Lecture 31 Cases

Question 1

• 26-day old baby girl is noted by the health visitor to be jaundiced. She is referred into paediatrics for further assessment

What are the differential diagnoses

Answer 1

• Unconjugated
- Physiological jaundice
- Breast milk jaundice
- Infection (urinary)
- Hypothyroidism
- Haemolytic anaemia (ABO incompatibility/G6DP)
• Conjugated
- Bild duct obstruction (biliary atresia/choledochal cyst)
- Neonatal hepatitis (congenital infection/metabolic)
- Intrahepatic biliary hypoplasia (Alagille’s-rare)

Question 2

• A 3y old boy presents with 4 weeks of lethargy, looking pale and recurring fevers
• Examination showed multiple bruised on the legs back and chest, enlarges cervical/inguinal lymph nodes and hepato-splenomegaly

What are the differential Diagnoses

Answer 2

Sepsis

Acute Leukaemia

Question 3

• A 3y old girl is brought into A+E following a 4 minute generalised tonic-clonic convulsion
• She has a temperature of 39.5, a red throat and runny nose

What is the most likely diagnosis

Answer 3

Febrile convulsions

Question 4

• A 10-year-old boy presents with 3w of excessive drinking, secondary nocturnal enuresis, lethargy and weight loss and 2 days of abdominal pain and vomiting
• He has cold peripheries, Temp 36.5, RR 35, HR 140, no focal chest or abdominal findings

What is the most likely diagnos

Answer 4

DKA

Question 5

• A 4y old boy is brough into A+E from nursery following an abrupt onset of facial swelling, tight feeling in his throat and difficulty breathing
• Examination shows he is lethargic, RR 50 HR 170, sats 88, he has a widespread urticarial rash and bilateral wheeze

What is the most likely diagnsois

Answer 5

Type 1 hypersensitivity

Anaphylaxis