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hasn’t been eating well. He was born by normal vaginal delivery at 37 weeks, and was
diagnosed with Down Syndrome. The mother noticed that Sylvian had a runny nose with
lots of coughing, slightly milky vomits and runny stools but she couldn’t be bothered to take
him to the GP last week. She did note that he has been appearing more tired as well. He has
been eating less and more slowly even though she has been trying to feed him more than
usual. He was breast-fed and is now on formula. Sylvian’s mother has depression that is not
managed and throughout the antenatal course, she has regularly failed to attend
appointments and receive appropriate investigations. Sylvian’s mother is a part-time worker
and is taking care of Sylvian alone as the father has chosen not to be involved in the family.
Immunisation is not up to date.
According to his growth chart, Sylvian is charting consistently at 40th percentile for his height
and head circumference, but his weight has crossed over from 60 th to 34th centile over the
past few weeks.
a. What are 4 possible causes of this change in the growth chart and provide 2 features
on the history that may support it? (8 marks).
b. For 2 of the differentials listed, provide 2 examination findings that may support it (2
marks).
c. For 2 of the differentials listed, provide investigations and the findings that would
definitively confirm the diagnosis (4 marks).
One of the investigations confirmed that Sylvian a moderate-size ventricular septal defect.
A follow-up appointment was made with the paediatric cardiologist but Sylvian’s mother did
not attend. Sylvian’s mother explains that she finds motherhood stressful and blames her
son’s Down Syndrome as for the reason why she doesn’t have a close relationship with her
son like her friends do with their own kids. She has recently lost the motivation to go to
work, and was consequently fired from her job. She has not been eating as much and has
been more tearful than usual.
e. List 2 other possible health professionals that may be involved in managing Sylvian’s
development (2 marks).
____________
Sylvian is an 7-month-old boy who was brought in to the hospital by his mother because he
hasn’t been eating well. He was born by normal vaginal delivery at 37 weeks, and was
diagnosed with Down Syndrome. The mother noticed that Sylvian had a runny nose with
lots of coughing slightly milky vomits and runny stools but she couldn’t be bothered to take
him to the GP last week. She did note that he has been appearing more tired as well. He has
been eating less and more slowly even though she has been trying to feed him more than
usual. He was breast-fed and is now on formula. Sylvian’s mother has depression that is not
managed and throughout the antenatal course, she has regularly failed to attend
appointments and receive appropriate investigations. Sylvian’s mother is a part-time worker
and is taking care of Sylvian alone as the father has chosen not to be involved in the family.
Immunisation is not up to date.
According to his growth chart, Sylvian is charting consistently at 40th percentile for his height
and head circumference, but his weight has crossed over from 60 th to 34th centile over the
past few weeks.
a. What are 4 possible causes of this change in the growth chart and provide 2 features
on the history that may support it? (8 marks).
b. For 2 of the differentials listed, provide 2 examination findings that may support it (2
marks).
Coeliac disease – dermatitis herpetiformis, enamel hypoplasia, muscle atrophy,
subcutaneous fat loss, pallor, rickets.
Ventricular septal defect- Tachypnoea, harsh systolic murmur heard at the LLSB.
c. For 2 of the differentials listed, provide investigations and the findings that would
definitively confirm the diagnosis (4 marks).
One of the investigations confirmed that Sylvian a moderate-size ventricular septal defect.
A follow-up appointment was made with the paediatric cardiologist but Sylvian’s mother did
not attend. Sylvian’s mother explains that she finds motherhood stressful and blames her
son’s Down Syndrome as for the reason why she doesn’t have a close relationship with her
son like her friends do with their own kids. She has recently lost the motivation to go to
work, and was consequently fired from her job. She has not been eating as much and has
been more tearful than usual.
e. List 2 other possible health professionals that may be involved in managing Sylvian’s
development (2 marks).
Subsequent investigations localised Staph Aureus from the skin. Amy looks generally well and is afebrile. She
appears well hydrated and all her observations are within normal limits. She has several flaccid, transparent,
cloudy,fluid filled bullae of varying size. Several have ruptured leaving a shallow moist eroisions. There are no
bullae on her face All other examinations are unremarkable. What is the diagnosis? (1 mark)
If SSSS was to develop in this child, what is the complication which will be the most important to watch out for in
this neonate? (1 mark)
- Hypothermia as she loses her skin. Hydration becomes a problem.