MLA Domain 5 · Presentation

Faltering growth (failure to thrive)

8 conditions in Finalist present this way. Work down the list and ask what would separate each one from the next — that discriminator is the exam question.

classic presentation · 1

Faltering growth

Signs of neglect/abuse; severe malnutrition; organic red flags (chronic diarrhoea, recurrent infection, dysmorphism)

recognised feature · 7

Atrioventricular septal defect (AVSD)

Heart failure + early pulmonary hypertension (complete AVSD) → timely surgical repair

Biliary atresia

Any conjugated neonatal jaundice — refer urgently; the window for Kasai is narrow

Coeliac disease

Severe malnutrition/failure to thrive; do NOT start a gluten-free diet before testing (false negatives)

Cow milk protein allergy

Anaphylaxis (IgE); faltering growth

Cystic fibrosis

Pseudomonas colonisation, haemoptysis, distal intestinal obstruction syndrome, CF-related diabetes

Patent ductus arteriosus (PDA)

Large PDA with heart failure (especially preterm) → treat/close

Ventricular septal defect (VSD)

Heart failure in infancy (large VSD) → diuretics + surgical closure