cases

Question 1

first step management in pnumothorax

Answer 1

insert large bore cannula into the 2nd intercostal space, mid clavicular line on the side of pneumothorax

Question 2

second step management of pneumothorax

Answer 2

insert a chest drain into the 4th or 5th intercostal space in the mid axillary line

Question 3

what definite management would possibly prevent further recurrence

Answer 3

refer for pleurodesis

Question 4

A child presents with infections at 4 months of age. Otherwise is developing normally and is achieving milestones. Has been previously well. After supportive treatment, the child goes on to develop normally and does not suffer repeated severe or unusual infections. Once recovered, their blood tests show no abnormality, in particular their differential white cell count is unremarkable.

Answer 4

transient hypogammaglobulinaemia of infancy

Question 5

A 3 month old boy presents with infections. There is a family history of early infant death, and his mother is incredibly worried. He has been previously well, and was breastfed exclusively for the first two months. He now has diarrhoea and is crossing centiles on the paediatric growth charts. Blood samples are taken, and his differential WCC shows a low T cell and raised B cell count.

Answer 5

Severe Combined Immunodeficiency

Question 6

A 15 day old baby is brought in by her parents severely unwell. She is febrile and difficult to settle. On examination she has extensive oral ulcers and you note she has lost more weight than you would expect for a newborn. Her blood results show a low neutrophil count. Genetic tests reveal the cause of her illness is an autosomal recessive form of primary immunodeficiency.

Answer 6

Kostmann syndrome