Specialty

Question 1

An 18 month old girl has refused to weight bear on her right leg for 3 days. Her mother
reports the child has been well. There is no history of trauma. Her temperature is 36.9°C,
pulse rate 110 bpm, respiratory rate 24 breaths per minute and oxygen saturation 98%
breathing air. An X-ray shows a spiral fracture of the right tibia. The fracture has been
stabilised.

Which is the most appropriate next step in management?

Answer 1

Admit and initiate safeguarding protocol

Question 2

A 2 year old girl refuses to weight bear for 3 days. Her mother reports no history of trauma or
recent infection. She has bruises and scattered petechiae on the legs and appears pale but
well kempt. Her temperature is 36.9 C, pulse rate 110 bpm, respiratory rate 24 breaths per
minute and oxygen saturations 97% breathing air.

Haemoglobin 80 g/L (110–140)
White cell count 32.1 x 10⁹/L (5.0–12.0)
Platelets 7 x 10⁹/L (150–400)
CRP 4 mg/L (<5)

Which is the most likely diagnosis?

Answer 2

Acute lymphoblastic leukaemia

Question 3

A baby born at 41+6 weeks gestation through thick meconium is grunting at 3 hours old. He required no resuscitation at birth. He has mild subcostal recession and nasal flaring. His temperature is 36.8ºC, pulse 156 bpm, respiratory rate 72 breaths per minute and oxygen saturations 95% breathing air.

Which is the most likely diagnosis?

Answer 3

Meconium Aspiration Syndrome

Question 4

A 3 year old girl is struggling with her breathing. She was given a single dose of PO dexamethasone by her GP 12 hours ago for a barking cough. She is happy playing but has mild stridor. Temperature 37.1ºC, pulse 130bpm, respiratory rate 37 breaths per minute and oxygen saturation 97% breathing air.

Which is the most appropriate next step in her management?

Answer 4

Oral Dexamethasone