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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

 

 

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I took the MRCPCH FOP exam last June, I'm a senior house officer currently posted at A&E. I passed with a percentage of 63.7%! The Android app is a lifesaver, I filled the spare time in between seeing patients to do the questions bit by bit. I'm taking the next exam soon and I'm going to use your app to it's fullest! I'm going to recommend this to every aspiring physician I meet

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Based on 2 reviews
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W
Waqar Ibrahim
Super site

Great questions with proper explanations

A
A&E Senior House Officer
App was a lifesaver

I took the MRCPCH FOP exam last June, I'm a senior house officer currently posted at A&E. I passed with a percentage of 63.7%! The Android app is a lifesaver, I filled the spare time in between seeing patients to do the questions bit by bit. I'm taking the next exam soon and I'm going to use your app to it's fullest! I'm going to recommend this to every aspiring physician I meet

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