Among the given options, psoriasis is not associated with hypertrichosis.The causes of hypertrichosis include:- Drugs: minoxidil, ciclosporin, and diazoxide.- Congenital hypertrichosis lanuginosa and congenital hypertrichosis terminalis.- Porphyria cutanea tarda- Anorexia nervosa

A transverse lie is a common malpresentation. It occurs when the fetal longitudinal axis is perpendicular to the long axis of the uterus. The location of the spine determines if the foetus is back up (the curvature of the spine is in the upper part of the uterus) or back down (the curvature of the spine is in the lower part of the uterus).Good antenatal care, ECV, and elective caesarean section are the mainstay of the management.Spontaneous delivery of a term foetus is impossible with a persistent transverse lie and, in general, the onset of labour is an indication for the lower segment caesarean section (LSCS) in a case of a transverse lie.

Cystic fibrosis is a genetic disease that interferes with the normal development of the child. It manifests with recurrent episodes of pneumonia accompanied by coughing, wheezing and dyspnoea. The appetite is normal but weight gain seems difficult. This condition also affects bowel habits with repeated gastrointestinal infections. The gold standard for the diagnosis is considered the sweat test which reveals abnormally high levels of Cl-.

Pyloric stenosis affects infants, typically in the second to fourth weeks of life and is caused most commonly by hypertrophy and thickening of the pylorus. It usually presents with projectile vomiting and failure to thrive. The infant usually has a normal appetite. Features include: ‘projectile’ vomiting, typically 30 minutes after a feed, constipation and dehydration may also be present and a palpable mass may be present in the upper abdomen.

The hypothalamus and pituitary gland control how much testosterone the testes produce and secrete. The hypothalamus sends a signal to the pituitary gland to release gonadotrophic substances (follicle stimulating hormone and luteinizing hormone). Luteinizing hormone (LH) stimulates testosterone production.

Ipecac, or syrup of ipecac (SOI), is a medication once used to induce vomiting. Its medical use has virtually vanished, and it is no longer recommended for routine use in toxic ingestion. The abuse of SOI as a purgative in eating disorders, however, is increasing. Ipecac has a high safety profile. Common side effects include prolonged vomiting (greater than 1 hour), lethargy, somnolence, diarrhoea, fever, irritability. More severe complications can consist of aspiration pneumonia, Mallory-Weiss tears, pneumomediastinum, and gastric rupture.The abuse of syrup of ipecac by patients with major eating disorders have been shown to have toxic effects on the skeletal and cardiac muscle.

The baby has duodenal atresia.Presenting symptoms and signs are results of high intestinal obstruction. Duodenal atresia is typically characterized by the onset of vomiting within hours of birth. While vomitus is most often bilious, it may be nonbilious because 15% of defects occur proximal to the ampulla of Vater. Occasionally, infants with duodenal stenosis escape detection of an abnormality and proceed into childhood or, rarely, into adulthood before a partial obstruction is noted. Nevertheless, one should assume any child with bilious vomiting has a proximal GI obstruction until proven otherwise, and further workup should be begun expeditiously.congenital duodenal atresia is one of the more common intestinal anomalies treated by paediatric surgeons, occurring 1 in 2500-5000 live births. In 25-40% of cases, the anomaly is encountered in an infant with trisomy 21 (Down syndrome).

The CSF picture in bacterial meningitis has the following characteristics: several polymorphs, cells, protein that is maximum 5g/l, a few lymphocytes and glucose that accounts for the two thirds of the blood level.

The most appropriate step in this patient would be to admit the patient for enteral rehydration via a nasogastric tube.Enteral rehydration:Oral rehydration is the most preferred way of rehydrating children. If a child is not tolerating small-frequent-feeds, then nasogastric rehydration is an underused next best step. The fluid can be run through a continuous pump so that it is better tolerated. Note:Intravenous fluids are effective but can have profound effects on the serum electrolyte balance if not monitored closely. Most children will tolerate fluids in an emergency department, but failure to take fluids orally is not an indication for intravenous therapy.

The pituitary gland synthesizes and releases various hormones that affect several organs throughout the body.The pituitary gland is entirely ectodermal in origin but is composed of 2 functionally distinct structures that differ in embryologic development and anatomy: the adenohypophysis (anterior pituitary) and the neurohypophysis (posterior pituitary).The anterior pituitary has three main regions:Pars distalis: Where the main hormone production occursPars tuberalis: Joins the pituitary stalk arising from the posterior pituitary glandPars intermedia: Divides the anterior and posterior parts of the pituitary gland. The pars distalis forms the majority of the adenohypophysis and resembles a typical endocrine gland.

Most individuals with eating disorders do not receive treatment. The treatment gap may involve individuals’ attitudes about accessing various types of treatment, as well as perceived barriers to seeking treatment. Therapies to be considered for the psychological treatment of anorexia nervosa include cognitive analytic therapy (CAT), cognitive behaviour therapy (CBT), interpersonal psychotherapy (IPT), focal psychodynamic therapy and family interventions focused explicitly on eating disorders.The first step is an evidence-based self-help programme. Antidepressants may be helpful for patients with substantial concurrent symptoms of depression, anxiety, obsessions, or certain impulse disorder symptoms. They may be particularly good for patients who have not benefited from or had suboptimal response to suitable psychosocial therapy or who have a chronic, difficult course in combination with other treatments.Acute pharmacologic treatment of anorexia nervosa is rarely required. However, vitamin supplementation with calcium should be started in patients, and although oestrogen has no established effect on bone density in patients with anorexia nervosa, oestrogen replacement (i.e., oral contraceptives) has been recommended for the treatment of osteopenia. Note: Oestrogen should not be used in children (due to premature fusion of the bones).

Among the treatment options provided, the most appropriate would be prednisolone 1-2 mg/kg.Other options:- Dexamethasone 0.15 mg per kg is the correct dose based on new trials and BNF guidance.- Inhaled budesonide 2mg would be a more appropriate dose.- Nebulised adrenaline may also be used.Croup:Laryngotracheobronchitis caused most commonly by parainfluenza virus. It most commonly affects children between 6 months to 3 years.Seasonal peaks: Most prevalent in autumn and spring.It starts as viral URTI then progresses to barking cough and a hoarse cry. Stridor and respiratory distress may occur. The illness can last from two days to 2 weeks.Relevant differential diagnoses include epiglottitis (the child will be septic with high temp and drooling) and inhaled foreign body.All children with moderate/severe croup should be given one dose of oral dexamethasone.Further doses may be needed if children have rebound symptoms.

The most overt phenotypic features of Klinefelter syndrome are caused by testosterone deficiency and, directly or indirectly, by unsuppressed follicle-stimulating and luteinizing hormones. Affected men typically have (in decreasing order of frequency): infertility, small testes, decreased facial hair, gynecomastia, decreased pubic hair, and a small penis. Because of their long legs, men with Klinefelter syndrome often are taller than predicted based on parental height. Body habitus may be feminized. In childhood, when there is a relative quiescence in the hormonal milieu, ascertainment of the syndrome may be difficult because the effects of hypogonadism (i.e., small external genitalia and firm testes) may be subtle or not present at all.

Acute epiglottitis is a life-threatening disorder with serious implications to the anaesthesiologist because of the potential for laryngospasm and irrevocable loss of the airway. There is inflammatory oedema of the arytenoids, aryepiglottic folds and the epiglottis| therefore, supraglottitis may be used instead or preferred to the term acute epiglottitis.Acute epiglottitis can occur at any age. The responsible organism used to be Hemophilus influenzae type B (Hib), but infection with group A b-haemolytic Streptococci has become more frequent after the widespread use of Hemophilus influenzae vaccination. The typical presentation in epiglottitis includes acute occurrence of high fever, severe sore throat and difficulty in swallowing with the sitting up and leaning forward position in order to enhance airflow. There is usually drooling because of difficulty and pain on swallowing. Acute epiglottitis usually leads to generalized toxaemia. The most common differential diagnosis is croup and a foreign body in the airway. A late referral to an acute care setting with its serious consequences may result from difficulty in differentiation between acute epiglottitis and less urgent causes of a sore throat, shortness of breath and dysphagia.

At least seven episodes in the previous year, five episodes in each of the previous two years, or three episodes in each of the previous three years are indications for tonsillectomy. Antibiotics should be administered in the conventional dosage for proved or suspected streptococcal episodes. For now the child should be treated on a case by case basis.

Based on the clinical scenario provided, this patient most probably has impacted gall stones. Gall stones in children can be caused by haematological diseases such as sickle cell anaemia and thalassemia. Cholesterol stones are also becoming more prevalent. A dilated common bile duct (> 10mm in adults) suggests gall stone impaction. The presence of pyrexia indicates cholecystitis.

Perforated appendices are common in children as it is more difficult to surgically assess an unwell child due to poor localisation of abdominal pain, and their inability to express discomfort. They are therefore prone to a greater risk of post operative complications including would infections, intra abdominal fluid collections, and chest infections. In the above scenario the spiking temperature points to an abscess, which characteristically presents with a swinging temperature. The fever is unlikely due to bacterial resistance as blood tests performed post surgery would have indicated any resistance, and a UTI is also unlikely since the child is already on antibiotics. As his chest is clinically clear, a severe chest infection may be ruled out, leaving intra-abdominal collection as the most likely explanation.

CF is inherited in an autosomal recessive manner.This means that to have CF, a person must have a mutation in both copies of the CFTR gene in each cell. People with CF inherit one mutated copy of the gene from each parent, who is referred to as a carrier.CF carriers can pass their copy of the CFTR gene mutation to their children. Each time two CF carriers have a child together, the chances are: 25 percent (1 in 4) the child will have CF50 percent (1 in 2) the child will be a carrier but will not have CF25 percent (1 in 4) the child will not be a carrier of the gene and will not have CFThis male’s parents are obligate carrier because he has a sibling with CFSo the chances he is a carrier too are 2 in 3The risk of having an affected child is the chance of both himself and his partner being carriers: (2/3 × 1/25 = 2/75) × 1/4 = 1/150.

Immunity against mumps develops over a long time. There is nothing to be done except to proceed with the usual vaccination schedule.

The most probable lesion in the patient is a dermoid cyst.Rationale:Dermoid cysts are embryological remnants and may be lined by hair and squamous epithelium (like teratomas). They are often located in the midline and may be linked to deeper structures resulting in a dumbbell shape to the lesion. Complete excision is required as they have a propensity to local recurrence if not excised.Note:Desmoid tumours are a different entity entirely. These lesions most commonly develop in ligaments and tendons. They are also referred to as aggressive fibromatosis and consist of dense fibroblastic lesions (resembling scar tissue). They should be managed in a similar manner to soft tissue sarcomas.

Based on the clinical scenario provided, the most probable nerve injured in this patient would be the trochlear nerve. The trochlear nerve has a relatively long intracranial course, and this makes it vulnerable to injury in head trauma. Head trauma is the most frequent cause of acute fourth nerve palsy. A 4th nerve palsy is the most common cause of vertical diplopia. The diplopia is at its worst when the eye looks medially which it usually does as part of the accommodation reflex when walking downstairs.

Reed-Sternberg cells are classically associated with Hodgkin lymphoma.Classical diagnostic Reed-Sternberg cells are large (15 to 45 micrometres), have abundant slightly basophilic or amphophilic cytoplasm and have at least two nuclear lobes or nuclei. Diagnostic Reed-Sternberg cells must have at least two nucleoli in two separate nuclear lobes. The nuclei are large and often rounded in contour with a prominent, often irregular nuclear membrane, pale chromatin and usually one prominent eosinophilic nucleolus, with perinuclear clearing (halo), resembling a viral inclusion.

The baby most probably has dystrophic epidermolysis bullosa, a primarily autosomal dominant disorder associated with keratin 5 and 14 defects. Initial management consists of supportive measures such as protecting the skin.

A 10 year old child, with a history of URTI and haematuria, presents a picture consistent with a diagnosis of IgA nephropathy. This condition can present with proteinuria and generalized swelling. However, an important differentiating point from rapidly progressive GN is the duration. IgA nephropathy is usually <10 days (commonly 4-5 day history of infection).

Scabies is a dermatological condition caused by infestation of the Sarcoptes Scaibie. The tiny mite, often unseen by the naked human eye, is able to burrow into the stratum corneum where it lays its eggs, causing irritation and a rash related to the immune response against the mite and its eggs, saliva and faeces. On examination, the pathognomic small burrows are often seen on the skin along with small red papules and scratch marks| granulomatous nodules may also be seen especially in darker skin types. Other clinical subtypes such as bullous, and Norwegian (crusted) also exist. Common areas of infection include the hands, wrists, and the interdigital spaces. Infestation can also occur on the genital area, the buttocks, feet, ankles, flexor surfaces. First line treatment is with permethrin 5% dermal cream. It is important that all members of the household are also treated at the same time, and that contaminated bedding, clothes and furniture is adequately disinfected. Scabies is usually associated with overcrowded conditions.

Based on the presentation, the patient is probably a case of Crohn’s disease. The first-line treatment of Crohn’s disease is exclusive enteral nutrition.Exclusive enteral nutrition (EEN)This involves drinking a protein-based formula exclusively for 6–8 weeks. It has been shown to have superior mucosal healing when compared with steroids. Furthermore, it is nutritionally advantageous when compared to steroids and does not have the side-effect profile of steroids.Other options:- Intravenous steroids: This is the first-line treatment for ulcerative colitis (UC) or Crohn’s disease if there is rectal disease (which is not the case here). Side-effects include adrenal suppression, behavioural effects, osteopenia and changes in adipose tissue distribution.- Oral steroids: This can be used if EEN is not possible. However, the side-effect profile is less favourable and is not as effective concerning mucosal healing.- Parental nutrition and surgery: They may be occasionally required in severe cases that have failed first-line therapy.

Thyroglossal cyst is the most common congenital thyroid anomaly which is clinically significant and affects women more than men. It is a vestigial remnant of developing thyroid. Although the thyroglossal cyst can develop anywhere along the thyroglossal duct, the most common site is in the midline between the isthmus of thyroid and hyoid bone, or just above the hyoid. Thyroglossal cysts are also associated with ectopic thyroid tissue. Clinically, the cyst moves upward with protrusion of the tongue. Rarely, the persistent duct can become malignant (thyroglossal duct carcinoma) where the cancerous cells arise in the ectopic thyroid tissue that are deposited along the duct. Exposure to radiation is a predisposing factor.

The most common organism responsible for tinea capitis is Trichophyton tonsurans.Tinea is a term given to dermatophyte fungal infections. There are three types of tinea, depending on what part of the body is infected:- Tinea capitis – scalp- Tinea corporis – trunk, legs or arms- Tinea pedis – feetTinea capitis (scalp ringworm):It is a cause for scarring alopecia mainly seen in children.If untreated, it can form a raised pustular, spongy/boggy mass called a kerion.The most common cause of tinea capitis in the UK and the USA is Trichophyton tonsurans.Tinea can also be caused by Microsporum canis acquired from cats or dogs.The diagnosis of tinea capitis and identification of the organism is possible from the skin lesions:- Scalp scrapings and Potassium hydroxide (KOH) mounts.- Wood’s lamp: Microsporum canis produces a green fluorescence under Wood’s lamp examination.Treatment: – Oral antifungals: terbinafine for Trichophyton tonsurans infections.- Griseofulvin for Microsporum infections. – Topical ketoconazole shampoo is recommended for the first two weeks to limit the transmission of the infection.

One of the most common congenital viral infections is cytomegalovirus infection. It is caused by herpesvirus type 5. The clinical features include failure to thrive, intellectual disability, epilepsy, and microcephaly. The most common clinical complication is sensorineural deafness. The drug of choice for the treatment of neonatal CMV infection is ganciclovir, an anti-viral drug that has shown to prevent deafness.

Asthma patients have an increased risk of developing complications like pneumonia or collapsed lung. A clear visualization of the lungs through a CXR will define the management necessary for this patient.