Paeds EMQs Flashcards
At which of these ages is the following action (screening, examination, health promotion activity) taken in the child health surveillance and promotion programme in the United Kingdom? Each answer can be used once, more than once, or not at all.
Guthrie test (biochemical screening test)
Newborn 5-6 days 12 days 8 weeks 3 months 4 months 8 months 12 months 13 months 2-3 years 4-5 years (pre-school) 5 years (school entry)
5-6 days
At which of these ages is the following action (screening, examination, health promotion activity) taken in the child health surveillance and promotion programme in the United Kingdom? Each answer can be used once, more than once, or not at all.
First routine immunisation with 5 in 1 immunisation - DTaP/IPV, Hib, PCV (diphtheria, tetanus, pertussis, polio, Haemophilus influenza, pneumococcal)
Newborn 5-6 days 12 days 8 weeks 3 months 4 months 8 months 12 months 13 months 2-3 years 4-5 years (pre-school) 5 years (school entry)
8 weeks
At which of these ages is the following action (screening, examination, health promotion activity) taken in the child health surveillance and promotion programme in the United Kingdom? Each answer can be used once, more than once, or not at all.
Hearing test using evoked otoacoustic emission or auditory brainstem response audiometry
Newborn 5-6 days 12 days 8 weeks 3 months 4 months 8 months 12 months 13 months 2-3 years 4-5 years (pre-school) 5 years (school entry)
Newborn
At which of these ages is the following action (screening, examination, health promotion activity) taken in the child health surveillance and promotion programme in the United Kingdom? Each answer can be used once, more than once, or not at all.
Advice on reducing the risk of sudden infant death syndrome by ‘Back to sleep’, avoiding overheating and avoiding parental smoking
Newborn 5-6 days 12 days 8 weeks 3 months 4 months 8 months 12 months 13 months 2-3 years 4-5 years (pre-school) 5 years (school entry)
Newborn
Steven has just had his first birthday party. During his party he commando-crawled with great speed, although he cannot walk. He managed to pick off all the Smarties (round chocolate sweets) from his birthday cake. He can say two words with meaning. After his birthday party, he impressed his guests by waving goodbye.
Which area of Steven’s development is delayed?
Gross motor Fine motor and vision Speech and hearing Social, emotional and behavioural development None of the above
None of the above
He has therefore achieved normal milestones for a 12-month-old.
At which of these ages is the following action (screening, examination, health promotion activity) taken in the child health surveillance and promotion programme in the United Kingdom? Each answer can be used once, more than once, or not at all.
First MMR (measles/mumps/rubella) immunisation
Newborn 5-6 days 12 days 8 weeks 3 months 4 months 8 months 12 months 13 months 2-3 years 4-5 years (pre-school) 5 years (school entry)
13 months
At what age will children achieve the milestones described in the scenarios (median age)? Each age can be used once, more than once, or not at all.
Herbert can transfer objects from one hand to the other whilst sitting without support and with a straight back.
6 weeks 6 months 8 months 10 months 12 months 18 months 2 yrs 3 yrs 4 yrs 5yrs
8 months
Jonathan is 4 years old and lives in a small village in southern England. He attends a paediatric outpatient clinic with his grandmother who is his legal guardian. She is concerned that he only seems to like to play with his toy train and insists on watching the same DVD every night before he goes to bed. He attends nursery where he plays with the toys but not with other children. His behaviour can be very difficult to manage at times. He does not say any words whereas the grandmother’s children were speaking in sentences at his age. On examination you notice he does not make eye contact with you and pushes his toy train back and forth on the floor. The rest of his examination is normal.
What is the most likely diagnosis?
ADHD Autistic spectrum disorder Developmental coordination disorder (dyspraxia) Asperger syndrome Expressive language disorder
Autistic Spectrum Disorder
Autism is a triad of impaired social interaction, speech and language disorder and ritualistic and repetitive behaviour.
At which of these ages is the following action (screening, examination, health promotion activity) taken in the child health surveillance and promotion programme in the United Kingdom? Each answer can be used once, more than once, or not at all.
An orthoptist assessment for visual impairment
Newborn 5-6 days 12 days 8 weeks 3 months 4 months 8 months 12 months 13 months 2-3 years 4-5 years (pre-school) 5 years (school entry)
4-5 years (pre-school)
At what age does autistic spectrum disorder usually become evident?
0-12 months 12-24 months 2-4yrs 4-8yrs >8yrs
2-4yrs
Autistic spectrum disorder usually presents at this age because this is when language and social skills rapidly develop.
At what age will children achieve the milestones described in the scenarios (median age)? Each age can be used once, more than once, or not at all.
Rosette can build a three-cube tower and can point to her nose.
6 weeks 6 months 8 months 10 months 12 months 18 months 2 yrs 3 yrs 4 yrs 5yrs
12 months
At what age would you expect the clinical features of cerebral palsy to become evident?
0-12 months 12-24 months 2-4 years 4-8yrs >8yrs
0-12 months
Cerebral palsy most often presents during this time when acquisition of motor skills occurs most rapidly.
Fortunate is an 8-month-old black African girl who was born at term. She is seen in the paediatric outpatient department. She can roll over. She does not crawl. She can say ‘dada’, but says it to everyone not just her father. She reaches out and grasps objects with her left hand but not with her right, and puts objects in her mouth. She smiles, but is not able to wave bye-bye.
Select the option that concerns you most about Fortunate’s development.
Unable to crawl Left hand preference Unable to use sounds discriminately to parents Unable to wave bye-bye None of the above
Left hand preference
Fortunate has developed a preference for using her left hand at 8 months. Development of a hand preference before 1 year of age is abnormal, and she needs to be assessed for hemiplegic cerebral palsy affecting her right side.
Gloria is a 19-month-old white British girl whose health visitor is concerned because she is still only babbling and says no distinct words. She is able to walk, scribbles with crayons and feeds herself with a spoon.
What is the most appropriate first action?
Hearing test
Assessment by a team specialising in autistic spectrum disorders
Reassure the health visitor
Refer to ENT surgeon
Refer to a paediatrician for a full developmental assessment
Hearing test
Speech delay can be due to hearing impairment, and this should be assessed first prior to referring her to a specialist.
Which of these investigations would you choose to confirm the diagnosis of developmental delay in the children described in the following scenarios? Each investigation can be used once, more than once, or not at all.
Clarissa, a cheerful 20-month-old white British girl, is referred to the child development clinic by her health visitor because she is not yet walking. She was born at term with no complications. She learnt to sit without support at 10 months, and is able to crawl, although she drags her right leg behind her. Her mother says that she has always been left-handed. Examination revealed reduced power and reflexes but increased tone in the right arm.
Chromosome karyotype DNA FISH analysis TFTs Maternal amino acids for raised phenylalanine Creatine kinase Blood lactate Congenital infection screen Cranial US CT or MRI of the brain Electroencephalography (EEG)
CT or MRI of the brain
