Paediatrics Flashcards
(111 cards)
1
Q
Brain injury is a common feature contributing to the course and outcome of meconium aspiration
True or False?
A
True
Loss of sphincter control in the uterus is unlikely as it is a poorly developed reflex, therefore uncommon in neonates and is often associated with listeria infection. For term babies this reflex is well developed and is more common.
• Term babies will require hypoxic and ischaemic insults in order to relax sphincter
• A further strong inspiratory reflex is required to inspirate
• Inspiration of meconium is a sign of severe hypoxic ischaemic brain injury
2
Q
Neonatal Respiratory Distress Syndrome is expected to improve following the initial 24 hours after birth
True or False?
A
False
NRDS affects premature babies due to surfactant deficiency (Hyaline membrane disease). It begins at 6 hours after birth and is worst between 24-48 hours before improving
• Treatment include giving steroids during pregnancy and tocolytics to prevent early delivery
• Once delivered management is with surfactant and CPAP
3
Q
In the absence of fever, hypothyroidism is the most common cause of sleepiness in a newborn baby
True or False?
A
False
The cause of sleepiness may be physiological or pathological. It is important to differentiate between the two in order to
• Physiological – due to the stressful nature of birth/sleep cycle is much faster in neonates
• Pharmacological – maternal intake of medication during birth/whilst breast feeding
• Pathological – non specific sign of illness e.g. hyponatraemia/hypoglycaemia/infection/hypothyroidism
4
Q
Intrapartum antibiotic prophylaxis protects babies against Group B Streptococcal sepsis throughout the neonatal period
True or False?
A
False
It prevents Group B Streptococcal sepsis at the beginning but not the entire duration of the neonatal period.
• E.Coli/Group B streptococcal (and gram negatives) are present in the digestive tract and so are the most common causative first organisms
• Can present in the first 48hrs after birth or delayed within the first few months, usually presenting as meningitis
• It is a medical emergency due to aggressive nature of infection
• Treatment is two doses @12hours of penicillin given Intrapartum that protects for the first 48hours after birth but not for duration of neonatal period
5
Q
Neck rigidity and bulging fontanelle are useful features for the diagnosis of bacterial meningitis in newborn babies
True or False?
A
False
Young infants are very bad at amounting an immune response.
• It will take a long time for neck rigidity to manifest due to irritation of meninges
• Bulging fontanelle will take a while as there is a lot of room for expansion
• Both present too late and are not a useful measure
6
Q
Cardiac murmurs detected on routine neonatal check 72 hours after birth, require more prompt assessment than those during a screening visit at two years of age
True or False?
A
True
Changes from foetal to neonatal circulation occur following birth
• This is an important time as duct dependency will manifest itself. Has three distinct casues:
(1) Severe tetraphalogy or conditions with impaired right ventricular circulation leading to a LR shunt
(2) Severe left ventricular circulation impairment that leads to a RL shunt
(3) No mixing between the two circulations (transposition of the great vessels)
7
Q
APGAR score includes RR.
True or False?
A
False
8
Q
APGAR score includes capillary return
True or False?
A
False
9
Q
APGAR score at 5 min has an important role in determining resuscitation interventions.
True or False?
A
False
Used at 5/10/15/20 minutes for prognostic information to see how neurodevelopment will occur
10
Q
APGAR scores are important determinants of the need for intensive care of extremely premature babies
True or False?
A
False
11
Q
APGAR scores can be artificially lowered by intra-partum use of analgesia and sedation
True or False?
A
True
12
Q
In resuscitation of babies at birth, adrenaline should be given if the hear rate is below 40 per minute
True or False?
A
False
In adults primary event leading to cardiac arrest is cardiovascular. In children it is most commonly due to respiratory events with cardiac arrest occurring as a secondary complication.
• Management: initial O2 and mucosal aspiration, if no response, cardiac assistance (adrenaline)
13
Q
Intra-ventricular haemorrhage is a recognised complication of forceps delivery
True or False?
A
False
Intra-ventricular haemorrhage is specific to premature births. Occurs due to large rapid changes in blood pressure that causes damage to poorly developed choroid plexus
14
Q
Low body temperature is a sign of systemic infection in young infants
True or False?
A
True
This can occur due to the larger surface area and thinner skin in infants
15
Q
Peri-umbilical redness precedes cord separation
True or False?
A
False
Umbilical stump will fall off within two weeks due to necrosis
• Redness SHOULD NOT extend to the area around the umbilicus
• If it is red it require IV antibiotics and admission to hospital as it is an easy site of peritoneal infection
16
Q
Seizures in premature babies can manifest only in colour change
True or False?
A
True
Due to lack or presence of myelin so are unable to have visible seizures just localised ones
• It is believed that you are born with the same amount of nerves as when you die. However, it is due to myelination that we develop progression of higher cognition and motor development
17
Q
Breast fed babies are at a higher risk of haemorrhagic disease of the newborn
True or False?
A
True
Breast feeing can casue generalised jaundice
• Haemorrhagic disease in the newborn is caused by a lack of vitamin K
• Formulae milk has Vitamin K addition, whereas breast does not
18
Q
Asthma is a common cause of recurrent wheezing in infancy
True or False?
A
DK
There is no conclusive evidence to point to this
• Wheeze is a dry, continuous, polyphonic noise
• Asthma is caused by reversible airways obstruction due to hyper-responsive airways caused by IgE mediated inflammation (usually) that is brought on by either allergic/infective or autoimmune parameters
19
Q
Apnoea is common in young babies with bronchiolitis
True or False?
A
True
Preterm infants or full term infants in the first 4 weeks of life can present with this
20
Q
Babies with bronchiolitis showing respiratory distress but no wheeze can be managed at home
True or False?
A
False
This requires muscular effort and babies will eventually tire, leading to lack of inspiration and eventual resp failure
21
Q
Dehydration is a frequent complication of bronchiolitis
True or False?
A
True
This can occur due to a lack of appetite
22
Q
Hospitalised infants with bronchiolitis are at risk of fluid overload
True or False?
A
True
Most commonly due to SIADH where respiratory manifestation is most common
23
Q
In a baby with vomiting and significant METABOLIC ACIDOSIS
Pyloric stenosis is a common underlying cause
True or False?
A
False
Due to the production of bicarbonate caused by excessive vomiting metabolic alkalosis would occur. So this is false.
• Additionally repeatedly vomiting would relax your pyloric sphincter, lessening your stenosis and would lead to a less severe form of alkalosis
24
Q
In a baby with vomiting and significant METABOLIC ACIDOSIS
Hyperkalaemia maybe present despite potassium depletion
True or False?
A
True
In this situation a shift from intracellular to extracellular concentration can occur
• This gives a false value and an impression of normal values
• Management: give fluids then K+ once kidneys are well perfused (unless in situations of pyloric stenosis or diabetes)
25
In a baby with vomiting and significant METABOLIC ACIDOSIS
Tetany can occur despite normal calcium levels
True or False?
False
This is caused by hypocalcaemia
• Calcium is in the blood (50% bound/50% unbound)
• Unbound is “active calcium”
• Acidosis does not change total calcium levels but it does cause a shift towards unbound “active” calcium leading to hypercalcaemia
• Alkalosis causes a shift towards bound “non-active” calcium leading to hypocalcaemia and subsequent tetany
o Hyperventilation/renal failure
26
In a baby with vomiting and significant METABOLIC ACIDOSIS
High lactate may suggest poor circulation
True or False?
True
| Poor circulation/sepsis or infection leads to increased lactate caused by poor perfusion
27
In a baby with vomiting and significant METABOLIC ACIDOSIS
High ketones may be the explanation
True or False?
True
| Ketones are acidotic and can be caused by starvation
28
In a baby with vomiting and significant METABOLIC ACIDOSIS
In the presence of hypoglycaemia, ketonuria would point to hyperinsulism
True or False?
Uncertain
29
In a baby with vomiting and significant METABOLIC ACIDOSIS
Genetic metabolic disorders need to be considered
True or False?
False
| If no other diagnosis is possible
30
Clindamycin IV +/- Immunoglobulin, 3rd Generation Cephalosporin IV, 3rd Generation Cephalosporin plus Vancomycin IV, IV co-amoxiclave, 3rd Generation Cephalosporin plus Flucloxacillin IV, 3rd Generation Cephalosporin plus Acyclovir plus a Macrolide IV, Trimethoprim orally, None, Oral Penicillin V
What is the most suitable antimicrobial treatment for: Scarlet Fever
Oral Penicillin V
31
Generation Cephalosporin IV, 3rd Generation Cephalosporin plus Vancomycin IV, IV co-amoxiclave, 3rd Generation Cephalosporin plus Flucloxacillin IV, 3rd Generation Cephalosporin plus Acyclovir plus a Macrolide IV, Trimethoprim orally, None, Oral Penicillin V
What is the most suitable antimicrobial treatment for:
Reseola Infantum in a 2 year old
None
32
Generation Cephalosporin IV, 3rd Generation Cephalosporin plus Vancomycin IV, IV co-amoxiclave, 3rd Generation Cephalosporin plus Flucloxacillin IV, 3rd Generation Cephalosporin plus Acyclovir plus a Macrolide IV, Trimethoprim orally, None, Oral Penicillin V
What is the most suitable antimicrobial treatment for:
Fever with no focus in 4 year old
None
33
Generation Cephalosporin IV, 3rd Generation Cephalosporin plus Vancomycin IV, IV co-amoxiclave, 3rd Generation Cephalosporin plus Flucloxacillin IV, 3rd Generation Cephalosporin plus Acyclovir plus a Macrolide IV, Trimethoprim orally, None, Oral Penicillin V
What is the most suitable antimicrobial treatment for:
Severe peri-orbital celulitis
3rd Generation Cephalosporin plus Flucloxacillin IV (caused by Staph aureus, Pneumococcus, Staph Epidermis)
34
Generation Cephalosporin IV, 3rd Generation Cephalosporin plus Vancomycin IV, IV co-amoxiclave, 3rd Generation Cephalosporin plus Flucloxacillin IV, 3rd Generation Cephalosporin plus Acyclovir plus a Macrolide IV, Trimethoprim orally, None, Oral Penicillin V
What is the most suitable antimicrobial treatment for:
UTI in a 4 year old
Trimethoprim only
35
Generation Cephalosporin IV, 3rd Generation Cephalosporin plus Vancomycin IV, IV co-amoxiclave, 3rd Generation Cephalosporin plus Flucloxacillin IV, 3rd Generation Cephalosporin plus Acyclovir plus a Macrolide IV, Trimethoprim orally, None, Oral Penicillin V
What is the most suitable antimicrobial treatment for:
Septic knee arthritis in non-immunised 2 year old
3rd Generation Cephalosporin plus Flucloxacillin IV (if immunised can given only Flucloxacillin) you are worried about Haemophilus Influenza B in non immunised child
36
Generation Cephalosporin IV, 3rd Generation Cephalosporin plus Vancomycin IV, IV co-amoxiclave, 3rd Generation Cephalosporin plus Flucloxacillin IV, 3rd Generation Cephalosporin plus Acyclovir plus a Macrolide IV, Trimethoprim orally, None, Oral Penicillin V
What is the most suitable antimicrobial treatment for:
Florid meningitis in a 3 year old with encephalopathic picture preceded by respiratory problems
3rd Generation Cephalosporin plus Vancomycin IV (for atypical infections such as Aspergillus)
37
Generation Cephalosporin IV, 3rd Generation Cephalosporin plus Vancomycin IV, IV co-amoxiclave, 3rd Generation Cephalosporin plus Flucloxacillin IV, 3rd Generation Cephalosporin plus Acyclovir plus a Macrolide IV, Trimethoprim orally, None, Oral Penicillin V
What is the most suitable antimicrobial treatment for:
Semi-comatosed 8 year old with encephalopathic picture preceded by respiratory symptoms
3rd Generation Cephalosporin plus Acyclovir plus a Macrolide IV (this is triple therapy for a picture of Encephalitis/Meningitis. Herpes is particularly severe and macrolide is used to treat Mycoplasma
38
Generation Cephalosporin IV, 3rd Generation Cephalosporin plus Vancomycin IV, IV co-amoxiclave, 3rd Generation Cephalosporin plus Flucloxacillin IV, 3rd Generation Cephalosporin plus Acyclovir plus a Macrolide IV, Trimethoprim orally, None, Oral Penicillin V
What is the most suitable antimicrobial treatment for:
A child with an infected skin lesion who developed generalised erythema, diarrhoea and postural hypotension
Clindamycin IV +/- immunoglobulin (This is toxic shock syndrome. Clindamycin weakens the bacteria and reduces toxin production whilst immunoglobulins neutralise the pre-produced toxins in order to reduce toxic effect)
39
The following are indications for admission to hospital for a young infant with bronchiolitis:
RR of 45 per minute
True or False?
False
Respiratory rates and age groups:
• Very preterm:
40
The following are indications for admission to hospital for a young infant with bronchiolitis:
Reduced feeding intake
True or False?
True
| Reduced feeding intake is worrying as it can lead to acute starvation and dehydration
41
The following are indications for admission to hospital for a young infant with bronchiolitis:
HR of 80 per minute
True or False?
False
| Hypoxia in infants results in a bradycardic effect
42
The following are indications for admission to hospital for a young infant with bronchiolitis:
Concerns regarding social history
True or False?
True
| Must be confident that the parents are able to provide for the child, regardless of situation
43
The following are indications for admission to hospital for a young infant with bronchiolitis:
Sleepiness
True or False?
True
| Sleepiness combined with respiratory pathology is a worrying situation
44
In a 7 year old child during an acute asthmatic attack, the following signs are reassuring:
Haemoglobin oxygen saturation monitor reading of 92%
True or false?
False
A normal saturation does not mean an absence of pathology. You can have serious progression (down to 7PaO2) before any changes in saturation are noticed
• Even at lowest saturation i.e. venous blood haemoglobin uptake is roughly at 75%
• Remember the sigmoid curve
45
In a 7 year old child during an acute asthmatic attack, the following signs are reassuring:
Absence of wheeze
True or false?
False
| "silent chest" is a very serious sign of severe asthma
46
In a 7 year old child during an acute asthmatic attack, the following signs are reassuring:
Improvement following salbutamol via spacer lasting for 60 minutes
True or false?
False
| You would ideally like to see improvement that lasts for 3-4 hours before you are willing to discharge the child
47
In a 7 year old child during an acute asthmatic attack, the following signs are reassuring:
Wheeze only on one side
True or false?
False
| Wheeze on one side could indicate pathology: pulmonary collapse, pneumothorax, foreign body inhalation
48
In a 7 year old child during an acute asthmatic attack, the following signs are reassuring:
pCO2 of 6.9 kPa on arterial blood gasses
True or false?
False
With moderate asthma you see polypic, hypocapnoea with a moderate or low PCO2. With severe asthma you see a high or a rising CO2
49
Urinary tract infections (UTIs) in infants and young children are unlikely in the absence of urinary symptoms
True or False?
Fase
| There can be a fever with no obvious source
50
Urinary tract infections (UTIs) in infants and young children, group A strep is a likely cause
True or False?
False
| E.Coli is the most common causative agent
51
Urinary tract infections (UTIs) in neonates can manifest in prolonged jaundice
True or False?
True
| UTIs can be one of the causes of non specific jaundice in neonates
52
Urinary tract infections (UTIs) in infants and young children are unlikely in children under 3 years of age if the urine dipstick is completely negative
True or False?
False
Urine dipsticks are very sensitive
• Babies are poor at mounting an inflammatory response so very few WCs can be found leading to a false negative
• Nitrites in the urine are also time dependent. Usually urine does not stay long enough in the bladder as the first thing that happens in infants is automatic voiding to combat inflammation or infection. Hence giving a false negative
53
Urinary tract infections (UTIs) in infants and young children have renal cysts as a common associated abnormality
True or False?
False
Structural abnormalities are the most common PUJ stenosis/reflux nephropathy
• Children present usually due to:
(1) UTIs present with generalised symptoms
(2) Can scar kidneys leading to completely dysfunctional kidneys
(3) 50% have an underlying abnormality
• Risk factors for UTIs include: dehydration, constipation, nappy hygiene
• Grade I-III reflux is treated conservatively
• Grade IV reflux is treated surgically
54
Urinary tract infections (UTIs) in infants and young children can manifest in drowsiness
True or False?
True
| Non specific drowsiness is due to the absorption of ammonia that has crossed the blood brain barrier
55
Loose motions can be a sign of constipation
| True or False?
True
| Overflow diarrhoea
56
Constipation is a risk factor for UTI in children
| True or False?
True
| Not clear as to why. One theory is the translocation of bacteria across intact walls
57
Bruising in immobile children is a strong indicator of physical abuse
True or False?
True
Any bruising in immobile children that remains medically unexplained is a cause of concern. As a clinician you are allowed to have an indication but not make an accusation
58
Bone fractures in infants are frequently a sign of metabolic bone disease
True or False?
False
| Less than 1% are due to metabolic disorders
59
In left handed children, left hand use preference can be noticed from 4 months of age
True or False?
False
Use preference can be noticed from 3 years onwards
• The presence of speech and language centre on either side of the brain only occurs at 2-3 years of age
• This is when hand dominance occurs as well
• If this occurs any earlier it is a pathological sign, showing hemiplegia
60
A 2 month old baby was brought to the GP with 24 hour history of refusal of feeds, vomiting, 2 diarrhoeal stools and sleepiness alternating with irritability. The baby has a slightly changed cry and his young mum is quite worried saying that her baby “looks different”. Is the following statement true or false regarding this case:
A temperature of 39oC that responds promptly to Paracetamol and/or Ibuprofen strongly suggests a viral aetiology
False
| You cannot differentiate between bacterial or viral infection with Paracetamol response
61
A 2 month old baby was brought to the GP with 24 hour history of refusal of feeds, vomiting, 2 diarrhoeal stools and sleepiness alternating with irritability. The baby has a slightly changed cry and his young mum is quite worried saying that her baby “looks different”. Is the following statement true or false regarding this case:
Serious bacterial infection is unlikely if there is no fever
False
| Infants are not able to mount a proper immune response
62
A 2 month old baby was brought to the GP with 24 hour history of refusal of feeds, vomiting, 2 diarrhoeal stools and sleepiness alternating with irritability. The baby has a slightly changed cry and his young mum is quite worried saying that her baby “looks different”. Is the following statement true or false regarding this case:
If the vomiting and diarrhoea stop and there are no signs of dehydration, admission to hospital is not necessary
False
Babies with less than 3 months are at high risk and all indicators point to CNS involvement. Unsafe to send home
•
63
A 2 month old baby was brought to the GP with 24 hour history of refusal of feeds, vomiting, 2 diarrhoeal stools and sleepiness alternating with irritability. The baby has a slightly changed cry and his young mum is quite worried saying that her baby “looks different”. Is the following statement true or false regarding this case:
In the absence of any neck rigidity, meningitis is unlikely
False
64
A 2 month old baby was brought to the GP with 24 hour history of refusal of feeds, vomiting, 2 diarrhoeal stools and sleepiness alternating with irritability. The baby has a slightly changed cry and his young mum is quite worried saying that her baby “looks different”. Is the following statement true or false regarding this case:
Oral rehydration should be attempted for 8 hours before considering admission to hospital for IV infusion of fluids
False
| 8 hours is too long
65
Enteroviral infection can present as fever with no obvious cause in an otherwise reasonably well toddler
True or False?
True
66
Ottitis Media can present as fever with no obvious cause in an otherwise reasonably well toddler
True or False?
True
67
UTI can present as fever with no obvious cause in an otherwise reasonably well toddler
True or False?
True
68
Pneumonia can present as fever with no obvious cause in an otherwise reasonably well toddler
True or False?
True
69
Meningitis can present as fever with no obvious cause in an otherwise reasonably well toddler
True or False?
True
70
Bacteraemia can present as fever with no obvious cause in an otherwise reasonably well toddler
True or False?
True
71
Septicaemia can present as fever with no obvious cause in an otherwise reasonably well toddler
True or False?
False
| Bacteraemia is the presence of bacteria in the blood. Septicaemia is this but with an inflammatory immune response
72
A 9 month boy presents to A&E with a history of recent gastroenteritis. His diarrhoea stopped 24 hour ago but he seems to have developed episodic periods of crying as in severe pain during which he may look ill and pale. In between, he seems to recover and look reasonably well. His temperature is 38oC. His abdomen is full and vaguely tender; there might be some fullness in the right middle/upper quadrant. There was no tenderness in the McBurney’s point and there was no obvious abdominal muscle rigidity. Is the following statement true or false regarding this case:
A heart rate of 80bpm is an indicator of good perfusion and circulation?
False
| This is far too low for this child
73
A 9 month boy presents to A&E with a history of recent gastroenteritis. His diarrhoea stopped 24 hour ago but he seems to have developed episodic periods of crying as in severe pain during which he may look ill and pale. In between, he seems to recover and look reasonably well. His temperature is 38oC. His abdomen is full and vaguely tender; there might be some fullness in the right middle/upper quadrant. There was no tenderness in the McBurney’s point and there was no obvious abdominal muscle rigidity. Is the following statement true or false regarding this case:
A heart rate of 190bpm reflects the increase in temperature?
False
This is far too high
• Expect to see a 10 bpm increase for every 1oC in adults
• Expect to see a 10-20 bpm increase for every 1oC in adults
74
A 9 month boy presents to A&E with a history of recent gastroenteritis. His diarrhoea stopped 24 hour ago but he seems to have developed episodic periods of crying as in severe pain during which he may look ill and pale. In between, he seems to recover and look reasonably well. His temperature is 38oC. His abdomen is full and vaguely tender; there might be some fullness in the right middle/upper quadrant. There was no tenderness in the McBurney’s point and there was no obvious abdominal muscle rigidity. Is the following statement true or false regarding this case:
A period of observation with monitoring in hospital is the recommended course of action to allow the diagnosis to be confirmed?
False
Always consider appendicitis if there is an atypical presentation
• Diagnosis is intussusception “recurrent jelly stools” too late, this is a sign of necrosis
(1) 9 months is peak age
(2) Episodic nature of pain
(a) Colic pain is spasmic and lasts for a few minutes
(b) Intermittent is days of pain then weeks of nothing
(c) Episodic in near normality with minutes of insufferable pain
(3) Cannot be felt in lower right quadrant (illeocaecal involvement that moves upwards)
(4) Vascular component require immediate management
75
A 9 month boy presents to A&E with a history of recent gastroenteritis. His diarrhoea stopped 24 hour ago but he seems to have developed episodic periods of crying as in severe pain during which he may look ill and pale. In between, he seems to recover and look reasonably well. His temperature is 38oC. His abdomen is full and vaguely tender; there might be some fullness in the right middle/upper quadrant. There was no tenderness in the McBurney’s point and there was no obvious abdominal muscle rigidity. Is the following statement true or false regarding this case:
This baby should have an immediate imaging of the abdomen?
False
76
A 9 month boy presents to A&E with a history of recent gastroenteritis. His diarrhoea stopped 24 hour ago but he seems to have developed episodic periods of crying as in severe pain during which he may look ill and pale. In between, he seems to recover and look reasonably well. His temperature is 38oC. His abdomen is full and vaguely tender; there might be some fullness in the right middle/upper quadrant. There was no tenderness in the McBurney’s point and there was no obvious abdominal muscle rigidity. Is the following statement true or false regarding this case:
This child is likely to have acute appendicitis and should be admitted and kept nil by mouth and started on IV infusion, to arrange a surgical review?
True
| Management and diagnosis is through barium/air enema
77
A 5 year old child with eczema and known nut allergy presents with a three day history of transient morning peri-orbital puffiness. He had a sore throat a couple of weeks beforehand. Is the following statement true or false?
A trial of anti-histamines for a few days is an appropriate initial management
False
| Fluid retention. Morning facial puffiness that resolves once you adopt a vertical position
78
A 5 year old child with eczema and known nut allergy presents with a three day history of transient morning peri-orbital puffiness. He had a sore throat a couple of weeks beforehand. Is the following statement true or false?
A referral to the allergist for allergy testing is appropriate
False
79
A 5 year old child with eczema and known nut allergy presents with a three day history of transient morning peri-orbital puffiness. He had a sore throat a couple of weeks beforehand. Is the following statement true or false?
A trial of extension of the exclusion died to seeds and legumes is appropriate
False
80
A 5 year old child with eczema and known nut allergy presents with a three day history of transient morning peri-orbital puffiness. He had a sore throat a couple of weeks beforehand. Is the following statement true or false?
A urine test should be obtained without delay
True
| Most likely renal disease --> nephrotic syndrome
81
A 5 year old child with eczema and known nut allergy presents with a three day history of transient morning peri-orbital puffiness. He had a sore throat a couple of weeks beforehand. Is the following statement true or false?
Imaging of the orbits and paranasal sinuses should be obtained without delay
False
82
A previously healthy 7 year old child presents with a week history of coryza followed by cough and for the last couple of days has starting getting a bit breathless and developed a fever. On examination he was found to have crepitations on the right lung base. Is the following an appropriate action, true or false?
Obtain a chest x-ray
True
83
A previously healthy 7 year old child presents with a week history of coryza followed by cough and for the last couple of days has starting getting a bit breathless and developed a fever. On examination he was found to have crepitations on the right lung base. Is the following an appropriate action, true or false?
Admit to hospital and start a course of Gentamicin
False
| Gentamycin is for gram negative
84
A previously healthy 7 year old child presents with a week history of coryza followed by cough and for the last couple of days has starting getting a bit breathless and developed a fever. On examination he was found to have crepitations on the right lung base. Is the following an appropriate action, true or false?
Admit to hospital for IV treatment with third generation Cephalosporin and Flucloxacillin
False
85
A previously healthy 7 year old child presents with a week history of coryza followed by cough and for the last couple of days has starting getting a bit breathless and developed a fever. On examination he was found to have crepitations on the right lung base. Is the following an appropriate action, true or false?
Use oral Amoxicillin to treat the chest infection
True
86
A previously healthy 7 year old child presents with a week history of coryza followed by cough and for the last couple of days has starting getting a bit breathless and developed a fever. On examination he was found to have crepitations on the right lung base. Is the following an appropriate action, true or false?
Use oral Co-Amoxiclav to treat the chest infection
False
| Co-amoxiclav is a broad spectrum and is used in acute settings when you do not worry about antibiotic resistance
87
A 16 year old girl presented with a 1 day history of nasal snuffliness, fever and fatigue. She also complained of headaches and pains in her claves and arms. Physical examination revealed an ill looking girl with fever at 39oC. There was no neck stiffness. She was also found to have a skin rash with generalised red spots. The “glass test” was negative (i.e. the spots do blanch on pressure). Is the following statement true or false in relation to this case?
Investigations to exclude calf deep venous thrombosis are appropriate
False
| Unless on pill and presence of thrombophilic disorder (v. unlikely)
88
A 16 year old girl presented with a 1 day history of nasal snuffliness, fever and fatigue. She also complained of headaches and pains in her claves and arms. Physical examination revealed an ill looking girl with fever at 39oC. There was no neck stiffness. She was also found to have a skin rash with generalised red spots. The “glass test” was negative (i.e. the spots do blanch on pressure). Is the following statement true or false in relation to this case?
In the absence of an obvious focus for infection, antibiotics shouldn’t be given
False
| This is an ill looking girl. You must treat in order to cover anything more serious
89
A 16 year old girl presented with a 1 day history of nasal snuffliness, fever and fatigue. She also complained of headaches and pains in her claves and arms. Physical examination revealed an ill looking girl with fever at 39oC. There was no neck stiffness. She was also found to have a skin rash with generalised red spots. The “glass test” was negative (i.e. the spots do blanch on pressure). Is the following statement true or false in relation to this case?
Tamiflu should be started following the appropriate swabs for virology
False
| This illness is far too rapid and aggressive to be flu. Should be considered as secondary differential diagnosis
90
A 16 year old girl presented with a 1 day history of nasal snuffliness, fever and fatigue. She also complained of headaches and pains in her claves and arms. Physical examination revealed an ill looking girl with fever at 39oC. There was no neck stiffness. She was also found to have a skin rash with generalised red spots. The “glass test” was negative (i.e. the spots do blanch on pressure). Is the following statement true or false in relation to this case?
Treatment for possible Meningococceamia should urgently be instated
True
91
A 16 year old girl presented with a 1 day history of nasal snuffliness, fever and fatigue. She also complained of headaches and pains in her claves and arms. Physical examination revealed an ill looking girl with fever at 39oC. There was no neck stiffness. She was also found to have a skin rash with generalised red spots. The “glass test” was negative (i.e. the spots do blanch on pressure). Is the following statement true or false in relation to this case?
Use of oral Amoxicillin to treat maxillary sinus infection
True
92
A 16 year old girl presented with a 1 day history of nasal snuffliness, fever and fatigue. She also complained of headaches and pains in her claves and arms. Physical examination revealed an ill looking girl with fever at 39oC. There was no neck stiffness. She was also found to have a skin rash with generalised red spots. The “glass test” was negative (i.e. the spots do blanch on pressure). Is the following statement true or false in relation to this case?
Measles is a likely cause if this girl has not been given the measles vaccine/MMR
False
The illness is too rapid. Measles is a disease with a prominent prodromal period of 3-4 days. Symptoms: conjunctivits, cough and rhinitis
93
History of exposure to measles in the previous week is a contraindication for giving the MMR vaccine.
True or False?
False
| MMR can be given exposure
94
The anterior fontanelle is expected to close at 6-18 months of age
True or False?
True
• If closed before --> Primary craniosynostosis (can be caused thyrotoxicosis) leading to raised ICP. Secondary macrocephaly with no brain growth
• IF close after --> Hydrocephaly, Down’s syndrome, hypothyroidism
95
Pneumococcal vaccine should not be administered to children with documented invasive pneumococcal infection in infancy
True or False?
False
There are 84 different strains of pneumococcus
• In small infants there is a poor response to encapsulated bacteria therefore we require immunisation
96
Learning difficulties are a common cause of delay in gross motor development
True or False?
```
False
There are three main causes for delays
• Normal variation
• Lack of opportunity and training
• Presence of physical or neurological abnormality
```
97
Maculopapular rash and non specific symptoms/ Retro-auricular lymphadenopathy/ Haematuria/ Rapidly evolving acute severe febrile illness/ Target lesions/ Persisting fever and irritability for 5 days in a young child/ Diarrhoea & orthostatic hypotension are important features/ Sub-conjunctival haemorrhages/ Slapped cheeks/ Deafness/ Fever with no obvious focus resolving as skin rash appears/ Papulovesicular rash at different stages of evolution/ Abruptly developing skin rash/ Oral Penicillin V is usually effective/ Prominent prodromal symptoms
Match the following condition with the most appropriate answer:
Scarlet Fever
Oral Penicillin V is usually effective
98
Maculopapular rash and non specific symptoms/ Retro-auricular lymphadenopathy/ Haematuria/ Rapidly evolving acute severe febrile illness/ Target lesions/ Persisting fever and irritability for 5 days in a young child/ Diarrhoea & orthostatic hypotension are important features/ Sub-conjunctival haemorrhages/ Slapped cheeks/ Deafness/ Fever with no obvious focus resolving as skin rash appears/ Papulovesicular rash at different stages of evolution/ Abruptly developing skin rash/ Oral Penicillin V is usually effective/ Prominent prodromal symptoms
Match the following condition with the most appropriate answer:
Reseola Infantium
Fever with no obvious focus resolving as skin rash appears
99
Maculopapular rash and non specific symptoms/ Retro-auricular lymphadenopathy/ Haematuria/ Rapidly evolving acute severe febrile illness/ Target lesions/ Persisting fever and irritability for 5 days in a young child/ Diarrhoea & orthostatic hypotension are important features/ Sub-conjunctival haemorrhages/ Slapped cheeks/ Deafness/ Fever with no obvious focus resolving as skin rash appears/ Papulovesicular rash at different stages of evolution/ Abruptly developing skin rash/ Oral Penicillin V is usually effective/ Prominent prodromal symptoms
Match the following condition with the most appropriate answer:
Measles
Prominent prodromal symptoms
100
Maculopapular rash and non specific symptoms/ Retro-auricular lymphadenopathy/ Haematuria/ Rapidly evolving acute severe febrile illness/ Target lesions/ Persisting fever and irritability for 5 days in a young child/ Diarrhoea & orthostatic hypotension are important features/ Sub-conjunctival haemorrhages/ Slapped cheeks/ Deafness/ Fever with no obvious focus resolving as skin rash appears/ Papulovesicular rash at different stages of evolution/ Abruptly developing skin rash/ Oral Penicillin V is usually effective/ Prominent prodromal symptoms
Match the following condition with the most appropriate answer:
German Measles
Retro-auricular lymphadenopathy
101
Maculopapular rash and non specific symptoms/ Retro-auricular lymphadenopathy/ Haematuria/ Rapidly evolving acute severe febrile illness/ Target lesions/ Persisting fever and irritability for 5 days in a young child/ Diarrhoea & orthostatic hypotension are important features/ Sub-conjunctival haemorrhages/ Slapped cheeks/ Deafness/ Fever with no obvious focus resolving as skin rash appears/ Papulovesicular rash at different stages of evolution/ Abruptly developing skin rash/ Oral Penicillin V is usually effective/ Prominent prodromal symptoms
Match the following condition with the most appropriate answer:
Parvoviral Infection
Slapped Cheeks
102
Maculopapular rash and non specific symptoms/ Retro-auricular lymphadenopathy/ Haematuria/ Rapidly evolving acute severe febrile illness/ Target lesions/ Persisting fever and irritability for 5 days in a young child/ Diarrhoea & orthostatic hypotension are important features/ Sub-conjunctival haemorrhages/ Slapped cheeks/ Deafness/ Fever with no obvious focus resolving as skin rash appears/ Papulovesicular rash at different stages of evolution/ Abruptly developing skin rash/ Oral Penicillin V is usually effective/ Prominent prodromal symptoms
Match the following condition with the most appropriate answer:
Mumps
Deafness
103
Maculopapular rash and non specific symptoms/ Retro-auricular lymphadenopathy/ Haematuria/ Rapidly evolving acute severe febrile illness/ Target lesions/ Persisting fever and irritability for 5 days in a young child/ Diarrhoea & orthostatic hypotension are important features/ Sub-conjunctival haemorrhages/ Slapped cheeks/ Deafness/ Fever with no obvious focus resolving as skin rash appears/ Papulovesicular rash at different stages of evolution/ Abruptly developing skin rash/ Oral Penicillin V is usually effective/ Prominent prodromal symptoms
Match the following condition with the most appropriate answer:
Whooping Cough
Sub-Conjuntival Haemorrhages
104
Maculopapular rash and non specific symptoms/ Retro-auricular lymphadenopathy/ Haematuria/ Rapidly evolving acute severe febrile illness/ Target lesions/ Persisting fever and irritability for 5 days in a young child/ Diarrhoea & orthostatic hypotension are important features/ Sub-conjunctival haemorrhages/ Slapped cheeks/ Deafness/ Fever with no obvious focus resolving as skin rash appears/ Papulovesicular rash at different stages of evolution/ Abruptly developing skin rash/ Oral Penicillin V is usually effective/ Prominent prodromal symptoms
Match the following condition with the most appropriate answer:
Chicken pox
Papulovesicular Rash at different stages of evolution
105
Maculopapular rash and non specific symptoms/ Retro-auricular lymphadenopathy/ Haematuria/ Rapidly evolving acute severe febrile illness/ Target lesions/ Persisting fever and irritability for 5 days in a young child/ Diarrhoea & orthostatic hypotension are important features/ Sub-conjunctival haemorrhages/ Slapped cheeks/ Deafness/ Fever with no obvious focus resolving as skin rash appears/ Papulovesicular rash at different stages of evolution/ Abruptly developing skin rash/ Oral Penicillin V is usually effective/ Prominent prodromal symptoms
Match the following condition with the most appropriate answer:
Allergic Reactions
Abruptly developing skin rash
106
Maculopapular rash and non specific symptoms/ Retro-auricular lymphadenopathy/ Haematuria/ Rapidly evolving acute severe febrile illness/ Target lesions/ Persisting fever and irritability for 5 days in a young child/ Diarrhoea & orthostatic hypotension are important features/ Sub-conjunctival haemorrhages/ Slapped cheeks/ Deafness/ Fever with no obvious focus resolving as skin rash appears/ Papulovesicular rash at different stages of evolution/ Abruptly developing skin rash/ Oral Penicillin V is usually effective/ Prominent prodromal symptoms
Match the following condition with the most appropriate answer:
Erythema Multiformae
Target Lesions
107
Maculopapular rash and non specific symptoms/ Retro-auricular lymphadenopathy/ Haematuria/ Rapidly evolving acute severe febrile illness/ Target lesions/ Persisting fever and irritability for 5 days in a young child/ Diarrhoea & orthostatic hypotension are important features/ Sub-conjunctival haemorrhages/ Slapped cheeks/ Deafness/ Fever with no obvious focus resolving as skin rash appears/ Papulovesicular rash at different stages of evolution/ Abruptly developing skin rash/ Oral Penicillin V is usually effective/ Prominent prodromal symptoms
Match the following condition with the most appropriate answer:
Enteroviral Infections
Maculopapular rash and non specific symptoms
108
Maculopapular rash and non specific symptoms/ Retro-auricular lymphadenopathy/ Haematuria/ Rapidly evolving acute severe febrile illness/ Target lesions/ Persisting fever and irritability for 5 days in a young child/ Diarrhoea & orthostatic hypotension are important features/ Sub-conjunctival haemorrhages/ Slapped cheeks/ Deafness/ Fever with no obvious focus resolving as skin rash appears/ Papulovesicular rash at different stages of evolution/ Abruptly developing skin rash/ Oral Penicillin V is usually effective/ Prominent prodromal symptoms
Match the following condition with the most appropriate answer:
Kawasaki Disease
Persisting fever and irritability for 5 days in a young child
109
Maculopapular rash and non specific symptoms/ Retro-auricular lymphadenopathy/ Haematuria/ Rapidly evolving acute severe febrile illness/ Target lesions/ Persisting fever and irritability for 5 days in a young child/ Diarrhoea & orthostatic hypotension are important features/ Sub-conjunctival haemorrhages/ Slapped cheeks/ Deafness/ Fever with no obvious focus resolving as skin rash appears/ Papulovesicular rash at different stages of evolution/ Abruptly developing skin rash/ Oral Penicillin V is usually effective/ Prominent prodromal symptoms
Match the following condition with the most appropriate answer:
Meningococceamia
Rapidly evolving acute severe febrile illness
110
Maculopapular rash and non specific symptoms/ Retro-auricular lymphadenopathy/ Haematuria/ Rapidly evolving acute severe febrile illness/ Target lesions/ Persisting fever and irritability for 5 days in a young child/ Diarrhoea & orthostatic hypotension are important features/ Sub-conjunctival haemorrhages/ Slapped cheeks/ Deafness/ Fever with no obvious focus resolving as skin rash appears/ Papulovesicular rash at different stages of evolution/ Abruptly developing skin rash/ Oral Penicillin V is usually effective/ Prominent prodromal symptoms
Match the following condition with the most appropriate answer:
Henoch-Schonlein Purpura
Haematuria
111
Maculopapular rash and non specific symptoms/ Retro-auricular lymphadenopathy/ Haematuria/ Rapidly evolving acute severe febrile illness/ Target lesions/ Persisting fever and irritability for 5 days in a young child/ Diarrhoea & orthostatic hypotension are important features/ Sub-conjunctival haemorrhages/ Slapped cheeks/ Deafness/ Fever with no obvious focus resolving as skin rash appears/ Papulovesicular rash at different stages of evolution/ Abruptly developing skin rash/ Oral Penicillin V is usually effective/ Prominent prodromal symptoms
Match the following condition with the most appropriate answer:
Toxic Shock Syndrome
Diarrhoea and orthostatic hypotension are important features
