Paeds

Question 1

outpouching of ileum due to peristence of vitelline duct is known as:

Answer 1

meckel’s diverticulum

Question 2

absence of ganglionic cells in submucosa is known as :

Answer 2

hirschsprungs disease

infants

• fail to pass meconium
• abdo distention
• vomiting

Question 3

6 features of cystic fibrosis:

Answer 3

MRS SEW

M- meconium ileus

R- recurrent pneumonia

S- steatorrhoea

S- short stature

E- extra energy needed

W- weight gain poor

Question 4

which manoeuvre is contraindicated in patients with suspicion of cervical spine injury?

Answer 4

head tilt and chin lift

Question 5

telescoping of one bowel segment into distal segment:

Answer 5

intussusception

- red current jelly stools

Question 6

palpable ‘olive’ mass in epigastric region.

non bilious projectile vomiting at 2-6 weeks of life

Answer 6

congenital hypertrophic pyloric stenosis

Question 7

ileus caused by

Answer 7

aperistaltic bowel

Question 8

what sign is seen on x-ray in a child with duodenal atresia

Answer 8

double bubble sign

association with downs.

Question 9

4 y/o ran into a door.
crying. vomited three times.

OE: swelling on forehead, CNS and PNS examination normal.

next best course of action?

options:

a) CT within 1 hr
b) CT within 8 hrs
c) observe 4 hrs
d) discharge now
e) social service involvement

Answer 9

observe for atleast 4 hrs.

CT within one hour if more than one of the following features

• loss of consciousness > 5mins
• abnormal drowsiness
• 3 episodes vomitting
• high impact injury
• amnesia

the child in this case only has one feature!

Question 10

supplementation with what prior to conception can help prevent neural tube defects

Answer 10

folate

• necessary in nucleic acid synthesis
• 400 micograms a day

however if +FH
- 5mg folic acid

Question 11

which vitamin prevents keratinised squamous metaplasia

Answer 11

vitamin A supplementation

Question 12

which vitamin is necessary for pyruvate dehydrogenase function:

Answer 12

thiamine

thiamine deficiency can cause beriberi and wernickes-korsakoffs syndrome observed in alcoholics

Question 13

11 month old

pc: failure to thrive, weight loss. recurrent diarrhoea, recurrent fevers, breathing difficulties
oe: generalised lymphadenopathy + eczema

likely diagnosis:

Answer 13

HIV

mothers with low viral load can have vaginal delivery, otherwise pre labour C-section done to reduce vertical transmission risk

Question 14

neonate with

• low birthweight
• jaundice
• small head
• seizures
• acutely unwell

could be due to:

Answer 14

congenital cytomegalovirus

Question 15

2 day old neonate

pc:

• refusing to feed
• irritable

oe

• hypotonic
• non blanching petechial rash over lower limbs

diagnosis:

Answer 15

early onset neonatal sepsis.

common organism: GBS

Question 16

treatment of GBS neonatal sepsis

Answer 16

IV benzylpenicillin

gentamicin

Question 17

10 day old neonate:

pc: blistering rash on scalp and face
oe: jaundice, hepatomegaly, vesicular rash

indicative of:

Answer 17

herpes simplex virus

Question 18

tx herpes simplex virus

Answer 18

IV aciclovir

Question 19

conjunctivitis (bilateral purulent discharge from eye) + respiratory distress

likely due to:

Answer 19

chlamydia infection

- can cause pneumonia and conjuctivitis

Question 20

treatment of chlamydia trachomatis ?

Answer 20

erythromycin

Question 21

6 week old

pc:

• struggling to feed
• increased work of breathing
• not gained weight in 2 weeks

oe:

• parasternal heave
• loud systolic murmur at left sternal border

indicative of :

Answer 21

ventral septal defect

spontaneous closure common < 1 years.

after 2 years VSD unlikely to close.

Question 22

what is a common method of diagnosing VSD?

Answer 22

Echocardiography

Question 23

when is surgical repair indicated in child with VSD?

Answer 23

• poor growth

- uncontrolled heart failure

Question 24

most appropriate investigation for child with suspicion of meningitis

Answer 24

lumbar puncture

csf fluid for gram staining and microscopy

Question 25

2 month old pc: fever + grunting, tacypnoeic, cough, nasal flaring investigation:

Answer 25

signs of respiratory distress + fever --> pneumonia Ix = CXR

Question 26

child under 5 with signs of gastroenteritis. investigation:

Answer 26

only <5% due to bacterial cause. so need to do electron microscopy of stool - demonstrates viruses

Question 27

6 month old 4 day hx paroxysmal cough + fine purpuric eruptions around eyes and neck. missed her diptheria, tetanus and pertussis vaccinations. indicative of:

Answer 27

patient have pertussis --> forceful coughing can lead to traumatic petechiae. traumatic petechiae - in periorbital areas - subconjunctival haemorrhage

Question 28

which commonly presents with - palpable purpuric rash - abdominal pain - arthralgia - glomerulonephritis

Answer 28

Henoch-schonlein purpura - immune complex small vessel vasculitis glomerulonephritis --> nephritic syndrome --> swelling of ankles and feet

Question 29

Henoch-schonlein purpura results from:

Answer 29

- IgA deposition | - post URTI or other infection

Question 30

bacterial cause sof meningitis

Answer 30

NHS N- neisseria menpngitidis (child and adult; meningococcus) H- haemophillus influenza S- strep pneumoniae (adults and elderly)

Question 31

acute lymphoblastic leukaemia presents with

Answer 31

1. progressive anaemia (lethargy + pallor) 2. neutropenia (recurrent infections) 3. thrombocytopenia (spontaneous bruising, purpura, mucosal bleeding) may be lymphadenopathy, hepatosplenomegaly --> organ infiltration

Question 32

what presents with : - abrupt onset platelet type bleeding - spontaneous bruising - petechiae - mucosal bleeding

Answer 32

idiopathic thrombocytopenic purpura

Question 33

management of idiopathic thrombocytopenic purpura is:

Answer 33

corticosteroids OR intravenous immunoglobulin

Question 34

where is a patent ductus arteriosus best heard?

Answer 34

left upper chest , pulmonary area

Question 35

what is the tetralogy of fallot?

Answer 35

SHOP S- ventricular septal defect H- hypertrophy of RV O- overriding aorta P- pulmonary stenosis

Question 36

causes of aortic stenosis:

Answer 36

REC R- rheumatic heart disease E- elderly calcification of tricuspid C- congenital calcification of bicuspid aortic valve

Question 37

newborn: cyanotic at birth CXR : boot shaped heart, holosystolic murmur audible at left lower sternal border indicative of:

Answer 37

tetralogy of fallot

Question 38

3 y/o boy pc: - cough (dry/ nocturnal/ worse with exercise) - wheeze - sob pmh - mild excema indicative ofL

Answer 38

asthma - intermittent attacks of wheese pmh of hay fever or eczema is also suggestive of asthma

Question 39

7 month old - chronic resp symptoms - offensive diarrhoea - failure to thrive indicative of:

Answer 39

cystic fibrosis steatorrhoea - malabsorption from pancreatic insufficiency

Question 40

15 y/o pc - intermittent abdo pain + diarrhoea for 2 years - blood + mucus in stools - weight loss, periodic fevers oe - erythema nodosum on shins

Answer 40

ulcerative colitis extraintestinal manifestations of IBD involve - monoarticular arthritis - erythema nodosum

Question 41

posititive anti-TTG and anti- EMA antibodies are characteristic of:

Answer 41

coeliacs disease association with HLA-DQ2, HLA-DQ8

Question 42

neonate - forceps delivery oe - reduced tone in left arm - reduced moro reflex (splaying arms and legs in front of their body) - arm in waiter tip position classical signs of:

Answer 42

erbs palsy management: physio

Question 43

14 y/o, started to limp, in pain, overweight diagnosis:

Answer 43

slipped femoral epiphysis secondary school

Question 44

deficiency in G6PD leads to:

Answer 44

G6PD enzyme needed in RBCs. Cells become more vulnerable to damage from reactive oxygen species (ROS) --> leads to haemolysis

Question 45

G6PD deficiency often presents with:

Answer 45

neonatal jaundice! - anaemia - gall stones - splenomegaly more common in mediterranean, middle eastern and african parents X-linked

Question 46

15 y/o pc: - recurrent abdo pain - bloody diarrhoea oe - small for her age - delayed puberty - oral and perianal ulcers indicative of:

Answer 46

Crohn's disease notes - transmural - skip lesions perianal fistulae and oral apthous ulcers are not classically seen in UC.

Question 47

3 key signs of intussusception

Answer 47

SSS S- screaming, pallor S-stool, red current jelly S-sausage shaped palpable abdo mass in RHS abdomen

Question 48

inheritance of haemophilia A

Answer 48

X-linked recessive

Question 49

haemophilia A characterised by deficiency in what

Answer 49

factor VII

Question 50

haemophilia B characterised by deficiency in what

Answer 50

clotting factor IX

Question 51

5 month old pc: respiratory distress hpc: coryzal symptoms 5 day hx oe: 37.8 temp - nasal flaring - intercostal recession - cyanosis widespread wheeze and crackles through lung fields indicative of:

Answer 51

acute bronchiolitis

Question 52

what syndrome is characterised by deafness and renal failure?

Answer 52

alport syndrome

Question 53

child has difficulty in hearing, several fractures after minor falls, sclera appear blue, legs short and deformed indicative of:

Answer 53

osteogenesis imperfecta

Question 54

18 month old pc: 4 day hx high fever + coryza oe: pink blanching maculopapular rash, now spread to arms , fever now settled indicative of:

Answer 54

Roseola infantum