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Full term
normal delivery with no neonatal complications. Immunisations up to date. There
is no FH/SH of note.
On examination he is apyrexial and well. Respiratory rate 12/min and pulse
65/min. Tender in the left loin on bimanual palpation.
What is the most likely diagnosis?
(Please select 1 option)
Correct
2-A 3-year-old boy goes to a children's party and eats some peanuts. Almost
immediately he spits them out, and runs to his mother saying his mouth hurts.
She notes a rapidly developing raised itchy rash over his face, and that his eyes,
lips and tongue are swelling. He begins to have marked difficulty in breathing with
audible stridor. An ambulance is called.
On the arrival of the paramedics he has collapsed and appears unconscious. He
has shallow breathing at 10/min, HR 160/min (thready pulse), and is responding
only to pain.
What is the most likely diagnosis?
(Please select 1 option)
Correct
Croup
Foreign body aspiration
Trauma
The history is of anaphylactic shock in response to peanuts. After attention to airway and
breathing he requires IM adrenaline, then IV steroids and antihistamines and nebulised
salbutamol. Fortunately anaphylactic shock is rare.
3-A 4-year-old girl presents with extensive bruising over the trunk, legs and
palate. She had an URTI 4 weeks ago, but has otherwise been well. 39+5/40
3.8kg delivery, with no neonatal problems. No FH of note.
On examination she is well. Temperature is 36.7C (tympanic), HR 90/min, RR
20/min. Extensive fresh bruising of irregular shape over trunk, thighs and shins.
Old bruises over shin.
What is the most likely diagnosis?
(Please select 1 option)
Correct
Meningococcal septicaemia
This girl had a presumed viral illness a month ago and now presents with sudden onset of
extensive bruising. The likely diagnosis is Idiopathic thrombocytopaenic purpura. This can
be confirmed by an FBC and film, which shows isolated thrombocytopaenia, often
<10X1012/l. Most can be managed conservatively, with the platelet count recovering
spontaneously over 1-4 weeks. IVIG or steroids may accelerate recovery. If steroid therapy
is contemplated it should be preceded by a bone marrow biopsy to exclude an
thrombocytopaenic presentation of leukaemia.
4-A 9 month old boy presents with a 24 history of fever and poor feeding. He
has become less responsive and has developed a purple rash over his arms and
trunk. 40+2/40, 3.03kg, no neonatal problems. No drugs. Fully immunised. No
FH or social history of note.
On examination temperature is 38.2C, RR 50/min (mild recession, HR 150/min.
Cool peripheries, with capillary refill time of 4 seconds. Non-blanching purple
spots 3-27mm over the arms and trunk.
What is the most likely diagnosis?
(Please select 1 option)
Correct
Pneumococcal septicaemia
The history is brief, with a sick, shocked child with purpura. The diagnosis is purpura
fulminans, probably due to septicaemia. The 3 commonest organisms which cause this are
meningococcus (esp. B, A and C), pneumococcus and Haemophilus influenzae (esp. B).
The incidence of Meningitis C and Hib have declined dramatically since the introduction of
routine immunisations.
5-A 9-year-old girl presents with a history of clear nasal discharge for several
weeks, accompanied by sneezing and red eyes. This has happened for the last 2
spring times. Full term normal delivery, no neonatal problems. Immunisations up
to date. No family or social history of note.
On examination she is apyrexial and well. She has clear rhinorrhoea, is constantly
rubbing her nose and eyes, and has bilateral non-purulent conjunctivitis. She
breathes through her mouth.
What is the most likely diagnosis?
(Please select 1 option)
Allergic rhinitis
Correct
HIV
Infectious mononucleosis
Kawasaki disease
Lymphoma
Correct
Mycobacterial adenitis
The progressive enlargement of nodes over several months without associated
inflammation suggests malignant infiltration. The abnormal voice suggests involvement of
the recurrent laryngeal nerve. Assessment will require chest X-ray and MRI or CT of neck
and thorax, and lymphnode biopsy. Prognosis will depend on staging and histology
(including molecular tests).
7-A 15 month old boy presents with high fever of 6 days duration, rash, tender
neck glands, red eyes and cracked lips. Full term normal delivery with no
neonatal complications. Immunisations up to date. There was no FH/SH of note.
On examination:
temperature
38.9C
Respiratory rate
30/min
Heart rate
120/min
The rash is maculopapular erythematous and blanching. The hands and feet are
swollen. He has tender cervical gland enlargement, non-purulent conjunctivitis
and prominent tongue papillae. He is miserable and clingy
What is the most likely diagnosis?
(Please select 1 option)
Kawasaki disease
Correct
Measles
Rubella
Scarlet fever
Toxic shock syndrome
The history is classical of Kawasaki disease (muco-cutaneous lymphnode syndrome). The
features described fulfil the international criteria, the diagnosis being purely clinical. Often
there is elevation of CRP, ESR and platelet count. IVIG 2g/kg should be given within the
first 10d of illness to reduce the risk of coronary artery aneurysm.
This patient is having an acute hypersensitivity reaction the most common, dose
independent adverse drug reaction. It is caused by previous exposure and being
sensitised to the drug. The initial exposure induces the production of antibodies of
Ig E class, subsequent exposure induces an immunological reaction - anaphylaxis.
Some drugs can produce an similar pseudoallergic reaction on first exposure.
9-A 10-year-old boy presents with a history of diarrhoea over the past 3 months.
This is loose, occasionally admixed with blood, and occurs up to 4 times per day.
He has felt unwell and lacking in energy, and has occasional griping abdominal
pain. Previous history is unremarkable. He is fully immunised and on no
medications. There is no FH/SH of note.
On examination he is pale and has early clubbing. He is on the 25% for height
and the 3% for weight. Temperature is 37.2C, Respiratory rate 15/min and pulse
80/min. The abdomen is diffusely tender and anal examination reveals an anal
fissure and small tag.
What is the most likely diagnosis?
(Please select 1 option)
Coeliac disease
Crohns disease
Correct
Perianal abscess
Shigella gastroenteritis
Ulcerative colitis
The chronic bloody diarrhoea, systemic upset, pallor, clubbing and perianal findings make
Crohn's disease the likeliest diagnosis. This can be confirmed histologically by upper and
lower GI endoscopy and biopsy (non-caseating granulomata). Barium series help to define
the extent of disease, which can affect from the mouth to the anus.
On examination she was unkempt, had slurred speech and an ataxic gait. Her
core temperature was 34.5C, but there were no other specific abnormalities to
find. Her BM stix result was 2.9 mmol/l.
What is the most likely diagnosis?
(Please select 1 option)
Alcohol ingestion
Correct
11-A 2-year-old girl presents with a raised itchy rash. She had been eating a
chocolate bar when she spat it out saying it hurt her mouth. Within minutes the
rash had appeared over her face and trunk. She was 39+1/40 weighing 3.25kg
and there were no neonatal problems apart from cradle cap. She has been fully
immunised to date. There is a family history of asthma.
On examination she has a florid raised rash over her face. Some of the lesions are
coalscing. She is scratching, but breathing and tongue size are normal. Her
temperature is 36.9C (tympanic), Respiratory rate 30/min, and heart rate of
100/min.
What is the most likely diagnosis?
(Please select 1 option)
Atopic dermatitis
Contact dermatitis
Impetigo
Scabies
Urticaria
Correct
The history suggests an urticarial reaction to one of the components of the chocolate bar.
Manufactured foods make it difficult to identify the offending substance. Treatment is with
antihistamines prn and avoidance of known precipitants.
12-A 16-year-old male presents with acute severe asthma. On examination his
peripheral pulse volume fell during inspiration.
Which one of the following is the most likely explanation for this clinical sign?
(Please select 1 option)
Correct
This patient is demonstrating pulsus paradoxus. The right heart responds directly
to changes in intrathoracic pressure, while the filling of the left heart depends on
the pulmonary vascular volume. At high respiratory rates, with severe air flow
limitation (eg acute asthma) there is an increased and sudden negative
intrathoracic pressure on inspiration and this will enhance the normal fall in blood
pressure.
Correct
If the pH is low then an acidosis is present, and inspecting the CO2 will enable you
to determine whether this is due to respiratory or metabolic causes. Inspecting
the PO2 will tell you whether the patient is hypoxic or not. In this case, the pH is
reduced, and the CO2 is high, with a base deficit of only -4, insufficient to explain
the acidosis from metabolic causes. This is, therefore, a respiratory acidosis, and
the PO2 is also low suggesting type 2 respiratory failure. Possible causes would
include severe pneumonia, end stage asthma or neurogenic causes such as
guillain-Barre. In asthma, the initial stages show a low CO2, with this climbing
only to accompany failing respiration. The results would therefore be consistent
with late severe asthma. In bronchopulmonary dysplasia, there is usually longterm CO2 retention with compensatory increase in bicarbonate leading to a
positive base excess and normal pH. Bicarbonate is usually only considered if the
base deficit exceeds about -8.
Addison's disease
Autoimmune hepatitis
Hashimoto's thyroiditis
Correct
Sjogren's syndrome
Vitamin B12 deficiency
Correct
muscle the more abnormal the cardiac architecture and the higher the risk of
arrhythmia and sudden death.
16-A 7 month old boy presents with a history of cough, fever and difficulty in
feeding for 3 days. He has become progressively more breathless. On admission
he has a fever to 38.9C and looks unwell. His respiratory rate is 65/min with
moderate recession. FBC showed a White cell count of 25.7 x109/L (4-11 x109)
[82% neutrophils]. The C-reactive protein was 145 mg/L (<10).
What is the most likely diagnosis?
(Please select 1 option)
Aspiration pneumonia
Asthma
Bronchiolitis
Cystic fibrosis
Pneumococcal pneumonia
Correct
17-A 12-year-old afro-caribbean girl presents with fever, malaise, and joint
pains of 3 months duration. She was previously well. Full term normal delivery, no
neonatal problems. Immunisations up to date. No family or social history of note.
On examination the temperature is 37.6C, respiratory rate 14/min, pulse 80/min
and Blood Pressure is 100/70 mmHg. She appears subdued and well perfused.
She has a scanty rash over her cheeks. She has generalised joint tenderness on
extremes of movement, but there is no obvious effusion not warmth in them. She
has 2+ haematuria and 2+ proteinuria.
What is the most likely diagnosis?
(Please select 1 option)
Correct
The prolonged history of fever, malaise, joint pains, malar rash and renal involvement
point to a multisystem disease. In this ethnic group SLE is the most likely diagnosis. This
can involve any system and is a great mimic. Treatment is with NSAIDs for joints plus
immunosuppressives for the renal involvement. Therapy may be difficult and prolonged.
18-A 5-year-old boy presents with recurrent ear pain and fever. Every time he
gets a cold he develops ear pain and receives antibiotics from the GP. He has
about 6 episodes a year. He was born at term weighing 2.9kg and there were no
neonatal problems. He is fully immunised. Parents are both smokers.
On examination he has a temperature of 38.0C, respiratory rate of 15/min and
pulse of 90/min. He has shotty slightly tender cervical nodes. His left eardrum is
red and bulging. Throat examination is normal.
>p>What is the most likely diagnosis?
(Please select 1 option)
The history suggests recurrent episodes of acute otitis media with each URTI. If these are
progressively causing damage (eg eardrum scarring) prophylactic antibiotics and
investigations for minor immune deficiency may be considered. Most improve with age.
19-A 12 day old girl presents with poor feeding, vomiting and lethargy. Born at
37+6/40, 2.98kg, no neonatal problems. Uncomplicated pregnancy and delivery.
No drugs or medications. No immunisations. No FH/SH of note.
On examination she is thin and wasted. She has occasional twitching of the
eyelids and mouth. She responds slightly to voice. Weight <3%, OFC 25%,
temperature is 36.5C (tympanic), RR 40/min, HR 150/min. Chest clear, no
murmur. No organomegaly. No rash or dysmorphic features.
What is the most likely diagnosis?
(Please select 1 option)
Correct
Sepsis
20-A 17 month old boy has been completely well and playing with his toys.
Mother hears him coughing and choking and rushes next door. She finds him
gagging and retching, drooling and red in the face. He was born at 37+3/40
weighing 3.7kg and there were no neonatal problems.
On examination his temperature is 36.9C, RR 30/min, HR 130/min. He looks
slightly cyanosed with an O2 saturation of 85% in air. He has marked stridor and
moderate recession.
What is the most likely diagnosis?
(Please select 1 option)
Retropharyngeal abscess
Foreign body aspiration
Correct
Anaphylaxis
Croup
Peritonsillar abscess
The history suggests aspiration of a foreign body. Small objects, such as toys, are
the commonest offenders. They can give rise to acute obstruction, or there may
be a latent period when symptoms settle before inflammation around the object
gives rise to symptoms. Assessment requires a chest X-ray, which will locate
radioopaque objects, and bronchoscopy to remove the object.
21-A 4-year-old girl develops a fever 14 day after returning from a family visit
to India. At the height of fever she feels shivery and cold. She has previously
been well. Full term normal delivery with no neonatal complications.
Immunisations up to date. There is no FH/SH of note.
On examination she has a fever to 39.8C, Respiratory rate 20/min and pulse
100/min. Chest and ENT examinations are normal. She is shivering violently. She
has 3 cm spleen, which is smooth and non-tender.
What is the most likely diagnosis?
(Please select 1 option)
HIV infection
Infectious mononucleosis
Kala-azar
Malaria
Correct
Schistosomiasis
The history of fever, rigors and splenomegaly in a child returning from an endemic
area suggests malaria. Thick and thin blood smears should be taken. Malarial
resistance is an increasing problem, and the latest information should be obtained
about the area of disease acquisition to ensure proper treatment.
22-A mother is concerned because her one-year-old girl was in contact with measles 2 days
previously. Which one of the following statements is correct.
(Please select 1 option)
Correct
Correct
The majority of those affected will die before reaching adult life
Correct
ALL is the most common representing 23% of childhood cancers, with an annual
rate of 30-40 per million. There is no genetic predisposition. Age of less than 2
and greater than 9 at presentation suggests adverse prognosis.The chromosomal
abnormality in ALL involves a translocation in the 11q23 region.It does affect the
meninges which is why prophylactic cranio-spinal irradiation and intrathecal
methotrexate is given. It carries a good prognosis with a cure rate of 80%.
However male sex carries a worse prognosis.
Correct
Obesity
Bone age would be normal in an adequately treated euthyroid child. Bone age
would be delayed in growth hormone deficiency. In exogenous obesity due to
overnutrition and underexercise bone age would be advanced. If there is a
concomitant endocrinopathy such as hypothyroidism then bone age would be
Actinomycosis
Haemophilus influenzae
Pseudomonas aeruginosa
Staphylococcus aureus
Streptococcus pneumoniae
Correct
Cerebral tumor
Cluster headache
Headache due to depression
Migraine
The two commonest causes of chronic daily headache are tension type headache
and analgesic misuse headache. The latter is the most likely diagnosis for this
patient's symptoms. It usually occurs as a result of chronic use of analgesics such
as codeine phosphate and paracetamol. Typically the headache is relieved with
the analgesics just to return in the next hours. The treatment of choice is the
slow reduction and withdrawal of analgesics.
endoplasmic reticulum
Gogli apparatus
lysosomes
Correct
microtubules
mitochondria
The lysosomes contain the enzymes and molecules such as oxidases, free radical
etc responsible for the breakdown of intracellular components. Micortubules are
involved in mitotic processes and intracellular transportation. The mitochondria
produce energy for cellular functions.
29-A 17-year-old male from India presents with fever of 4 months duration and
splenomegaly. What is the most likely diagnosis?
(Please select 1 option)
Coccidiomycosis
Giardiasis
Tropical sprue
Typhoid
Visceral leishmaniasis
Correct
Correct
It differs from other isotypes in not being able to cross the placental barrier.
It is the major antibody produced during the primary response.
a) Each light chain has a MW of 25,000 and each H chain a MW of 50,000. Therefore, since
the whole molecule consists of 2 L and 2 H chains, the MW is 150,000 kd. b) It exists as a
monomer with 2 Fab portions, each of which can interact with an antigenic determinant.
Therefore it is divalent. c) Normal range 8-19 g/l. Next is IgA, 1-5 g/l, followed by IgM
0.5- 2 g/l. d) It is in fact the only antibody capable of crossing the placental barrier, which
it does through gaining attachment via its Fc portion. e) It is the major antibody produced
in the secondary immune response. IgM is the major antibody produced during the
primary response. (c) Dr Alan Cann
31-A 17-year-old girl is short in stature for her age. She has not shown any
changes of puberty. She has a webbed neck. Her vital signs include Temperature
36.6C Respiratory rate 18/min Pulse 75 bpm and BP 165/85 mmHg. On physical
examination, she has a continuous murmur heard over both the front of the chest
as well as her back. Her lower extremities are cool with poor capillary filling. A
chest radiograph reveals a prominent left heart border, no oedema or effusions,
and rib notching. Which of the following pathologic lesions best explains these
findings?
(Please select 1 option)
Correct
She has coarctation of the aorta, and the constriction is postductal, allowing
prolonged survival. Her physical characteristics also suggest Turner syndrome
(monosomy X).
Ankylosing spondylitis
Correct
Erythropoietic porphyria
Fragile X syndrome
Huntington's disease
Pendreds syndrome
Unlike the other conditions, no one specific genetic defect has been identified to
account for ankylosing spondylitis. Hungtindon's chorea is an autosomal dominant
condition. Fragile X syndrome is due to a trinucleatide repeat at the FMR 1 gene
on the X chromosome. Erythropoietic porphyria is an autosomal recessive
condition as is Pendred's syndrome.
33-A 17-year-old male who appears tall and thin for his age, presents with a
high arch palate, chest wall deformities and livedo reticularis. Which of the
following is also associated with this syndrome?
(Please select 1 option)
Autosomal Dominance
Methionine accumulation
Osteopetrosis
Positive Guthrie test
Upward dislocation of the lens
Retinoblastoma
Achondroplasia
Neurofibromatosis type 1
Huntington disease
Marfan syndrome
Anaemic
Cardiogenic
Distributive
Correct
Hypovolaemic
Septic
The history suggests spinal cord transection causing neurogenic shock. Severe head injury
or cord transection can prevent autonomic control of blood vessels, leading to fluid loss
into the tissues (distributive shock). Unusually for shock the pulse is slow and the
peripheries warm. Fluid replacement and treatment of the underlying cause (if possible) is
indicated.
Adrenaline IM
Chlorpheniramine IV
Hydrocortisone IV
Intubation
Salbutamol nebulised
37-A 2-year-old boy presents with neck glands and general unwellness for the
past month. Mother has also noted that 'his eyes look funny'. Full term normal
delivery, no neonatal problems. Immunisations up to date. No family or social
history of note.
On examination the temperature is 36.7C, with RR 25/min and HR 100/min. He
looks unwell and has marked rubbery cervical lyphadenopathy. The right eye has
a small pupil, which fails to dilate in the dark.
What is the most likely diagnosis?
(Please select 1 option)
Cerebral abscess
Cerebral TB
Cerebral toxoplasmosis
Lymphoma
Neuroblastoma
Correct
Correct
The 50% of males who carry a copy of the abnormal gene, passed down from
their mother, will express the disease. The other 50% will be asymptomatic. All of
the females will be asymptomatic, with 50% carrying the abnormal gene.
39-An 18 month old boy investigated for failure to thrive and delayed development is found
to have primary hypothyroidism. Which of the following statements applies to his condition.
(Please select 1 option)
Correct
If his bone age was 3 months the onset of his hypothyroid state is most likely to
have occurred at 3 months of age
hypothermia
Diarrhoea
Prolonged conjugated hyperbilirubinaemia
41-A 15 month old boy presents with high fever of 6 days duration, rash, tender
neck glands, red eyes and cracked lips. Full term normal delivery with no
neonatal complications. Immunisations up to date. There was no family or social
history of note.
On examination temperature is 38.9C and he is miserable and clingy. Respiratory
rate is 30/min and heart rate 120/min, well perfused. The rash is maculopapular
erythematous and blanching. The hands and feet are swollen. He has tender
cervical gland enlargement, non-purulent conjunctivitis and prominent tongue
papillae.
What is the most likely diagnosis?
(Please select 1 option)
Correct
Meningococcal sepsis
Stevens-Johnson Syndrome
42-A 2 month old baby is admitted with seizures and failure to thrive. Follwoing
a seizure he is found to have a blood glucose concentration of 1.2 mmol/L (3.06.0). Other biochemistry reveals a lactic acidosis and hyperlipidaemia.
Examination reveals hepatomegaly with palpable kidneys. What is the most likely
diagnosis?
(Please select 1 option)
Gaucher's disease
McArdle's disease
Niemann-Pick disease
Pompe Disease
Von Gierke disease
Correct
This baby has hypoglycaemia accounting for fits, associated with lactic acidosis
and hepatomegaly which would point to a diagnosis of von Gierke's disease. This
is a glycogen storage disease due to deficiency of glucose-6-phosphatase.
Glycogen is stored in both liver and kidney causing enlargement. Both Gaucher
and Niemann-Pick disease are lipid storage disorders. McArdle's disease is a
glycogen storage disease affecting muscle rather than liver as is Pompe's disease.
Neither would be expected to produce profound hypoglycaemia.
43-A 5-year-old girl presents with ataxia. She keeps falling to the left during a
ballet lesson. The symptoms persist, and parents take her to casualty. 41/40
gestation 2.9kg, with no neonatal problems.
On examination she is alert with temperature of 36.9C (tympanic), RR of 20/min
and HR of 95/min. She has obvious nystagmus, dysdiadochokinesis and falls to
the left when asked to walk.
Brain tumour
Correct
Infections
Ingestions
44-An 18 month old boy because of maternal concerns about delayed speech.
He was born at 39+4/40 weighing 2.6kg and there were no neonatal problems.
He sat at 12/12, and now pulls to stand. He is able to make a tower of 2 inchhigh bricks. He is saying 2-3 single words which his mother can understand and
seems to hear well. He drinks from a bottle. He is fully immunised, on no
medications, and there is no FH/SH of note.
On examination he looks well. He is on the 25th centile for height and weight and
OFC. There are no specific findings of note.
What is the most likely diagnosis?
(Please select 1 option)
Correct
Impaired hearing
Autism
He was born at 41/40 weighing 3.4kg and there were no neonatal problems. He is
fully immunised, on no medications, and comes from a middle class articulate
family.
On examination he is on the 25th centile for height, weight and OFC. There are
no specific abnormalities to find. ENT examination is unremarkable.
What is the most likely diagnosis?
(Please select 1 option)
Correct
The history is of isolated speech delay in a child who apparently hears normally.
Hearing should be formally checked, as it is the commonest reason for speech
delay.In this case the problem involves mainly expression rather than reception of
speech. Such speech problems may interfere significantly with schooling.
46-A 12-year-old boy complains of persistent clear nasal discharge during the
spring and summer. He constantly rubs his nose and his eyes. Sometimes he has
an associated cough. The symptoms usually get better in the autumn. He was
diagnosed with asthma at 2 years, but this has improved with age. He rarely
requires beta agonist inhaler.
On examination he has a clear nasal discharge, nasal speech, and pink nonpurulent conjunctivae.
What is the most likely diagnosis?
(Please select 1 option)
Gastroesophageal reflux
Allergic rhinitis
Correct
Sinusitis
Asthma
Croup
This atopic boy has classical symptoms of seasonal rhinitis. Although skin prick
testing may be helpful in resistant cases, it is usual to treat sufferers
symptomatically with oral antihistamines or topical steroids to eyes and nose.
47-year-old girl presents with high fever and severe left-sided throat pain. She
has had difficulty in swallowing over the last 2 days, and has been finding it
increasingly uncomfortable to open her mouth. Her voice is muffled and she
dribbles saliva. She was born at 41/40 gestation weighing 4.0kg and there were
no neonatal problems.
On examination she looks ill. Her temperature is 40.2C (tympanic), RR 15/min
and HR 100/min. ENT examination shows left tonsillar enlargement and exudate,
with a uvula deviated to the right.
What is the most likely diagnosis?
(Please select 1 option)
Retropharyngeal abscess
Foreign body aspiration
Anaphylaxis
Croup
Peritonsillar abscess
Correct
48-A 9-year-old boy presents with a history of headache and persistent green
nasal discharge. At night he has a cough and snores loudly. The headache is
exacerbated by leaning forwards.
On examination he is apyrexial, but has a persistent nasal obstruction and nasal
speech. He is tender over the maxillae and forehead.
What is the most likely diagnosis?
(Please select 1 option)
Gastroesophageal reflux
Allergic rhinitis
Sinusitis
Asthma
Croup
Correct
The picture is one of upper airways obstruction associated with nasal discharge,
most likely due to sinusitis. In this case the maxillary and frontal sinuses are
most likely to be involved
50-A 41+5/40 gestation infant is born by SVD weighing 2.31kg with apgars of 7
at 1 minute and 9 at five minutes. Pregnancy was complicated by maternal
smoking and poor growth on antenatal ultrasound in the final trimester. There is
no family history of note.
On examination his weight is between the 0.4% and 3% and his OFC on the 25%.
He has peeling skin. His temperature on arrival in the neonatal unit is 35.6C and
BM stix is 2.0 mmol/l. There are no specific abnormalities to find.
What is the most likely diagnosis?
(Please select 1 option)
Asymptomatic hypoglycaemia
CMV infection
Edwards syndrome
Correct
Hypoparathyroidism
Sepsis
This child is small for gestational age, with preservation of head size. This
suggests late pregnancy malnutrition. As in this case, such children are at risk of
hypoglycaemia and hypothermia, as they have limited glycogen and brown fat
reserves. Hypothermia increases surfactant consumption, with a risk of
developing surfactant-deficient lung disease. Peeling skin indicates post-maturity.