Middle twist
One twist — a threshold, a comorbidity, an atypical presentation. 741 questions.
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 boy has had a fever above 39 degrees Celsius for six days despite regular paracetamol. Both eyes are red without any discharge or crusting. His lip…
Paediatrics · Clinical rotations · 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
A 2-year-old boy whose parents were born in Vietnam has a blood test before starting childcare. He drinks about 700 mL of cow milk a day and refuses meat. He is…
Paediatrics · Clinical rotations · middle twist
A 6-day-old term girl, home since day two and feeding well until this morning, is brought in mottled and lethargic. Heart rate is 186 per minute, respiratory ra…
Paediatrics · Pre-internship · middle twist
A 4-year-old girl has refused to walk since yesterday and cries whenever her right leg is moved. Temperature is 38.9 degrees Celsius and heart rate 148 per minu…
Paediatrics · Pre-internship · middle twist
A 4-day-old term boy, discharged home yesterday and feeding well until this morning, has vomited four times in six hours. The vomit is dark green. He passed mec…
Paediatrics · Clinical rotations · middle twist
You are drawing a three-generation pedigree for a 7-year-old girl referred with recurrent headaches. Her mother mentions that the child's father, from whom she…
Paediatrics · Pre-internship · middle twist
A 9-year-old boy has two years of worsening exercise intolerance, drooping eyelids and newly fitted hearing aids. You take a family history to draw a pedigree.…
Paediatrics · Clinical rotations · middle twist
A 3-week-old boy has just had a pyloromyotomy for infantile hypertrophic pyloric stenosis. He is his parents' first child and neither parent nor any grandparent…
Paediatrics · Clinical rotations · middle twist
A woman has an amniocentesis at 17 weeks after a cell-free DNA test reported a high chance of trisomy 21. She is booked to fly interstate in three days for a fa…
Paediatrics · Pre-internship · middle twist
A couple in their early thirties have had three consecutive first-trimester miscarriages and have no living children. Both are well and neither has a family his…
Paediatrics · Clinical rotations · middle twist
A 28-year-old woman who has had type 1 diabetes since she was twelve asks how to prepare for a pregnancy she hopes to start in about six months. Her most recent…
Paediatrics · Pre-internship · middle twist
You are the intern in a newborn follow-up clinic. A 9-day-old boy has been recalled because his newborn bloodspot screening result shows a markedly raised thyro…
Paediatrics · Pre-internship · middle twist
A boy born at 38 weeks is hypotonic and feeds slowly. Rapid chromosome testing has confirmed trisomy 21. He is pink in air with a normal respiratory rate, the p…
Paediatrics · Pre-internship · middle twist
A term girl weighing 2.6 kg is examined before discharge. The backs of both hands and both feet are puffy and doughy, and there is loose redundant skin over the…
Paediatrics · Clinical rotations · middle twist
The parents of a healthy 3-day-old boy ask you to arrange his circumcision before they go home. They give family and cultural reasons. His foreskin is normal fo…
Paediatrics · Pre-internship · middle twist
A boy was born at term to a woman with chronic hepatitis B infection. He was given hepatitis B immunoglobulin and monovalent hepatitis B vaccine within twelve h…
Paediatrics · Pre-internship · middle twist