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Flashcards in Paediatrics Deck (46):
1

Which of the following chromosomal abnormalities indicates Turner Syndrome?
A) 46 XY
B) 47 XXY
C) 45 XX
D) 45 X
E) 45 Y

D) 45 X

2

Which of the following chromosomal abnormalities indicates Klinefelter Syndrome?
A) 46 XY
B) 47 XXY
C) 45 XX
D) 45 X
E) 45 Y

B) 47 XXY

3

Give 6 changes or anomalies which might lead you to suspect T21 in an infant.

Craniofacial changes: round face, flat nasal bridge, upslanted palpebral fissures, epicanthic folds, brushfield spots in the iris, small mouth, protruding tongue, small ears, flat occiput and third fontanelle.

Medical anomalies: hypotonia, congenital heart disease, duodenal atresia, Hirschsprungs Disease.

Other changes: single palmar crease, I curved 5th finger, wide sandal gap.

4

What is the cardinal feature of the chromosomal abnormality 45, X?

Short stature (Turner Syndrome).

5

What is the most common presenting feature of the chromosomal abnormality 47, XXY?

Infertility (Kleinfelter Syndrome)

6

Which of the following conditions is inherited in an autosomal dominant manner?
A) Cystic Fibrosis
B) Down Syndrome
C) Achondroplasia
D) Sickle Cell disease
E) Friedrichs Ataxia

C) Achondroplasia

B) T21
A, D and E all autosomal recessive

7

Which of the following conditions is inherited in an autosomal recessive manner?
A) Congenital Adrenal Hyperplasia
B) Ehlers-Danos Syndrome
C) Huntington’s Disease
D) Marfan Syndrome
E) G6PD deficiency

A) Congenital Adrenal Hyperplasia

B, C and D are autosomal dominant inheritance.

E) X linked recessive inheritance

8

Which of the following conditions are inherited in an X-linked recessive manner?
A) Myotonic Dystrophy
B) Haemophilia A
C) Polyposis Coli
D) Tay-Sachs Disease
E) Phenylketonuria

B) Haemophilia A

A and C are autosomal dominant
D and E are autosomal recessive

9

A woman is a known carrier of the Duchenne muscular dystrophy (DMD) genetic mutation. Her and her partner are now expecting their first child.

Ai) what mode of inheritance is present in this condition and illustrate this with a diagram.
Aii) If they have a son what is the likelihood he will be affected by or be a carrier of the condition?
Aiii) If they have a daughter what is the likelihood she will be affected by or be a carrier of the condition?

B) Which muscles are commonly the first to be affected in children with DMD?

C) In toddlers with DMD, which muscles may undergo pseudo-hypertrophy?

D) What is the life expectancy of individuals affected by this condition?

Ai) X-linked recessive inheritance
Aii) 50% chance of being affected, 0% chance of being a carrier
Aiii) 0% chance of being affected, 50% chance of being a carrier

B) muscles of the hips, thighs and shoulders

C) the calf muscles

D) in males with DMD, 20 years is the normal life expectancy.

10

Which clinical syndrome features failure to thrive in infancy but then obesity in later childhood, excessive appetite, small hands and feet and developmental delay?

Prader-Willi Syndrome

11

Give some of the main aims of genetic counselling.

To help a patient understand their situation.

To guide their decisions regarding the managment of the disease, risks of it occurring and whether other family members may want to be tested

It adjust their situation due to the risk of being affected by the condition

12

Give two of the physical features of foetal alcohol syndrome.

Two from...
saddle shaped nose, maxillary hypoplasia, absent philtrum, short and thin upper lip.

13

Which of the following is the most common congenital infection?
A) Rubella
B) CMV
C) Toxoplasmosis
D) Parvovirus
E) Varicella zoster

B) CMV

All the others can cause congenital infections but CMV is the most common, affecting 3-4/1000 live births in the UK.

14

A baby is born and at 5 minutes is exhibiting the following...
- HR <100bpm
- regular, strong cry
- well flexed, active limbs
- cry and cough
- body pink, extremities blue
What is it's APGAR score at this stage?

8/10
1 for HR <100bpm and body pink, extremities blue
2 for everything else

15

15a) In foetal circulation which structure does the majority of the blood from the right ventricle flow through?
b) Is this blood oxygenated or deoxygenated?
c) What other structure within the foetal heart allows blood to move from the right to the left side?
d) In the foetus, is the pulmonary vasculature constricted or dilated?
e) The ductus venosus allows blood from the left umbilical vein to bypass which structure?
f) In adults, which structure is formed from the remnants of the ductus venosus?

a) The ductus arteriosus
b) oxygenated
c) The foramen ovale
d) Constricted
e) the liver
f) the ligamentum venosum

16

'A common rash appearing at 2-3 days of age consisting of white pinpoint papules at the centre of an erythematous base' describes which skin lesion that affects newborns?

Neonatal uticaria (aka erythema toxicum)

17

A newborn infant is noted to have a tuft of hair over their lumbar spine. What condition might this indicate?

Spina bifida

18

Which two manoeuvres are used to test for developmental dysplasia of the hip and what do they do?

Barlow manoeuvre: dislocates the hip posteriorly from the acetabulum
Ortolani manoeuvre: dislocated hip is relocated into the acetabulum

19

Which conditions are screened for by a heel prick blood test when a baby is 5-9 days old (aka The Guthrie Test)?

- Phenylketonuria
- Hypothyroidism
- Sickle cell disease and thallasaemia (haemaglobinopathies)
- Cystic fibrosis
- MCAD (medium-chain acyl-CoA dehydrogenase) deficiency

20

Give three possible causes of hypoxic-ischaemic encephalopathy (HIE) in neonates?

Three from...
- failure of gas exchange across the placenta (i.e. prolonged/excessive contractions, placental abruption, rupture uterus)

- Interruption of umbilical cord flow (i.e. cord compression or cord prolapse)

- Inadequate maternal placental perfusion, maternal hypotension/hypertension (often with IUGR)

- Compromised foetus (i.e. anaemia or IUGR)

- Cardiorespiratory adaptation failure at birth

21

During a complicated delivery, an infant suffers a left-sided shoulder dystocia.
a) Which bone may be fractured?
b) Which structure beneath this bone may be damaged?
c) Damage to this structure results in which abnormality?
d) How will this abnormality present?

a) the left clavicle
b) the left brachial plexus
c) Erb's Palsy
d) Left arm will be straight, limp and have the hand pronated with the fingers flexed.

22

A baby boy is born at 28 weeks via planned C-section due to maternal pre-eclampsia. Within 4 hours of birth he develops a tachyapnoea of >60 with subcostal recession, nasal flaring and expiratory grunting.
a) What is the likely diagnosis?
b) Describe the characteristic chest x-ray appearance of this condition.
c) What is the underlying pathophysiology of this condition?
d) What is given antenatally to reduce the risk of this condition occurring?

The baby is moved to NICU and put on a ventilator.
e) What complication might arise from this baby being ventilated and how might you identify it?

a) Respiratory distress syndrome
b) CXR will have a ground glass appearance with the heart border indistinct or obscured (in severe disease)

c) It is due to a deficiency of surfactant in the baby's immature lungs due to a low number of type II pneumocytes in the alveolar epithelium. Surfactant lowers surface tension within the alveoli and keeps them open and so in it's absence there is widespread alveolar collapse and inadequate gas exchange, leading to RDS.

d) Glucocorticoids are given antenatally to stimulate surfactant production.

e) Pneumothorax, will present reduced breath sounds and chest wall movement on the affected side and an increase in oxygen requirements.

23

Give two options for closing a patent ductus arteriosus in a pre-term infant.

Ibuprofen or surgical ligation

24

A pre-term infant has stopped tolerating her feeds of cow's milk formula and has produced bilious vomit. On examination her abdomen is distended.
a) What is the most likely diagnosis?
b) What is the underlying pathophysiology?
c) Describe it's characteristic x-ray appearance.
d) What is the medical management of this condition?
e) Which complication may arise from this condition and who should patients be referred to?

a) Necrotising enterocolitis
b) Bacterial invasion of ischaemic bowel wall.
c) distended loops of bowel and thickened bowel wall with intramural gas. There may also be gas in the portal tract.
d) stop oral feeding and commence broad spectrum antibiotics to cover aerobes and anaerobes.
e) Bowel perforation therefore refer immediately to general surgery.

25

Why would ibuprofen stimulate the closure of a patent ductus arteriosus?

Because PDAs are kept open through the action of prostaglandins, the production of which is inhibited by ibuprofen.

26

At what ages are children typically given the MMR vaccine?

1 year and 3 years 4 months

27

Which of the following viral infections has a prodrome which includes cough, coryza and conjunctivitis?
a) Measles
B) Mumps
C) Rubella
D) Parvovirus
E) Varicella

A) measles

28

Describe the measles rash.

Red spots ranging from 0.1–1.0cm in diameter appear on the 4th or 5th day following the start of symptoms (‘maculopapular’).
This non-itchy rash begins on face and behind the ears. Within 24–36 hours it spreads to the entire trunk and extremities (palms and soles rarely involved).

29

Which of the following is a possible complication of measles?
A) Bronchiolitis
B) Otitis media
C) Sinusitis
D) arthritis
E) orchitis

B) Otitis media

Infants at risk of developing croup and tracheitis

30

Which of the following infections is not notifiable?
A) Measles
b) Mumps
C) Rubella
D) Parvovirus
E) Tetanus

D) parvovirus

31

A child presents with a history of malaise and fever accompanied by a bilaterally swollen and painful neck. They do not have a rash,

A) what is the most likely diagnosis?
B) which structure in the neck is swollen?
C) how is this condition spread?

A) mumps
B) the parotid glands
C) droplet/saliva spread

32

A child presents with fever, coryza, conjunctivitis and lethargy. On examination they have small grey lesions visible within their mouth.
A) what is the likely diagnosis?
B) where might a rash first appear in this condition?
C) what are the lesions within the mouth called?
D) how is this condition spread?
E) If you diagnose a child with this condition what must you do?

A) Measles

B) behind the ears

C) Koplik Spots

D) droplet

E) Notifty PHE

33

A child is diagnosed by his GP with rubella.

A) Give two key differences between rubella and measles.
B) Which patient group must the child be kept away from until they are not longer infectious and why?
C) how long does it typically take for rubella to resolve?

A) the fever in measles is higher typically and the spots of the rash can join to form larger patches. Also measles generally takes longer to resolve. Rubella is teratogenic in the 1st trimester, measles is not.

B) Pregnant women, due to risk of contracting congenital rubella syndrome


C) 7-10 days

34

Which of the following typically presents with malar erythema?
A) Rubella
B) Measles
C) Mumps
D) Erythrovirus
E) Hand, Foot and Mouth

D) Erythrovirus( aka slapped cheek syndrome/parvovirus/erythema infectiosum)

Rubella and measles present with a macular rash which starts on the face and spreads over the body.

Hand, foot and mouth presents with vesicles on the palms, soles and in the mouth.

35

A baby was born in the breech position. Barlow’s and Ortolani’s tests were normal. What would be your next step in the management and what would it exclude?

USS hip, DDH (higher risk in breech babies)

36

You diagnose a 2 month old girl with bacterial meningitis. Aside from a 3rd gen. cephalosporin, what other antibiotic do you prescribe and what is the indication?

Amoxicillin, to cover for Listeria monocytogenes.

37

A 14 month child presents with a 3 day history of high fever followed by a maculopapular rash which began on the trunk then moved to the limbs.
A) What is the likely diagnosis?
B) What is the underlying cause?
C) What diagnosis is important to exclude and how might you do this as you take the history?

A) Roseola infantum
B) Herpes 6 virus infection
C) measles, exclude through a vaccination history.

38

Which of the following will NOT cross the suture lines on the head of a newborn infant?
A) Caput succedeneum
B) Subaponeurotic haematoma
C) Cephalohaematoma
D) Mongolian blue spots
E) All of the above

C) Cephalohaematoma.

Most commonly seen in instrumental deliveries and often over the parietal region.

39

A mother has taken lithium during her pregnancy to treat bipolar disorder. Which of the following cardiac abnormalities might her baby suffer from?
A) transposition of the great arteries
B) ‘atrialisation’ of the right ventricle
C) VSD
D) Coarctation of the aorta
E) pulmonary stenosis

B) ‘atrialisation’ of the right ventricle.

this is Ebstein’s anomaly, there is low insertion of the tricuspid valve leading to a grossly enlarged right atrium and smaller right ventricle.
Associated with tricuspid incompetence and WPW syndrome

40

An 8 year old with asthma is suffering from regular exacerbations and a night time cough. He is currently taking salbutamol and beclamethasone inhalers. What is the approapriate next step?
A) a LABA
B) a leukotriene receptor agonist (LTRA)
C) both a LABA and an LTRA
D) Oral prednisolone
E) Increase the salbutamol dose

B) an LTRA, this is the 3rd step in the management of asthma in children.

41

What triad of pathologies compromise ‘shaken baby syndrome’?

Retinal bleeding, encephalopathy, and subdural haematoma.

42

A child has chicken pox. What advise should you give regarding school exclusions?

No school until 5 days after the rash first appeared.

43

Which of the following is the most common cause of stridor in neonates?
A) Croup
B) Epiglottitis
C) Bronchiolitis
D) Laryngomalacia
E) Asthma

D) laryngomalacia, the cause in around 50% of neonatal cases

44

You are in a GP surgery and an 18 month old child comes in who the parents report is having visual problems. On examination you find the right pupil is normal but the left appears white when testing the red reflex.
A) what is the name of this clinical finding?
B) what is the likely diagnosis?
C) what is the underlying pathophysiology?
D) what is the prognosis for this child?

a) leukocoria
B) retinoblastoma
c) loss of function mutation on the retinoblastoma tumour suppressor gene on q13.
D) good, 90% survive to adulthood

45

A 1 day old baby born via cat. 1 C-section for foetal distress is found to have reduced air entry on the left side and a displaced apex beat. How might his abdomen appear?
A) distended
B) scaphoid
C) firm
D) bruised
E) jaundiced
Bonus: describe his left lung?

B) Scaphoid

Reduced air entry plus displaced apex plus scaphoid abdomen is suggestive of a congenital diaphragmatic hernia. His left lung would be hypoplastic.

46

What are the components of the triad that makes up nephrotic syndrome in children?

proteinuria (> 1 g/m^2 per 24 hours)
hypoalbuminaemia (< 25 g/l)
oedema