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October 2023 Exam
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Demo Question
A 3-year-old boy is brought to A&E by ambulance, having been found unconscious by his mother. He has had a cold for the past 3 days. He was born at term by SVD weighing 2.7kg and was discharged home the following day. He has been seen in A&E on 3 previous occasions with minor injuries. He is on no regular medications and has no known allergies. He has received primary immunisations. Mother is single but has a partner. On examination his nose is crusty. His heart rate is 95/min, blood pressure 80/60, respiratory rate 14/min and tympanic temperature 36.8C. Ear and throat examinations are normal. He groans in response to sternal rub. He has pinpoint pupils. Plantars are downgoing. Oxygen saturations are 88% in air, but improve to 98% with face mask oxygen.
What is the most likely diagnosis?
Febrile convulsion secondary to upper respiratory infection
Encephalitis
Meningitis
Opiate ingestion
Diazepam ingestion
Key Learning Point
Know the common causes of poisoning in children and adolescents including safeguarding implications
Explanation
The picture is of a toddler with coryza, who is found unconscious and unresponsive. The triad of hypoventilation, decreased conscious level and pinpoint pupils makes opiate ingestion most likely. Further inquiry should be made about the family circumstances, and in particular whether mother is a drug abuser or is on a methadone programme. Confirmation of either has safeguarding implications. Loperamide overdose is another possibility.
[FEmgM13] Know the common causes of poisoning in children and adolescents including safeguarding implications
