Everything paeds

Question 1

Ritha, aged 2 months, is admitted to hospital with a 2-day history of mild coryza and tachypnoea without significant intercostal recession. She has been feeding poorly for the last 3 weeks. Which clinical feature most supports her having congenital heart disease rather than respiratory disease?
Select one answer only.
A. Sibling with congenital heart disease
B. Poor feeding
C. Generalized wheeze on auscultation
D. Hepatomegaly
E. Ejection systolic murmur, grade II/VI, at the left sternal edge

Answer 1

Sibling with congenital heart disease

A sibling with congenital heart disease slightly increases the risk for Ritha, but it is still very low.

Question 2

Nazma, aged 4 years, presents with a 1-week history of episodic central abdominal pain. She is of Indian ethnicity, but the family live in Kenya and are visiting relatives in the UK. She is otherwise well. Her relative’s general practitioner thinks she may be slightly pale and that her spleen is enlarged, as it is 3 cm below the costal margin. There are no other abnormalities on examination.
Which of the following is the most likely cause for her enlarged spleen?

A. Acute lymphoblastic leukaemia
B. Malaria
C. Hookworm infestation
D. Wilms tumour
E. Sickle cell disease

Answer 2

A. Acutelymphoblasticleukaemia
Acute lymphoblastic leukaemia may cause splenomegaly, but other clinical manifestations would also be present.

B. MALARIA IS CORRECT
Correct. High prevalence in Kenya and may cause chronic anaemia and splenomegaly.

C. Hookworm infestation
Hookworm infestation is associated with anaemia but not splenomegaly.

D. Wilms tumour
Wilms tumour would cause enlarged kidney rather than spleen.

E. Sickle cell disease
Sickle cell disease may cause anaemia and splenomegaly, but prevalence is very low in Indian ethnicity, whereas malaria is common in Kenya.