2paeds

Question 1

roseola cause

Answer 1

herpes 6

Question 2

DDH RF

Answer 2

oligohydramnios - low level of fluid restricts movement and development of hip

Question 3

newborn hearing test

Answer 3

automated otoacoustic emission test.

Question 4

Asthma in children aged 5-11: first-management →

Answer 4

Asthma in children aged 5-11: first-management → twice-daily paediatric low-dose ICS + SABA as needed

Question 5

when do you not do USS for DDH?

Answer 5

DDH in a child >4.5 months: x-ray is the first-line investigation

Question 6

A 4-year-old boy is brought to the emergency surgery with a fever and a blotchy rash. His mother says the rash was initially just behind his ears but is now all over his body. On examination, you also noticed clusters of white lesions on the buccal mucosa. The child has not been vaccinated.

What complication is this child at risk of?

Answer 6

pneumonia from measles

Question 7

A mother arrives at the paediatric emergency department with her 4-year-old boy. He has a fever and she has noticed raised nodes on his neck. She has given him paracetamol and ibuprofen but his temperature is not reducing. His lips have become extremely dry and cracked and his tongue red and slightly swollen. She has noticed that his feet are also red and puffy now, and he is developing a widespread fine rash. What is the most likely diagnosis?

Answer 7

High fever lasting >5 days, red palms with desquamation and strawberry tongue are indicative of Kawasaki disease

Hand, foot and mouth disease starts with general malaise and pyrexia, however skin lesions in the form of vesicles appear in the mouth.

Question 8

pertussis treatment

Answer 8

Whooping cough - azithromycin or clarithromycin if the onset of cough is within the previous 21 days

Question 9

A 4-hour-old baby boy, born at 36 weeks gestation, is observed to have hypotonia and poor sucking reflex during feeding in the maternity unit. The nursing staff is concerned and has requested an urgent review by the on-call doctor. Initial investigations reveal a blood glucose level of 2.3 mmol/L.

Answer 9

Admit to neonatal unit and give IV 10% dextrose is the correct answer, as the infant presents with symptoms of hypotonia and poor sucking reflex. Pre-term infants are particularly susceptible to neonatal hypoglycaemia.

increase breastfeeding and monitor glucose only if asymptomatic

Question 10

neonatal sepsis most common presentation

Answer 10

grunting and RDS

Question 11

female puberty

Answer 11

breasts –> axillary hair –> menarche

Question 12

sandpaper rash and strawberry tongue

Answer 12

scarlett fever - seizures common

Question 13

Perthes disease in young child

Answer 13

avascularisation of femoral head

Perthes’ disease presenting under the age of 6 years has a good prognosis requiring only observation

Question 14

The most common heart lesion associated with Duchenne muscular dystrophy is

Answer 14

dilated cardiomyopathy

Question 15

A baby born at 34 weeks to a healthy mother, is currently undergoing a check whilst on the ward. The baby appears healthy on general inspection and the mother reports no concerns so far. On examination, a large volume, collapsing pulse is noted, and a heaving apex beat, as well as a left subclavicular thrill. On auscultation of heart sounds, the doctor notes a continuous ‘machinery-like’ murmur.

The doctor arranges an urgent echocardiogram, which confirms her suspected diagnosis. No other abnormalities or defects are demonstrated on the echo.

If the findings persist after one week, what would be the most appropriate initial management?

Answer 15

give indomethacin

Preterm infants with haemodynamically significant patent ductus arteriosus 1 week after birth - give ibuprofen/indomethacin to promote duct closure

Question 16

cause of cleft

Answer 16

maternal anti epileptic use in pregnancy

Question 17

partial seizures at night - diagnosis and Ix result

Answer 17

benign rolandic epilepsy- EEG showing centrotemporal spikes

Question 18

should you start CPR in a 4 year old boy with a pulse of 30bpm?

Answer 18

also start CPR in children who become bradycardic (heart rate < 60 min-1) with signs of inadequate perfusion despite adequate respiratory support’.

15:2 ratio

Question 19

turners heart defects

Answer 19

bicuspid aorta more common that coarctation

Question 20

turners murmur

Answer 20

crescendo-decrescendo murmur on the upper right sternal border which radiates to the carotids.

ejection systolic

Question 21

investigation of choice for reflux nephropathy

Answer 21

Micturating cystography is the investigation of choice for reflux nephropathy

Question 22

Term infant with clinical significant PDA →

Answer 22

transcatheter ΡDA closure (not ibuprofen/indomethacin)

Question 23

bronchiolitis features

Answer 23

fine inspiratory crackles, rhinitis, feeding difficulties, expiratory wheeze, low grade fever

Question 24

when to consider pneumonia in suspected bronchiolitis

Answer 24

Consider a diagnosis of pneumonia if the child has:
high fever (over 39°C) and/or
persistently focal crackles.

Question 25

Trident hands -

Answer 25

achondroplasia -

Question 26

more achondroplasia features

Answer 26

short limbs (rhizomelia), lumbar lordosis and midface hypoplasia.

Question 27

severe vs life threatening asthma

Answer 27

Question 28

A baby born at 35 weeks gestations via normal vaginal delivery is found to be irritable 48 hours after birth and suffers a convulsion. There is no obvious head trauma or swellings. Which one of the following cranial injuries is most likely to have occurred?

Answer 28

intraventricular haemorrhage

Question 29

congenital diaphrgamatic hernia

Answer 29

more common on left, can recur, can get pulmonary HTN, increased risk of sibling having it

Question 30

whooping cough how long to exclude from school after abx

Answer 30

48 hours

Question 31

The initial management in Hirschprung's disease is

Answer 31

rectal washouts/bowel irrigation

Question 32

paeds BLS rescue breaths

Answer 32

5

Question 33

Females in the family all have the disease, and there is an abrupt stop when it is passed through male lineage ?

Answer 33

mitochondrial disease- will not be passed on to children from father

Question 34

murmurs in VSD, aortic coarctation, PDA and pulmonary stenosis

Answer 34

Question 35

when is neonatal blood spot screening performed

Answer 35

Between fifth and ninth day of life

Question 36

boy with very swollen inflamed leg after chickenpox and high temp

Answer 36

Chickenpox is a risk factor for invasive group A streptococcal soft tissue infections including necrotizing fasciitis strep pyogenes

Question 37

maintain vs close congenital heart hole

Answer 37

maintain = prostaglandin E1 close = indomethacin (do like door like closing a door)

Question 38

boy with temp, anaemia, neutropaenia and thrombocytopaenia

Answer 38

ALL - acute lymphoblastic leukaemia Meningitis is a cause of fever and purpura, as seen in this patient. However, you would expect to see neutrophilia in bacterial meningitis, not neutropaenia; therefore, bacterial meningitis is unlikely here.

Question 39

You are asked to review a term neonate on the postnatal wards. On examination of the palate, you notice a white-coloured nodule at the roof of the mouth. This is not interfering with feeding and baby is alert and active. What is the most likely diagnosis?

Answer 39

epsteins pearl

Question 40

what can cause bronchiolitis to be more severe

Answer 40

congenial heart disease

Question 41

You are called by the mother of a 18-month-old boy. He has been unwell with a suspected viral upper respiratory tract infection for the past few days. His mother reports that he has just had a seizure. Three months ago he had a confirmed febrile convulsion following a similar illness. You arrange to see the child that morning. Which one of the following factors should prompt referral to paediatrics?

Answer 41

child still being drowsy 2 hours post seizure

Question 42

2 year old sudden onset bilateral limp next steps

Answer 42

Urgent assessment should be arranged for a child < 3 years presenting with an acute limp - urgent paeds referral not just urgent x ray

Question 43

All breech babies at or after 36 weeks gestation require

Answer 43

USS for DDH screening at 6 weeks regardless of mode of delivery

Question 44

2 main findings in congenital rubella

Answer 44

Congenital rubella sensorineural deafness congenital cataracts

Question 45

A 6-year-old boy is brought to surgery by his mother. For the past 2 months he has been complaining of pain in his shins and ankles at night-time. His symptoms are bilateral he is otherwise well. There is no family history of note. Clinical examination is unremarkable. What is the most likely diagnosis?

Answer 45

growing pains

Question 46

GORD 1st line in bottle vs breast fed

Answer 46

bottle - thickened breast - alginate

Question 47

An 18 month old boy is brought to the emergency room by his parents. He was found in bed with a nappy filled with dark red blood. He is haemodynamically unstable and requires a blood transfusion. Prior to this episode he was well with no prior medical history. What is the most likely cause?

Answer 47

Meckels diverticulum is the number one cause of painless massive GI bleeding requiring a transfusion in children between the ages of 1 and 2 years. NEC is typically seen in the first few weeks of life, whereas Meckel's presents later

Question 48

well child with diarrhoea and vomiting

Answer 48

Introduce oral rehydrating solution Discourage the drinking of fruit juices and carbonated drinks, especially in those at increased risk of dehydration [NICE 2009].

Question 49

You are asked to attend a preterm delivery. The neonate is born at 36 weeks gestation via emergency Caesarean section. The neonate has difficulty initiating breathing and requires resuscitation. They are dyspnoeic and tachypnoeic at a rate of 85 breaths/min. On auscultation of the chest, there is reduced breath sounds bilaterally. Heart sounds are displaced medially. The abdominal wall appears concave. What is the most likely diagnosis?

Answer 49

concave appearance = Congenital diaphragmatic hernia presents with scaphoid abdomen, due to herniation of the abdominal contents into the cleft

Question 50

noonan

Answer 50

webbed neck, pulmonary stenosis, ptosis and short stature. pectus excavatum

Question 51

A 6-year-old girl with cystic fibrosis attends for her routine clinic appointment. She was diagnosed with cystic fibrosis at 3 weeks of age following newborn screening. She has been well with no recent respiratory exacerbations. Her sputum culture has grown Pseudomonas aeruginosa for the first time. She is currently on pancreatic enzyme replacement therapy. What is the most appropriate next step in management?

Answer 51

Commence nebulised colistin and oral ciprofloxacin important to try and eradicate

Question 52

red flag RR

Answer 52

A respiratory rate of >60 per minute (at any age) is a red flag according to the NICE paediatric traffic light system temp over 38 only in children under 3 months

Question 53

unwell child traffic light

Answer 53

Question 54

resp and HR normal observation in infant - 1 week old baby

Answer 54

30-60 breaths per minute is normal, pulse should be 100-160, 37 degrees temp, passing urine and stool regularly

Question 55

infantile colic typically occurs in

Answer 55

infants less than 3 months old

Question 56

jittery and tachypnoeic neonate

Answer 56

neonatal hypoglycaemia - preterm birth is key risk factor

Question 57

what can lead to increased risk of autism

Answer 57

trinucleotide repeat disorder of the X chromosome - fragile X not alcohol consumption

Question 58

haemophilia A inheritance

Answer 58

X linked recessive - all female offspring of affected men will be carriers

Question 59

most likely cause of worsening neurological function in premature infant

Answer 59

intraventricular haemorrhage

Question 60

evidence of bowel sounds in respiratory exam of neonate in respiratory distress ?

Answer 60

diaphragmatic hernie

Question 61

additional vaccines recommended for baby born to south asian parents

Answer 61

BCG vaccine

Question 62

infants with GORD who do not respond to alginates, features of rash diarrhoea

Answer 62

trial of PPI

Question 63

initial management for 5 year old with asthma

Answer 63

twice daily paediatric low dose ICS + SABA management for 5-11 year old

Question 64

TF for DDH

Answer 64

FH, breech, female, firstborn NOT AFRO CARIBBEAN

Question 65

jaundiced and hepatomegaly baby, appetite and growth disturbance. first few weeks of life, mother contracted CMV in pregnancy

Answer 65

biliary atresia