestation is noted to be oedematous and pale, with poor respiratory effort and shallow breathing soon after birth. His birthweight is 2.9 kg. ...
with fever and abdominal pain An 11 month old girl is admitted to the paediatric ward with a 2 day history of fever and abdominal pain. Past history includes episodic temperatures without identified f...
with fever and abdominal pain An 11 month old girl is admitted to the paediatric ward with a 2 day history of fever and abdominal pain. Past history includes episodic temperatures without identified f...
admitted with lethargy A 3 year old boy is admitted to hospital with a week-long history of progressive lethargy and sleepiness. He is drinking slightly more than usual but his appetite has reduced ov...
admitted with lethargy A 3 year old boy is admitted to hospital with a week-long history of progressive lethargy and sleepiness. He is drinking slightly more than usual but his appetite has reduced ov...
with a troublesome wheeze A 6 year old boy is referred to the clinic due to a recurrent cough and wheeze for the past 2 years. These are present most days but are worse with colds. His GP prescribed 2...
with a troublesome wheeze A 6 year old boy is referred to the clinic due to a recurrent cough and wheeze for the past 2 years. These are present most days but are worse with colds. His GP prescribed 2...
to the emergency department with bruises A 3 year old boy is brought to the emergency department by a police officer and a neighbour who had found him wandering in the street. The child is dishevelled...
to the emergency department with bruises A 3 year old boy is brought to the emergency department by a police officer and a neighbour who had found him wandering in the street. The child is dishevelled...
with persistent fever and a rash A 2 year old boy presents to the emergency department with a 6-day history of sore throat, persistent fever and a rash. On examination, his temperature is 38.9°C, resp...
with persistent fever and a rash A 2 year old boy presents to the emergency department with a 6-day history of sore throat, persistent fever and a rash. On examination, his temperature is 38.9°C, resp...
with persistent fever and a rash A 2 year old boy presents to the emergency department with a 6-day history of sore throat, persistent fever and a rash. On examination, his temperature is 38.9°C, resp...
with a petechial rash A male infant with a birthweight of 3.4 kg is noted to have a widespread petechial rash at about 24 hours of age. He was born at term by a normal delivery to a primiparous Caucas...
with a petechial rash A male infant with a birthweight of 3.4 kg is noted to have a widespread petechial rash at about 24 hours of age. He was born at term by a normal delivery to a primiparous Caucas...
with a periocular rash A 3 year old Asian boy presents with a unilateral facial rash for the previous 10 days. He has no significant medical history and is otherwise well. There is no relevant family ...
with acute cough and wheeze A 2 year old girl presents to the emergency department with an acute wheeze and breathlessness. She has had a runny nose for 4 days, but was otherwise well until 3 hours pr...
A 13 year old girl with type 1 diabetes is seen for an annual medical review in a diabetes outpatient clinic with both her parents. She was diagnosed at age 5 and continues to share care with them. He...
A 13 year old girl with type 1 diabetes is seen for an annual medical review in a diabetes outpatient clinic with both her parents. She was diagnosed at age 5 and continues to share care with them. He...
Study: An assessment of the efficacy and tolerability of a newly developed low-cost human-bovine (116E) rotavirus vaccine in low-resource urban and rural settings in India. Methods: A randomised doubl...
Study: An assessment of the efficacy and tolerability of a newly developed low-cost human-bovine (116E) rotavirus vaccine in low-resource urban and rural settings in India. Methods: A randomised doubl...
Study: Efficacy of early neonatal supplementation with vitamin A to reduce mortality in infancy in Haryana, India. Methods: Over a 2-year period, all babies of women aged 15 to 49 were identified in 2...
A 12 year old boy is brought to clinic after two episodes of syncope. Both occurred during PE at school. He recovered quickly each time. There is a family history of sudden death - his uncle died aged...
A 12 year old boy with exertional syncope. ECG shows a prolonged QTc of 500ms. Which of the following activities should be avoided?
A 5 year old boy is referred to the outpatient clinic because his parents are very concerned about a skin rash involving an increasing number of enlarging and proliferating ‘spots’ on his arms and tru...
A 5 year old boy is referred to the outpatient clinic because his parents are very concerned about a skin rash involving an increasing number of enlarging and proliferating ‘spots’ on his arms and tru...
A male infant with a birthweight of 3.5 kg was admitted from the postnatal ward to the neonatal unit at about 10 hours of age with a history of poor feeding, lethargy and floppiness. He was born by no...
A male infant with a birthweight of 3.5 kg was admitted from the postnatal ward to the neonatal unit at about 10 hours of age with a history of poor feeding, lethargy and floppiness. He was born by no...
A 6 year old boy is referred with early puberty. He has developed pubic hair and his penis has enlarged. His testes measure 3ml bilaterally. His bone age is advanced at 9 years. Which of the followin...
A 6 year old boy with suspected congenital adrenal hyperplasia presenting with early puberty. Which investigation would be most helpful in confirming the diagnosis?
A 10 year old girl presents with dark urine for 2 days. She had a sore throat last week. On examination, she looks pale and mildly jaundiced. Blood tests show: Hb 7.2 g/dL, reticulocytes 15%, bilirubi...
A 10 year old girl with autoimmune haemolytic anaemia. Hb 7.2 g/dL. Which of the following is the most appropriate first-line treatment?
A 3 year old boy presents to your clinic with a 1 year history of abdominal pain, with periods of constipation, alternating with periods of loose stools. He is reported to pass a hard stool once weekl...
A 3 year old boy presents to your clinic with a 1 year history of abdominal pain, with periods of constipation, alternating with periods of loose stools. He is reported to pass a hard stool once weekl...
A 14 year old girl presents with a 3 month history of daily headaches. They are worse in the morning and when she bends forward. She has gained weight recently. On examination, she is obese (BMI 32). ...
A 14 year old obese girl with suspected idiopathic intracranial hypertension. Which investigation would confirm the diagnosis?
with respiratory distress A baby boy was born at 39 weeks of gestation by normal delivery. The mother had a proven UTI caused by group B Streptococcus 3 weeks before delivery, and received a full cour...
A7 year old, previously healthy, boy presents to the paediatric outpatient clinic with a 6 month history of lethargy, weakness, intermittent nausea and vomiting, and “feeling dizzy” when he stands up....
A7 year old, previously healthy, boy presents to the paediatric outpatient clinic with a 6 month history of lethargy, weakness, intermittent nausea and vomiting, and “feeling dizzy” when he stands up....
A mother who is living in the UK is known to be HIV positive and has been on antiretroviral therapy throughout her pregnancy. At 37 weeks of gestation, her viral load is 184,000 copies/ml and she goes...
A mother who is living in the UK is known to be HIV positive and has been on antiretroviral therapy throughout her pregnancy. At 37 weeks of gestation, her viral load is 184,000 copies/ml and she goes...