Pre-internship
The harder call — the unwell patient, escalation, prioritisation, prescribing detail, ethics and law. 488 questions.
A five-month-old boy is brought to a regional emergency department at 2 am because he cannot be roused. His respiratory rate is 12 per minute and his pupils are…
Paediatrics · Pre-internship · middle twist
You are the resident covering an after-hours paediatric telephone line. The mother of a two-year-old boy rings about his second day of gastroenteritis. He was r…
Paediatrics · Pre-internship · common
An 18-month-old girl weighing 10.0 kg has had four days of diarrhoea and has been given water and diluted cordial at home. She is lethargic with a doughy feel t…
Paediatrics · Pre-internship · niche
A 10-year-old boy weighing 32 kg is admitted to the ward for observation after an appendicectomy. He is comfortable, normotensive and well perfused, has not vom…
Paediatrics · Pre-internship · middle twist
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 is seen in general practice with a two-day blanching viral rash and is otherwise well. He is eating, playing and having his usual number of wet…
Paediatrics · Pre-internship · niche
An 8-year-old girl with chronic kidney disease is brought in vomiting after missing two dialysis sessions. She is alert and her blood pressure is 128/78 mmHg. S…
Paediatrics · Pre-internship · common
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 9-year-old girl is on day three of treatment for pneumococcal meningitis and has been receiving intravenous sodium chloride 0.9% with glucose 5% at full maint…
Paediatrics · Pre-internship · niche
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 3-year-old inpatient was given 15 mg of oral morphine instead of the prescribed 1.5 mg one hour ago, because a decimal point on the drug chart was misread. He…
Paediatrics · Pre-internship · common
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
An 8-year-old boy who had a right tympanostomy tube inserted last year has a two-week history of an itchy, discharging right ear after swimming lessons. He has…
Paediatrics · Pre-internship · niche
A 5-year-old boy has had a clear runny nose and a dry night cough for four days. He is afebrile and eating normally, and his chest, throat and ears are normal.…
Paediatrics · Pre-internship · common
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 boy with Crohn disease attends a routine clinic review with his mother. He has lost 4 kg in three months and has missed a third of school days thi…
Paediatrics · Pre-internship · common