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Flashcards in Diagnosis- Paediatrics Deck (8)
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1
Q

You follow the consultant pediatrician on his call out to A+E. Upon arrival you see a distressed mother who explains her 5M had rapid onset high temperature and noisy breathing. When you inspect the child, you see him drooling a lot of saliva as he leant forward with his neck extended while seated. The consultant, asks you what likely x-ray sign will be present on this boy.

a) Thumb sign
b) Steeple sign
c) Target sign
d) Sign of foreign body
e) Cardiomegaly

A

a)Thumb sign

b) Steeple sign – this is a CXR sign for croup which presents with stridor and a barking cough (that’s worse at night), croup is caused by parainfluenza; it is treated with singe dose of oral dexamethasone or prednisolone along with admission in most cases
c) Target sign – US presentation of intussusception
d) Sign of foreign body – doesn’t explain fever at presentation
e) Cardiomegaly

2
Q

You walk into the pediatric consultant’s room and see him filling out a sheet titled Alvarado score. He then asks you what is the most common cause for pediatric patient presenting with elevated CRP and WBC and rovsing sign?

a) Fecaliths
b) Fecal stasis
c) Lymphoid tissue hyperplasia
d) Tumors
e) Abdominal injury

A

a) Fecaliths
b) Fecal stasis

c)Lymphoid tissue hyperplasia

d) Tumors
e) Abdominal injury

3
Q

A young boy presents for an echo to check for coronary aneurysms due to a previous illness. You take a collateral history from the boy’s father who attended with him. He explains how his son fell very ill and was resistant to all the ”temperature tablets” given by the doctors. The father explains how his son also had a rash and some other swellings. He explains his son was given special drugs through an IV and given antiplatelet drugs just like his dad. What is the most likely condition that the child had?

a) Rubeola
b) Rubella
c) Roseola infantum
d) Kawasaki
e) Scarlett fever

A

a)Kawasaki

4
Q

A 2F comes into the GP. Her mother explains that her daughter has been acting strange recently. She states she has not been listening following commands like ‘give it to mummy’ which she previously did. Her mother also explains how often she needs to call her daughter a few times before she turns to her. When examining the child, you see that she has her thumb in her mouth and is pulling on her left ear. She is slightly feverish but otherwise well. You suspect the child is suffering from progressive hearing loss. What is the most common acquired cause of hearing loss in children?

a) Presbycusis
b) Congenital cytomegalovirus infection
c) Noise damage
d) Meniere’s disease
e) Glue ear

A

a) Presbycusis – age related sensorineural hearing loss
b) Congenital cytomegalovirus infection – most common cause of congenital, nonhereditary, progressive sensorineural hearing loss, treated with ganciclovir
c) Noise damage – workers in heavy industry
d) Meniere’s disease – middle aged adults, vertigo, tinnitus, etc

e)Glue ear – otitis media with effusion, commonest cause of conductive hearing loss, peaks at 2 years of age

5
Q

A 6M presents to your GP practice with their concerned mother. The mother states that he is very short compared to all his other siblings for his age and she wanted to make sure everything is okay. The child seems well enough but of short stature. PMH: a few chest infections and needed NG n-acetyl cysteine at birth. You ask the mother if there is anything else she has noticed and she explains how he pees a lot and has pale foul-smelling stools, but she puts this down to him drinking a lot of fluid as he is always thirsty. What investigation would help prove your suspected diagnosis?

a) HBA1c
b) Fasting glucose
c) Tissue transglutaminase antibodies
d) Diet low in cow-milk protein
e) Sweat test

A

e)Sweat test

6
Q

You follow the pediatrician on call to the neonatal ward to see a concerned mother. She says her baby is very yellow and she needs you to do something urgently. The baby is currently 13 days old and has developed this skin change in the past 48 hours. What is the most likely explanation for the baby’s presentation?

a) glucose-6-phosphodehydrogenase deficiency
b) Rhesus haemolytic disease
c) Physiological
d) Biliary atresia
e) Galactosaemia

A

a) glucose-6-phosphodehydrogenase deficiency – x-linked disorder, red blood cells hemolysis occurs after exposure to infection or oxidative drugs e.g. aspirin
b) Rhesus haemolytic disease – maternal IgG attack on baby’s blood cells, a lot of complications

c)Physiological – reassure that this is normal and due to less developed liver function, more red bloods cells, and more fragile red blood cells, recommend giving baby sunlight

d) Biliary atresia –abnormal bile duct development leads to blockage leading to inc conjugated bilirubin and biliary system failure, treated with urgent kasai procedure
e) Galactosaemia – defect in galactose metabolism (a sugar) leads too much galactose in the blood that can go on to affect liver, eyes, kidneys, and brains

7
Q

A 5M present to your GP practice. His parents explain how he has been very tired recently. The parents explain that their boy frequently gets infection and struggles to shake them off when he does. He also bleeds very easily from his gum which the parents have booked him a dentist appointment for.

When inspecting the child, you notice he is slightly pale, has up slanting palpebral fissures, low-set folded ears, short neck, epicanthal folds, and a flattened nasal bridge. On further inspection, the child has brushfield spots, small white spots arranged in a ring in his eye.

What conditions are associated with children that present with similar features as this boy?

a) Pulmonary stenosis, right ventricular hypertrophy, overring aorta, ventricular septal defect
b) Mechanical blockage due to duodenum closure
c) Absence of ganglions in colon
d) Anemia, neutropenia and thrombocytopenia secondary to genetic mutations
e) All of the above

A

a) Pulmonary stenosis, right ventricular hypertrophy, overring aorta, ventricular septal defect – tetralogy of fallot is associated with down’s syndrome
b) Mechanical blockage due to duodenum closure – duodenal atresia is associated with down’s syndrome
c) Absence of ganglions in colon – Hirschsprung’s disease is associated with down’s syndrome
d) Anemia, neutropenia and thrombocytopenia secondary to bone marrow failure – acute lymphoblastic leukemia is associated with down’s syndrome, not this is the most common malignancy in children

e)All of the above

8
Q
A