1. A 4 week old baby is developing well and develops profuse and projectile vomiting after feeds. He has been losing weight and the vomit is described as being non bilious. Hypertrophy of the pyloric sphincter A history of projective vomiting and weight loss is a common story suggestive of pyloric stenosis. The vomit is often not bile stained. Diagnosis is further suggested by hyperchloraemic metabolic alkalosis and a palpable tumour on test feeding. 2. A 1 day old child is born by emergency cesarean section for foetal distress. On examination he has decreased air entry on the left side of his chest and a displaced apex beat. Abdominal examination demonstrates a scaphoid abdomen but is otherwise unremarkable. Congenital diaphragmatic hernia Displaced apex beat and decreased air entry are suggestive of diaphragmatic hernia. The abdomen may well be scaphoid in some cases. The underlying lung may be hypoplastic and this correlates directly with prognosis. Question A 2-day-old baby girl is noted to become cyanotic whilst feeding and crying. A diagnosis of congenital heart disease is suspected. What is the most likely cause? A. Transposition of the great arteries B. Coarctation of the aorta C. Patent ductus arteriosus D. Tetralogy of Fallot E. Ventricular septal defec