Dr Joseph Mizzi

A 4 year old child is being investigated for bowed legs. 1. Interprete the following investigations (normal values in brackets). Calcium 2.15 (2.2 - 2.7) Phospate 1.1 (1.30 - 2.00) ALP 850 (100 - 350) Calcidiol 22 (> 50) Mild hypocalcaemia, significant hypophophataemia, markedly elevated alkaline phosphatase (suggesting increased osteoblastic activity, low vitamin D levels. 2. What is the clinical diagnosis?  Vitamin D deficiency rickets 3. What do you expect the parathyroid hormone level to be? Raised (secondary hyperparathyroidism). Vitamin D deficiency → reduced intestinal calcium absorption Falling calcium stimulates PTH secretion PTH increases bone resorption and renal phosphate excretion This contributes to the low phosphate level and helps maintain serum calcium 4. Name other clinical features which may be present. Delayed growtth Bone pain Muscle weakness  Widening of wrists and ankles Frontal bossing Craniotabes  Rachitic rosary (prominent costochondral j...

An 8 year old child presents with exercise intolerance and syncope. An ECG was done as part of the investiations. 1. Describe the key findings. I will first confirm the name of the patient, date, and note the settings. Atrioventricular (AV) dissociation: P waves and QRS complexes occur independently with no relationship between them. Regular R–R intervals (escape ventricular rhythm), but at a slower rate than P waves. Bradycardia: Ventricular rate is approximately ~50 bpm (or lower for age, depending on the strip) Findings are consistent with third-degree (complete) AV heart block. 2. Name 3 important etiologies to consider. Infectious / inflammatory causes: Myocarditis, Acute rheumatic fever Post-surgical cause: Following repair of congenital heart disease (e.g., VSD, AV canal defects) Congenital / autoimmune causes: Maternal anti-Ro/SSA or anti-La antibodies (congenital heart block) (unlikely to present at 8 years of age). 3. What is management and definitive treatment. Immediate man...

You are given the following investigation results (normal range in brackets):     pH   7.12     PaCO₂   20 mmHg  ( 35–45 mmHg)     HCO₃⁻   7 mmol/L (22–26 mmol/L)     PaO₂   98 mmHg (80–100 mmHg)     BE   −20 mmol/L (−2 to +2 mmol/L) 1. What investigation is this? Arterial blood gas analysis / ABG 2. What is the normal range for pH? 7.35–7.45 3. Interpret these results systematically. Severe acidaemia (pH 7.12) Markedly reduced bicarbonate and BE → metabolic acidosis Low PaCO₂ indicates respiratory compensation Oxygenation is normal 4. What is the overall acid–base diagnosis? Severe metabolic acidosis with respiratory compensation 5. Name four clinical situations in paediatrics that may present with this metabolic derangement. Diabetic ketoacidosis Severe gastroenteritis with dehydration Septic shock / severe sepsis with lactic acidosis Poisoning or toxic ingestion (e.g. sali...

Il-ġidri r-riħ (chickenpox, varicella) hu infezzjoni komuni fit-tfal ikkawżata minn virus (varicella-zoster virus, VZV). Tinxtered faċilment speċjalment jekk it-tfal ikunu flimkien, ngħidu aħna fil-klassi tal-iskola. Normalment il-ġidri hi marda ħafifa imma kultant tkun aktar gravi, b’ħafna ħakk, uġigħ u deni. Ġieli jkun hemm komplikazzjonijiet bħal infezzjoni fil-pulmun, infezzjoni fil-ġilda, u infjammazzjoni fil-moħħ. Waqt it-tqala l-virus jista’ jaffettwa l-iżvilupp tat-tarbija fil-ġuf. Jekk l-omm toħroġ il-ġidri fiż-żmien tat-twelid, it-tarbija tista’ tiżviluppa infezzjoni qawwija ħafna. Tixrid Il-marda tittieħed minn tfal oħra morda bil-ġidri r-riħ u minn adulti li għandhom il-ħruq ta’ Sant'Antnin (shingles). Tixtered mill-arja (għatis jew sogħla), u b’kuntatt mal-ġilda, ħwejjeġ u oġġetti kkontaminati. Il-virus jibda jinxtered minn ġurnata qabel joħorġu l-ewwel ponot u sakemm jinxfu kollha. Sintomi L-ewwel sintomi jibdew bejn għaxart ijiem sa tliet gimgħat minn meta tkun e...

The paediatric viva consists of five 4-minute interviews with different examiners. The stations may include the following: communication, history, a practical, data interpretation, ECG, growth chart, case management, and a video. I trust you will find the following articles helpful as you prepare for the paediatric viva. The most effective way to revise is not only to study the topics but also to practise them actively, ideally with fellow students, taking turns as examiner and candidate, or even with a friend or family member. Speak your answers out loud, listen to yourself, and make sure to time your responses. This will build both your confidence and fluency. Stations History Charts Communication ECG - read ECG in SVT, VT, AV block , and hyperkalaemia; discuss causes and management. Topics Blood gases Rickets Croup Acute Asthma Pulse oximeter Peak flow meter Inhaler and spacer Acute gastroenteritis Breastfeeding Breastfeeding - advantages Formula milk Febrile child ...

Il-pinworms huma dud irqaq, qishom biċċiet ta’ ħajt, li jinfettaw il-musrana. Din l-problema hi komuni ħafna fit-tfal żgħar. Matul il-lejl id-duda toħroġ mit-toqba tal-patata biex tbid. Dan jikkawża skumdita, ugigħ u ħakk u ġieli jqajjem lit-tfal mir-raqda. Madankollu xi wħud ma jkollhom ebda sintomi. Il-bajd jispiċċaw mal-ħwejjeġ ta’ taħt, fil-lożor u fl-idejn (minħabba l-ħakk, speċjalment taħt id-dwiefer), u mill-idejn jispiċċaw ma’ kull ħaġa li jmissu u mal-ikel. Għalhekk huwa faċli li persuni oħra fil-familja jew fil-klassi jkunu infettati billi jikkontaminaw idejhom u jdaħħluhom f’ħalqhom. Kif tkun taf jekk it-tfal għandhomx id-dud? L-ewwelnett mill-ħakk. Id-dud ġieli jidhru qishom ħjut bojod fit-toqba, speċjalment xi sagħtejn wara l-irqad. Il-bajd ma jidhirx, imma t-tabib jista’ jgħidlek biex twaħħal biċċa tape trasparenti mal-patata l-ewwel ħaġa kif iqumu biex jiċċekkja għall-bajd taħt il-mikroskopju. It-trattament jinvolvi mistura jew pilloli (Vermox) li tingħata f’dar...

It-tfal żgħar tista' tagħtihom aċċessjoni minħabba d-deni. L-aċċessjoni tad-deni tiġri meta t-tfal ikollhom bejn sitt xhur u sitt snin, imma hi l-aktar komuni fl-età bejn sena u tmintax-iil xahar. Għalkemm tidher tal-biża’, l-aċċessjoni tad-deni s-soltu tgħaddi fi ftit minuti u mingħajr ebda konsegwenzi. Waqt l-aċċessjoni l-ġisem għall-ewwel jibbies; ftit wara jibdew jiċċaqalqu d-dirgħajn u r-riġlejn bla kontroll. It-tifel jista’ wkoll jitniegħed, wiċċu jsir blu għal ftit ħin, u jintilef minn sensih. Dan kollu jdum ftit minuti. Meta tgħaddi l-aċċessjoni, it-tifel jerġa’ jiġi f’sensih, imma wara jista’ jħossu bin-nagħas u jorqod. Madwar 4% tat-tfal ikollhom aċċessjoni tad-deni fi tfulithom. Hemm ċans akbar li t-tfal ikollhom aċċessjoni tad-deni jekk wieħed mill-ġenituri kellu aċċessjonijiet bħal dawn fi tfulitu. It-tfal li kellhom l-ewwel aċċessjoni tad-deni għandhom 30% ċans li f’xi żmien jerġa’ jkollhom aċċessjoni oħra. It-tfal li kellhom aċċessjoni tad-deni ordinarja jiżvilluppaw...