MEQ

Part 1

A 1- month- old boy was admitted to paediatric ward for rapid breathing. He was
unwell since a week prior to presentation when he started to developed cough.
Cough was described as short intermittent bouts associated with clear nasal
discharge. Three days later he was noted to have low to moderate grade fever
and he was brought to see a general practitioner who prescribed him with syr
paracetamol and cough mixture. Despite medication, his symptoms worsen, and
he started to develop rapid breathing. He was born full term via spontaneous
vaginal delivery with a birth weight of 3.2 kg.

On examination, his weight was 3.8 kg and no dysmorphic features noted. The
temperature was 38.5°C, respiratory rate was 60/breaths min and the oxygen
saturation were 90% on air. His pulse was 180 beats per minute and the blood
pressure was 80/50 mmHg. There were subcostal and intercostal recessions.
The apex beat was located at the left 5​th intercostals space about 1cm lateral to
the mid-clavicular line. A pansystolic murmur of grade 3/6 was heard all over the
precordium but loudest at the lower left sternal edge. A loud second heart sound
was also heard. There were generalise crepitation over both lung fields. The
liver was palpable, 3 cm below the right subcostal margin.

Q1 State ​FIVE​ additional information that you would like to ask in the
history (5 marks)

Q2 State the most likely diagnosis (4 marks)