A placid 4-week-old formula-fed baby has vomited feeds since the first week of life. Her maternal grandmother is convinced that the baby is ill. The mother is also concerned but says that the baby feeds well. You confirm that she has gained weight normally, and find no clinical abnormality. You SHOULD
(A) reassure the mother and tell her to ignore anyone who says the child is ill.
(B) explain that the baby probably has gastro-oesophageal reflux.
(C) arrange barium swallow and meal.
(D) arrange suprapubic aspiration of urine for microscopy and culture.
(E) advise that the formula be diluted to make it more digestible.
A 67-year-old man presents with a history of progressive dysphagia and hoarseness over the preceding 24 h. On examination there is a right Horner syndrome and the right side of the palate does not elevate on phonation. The right gag reflex is absent and the patient cannot produce an explosive cough. These signs and symptoms are MOST LIKELY due to which one of the following?
(A) A left capsular haemorrhage.
(B) A meningioma at the foramen magnum.
(C) Thrombosis of the left posterior inferior cerebellar artery.
(D) A left cerebello-pontine angle tumour.
(E) A right-sided brain stem infarction.
A previously well boy aged 18 months presents with a 24 h history of cough and wheeze and has a respiratory rate of 35/min. There is a family history of asthma and allergy. Examination shows a boy who is generally well but he has softer breath sounds over the left hemithorax. There are bilateral wheezes, more marked on the left. The APPROPRIATE MANAGEMENT is
(A) give nebulised salbutamol 4 hourly.
(B) refer for physiotherapy.
(C) give amoxycillin.
(D) arrange inspiratory and expiratory chest x-rays.
(E) admit to hospital and nurse in 30% oxygen.
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