Pre-internship
The harder call — the unwell patient, escalation, prioritisation, prescribing detail, ethics and law. 309 questions.
A 7-month-old boy has had 18 hours of loose stools and two vomits. His mother says the nappies are as wet as usual and he is still breastfeeding well. He is ale…
Paediatrics · Pre-internship · middle twist
A 4-year-old girl is admitted with four days of diarrhoea. She is 10 per cent dehydrated but not shocked, and her serum sodium on arrival is 172 mmol/L (135-145…
Paediatrics · Pre-internship · middle twist
A 3-year-old boy weighing 15 kg has had two days of profuse vomiting and diarrhoea. On arrival he was drowsy with cold mottled legs, capillary refill of five se…
Paediatrics · Pre-internship · middle twist
A 14-month-old boy is being discharged with amoxicillin oral suspension to be given three times a day for five days. His mother arrived in Australia four months…
Paediatrics · Pre-internship · middle twist
A 3-year-old boy weighing 18 kg has a bulging left tympanic membrane with purulent discharge in the ear canal, and antibiotic treatment is indicated. He is at l…
Paediatrics · Pre-internship · middle twist
A 9-year-old boy has a forearm fracture and needs regular oral paracetamol in the emergency department. He weighs 52 kg; the 50th centile weight for his age and…
Paediatrics · Pre-internship · middle twist
A 4-year-old girl admitted with a severe exacerbation of a chronic illness has a nasogastric tube in situ and cannot swallow tablets. One of her regular medicin…
Paediatrics · Pre-internship · middle twist
A 26-month-old girl with no known epilepsy is brought in convulsing. The seizure began 14 minutes ago; paramedics gave buccal midazolam at six minutes and a fur…
Paediatrics · Pre-internship · middle twist
A woman telephones the practice about her 3-week-old, who was born at term and is thriving on exclusive breastfeeding. Yesterday another doctor started her on a…
Paediatrics · Pre-internship · middle twist
A 15-year-old girl attends a general practice for a repeat of her salbutamol inhaler. She has had asthma since childhood. She uses salbutamol two or three times…
Paediatrics · Pre-internship · middle twist
A 12-year-old Aboriginal girl from a remote community has been admitted to a tertiary hospital with newly diagnosed type 1 diabetes. English is the family's fir…
Paediatrics · Pre-internship · middle twist
A 15-year-old girl with type 1 diabetes since the age of nine attends the clinic with her father. Her glycated haemoglobin has risen steadily over 12 months. He…
Paediatrics · Pre-internship · middle twist
A 7-year-old boy has had atopic dermatitis since infancy. His skin is currently red, thickened and excoriated across both antecubital and popliteal fossae and h…
Paediatrics · Pre-internship · middle twist
A 5-week-old boy is admitted after a fortnight of vomiting that now shoots across the change table after every feed. The vomit has never been green. He feeds hu…
Paediatrics · Pre-internship · middle twist
A 2-year-old boy is brought to a regional emergency department at 3 am with two days of runny nose and a harsh barking cough. Forty minutes ago he was given dex…
Paediatrics · Pre-internship · middle twist
A 10-week-old girl is brought to the emergency department by both parents with a bruise on the left cheek and a smaller one over the left ear. Her father says h…
Paediatrics · Pre-internship · middle twist
A 5-month-old ex-term boy is on day four of bronchiolitis. Over the past 24 hours he has taken about 40 per cent of his usual milk and had two wet nappies. Resp…
Paediatrics · Pre-internship · middle twist
A 14-month-old girl has been crying, pulling at both ears and febrile for a day. She has had paracetamol, is drinking normally and is not vomiting. Temperature…
Paediatrics · Pre-internship · middle twist
A 2-year-old boy brought in at 2 am has a harsh barking cough and a hoarse cry. His general practitioner gave him prednisolone 1 mg/kg nine hours ago and he set…
Paediatrics · Pre-internship · middle twist
A 3-year-old girl who arrived from Ethiopia six months ago is screened after her grandmother, who shares the house, was diagnosed with smear-positive pulmonary…
Paediatrics · Pre-internship · middle twist