Anurag discussed details of a child he looked after 2 days ago.

A 6-7 year old child admitted with chest infection. She was diagnosed soon after birth with cystic fibrosis presenting with meconium ileus, delayed passage of stools confirmed by IRT. Parents could not afford the treatment and child was seen intermittently.

On presentation she was febrile, small, failing to thrive, deeply cyanosed 55% saturation – improved with O2 to 100% saturation. Lung infiltration and dilated cardiac outline. No hepatomegaly. She was treated appropriately with positive pressure ventilation but died 24 hours later. Results came as Covid 19 +ve.

Carrying on with the theme we discussed optimum care for children with cystic fibrosis: MDT care, physiotherapy, regular medication – pancreatic enzymes, antibiotics, prevent colonisation.
Monitor for growth failure, diabetes. Annual blood tests.

Learning points:

  • Good to see ‘all’ the findings of a young person with CF.
  • Pubertal delay, clubbing, diabetic monitor and insulin pump, Hickman line.
  • If ‘sure’ of diagnosis – mention it and then give supporting signs.
  • Interpret the signs with reference to child you have examined.
  • Know the support available in UK and put in perspective with local facilities.
  • All the respiratory exam can be done in 5 minutes
  • If one decides to be ‘choosey’ – may run the risk of disorganised examination
  • Examination technique get 2 marks at each clinical station.

Add any other points I may have missed or to add your comment.
Anil Garg