Paediatrics Flashcards

A 12-month-old infant presents with pallor, irritability, and a haemoglobin of 7 g/dL. Peripheral smear shows microcytic hypochromic anaemia with target cells. HPLC shows HbS 80% and HbF 15%. What is the diagnosis?

Answer: Sickle cell disease (HbSS)

HbS of 80% with HbF 15% on HPLC is diagnostic of sickle cell disease (homozygous HbSS). Sickle cell disease is prevalent in Saudi Arabia, particularly in the Eastern Province and southwestern regions. HbF levels above 10% in SCD are common in the Saudi variant.

A 3-year-old child presents with a limp and refusal to bear weight after an upper respiratory infection. Hip X-ray is normal. What is the most likely diagnosis?

Answer: Transient synovitis (irritable hip)

Transient synovitis is the most common cause of atraumatic hip pain in children aged 3-8 years, typically following a viral upper respiratory infection. The child may limp or refuse to bear weight. X-ray is usually normal, and the condition is self-limiting.

A child is brought to the emergency department with burns. The pattern shows clearly demarcated burns on both feet in a stocking distribution with no splash marks. What should be suspected?

Answer: Non-accidental injury (child abuse)

Symmetrical, sharply demarcated burns in a stocking or glove distribution without splash marks are highly suspicious for immersion burns caused by non-accidental injury. This pattern occurs when a child is held in hot water. Mandatory reporting to child protection services is required.

A breastfed infant develops prolonged jaundice beyond 14 days of life. The infant is well, gaining weight, and passing normal stools. Total bilirubin is 200 μmol/L (unconjugated). What is the most likely cause?

Answer: Breast milk jaundice

Breast milk jaundice is a common cause of prolonged unconjugated hyperbilirubinaemia in well, thriving breastfed infants. It is benign and self-limiting, typically resolving by 12 weeks. Importantly, conjugated hyperbilirubinaemia must be excluded to rule out biliary atresia.

According to WHO growth standards used in Saudi Arabia, a child whose weight-for-height Z-score is below -3 SD is classified as having what degree of malnutrition?

Answer: Severe acute malnutrition

According to WHO growth standards adopted by SCFHS, a weight-for-height Z-score below -3 SD indicates severe acute malnutrition (SAM), which requires urgent medical and nutritional intervention including therapeutic feeding and monitoring for complications.

A 10-year-old child presents with fatigue, bone pain, hepatosplenomegaly, and pancytopenia. Peripheral blood smear shows blast cells with positive PAS staining. What is the most likely diagnosis?

Answer: Acute lymphoblastic leukaemia (ALL)

Acute lymphoblastic leukaemia (ALL) is the most common childhood malignancy. PAS-positive blast cells are characteristic of lymphoblasts. ALL presents with bone marrow failure symptoms (anaemia, bleeding, infection) and organ infiltration (hepatosplenomegaly).