AKT – Child and youth health (Paediatrics)

Isla Cameron, aged 3, is brought in by her mother due to frequent wheeze and cough that worsen at night. This has been ongoing for the past 6 weeks. There is no fever. Her mother reports that she was admitted for bronchiolitis as an infant. She is otherwise growing well and is up to date with immunisations.

Relevant Family history: Mother has asthma

What is the MOST appropriate next step in management?

Maxwell Tan, aged 13, presents with progressive fatigue and pallor over the past month. On examination he appears pale, has mild splenomegaly and a systolic flow murmur. He is vegetarian. Recent bloods show Hb 82 g/L, MCV 68 fL, ferritin 8 µg/L.

What is the MOST likely diagnosis?

Ella Watson, aged 6 weeks, is brought in due to frequent vomiting after feeds. She is exclusively formula fed. Her mother describes non-bilious projectile vomiting and says she feels a ‘small lump’ in the baby’s upper abdomen. Ella appears hungry after vomiting.

Relevant examination findings: Mild dehydration, palpable olive-shaped mass in RUQ

What is the MOST likely diagnosis?

Leo Harper, aged 15, presents with low mood, social withdrawal, and declining school performance over the past 2 months. He denies suicidal thoughts but says he ‘doesn’t care about anything anymore’. His parents are concerned as he spends most of his time alone in his room.

What is the MOST appropriate initial management step?

Charlotte Nguyen, aged 10, presents with a sore throat, fever, and headache for two days. On examination, she has tender anterior cervical lymphadenopathy, enlarged tonsils with white exudates, and a temperature of 39°C. There is no cough or rhinorrhoea.

What is the MOST appropriate next step?

Henry Miles, aged 5, presents with a limp that started suddenly two days ago. He has no history of trauma. He is afebrile and otherwise well. On examination, there is mild pain with internal rotation of the right hip, but no swelling or erythema.

Relevant Past history: Recent upper respiratory tract infection 1 week ago

What is the MOST likely diagnosis?

Zara Wallace, aged 8, is brought in due to itchy scalp and white flecks in her hair. Her mother reports that several children at school have the same problem. On examination, there are visible nits attached to hair shafts near the scalp.

What is the MOST appropriate treatment?

Jacob Singh, aged 4 months, is brought in for immunisations. His mother asks about introducing solid foods. He was born at term, is exclusively breastfed and growing well.

What is the MOST appropriate advice?

Olive Baxter, aged 11, presents with frequent abdominal pain, often around school days. The pain is periumbilical, episodic, and not associated with red flags such as weight loss or vomiting. Her appetite and growth are normal.

What is the MOST likely diagnosis?

Amira Hussain, aged 2, is brought in with a 2-day history of fever and irritability. Today she developed a widespread maculopapular rash. She is now afebrile and active. Her mother says she had a high fever and then the rash appeared as it broke.

What is the MOST likely diagnosis?

Louis Tran, aged 7, presents with a persistent dry cough, worse at night and during physical activity. He has no fever, but sometimes complains of chest tightness. He has a personal history of eczema and allergic rhinitis.

What is the MOST likely diagnosis?

Emily Johns, aged 16, presents with amenorrhoea for 5 months. She is a competitive dancer and has lost weight recently. She denies pregnancy and says she ‘hardly ever eats carbs’. On examination, BMI is 17.2 and she appears anxious about her weight.

What is the MOST likely cause of her amenorrhoea?

Joshua Riley, aged 6, is brought in due to frequent ear infections. He has had five episodes of acute otitis media in the last 6 months. His hearing is slightly reduced and he is falling behind at school.

What is the MOST appropriate next step?

Lachlan Murphy, aged 14, presents with acute scrotal pain that started 3 hours ago. He is nauseated and has not passed urine since the pain began. On examination, the left testis is high-riding and very tender with absent cremasteric reflex.

What is the MOST appropriate next step?

Amira El-Khoury, aged 4, presents with poor weight gain and loose stools. Her mother says she looks pale and her belly is often bloated. On examination, she is thin, with pallor and a protuberant abdomen. Her growth chart shows flattening of both height and weight curves.

What is the MOST appropriate initial investigation?

Chloe Baxter, aged 9, is brought in by her father due to bedwetting. She has never been dry at night. There are no daytime symptoms. She is otherwise healthy and has no concerns at school.

What is the MOST appropriate initial management?

Noah Ibrahim, aged 12, presents with a widespread vesicular rash, low-grade fever, and mild itch. His mother reports that a classmate had a similar illness last week. On examination, he has lesions in various stages of development including vesicles, pustules, and crusts.

What is the MOST likely diagnosis?

Grace O’Malley, aged 2, is brought in after a febrile seizure lasting 3 minutes. She has recovered and is now alert and interactive. This is her first seizure. She has no neurological abnormalities and is up to date with vaccinations.

What is the MOST appropriate next step?

Leo Zhang, aged 15, presents with bilateral knee pain, worse with running and kneeling. He plays basketball and is going through a growth spurt. On examination, there is tenderness and swelling over the tibial tuberosities.

What is the MOST likely diagnosis?

Sophie Thompson, aged 6 months, presents with noisy breathing that worsens when lying on her back. Her mother says she has been like this since birth but is otherwise feeding and growing well. On examination, there is inspiratory stridor, but oxygen saturations are normal and there is no distress.

What is the MOST likely diagnosis?

Samuel West, aged 10, presents with increasing daytime sleepiness and poor concentration at school. His parents report loud snoring and occasional pauses in breathing during sleep. He has enlarged tonsils on examination and a BMI in the 90th percentile.

What is the MOST likely diagnosis?

Ava Robertson, aged 3, is brought in with a barking cough and hoarse voice. She had rhinorrhoea and low-grade fever 2 days ago. Last night, she developed inspiratory stridor and coughed for hours. She is alert and not in distress now.

What is the MOST appropriate management?

Charlotte D’Souza, aged 6 weeks, is brought in due to persistent crying and pulling at her ears. Her mother reports poor feeding and a temperature of 38.3°C. On otoscopy, her right tympanic membrane appears red and bulging.

What is the MOST appropriate next step in management?

Mason Ali, aged 11, presents with bruising and gum bleeding. His mother noticed petechiae on his legs. He had a viral illness two weeks ago. Bloods show isolated thrombocytopenia with platelets at 18 x 10^9/L, normal Hb and WCC.

What is the MOST likely diagnosis?

Isabelle Grant, aged 13, presents with breast tenderness and irregular periods. She has mild acne and hirsutism. On examination, BMI is 28. Ultrasound shows polycystic ovaries.

What is the MOST appropriate initial management?

Benjamin Scott, aged 17, presents with a 3-month history of fatigue, low mood, and difficulty concentrating. He has no suicidal ideation. He recently failed two subjects and stopped playing football. He has a BMI of 22 and no substance use.

What is the MOST appropriate initial management step?

Nina Patel, aged 4, presents with frequent episodes of abdominal pain and loose stools containing mucus. Her growth is normal. On examination, her abdomen is soft and non-tender. Her parents follow a vegetarian diet and she consumes significant dairy products.

What is the MOST likely diagnosis?

Elijah Rhodes, aged 2, presents with a rash and refusal to walk. He had a viral illness a week ago. On examination, there is a purpuric rash over his buttocks and legs, and mild ankle swelling. Urinalysis shows microscopic haematuria.

What is the MOST likely diagnosis?

Sienna Lucas, aged 6, presents with difficulty seeing the board at school. She holds books very close when reading. There is no headache or other neurological symptoms. Family history reveals both parents wear glasses.

What is the MOST likely diagnosis?

Lucas Nguyen, aged 8, presents with a 5-day history of fever, conjunctival injection, cracked lips, and rash on his trunk and hands. He also has swollen cervical lymph nodes. There is no sore throat or cough.

What is the MOST likely diagnosis?

Olivia Reid, aged 15, presents with heavy, irregular periods since menarche at age 13. Her cycles vary from 21 to 45 days and menses last 7–10 days with flooding and clots. She is otherwise well and not sexually active. BMI is 24 and there is no hirsutism or acne.

What is the MOST appropriate first-line treatment?

Harry Williams, aged 6, presents with poor academic performance and disruptive classroom behaviour. His teacher notes that he struggles to sit still and often blurts out answers. His parents say he is impulsive and often forgets tasks.

What is the MOST appropriate initial step in assessment?

Zoe McDonald, aged 2, presents with a rash on her cheeks described as ‘slapped cheek’. She had mild fever last week but is now afebrile and well. Several children at daycare have similar symptoms.

What is the MOST likely diagnosis?

Samuel Ibrahim, aged 13, presents for a routine check-up. His parents are concerned he is small for his age. He is otherwise healthy and doing well academically. Examination shows height and weight at 5th percentile, Tanner stage 2, and mid-parental height around the 50th percentile.

What is the MOST likely explanation for his growth pattern?

Jasmine Le, aged 5, presents with sudden onset of right elbow pain after her brother swung her by the arms. She is holding the arm pronated and slightly flexed, and resists movement. There is no swelling or bruising.

What is the MOST likely diagnosis?

James Holloway, aged 8, presents with a 3-day history of fever, headache, vomiting and photophobia. On examination, he is febrile and irritable. Neck stiffness is present. Kernig’s and Brudzinski’s signs are positive.

What is the MOST appropriate next step?

Mila Georgiou, aged 3, presents with painless limping for one week. Parents report no trauma. On examination, there is decreased internal rotation and abduction of the left hip. X-ray shows increased density of the femoral epiphysis and flattening of the femoral head.

What is the MOST likely diagnosis?

Ryan Tan, aged 6, presents with increased thirst and urination for the past 2 weeks. He has lost 2 kg despite normal appetite. Today he appears tired and has acetone on his breath. Capillary BGL is 21 mmol/L.

What is the MOST appropriate next step?

Isla Freeman, aged 18 months, presents for a routine health check. She has just started walking. Her parents are concerned she does not speak any words. She responds to her name and follows simple commands. There are no concerns with vision or social interaction.

What is the MOST appropriate next step?

Aaliyah Khan, aged 14, presents with fatigue and shortness of breath on exertion. On examination, she has conjunctival pallor and a systolic murmur. Bloods show Hb 88 g/L, MCV 72 fL, and ferritin 6 µg/L.

What is the MOST appropriate next step?

Emily Zhao, aged 9, presents with recent fatigue, increased thirst, and occasional bedwetting at night. She is otherwise well. Examination is unremarkable. Capillary BGL in clinic is 14.2 mmol/L.

What is the MOST appropriate next step?

Riley Jamieson, aged 11, presents with sudden chest pain while playing soccer. The pain is sharp, worse with inspiration, and located on the left side. He is not short of breath. Examination reveals normal breath sounds, no wheeze or crepitations, and normal oxygen saturation.

What is the MOST likely diagnosis?

Sophie Kravitz, aged 4, is brought in with fever, irritability, and refusal to bear weight on her right leg. There is no history of trauma. On examination, she has pain on passive movement of the right hip and appears systemically unwell.

What is the MOST appropriate next step?

Luka Petrovski, aged 16, presents with delayed puberty. He has no facial or pubic hair and no testicular enlargement. He is otherwise well, with normal growth velocity. His father had late puberty. Height and weight are at the 50th percentile. Tanner stage 1.

What is the MOST likely diagnosis?

Layla Hussein, aged 6, presents with a persistent dry nocturnal cough. Her parents report she often wakes coughing and sometimes wheezes after running. There is a family history of atopy. Examination today is normal.

What is the MOST appropriate next step?

Hamish Cooper, aged 7, presents with increasing thirst and a recent history of wetting the bed after having been dry for over a year. He has lost 1.5 kg in the past month. His random capillary blood glucose is 17.8 mmol/L.

What is the MOST appropriate next step?

Amelia D’Angelo, aged 12, presents with right lower quadrant pain, nausea, and anorexia for 24 hours. On examination, there is rebound tenderness in the right iliac fossa and positive Rovsing’s sign. Her temperature is 38.4°C.

What is the MOST likely diagnosis?

Reuben Wells, aged 3, is brought in after swallowing a button battery 30 minutes ago. He is asymptomatic and vital signs are normal. A chest X-ray confirms the battery is in the oesophagus.

What is the MOST appropriate next step?

Freya Martin, aged 18 months, presents with multiple café-au-lait spots noted by her childcare worker. She is otherwise well and meeting developmental milestones. Her mother has similar marks on her arms.

What is the MOST appropriate next step?

Jackson Lee, aged 6, presents with a new murmur found on school screening. He is asymptomatic, and physical examination reveals a grade 2/6 systolic murmur, best heard at the left lower sternal edge, which disappears on standing.

What is the MOST likely diagnosis?