1.
A 14-month-old baby girl is brought to the outpatient clinic as her parents are concerned about her size. She is on the 2nd centile for weight and height and head circumference. She was born on the 2nd centile. She is taking cow’s milk and is fully weaned, her stool is normal and examination unremarkable. Her parents are concerned as they are both short and do not want her to be small when she is older. Which of the following is the most likely cause of her size?
- Constitutionally small
- Cow’s milk protein enteropathy
- Hypothyroidism
- Growth hormone deficiency
- Skeletal dysplasia
Constitutionally small. This baby is following the centile she was born on and has small parents. There is no suggestion of any organic illness and she is healthy. Some parents request treatment to increase height but the use of growth hormone is restricted to a few very specific indications.
2.
A 15-year-old boy presents to hospital with malaise, fever and mild jaundice over the last week. He says two other girls at his school have the same symptoms following a recent ski trip to France. On examination he has tender hepatomegaly and cervical lymphadenopathy. What is the most likely cause of his illness?
- Acute myeloid leukaemia
- Leptospirosis
- Hepatitis A infection
- Non-Hodgkins lymphoma
- Epstein–Barr infection (EBV)
Epstein–Barr infection (EBV). The combination of lymphadenopathy, fever and malaise suggests EBV, also called glandular fever. It is known as the kissing disease as it can be passed from person to person and occurs in teenagers. Hepatomegaly is common and contact sports should be avoided until recovery.
3.
A 6 week old baby is referred by the health visitor as she has only just regained her birth weight. She is being fed with formula milk and her stools are normal. On examination she appears thin but otherwise normal. She is admitted to the ward and fed by the nursing staff for a week as her mother is readmitted with an infection. She demonstrates excellent weight gain during this period. What is the most likely cause for her initial poor weight gain?
- Cow’s milk protein intolerance
- Gastro-oesophageal reflux
- Cystic fibrosis
- Inadequate intake/neglect
- Urinary tract infection
Inadequate intake/neglect. There is no suggestion of an organic illness in the history. The fact that the infant gained weight quickly when adequate intake was offered makes previous inadequate intake likely. This may have been due to lack of understanding of the needs of the baby or neglect but it needs thorough assessment before discharge.
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