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Question 1

What is the most common organism found in septic arthritis in young people vs everyone else?

Answer 1

Neisseria gonorrhoeae (esp. if previous sexual health hx)

Staph aureus - most common overall

Question 2

If a pt with COPD exacerbation shows type II resp failure without reaction when on O2 masks what should be changed~?

Answer 2

Start non-invasive ventilation

Question 3

What is the treatment for methotrexate toxicity?

Answer 3

Folinic acid

Question 4

What is Trendelberg’s gait?

Answer 4

Dropping of the unaffected side when walking

• indicates a weak gluteal medius on the opposite side to the drop

Question 5

What paediatric hip conditions are associated with the following age ranges:
- 1-5
- 5-10
- 10-15

Give a rough explanation of each and management

Answer 5

1-5 = missed DDH
- femoral head not fitting in the acetabulum properly
- most will stabilise 3-6months post birth
- pavlik harness in children <4-5mnths and ~surgery after that

5-10 = perthe’s disease
- degenerative condition due to AVN of femoral head
(concerned if short stature)
- <6 yo = observation
- >6yo = surgical management
- aim to keep the femoral head in the acetabulum with casts and braces

10-15 = slipped upper femoral epiphysis (SUFE)
- more common in obese boys
- slip of the femoral head epiphysis postero-inferiorly
- internal fixation

Question 6

What is often the first sign of hip problems in children?

Answer 6

Loss of internal rotation

Question 7

What should be done in every sore knee in children?

Answer 7

Hip examination as well as knee
- even just say that in OSCE

Question 8

What children should get USS of hip post birth?

Answer 8

• 1st degree FH of hip problems in early life
• breech presentation =>36 wks (regardless of birth position)
• multiple pregnancy

Question 9

Match the following type of knee compliants to most likely pathology:
- pain after twisting injury with ‘knee giving way’ and worse on straightening leg/ inability to fully extend leg

• sudden ‘popping’ sound and knee swelling and instability
• knee forced into valgus position (lateral blow) and now unstable in valgus position
• teenage girl pain going downstairs with quad wasting and knee tenderness
• hyperextension injury and paradoxical anterior drawer test

Answer 9

1. meniscal tear
2. ACL
3. medial collateral
4. chondromalacia patellae
5. PCL

Question 10

Jaundice in the first 24hrs post birth?

Answer 10

ALWAYS pathological

• rhesus haemolytic disease
• ABO haemolytic disease
• hereditary spherocytosis
• glucose-6-phosphodehydrogenase

Question 11

Why is it so important to treat excessive bilirubin levels in babies?

Answer 11

Bilirubin can cross the BBB
-> direct damage to CNS -> cerebral palsy, intellectual disability, deafness

Question 12

What is the benefit of blue-light in neonatal jaundice?

Answer 12

Blue light converts unconjugated bilirubin into ISOMERS that can be excreted into bile and urine without conjugation in the liver

Question 13

How long do you expect physiological jaundice of the newborn to last?

Answer 13

Max 10 days

(occurs as high conc. of RBC in neonates that are more fragile and break down more rapidly then normal RBC = increase in bilirubin)

Question 14

Is breastfeeding more or less likely to be associated with neonatal jaundice?

Answer 14

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