Paeds past questions 16-21 Flashcards by J Akoro

A 13 year old girl in the Paediatric Emergency Department has drowsiness, weight loss and tiredness over the last 10 days. Her capillary blood gas results on arrival shows:
pH 7.01 (7.35 - 7.45)
PCO2 2.9 kPa (4.6 - 6.4)
HCO3 9 mmol/L (22 - 30)
Glucose 24 mmol/L (3.0 - 6.0)
Blood ketones 6 mmol/L

Following an initial ABC assessment, bloods were taken. Her latest observations are: temperature 37C, pulse rate 118 bpm, BP 105/74 mmHg, capillary refill time 3 seconds, respiratory rate 27 breaths per minute, oxygen saturation 96% breathing air.

Rank the following subsequent management steps in order of priority with (1) being performed first and (5) being performed last

a. SC insulin
b. Repeat blood gas
c. Administer a fluid bolus
d. IV insulin
e. Calculate IV fluid requirement

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A previously well, fully immunised, 2 year old girl, has a fever, irritability and vomiting for the last 3 days. A lumbar puncture is performed, and her CSF results are as follows:
CSF protein 0.8 g/L (0.15 - 0.45)
Glucose 2.9 mmol/L (2.2 - 2.4) (blood glucose 7 mmol/L)
Polymorphonuclear cells 95%
Mononuclear cells 5%

Rank the following causative organisms in order of likelihood with (1) being the most likely and (5) being the least likely.

a. Streptococcus pneumoniae
b. Cryptococcus
c. Haemophilus influenzae type B
d. Staphylococcus aureus
e. Enterovirus

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A 2 week old baby has been recently diagnosed with trisomy 21. Rank the following cardiac defects in order of likelihood

a. ASD
b. Pulmonary atresia
c. Mild coarctation of the aorta
d. AVSD
e. VSD

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A 4 month old boy in General Practice has 2 months of slowly worsening vomiting after feeding. He frequently cries and arches his back after feeding and refuses feeds. He is formula fed. He was just below the 50th centile for weight at birth and is now just above the 25th percentile.

Rank the following interventions according to the sequence in which they should be implemented with (1) being carried out first and (5) being carried out last.

a. Refer to paediatrics team
b. Trial smaller and more frequent feeds
c. Trial of proton pump inhibitor treatment
d. Trial of feed thickener
e. Prescribe alginate therapy with feeds

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A 5 year old boy in General Practice has 3 days of cough and coryza. His mother noticed a fever and a rash this morning. His temperature is 39C, pulse rate 150 bpm, respiratory rate 35 breaths per minute, and oxygen saturation 99% breathing air. His rash is found to be non-blanching. Which medication should be prescribed in this scenario?

a. IM Benzylpenicillin
b. IM Hydrocortisone
c. PO Co-Amoxiclav
d. PO Paracetamol
e. PO Penicillin V

a. IM Benzylpenicillin

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A 9 year old girl is in Paediatric Outpatients following parental concerns about her weight. During the consultation the girl reveals she is being bullied at school. Her weight is 49kg, and height is 1.37m (given growth chart with this plotted). Her thyroid function test results are as follows. TSH 3.5mU/L (0.7-4.1), free T4 16 pmol/L (12-22). Which is the most appropriate next step in her weight management?

a. Prescribe metformin
b. Prescribe orlistat
c. Refer to a paediatric dietician
d. Refer to Child and Adolescent Mental Health Services (CAMHS)
e. Refer to endocrinology

c. Refer to a paediatric dietician???

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A 3 week old girl has had loose stools since day 2 of life and there are now streaks of blood in the stool. The baby examies well with normal observations, normal findings on abdominal examination, but there is dry skin on the scalp and face. Which is the most likely diagnosis?

a. Coeliac disease
b. Cow’s milk protein allergy
c. Gastroenteritis
d. Intussusception
e. Lactose intolerance

b. Cow’s milk protein allergy

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A 3 year old girl with eczema has a 2 day history of a new rash on her arms (see image). Which is the most appropriate treatment for this rash?

a. IV aciclovir
b. IV flucloxacillin
c. Topical clobetasone
d. Topical emollient
e. Topical fucidin

eczema herpeticum

a. IV aciclovir

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An 11 year old girl has had intermittent central abdominal pain for 6 months. Her symptoms improved over the summer holidays but returned in the autumn. She also had headaches, which settled with no treatment. She opens her bowels daily with type 4 stool, and no bleeding. There is no history of fevers, vomiting or urinary frequency. Her height and weight have remained on the 75th centile. Which is the most likely diagnosis?

a. Coeliac disease
b. Constipation
c. Crohn’s disease
d. Functional abdominal pain
e. Urinary tract infection

d. Functional abdominal pain

better when not at school

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A 15 year old boy has 3 weeks of cough, weight loss, night sweats and fever. He moved to the UK from India 3 years ago. His chest x-ray is show in the image (can’t find exact image but showed some left upper zone shadowing I think). Which investigation is regarded as the gold standard for diagnosis for his underlying condition?

a. Blood culture
b. Gastric washings
c. Mantoux
d. QuantiFERON / IGRA
e. Sputum culture

Sputum culture

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The parents of a 7 year old boy are concerned about intermittent pains in his leg, which have worsened over the last few days. He has now developed a limp. His temperature is 36.5C, heart rate 80 beats per minute, respiratory rate 20 breaths per minute. Which is the most likely diagnosis?

a. Henoch Schönlein Purpura
b. Osgood Schlatter’s
c. Perthes disease
d. Reactive arthritis
e. SUFE

c. Perthes disease

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A 3 year old girl in the paediatric Emergency Department has conjunctival pallor, lethargy and dark urine. Last week she finished a course of nitrofurantoin for a urinary tract infection. Her blood results are as follows: Hb 70 g/L (110-140), WBC 3.2 x 10^9/L (5.0 - 12.0), platelets 520 x 10^9/L (150 - 400), albumin 37 g/L (30 - 50), bilirubin 75 umol/L (<21), ALT 18 IU/L (0 - 29), ALP 130 IU/L (60 - 425). Which is the most likely underlying diagnosis?

a. Beta Thalassaemia
b. G6PD deficiency
c. Hereditary spherocytosis
d. Iron deficiency anaemia
e. Sickle cell disease

b. G6PD deficiency

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A 7 year old boy has a history of recurrent chest infections, persistent sinusitis and has been prescribed multiple courses of antibiotics. He has bibasal crepitations and a right-sided apex beat. Which is the most likely underlying diagnosis?

a. Agammaglobulinaemia
b. Cystic fibrosis
c. HIV
d. Primary ciliary dyskinesia
e. Tracheo-oesophageal fistula

d. Primary ciliary dyskinesia

kartageners triad

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A 3 day old baby girl is not feeding well. Her temperature is 36.7C, heart rate 180 bpm, respiratory rate 66 breaths per minute. There is a systolic murmur and femoral pulses are not palpable. Which is the most likely diagnosis?

a. Atrial septal defect
b. Coarctation of the aorta
c. Patent ductus arteriosus
d. Patent foramen ovale
e. Ventricular septal defect

b. Coarctation of the aorta

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A 5 year old boy in the paediatric Emergency department recently had a sore throat and now has a rash across her lower legs. She is afebrile but has abdominal pain and joint pains in both legs. Her full blood count result is as follows: Hb 110 g/L (115 - 140), WCC 10.3 x 10^9/L (3.8 - 10), neutrophils 6 x 10^9/L (150 - 400). Which is the most likely diagnosis?

a. Acute lymphoblastic leukaemia
b. Henoch Schonlein Purpura
c. Idiopathic thrombocytopenic purpura
d. Juvenile idiopathic arthritis
e. Meningococcal septicaemia

b. Henoch Schonlein Purpura

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. A 15 year old girl in outpatients has no sign of breast development. Her growth is plotted in the chart below (growth chart showed short stature for age). She has widely spaced nipples and wide carrying angle of her arms. Which is the most likely diagnosis?

a. Familial short stature
b. Hypothyroidism
c. Kallmann’s syndrome
d. Noonan’s syndrome
e. Turner’s syndrome

e. Turner’s syndrome

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A 15 year old boy presents to the Emergency Department with nausea, diarrhoea and abdominal pain, jaundice, lethargy and generalised joint pains. The diarrhoea is watery, pale in colour and does not contain blood. He returned from Thailand last week.
Investigations:
Hb 150 g/L (130 -175)
WBC 12.5 x 10^9/L (3.8 - 10.0)
Platelets 380 x 10^9/L (150 - 400)
Albumin 48 g/L (30 - 50)
ALT 650 IU (0-37)
ALP 280 IU (60 - 425)
Bilirubin 110 umol/L (<21)
Gamma-GT 94 IU/L (9 - 40)
Which is the most likely diagnosis?
a.	Hepatitis A infection
b.	Hepatitis B infection
c.	Infectious mononucleosis
d.	Shigella enteritis
e.	Typhoid fever

a. Hepatitis A infection

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An 8 year old boy in the Emergency Department has been unable to open his left eye for 1 day. Prior to this he had a cold one week ago. When examining the left eye, it is difficult to open, and he reports pain on all eye movements. The conjunctiva is injected. Which is the most appropriate next step in management?

a. Blood pressure
b. Blood tests
c. CT head
d. Lumbar puncture
e. Refer to specialist

e. Refer to specialist

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A 4 year old boy has recently emigrated to the UK with a chronic persistent cough, frequent chest infections and loose stools. He has low weight, a wet cough and nasal polyps. His uncle had a similar condition, and died at age 28. Which investigation is discriminatory in this scenario?

a. Chest x-ray
b. Mantoux test
c. Pernasal swab
d. Sputum culture
e. Sweat test

e. Sweat test

cystic fibrosis

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A 5 year old girl has 5 days of fever, red lips, red eyes and cervical lymphadenopathy. She has had a course of amoxicillin for a sore throat. Which is the definitive treatment in this scenario?

a. IV aciclovir
b. IV ceftriaxone
c. IV clindamycin
d. IV IG
e. IV remdesivir

d. IV IG

Kawasakis

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A 7 year old girl has breast buds but no pubic hair. Her height is on the 98th centile and her weight is on the 75th centile. She is otherwise fit and well. There is no significant family history. Investigations show: bone age of 10 years, FSH 3.2 IU/L (<1), LH 3.4 IU/L (<1). Which is the most likely diagnosis?

a. Adrenarche
b. Central precocious puberty
c. Congenital adrenal hyperplasia
d. Normal variant
e. Thelarche

e. Thelarche (breast development)

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A 4 year old boy is in the Emergency Department has 1 week of tiredness. His mother reports that he has generalised swelling, mostly around the eyes and lower legs. His abdomen also seems bigger than normal. Which is the most appropriate first line investigation in this scenario?

a. 24 hour urine collection
b. Abdominal ultrasound
c. Abdominal x-ray
d. Blood tests
e. Urine dipstick

e. Urine dipstick

minimal change disease

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A 2 year old boy has daily loose stools for 2 weeks, containing visibly undigested food matter, such as peas and carrots. He is growing along the 50th centile. Which is the most likely diagnosis?

a. Constipation with overflow
b. Food poisoning
c. Gastroenteritis
d. Inflammatory bowel disease
e. Toddler diarrhoea

e. Toddler diarrhoea

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A 4 year old boy has abdominal pain for 2 weeks and noticed some blood in his urine. He has a palpable abdominal mass on the left side, extending below the umbilicus. Which is the most likely diagnosis?

a. Constipation
b. EBV
c. Horseshoe kidney
d. Neuroblastoma
e. Wilms tumour

e. Wilms tumour

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A 3 year old boy attends the Emergency Department after an episode of sudden onset jerky movements of both arms and legs for 5 minutes, which stopped before the ambulance arrived. His current observations are: temperature 38.5C, pulse 130 bpm, blood pressure 100/90 mmHg, respiratory rate 25 breaths per minute, oxygen saturation 98% breathing air. He has had a coryzal illness for 24 hours and is otherwise fit and well. He is alert, with a blood glucose of 4.5 mmol/L (3.0 - 6.0) and neurological examination is normal. Which is the most appropriate next step in management? a. Order a CT brain and observe b. Prescribe buccal midazolam and discharge c. Prescribe IV ceftriaxone and admit d. Prescribe oral antipyretics and observe e. Prescribe oral co-amoxiclav and discharge

d. Prescribe oral antipyretics and observe | febrile seizure

A term infant born to a diabetic mother is 4 hours old on the postnatal ward and is noted to be jittery. The capillary blood gas result is as follows: pH 7.37 (7.35 - 7.45), PCO2 5.5 kPa (4.6 - 6.4), PO2 4.9 kPa (8 - 12), glucose 2.4 mmol/L (3 - 6), lactate 2.0 mmol/L (1 - 2). Which is the most appropriate treatment for the baby in this scenario? a. Buccal midazolam b. Feed the baby c. IV dextrose d. IV lorazepam e. Oxygen

b. Feed the baby

A 2 year old boy has acute onset of cough and drooling, with inspiratory upper airway noises. His vaccinations are up to date. His examination is otherwise normal. His temperature is 36.8C, pulse 120 bpm, blood pressure 100/60 mmHg, respiratory rate 26 breaths per minute and oxygen saturation 98% breathing air. Which is the most likely diagnosis? a. Anaphylaxis b. Croup c. Epiglottitis d. Inhaled foreign body e. Laryngomalacia

d. Inhaled foreign body

A 14 year old girl attends Paediatric Outpatients with ongoing headaches. These are associated with nausea and vomiting and she is missing school. They are occurring once per month and at any time of day. The headaches eventually settle after lying down in a dark room. She has tried NSAIDs, which do not help. Neurological examination is normal. Which is the most appropriate treatment? a. Aspirin once daily b. Metoclopramide when required c. Nasal sumatriptan when required d. Pizotifen when required e. Propanolol once daily

c. Nasal sumatriptan when required

A 12 year old girl in GP complains of ongoing headaches for the last 4 months. The headaches are severe and throbbing in nature and often associated with nausea and vomiting. The headaches are worse in the morning. His father has noticed he is more tired than usual and has been more irritable. His weight is 62 kg. Which is the most likely diagnosis? a. Benign intracranial hypertension b. Insomnia c. Low mood d. Migraine e. Tension headaches

a. Benign intracranial hypertension

A 5 year old boy in General Practice has bright red blood when opening his bowels for 1 week. He opens his bowels every 3 days. He has no past medical history and is thriving. He has a well-balanced diet and has good fluid intake. There are no safeguarding concerns. Abdominal examination is unremarkable. Rectal inspection reveals a fissure. Which is the most appropriate management? a. Dietary advice b. Osmotic laxative c. Phosphate enema d. Stimulant laxative e. Toilet training

b. Osmotic laxative

A 7 year old boy in General Practice has a sore throat, fever and pain on swallowing for 1 day. His temperature is 38.5C, pulse rate 110 bpm, respiratory rate 24 breaths per minute, and oxygen saturation 99% breathing air. He has bilateral tonsillar enlargement with exudate and bilateral cervical lymphadenopathy. He is talking in full sentences without using accessory muscles. Which is the most appropriate management? a. Admit to hospital b. Continue supportive measures c. Prescribe amoxicillin d. Prescribe phenoxymethylpenicillin e. Review in 48 hours

b. Continue supportive measures or d????

A 14 year old has a 2 day history of worsening abdominal pain, reduced appetite and constipation. His temperature is 38.1C. He is tender in his right lower quadrant. Which is the most appropriate action? a. Admit to hospital for assessment b. Encourage oral fluids c. Prescribe analgesia and follow up next week d. Prescribe movicol e. Refer to paediatric 2 week wait

a. Admit to hospital for assessment appendicitis??

A 6 week old baby is seen for his routine baby check in General Practice with his mother. She has no concerns. A soft systolic murmur is heard on examination. It varies with posture and does not radiate. The child appears well. Which is the most likely diagnosis? a. Coarctation of the aorta b. Innocent murmur c. Patent ductus arteriosus d. Pulmonary stenosis e. Ventricular septal defect

b. Innocent murmur

``` A 7 year old boy in General Practice has ongoing night time bed-wetting. He is dry during the day but has never been dry at night. His mother has tried managing his fluid intake, regular toileting and a star chart for 6 months with no success. He has no past medical history and takes no regular medication. He is doing well at school and at home. Abdominal examination is unremarkable. Urinalysis: Glucose - negative Protein - negative Ketone - negative Blood - negative Nitrites - negative Leukocytes - negative Which is the most suitable management option? a. Continue star chart b. Desmopressin c. Enuresis alarm d. Imipramine e. Oxybutynin ```

c. Enuresis alarm

The father of a 3 year old is concerned about her weight. She is always hungry and has put on a lot of weight this year due to overeating. The child is short in stature, has almond-shaped eyes and a narrow forehead. Which is the most likely diagnosis? a. Edward’s syndrome b. Fragile X syndrome c. Pierre-Robin syndrome d. Prader-Willi syndrome e. William’s syndrome

d. Prader-Willi syndrome

A 2 year old in General Practice has a cough. He has reached all of his developmental milestones at the right time so far. Which motor skill would this child have most recently acquired? a. Crawling b. Draw a circle c. Draw a square d. Transfers objects from one hand to the other e. Turning one page in a book

Turning one page in a book

An 8 month old baby is seen in clinic with widespread rash localised to his flexures, cheek and neck. There is a strong family history of atopy. What is the most appropriate first line treatment?

emollients

A 5 month old baby who is unvaccinated is in the Paediatric Emergency Department following apnoeic episodes with coughing at home. What is the most likely causative organism?

bordetella pertussis

A widespread rash is found on a 2 day old baby at his newborn check (see image). He is feeding well, is active and has no fever. What is the most appropriate management?

erythema toxicum???

A 9 month old boy in the Paediatric Emergency Department has left cheek bruising. He had multiple bruises on both thighs and buttocks. Full blood count and clotting screens were unremarkable. What is the most likely cause for his presentation?

NAI

A 4 year old boy in paediatric outpatients is unsettled with abdominal pain. He is scratching his bottom, worse at night, He has small white threads seen in his stool. What is the most appropriate treatment for this condition?

mebendazole

A 6 year old girl with known sickle cell disease is in the Emergency Department with lethargy and shortness of breath. This is in the context of a recent febrile illness with a rash that has now resolved. Her blood results show: Hb 45 g/L (115 - 140), WBC 2.8 x 10^9/L (3.8 - 10), platelets 55 x 10^9/L (150 - 400). What pathogen is likely to have caused this presentation?

parvovirus b19 | aplastic anemia??

A 3 year old non-verbal girl is seen in outpatients. She is noted to have ritualistic behaviours, poor eye contact and a lack of pretend play. She has significant sensory issues. What is the most likely diagnosis?

autism spectrum disorder

A 2 year old boy in the Paediatric Emergency Department has a barking cough and difficulty breathing. He has inspiratory stridor on crying and mild intercostal and subcostal recessions. He is alert and playing. There is no drooling. His temperature is 38.2C, pulse rate 130 bpm, respiratory rate 34 breaths per minute, oxygen saturation 98% breathing air. What is the most appropriate first line treatment?

oral dexamethasone

A 6 month old boy presents with abdominal distension, bilious vomiting, excessive crying and drawing her legs up to his chest. He has recently been weaned off breastfeeding. He has blood in his stools. What is the most likely diagnosis?

intussuception

A 12 year old girl develops discolouration of her urine and tears after starting medication for persistent chronic cough and fever. What medication commonly used for this condition is causing her symptoms?

rifampicin

A 6 week old girl in the Paediatric Emergency Department has jaundice which has been present since 1 week of age. She has pale stools and dark urine. She has dropped two centiles for weight. What is the most likely diagnosis?

duodenal atresia??

A 6 year old girl in clinic has asthma, and is currently on treatment with salbutamol and Clenil inhalers. What device is most suitable for delivering these medications?

inhaler with spacer

A small for gestational age baby is born following an unremarkable pregnancy. He has low set ears, micrognathia, microcephaly, rocker bottom feet, overlapping digits, cleft lip and palate. What is the most likely diagnosis following chromosomal analysis?

trisomy 18 - Edwards

A previously well 4 year old boy is in the Paediatric Emergency Department with his mother. She saw him swallow a 20p coin while playing outside 30 minutes ago. She reports no coughing, choking or difficulty in breathing since. What is the investigation of choice in this scenario?

x ray

A 3 year old boy has 3 days of fever and a sore throat. He has red tonsils with exudate and a coarse, sandpaper rash on his abdomen. His temperature is 38.5C, pulse rate 125 bpm, respiratory rate 26 breaths per minute, oxygen saturation 98% breathing air. What is the most likely diagnosis?

scarlet fever

A 13 year old girl in General Practice has 3 weeks of left knee pain. The pain feels worse after running. She is very active and does a lot of sport. There is tenderness at the left tibial tuberosity. She is systemically well. What is the most likely diagnosis?

osgood schlatter

The mother of a 3 year old boy in General Practice has noticed that her son’s foreskin is ballooning on urination. The foreskin is non-retractile. There is no redness or discomfort. What is the most likely diagnosis?

phimosis

. A 5 month old girl in General Practice has a worsening nappy rash for the last 2 weeks despite regular nappy changes, barrier cream and nappy-free time. She is feeding normally and otherwise well. Her temperature is 36.8C, and pulse rate 128 bpm. The rash is depicted in the image provided. What is the most appropriate management option in this scenario?

1% hydrocortisone

A 6 year old boy in General Practice has a new petechial rash on his legs and a bruise on his left knee, after knocking it on a table. He had a cold last week but fully recovered and was back to his normal self after a few days. There are no safeguarding concerns. He is well on examination and vital signs are normal. Investigations: Hb 123 g/L (115 - 140), WCC 6.2 x 10^9/L (3.8 - 10.0), platelets 15 x 10^9/L (150 - 400), normal blood film and normal coagulation screen. What is the most likely diagnosis

ITP

A 5 month old boy in General Practice is found to have developmental delay and recurrent spasms. An EEG has shown hypsarrhythmia. What is the most likely diagnosis?

infantile spasms (west syndrome)

1. Kid with harsh cough and stridor, pretty SOB in GP, what would be immediate mx?

dexamethasone (croup???)

2. Child w Hx of eczema, who now has a painful rash. Picture of eczema herpeticum, what would your Mx be?

aciclovir

3. Kid fighting with brother, sustains injury where elbow is flexed and pronated, pain on supination. What is the injury?

4. Kid with 2 by 2cm lump on neck with toxic left shift and post-infectious, what dx?

lymphadenitis

5. Child with a single enlarged lymph node in posterior cervical neck, had a viral infections one week age. How would you manage it?

Arrange urgent ENT

6. Kid from Pakistan whose parents are first cousins has acute respiratory failure and pneumocystis pneumonia, what dx?

SCID

7. Neonate with fever, sunken fontanelle and reduced right leg movement, most likely dx?

8. Kid with fever, non-blanching rash + bulging fontanelle, no neck stiffness - dx?

bacterial meningitis

9. Bilateral undescended testes in a phenotypically male newborn examination, most likely dx?

CAH

10. 14-year old girl presented to GP with short stature and no secondary sexual characteristics. Otherwise well. The mean parental height is on the 50th centile. What is most likely dx?

Turners

11. Child with sickle cell anaemia presents with bloods- Hb of about 40 and reticulocytes of about 5, what is the most likely cause?

aplastic anaemia

12. Photos of a hand, foot and a mouth with lesions, what could the diagnosis be?!

hand foot and mouth

13. Kid pervasively inattentive, not many friends at school, most likely dx?

conduct disorder

14. Frequent falls and motor delay with hypertrophied calves in a boy, what marker in the blood would be elevated?

creatine kinase

15. Raised conj bili in a 3w old kid, what would you do next?

investigate it lol

16. Itchy maculovesicular rash w fever started on chest and spread to arms, dx?

chicken pox

17. 2d hx of fever, cracked lips, lymphadenopathy, fine macular rash, what tx?

IVIG + high dose of aspirin | suspecting Kawasaki disease

18. Kid with murmur loudest at the left sternal border and periods of turning blue at 6m, dx?

ToF

19. Kid falling to the ground with stiffening and tightening of hands, and screaming. Otherwise normal development. Dx?

Temper tantrum

20. Between 5-10 year old with abdominal pain, loose stools and soiling. Passed a hard blood-streaked stool recently. Ix?

Abdo x ray

21. 14 year old girl presents to the GP with vomiting, headaches, loss of appetite. She has been falling behind her peers at school and regularly presents to the school nurse after falls in the playground. Most appropriate mx?

brain tumour

22. Kid with acute otitis media, high temperature. What to do next?

nothing, maybe a back up prescription

23. Pic of kid with red rash around cheeks and nose, had fever. Dx?

parvovirus b19

24. Boy has hearing difficulties and has been getting into trouble at school. On examination, narrowed ear canals with non-occluding wax. How would you manage him?

hearing test + referral ENT

25. 14 year old comes in with DKA symptoms? What do you want to give first?

fluid bolus

26. 15 year old girl who had generalised abdominal pain and then now right iliac fossa pain, she had a cough and coryza a few days previously. What is the most likely diagnosis?

mesenteric adenitis

27. Hearing difficulties in a 7 year old boy, which test would you do?

pure tone audiometry

28. 3 year old girl well-kempt, who has reached developmental milestones, nursery comments that she does not speak much, her mother says at home she is well-behaved and plays alone quietly. Most likely diagnosis?

ASD

29. 19 month old girl, born at 30 weeks, has been able to sit unsupported for 1 month, can feed herself and is able to speak 11 words. What is the best description?

motor delay

30. Young boy with itchy bottom at night time. Observations and bloods are normal. Which treatment would you give?

mebendazole | + for family

31. 10 month old child with UTI infection by non-E coli organism. USS was normal. What ix needed?

DMSA in 4-6 months

32. Baby born at term by c-section has RR of 170 at 4 hours. Uncomplicated pregnancy. Likely dx?

transient tachypnoea

33. Girl was recently ill, now has a petechiael rash, low platelets, everything else normal. Mx?

conservative

34. Child with bruises all over knees after being able to walk, some swelling in knee joint. Dx?

bleeding disorder

35. 8 year old child with intermittent limp for the past few weeks. Dx?

36. Teenager with knee pain after exercising. Tenderness over tibial tuberosity. Dx?

osgood schlatter

37. Image of post-infection kid’s bum purpuric rash with not much else going on, what dx?

henoch Schonlein purpura

38. Child with weight loss, positive anti-endomysial antibodies. Dx?

-coeliac

39. Child migrated to the UK from Pakistan, with a history of recurrent chest infections and dropped some centiles on the growth chart. Most def ix?

sweat test

1. Child with lip swelling and difficulty breathing, (Anaphylactic kid), what medication would you give. Name the drug and the route that is most important?

adrenaline IM

2. Parents have noticed beer-coloured urine in a girl following URTI, what diagnosis?

post strep glomerulonephritis

3. 45XO is? - most likely cardiac abnormality in a child who had a description of Turner’s?

bicuspid aortic valve

4. 15yo M with morning vomiting with severe headache, what investigation would confirm diagnosis?

5. Most common allergen in perennial rhinitis?

dust mites

6. Neonate with red sticky eyes and purulent discharge 2w post birth, most likely cause?

gonococcal infection

7. 4m old kid with non-billious vomiting post feeds and persistent crying, growing well along centiles, most likely dx?

GORD?//

8. Young boy with swelling around eye (photo I think?). Which medication do you want to give?

steroids if minimal change disease

9. Baby born to a mother with SLE has bradycardia. What is the most likely diagnosis?

complete heart block

10. Child who was a late walker, has bowed legs. Normal development otherwise. Dx?

rickets

11. Child with JIA has weight gain, abdominal striae and plethoric face. What drug is he likely on?

steroids

12. 5-year old boy with a soft systolic murmur at left sternal edge. Asymptomatic. Dx?

``` o Symptomless o Soft blowing murmur o Systolic murmur only, not diastolic o Left Sternal edge o Standing/sitting – postural variation o S1 and S2 normal o Special tests normal (CXR, ECG) o Sternal depression ```

13. Newborn exam of baby, clunking sound of the hip during ortolani test. Test to request?

USS hip

14. Child had sore throat, was given abx, a few days later a rash appeared. What is the likely cause of sore throat?

EBV

Baby drawing up legs in pain and crying, bilious vomiting. Definitive mx?

air insufflation

16. 4 year old girl with chronic cough and wheeze, mostly at night. Courses of abx has not helped. Next mx?

bronchodilator, SABA

17. Baby has poor feeding, jaundice, yellow stools 20 hours after delivery. Mother had GBS in 2 previous pregnancies. Dx?

sepsis

18. Child with non-blanching rash and fever at GP. What immediate tx to give?

Im benzylpenicillin

19. Girl weighing 100 kg, striae and darker skin in armpits and necks, feeling tired, has thrush. Fasting glucose is over 7 mmol/L (7.8). What pharmacological tx to try?

metformin

20. Girl (pre-pubertal) with offensive vaginal discharge. What is the most common cause of this?

bacterial vaginosis or vaginitis

1. 3 year old girl with tiredness and snoring, and frequent coughs and colds, and speech was normal but difficulty articulating words. What Ix.

karyotyping for downs

2. Boy on motorbike twists his testicle. What tx?

immediate surgery

3. Kid with crash and burn symptoms, and coronary aneurysm

Kawasaki

4. Kid with semi circular bruises on his thigh. what is the mechanism of injury?

NAI

5. On newborn check, inverted ankles and plantar flexed, what sign is this?

talipes equinovarus

7. Kid with speech problems, other milestones are normal, who do you do refer to?

SALT

8. Jittery baby - what should your first test be?

blood glucose

9. Obese boy with one leg shorter than the other

SUFE

10. Ortolani test positive, what is the next investigation

USS hip

11. 12 year old girl has 13 year old boyfriend and they are having unprotected sex - who to refer to?

inform police

1. Kid with diarrhoea for the last few months, with pieces of vegetables undigested, otherwise healthy -

toddlers

2. 6 year old kid with Down’s syndrome with bilious vomiting and distended abdomen, patent anus

hirschprungs

3. 5 year old kid with headache and bed wetting, low end of normal specific gravity

diabets insipidus

4. Metabolic alkalosis with vomiting, hungry

pyloric stenosis

5. 15 year old with heart disease. Refuses to have life saving treatment (heart surgery) - how do you proceed?

consent from treatments

6. Girl goes to pakistan. Develops macular rash. High fever for 5 days. HR was 70bpm. Cause?

typhoid

7. Difficult balance, cannot build block of towers, hyperreflexia (description of ataxic CP). Where is lesion?

cerebellum

8. Cannot examine ear directly, lump behind ear

mastoiditis

9. Infrahyoid lump on neck

thyoglosssal cyst

10. Threadworms, what treatment

mebendazole

12. Kid with constipation, and one episode of blood streaked stool. What Ix.

abdo XR

13. Girl with abdo pain only when going to school, not weekends

functional pain

14. Pic of molluscum, next step?

self limiting, treat with emollients and abx or steroids if eczema or infection develops

15. Organism which causes bronchiolitis?

RSV

16. You are in GP, Child with croup comes in?

dexamethasone

17. Kid is seizing for 5 mins and also difficulty breathing, what should you give?

high flow O2

19. Girl with a broad chest or cooarctation of the aorta

turners

20. Young girl presenting to GP with hepatomegaly and clotting, and petechiae across chest and arms, seems well

ALL

21. Cyanosis in 6 week old with clubbing and systolic stenosis heard at left sternal border

ToF

22. How should you give influenza vaccine to kid who is allergic to eggs, cow's milk protein....?

in hospital

23. Sickle cell anaemia patient with hb of 40 and low reticulocyte count, Howell-Jolly bodies, cause?

splenic infarction

24. Kid take medication for UTI, becomes anaemic and jaundiced, irregularly contracted cells and polychromasia, Dx?

G6PD

25. 4hr old new born baby has raised respiratory rate, everything else is normal -

transient tachypnoea

26. Medication for neonate in respiratory distress on oxygen

exogenous surfactant

27. Kid with hepatomegaly and breathlessness

thalassaemia

28. FH of T1DM, and the kid is not gaining weight and has loose stools -

coeliac

29. Maternal T1DM increases risk of what condition in newborn?

hypoglycaemia

30. Kid not making friends, and likes to arrange things

ASD

31. Kid needing salbutamol

asthma

32. Kid with red currant jelly stools

intusussception

33. Kid with bilateral calf hypertrophy, Ix

muscle biopsy

34. Kid with ?? has a hearing test at age 3 - which one?

play audiometry???

36. Definitive test for patient with recurrent chest infections and FTT

sweat test

37. 5 year old with nocturnal enuresis every single night, next step

reassure + star charts and education

38. Kid with pellets, and loose stool sometimes - Dx

constipation + overflow

39. Maintenance fluid to give to kid with diabetes mellitus

In DKA: 0.9% saline, not in DKA: 0.9% saline with 5% dextrose

40. Child with mild croup symptoms comes into GP, RR of 60. What is your management?

dexamethasone

Kid with spiral fracture. What do you do?

social services + police

Kid with faltering growth and loose fatty stools Growth chart shown, what could be the cause?

coeliac

Kid with petechial rashes, low RBC and raised WBC with a limp and I think and sick.

-ALL (lets ignore the limp)

Foreign kid that is drooling and something about not being vaccinated

acute epiglottitis

Kid given dexamethasone for croup 12 hours ago by GP, was stable and well with good sats but still mild stridor. What else do you give?

repeat dexamethasone

Kid with delayed milestones in language, GP clicked his fingers and she turned to look, what’s the next step

proper hearing test

Kid with globally delayed milestones, started to walk at like 18 months, saying 2 word phrases at 3 years, 50 word vocabulary at 3 years or something and some other stuff. What would be the most useful investigation?

full developmental assessment

Another kid with a strawberry tongue, what was the likely diagnosis?

Scarlet fever

Kid with anal itch, what do you give?

mebendazole

Kid with episodes of stiffening of hands and limbs, accompanied by screaming and sweating.

sickle cell crisis

Kid with impaired taste stuff, then awareness and then goes to sleep for like an hour and back to normal. No memory of event

focal seizure

Another kid that would fall down and scream and stuff but was completely fine afterwards.

Kid with yellow and grey stools and was like 4 weeks old or something. What do you test for?

Conjugated bilirubin levels (always do bilirubin first

Kid with bouts of crying and episodes where they flex their knees and hips and red stool

intussusception

Hypochloraemic hypokalaemic pH shown, with some clinical information. What is the initial management for it?

pyloric stenosis, correct electrolyte abnormalities then corrective surgery

Premature kid that was born and sounded like he had distended abdomen, vomiting, episode of blood in stool

NEC

Question on a kid who had bloods that demonstrated: low platelets, normal white cells and normal red cells

ITP?

7 year old kid headache and secondary nocturnal enuresis. He’s lost 1.5kg. Urine dipstick normal (i.e. no glucose, proteins, blood. Specific gravity ?1.010 to 1.030) What is the likely diagnosis? Urinalysis nil (plasma osmolality not given?).

diabetes insipidus

Voraciously hungry kid, hypotonia and almond eyes what was the diagnosis? Initial problems feeding

prader willi

7 year old kid has an accident and needs to have his leg amputated below the knee. He says no and wants to wait for his mum to approve first but she’s on a business trip, dad says go for it. What do you do:

go for it

Kid with nocturnal enuresis where behavioural therapy and enuresis alarm hasn’t worked. He’s going to friends for a sleepover. What is next management?

desmopressin

9 months old not feeling well, temperature was like 38 or something like that, comes into the GP. What should you do? Give Abx, tell him to go to hospital, discharge

tell him to go to hospital,

Kid soiling his pants at school, something along those lines. What was the cause for it?

``` constipation --> overflow soiling Dehydration o Painful defecation (e.g. anal fissure) o Fear of punishment o Toilet fears (e.g. monsters) o Hirschsprung's disease (rare) ```

Another neonate with reduced leg movements or something and his temperature was a bit high. What was it (?>38)?

Photo of a kid, I think it was chickenpox, had bare rashes and stuff- what is you management?

leave unless superimposed bacterial infection

Kid who had rashes which had crusted over and he was also scratching them and now he had a peak fever and cool peripheries. What is the cause for his acute presentation?

bacterial superinfection leading to toxic shock syndrome

3 year old kid with unilateral nasal discharge with bleeding and crust or something like that, What was the most likely cause

foreign body in the nose

Another case with an unwell child where chest was clear, had a fever. Lost weight recently. What do you do next?

urine dip

Kid had been coughing for 2 months, during winter season. He coughs a lot in night. Hx of atopy and he’s been recently getting some new wheezes. He was stable, so what should you do at the GP?

refer for asthma testing or bronchodilator reversal test

Neonate with some cardio problem. Systolic murmur loudest at the left sternal edge 2/6. What was it,

Kid growing along the 55th centile and is vomiting after food. He was bottle and breast-fed. So what is the cause?

GORD

Kid who basically had ADHD. What is the management

family coaching then methylphenidate

14 year old kid who thieves, got into fights (basically conduct disorder). What is 1st Mx?

Baby who just started solid foods and was being weaned or something and has become constipated. What do you do?

Child who has a hx of very dry skin, rash over arms, getting worse & spreading to ?extensor surfaces. Sister has itchy rash on ankles and wrists. (Sounds like Eczema) What would be the management?

emollients then low dose topical steroids

Hip pain on exercise and climbing stairs. Prolonged history, otherwise well.

perthes

3yo female child with intermittent limp, otherwise well

Uncle gets TB, kid lives with him, Mantoux test showed a number between 10-14mm for the result. What should you do?

Start anti-TB treatment (the kid has TB with those diameters and risk factor of living with someone with TB, plus his age if he’s under 4)

Precocious puberty (5yo and has sparse axillary and pubic hair as well as breast bud development) and high centile growth parents are along some lower centile. What definitive diagnostic test do you do?

Girl was reaching early puberty and stuff and along those lines- both breasts and adrenarche. What investigation do you do/ what test would give you the diagnosis?

Fussy eater who drinks a lot of cows milk and was bare tired. What is the cause?

iron deficiency anaemia

3 year old Kid with hypochromic microcytic anaemia and low ferritin. What could be the cause?

iron deficiency anaemia

Cerebral Palsy (described hemiplegic weakness with brisk reflexes), what area of the brain is affected?

Kid having 1st set of primary vaccinations, what would stop you giving it?

acute fever

Kid with rough (i.e. sandpaper) rash on face & trunk, flushed face. No rash around mouth -

scarlet fever

Kid with 2cm mass (inframandibular) on L side, painful, neck mass, reactive neutrophils - blood film shows: toxic left shift with reactive neutrophilia ????

infectious mononucleosis

Girl with sickle cell, has 0 reticulocytes -

aplastic crisis

Newborn with purple spot on face [f], what is the next best approach?

Discharge to Gp follow up

Young child (non obese) with issues with internal rotation of the hip?

perthes

Kid needs fluids, but you can’t get standard IV access. Where do you go?

intraosseous

Kid with symptoms of nephrotic syndrome - 1st line treatment? ?

steroids???

A newborn appears to be in severe respiratory distress and appears blue. Despite being given high flow O2, his saturations remain at 65%. What is the next best step to take with regards to his management?

prostaglandin

There were at least 4 questions describing ADHD or knowing that methylphenidate is the treatment

family training first then methylphenidate

3 months old baby with signs of HF, systolic murmur that radiates over the praecordium

vsd

What is the most important thing to look at in follow up of HSP?

urine protein

15 year old boy with short stature. Passing urine 10 times a day with no dysuria. Pale with heart rate at 78bpm, blood pressure at 158/88 and respiratory rate at 14. What is the likely diagnosis?

diabetes

CT peri orbital

Boy with itchy bottom, what do you prescribe?

mebendazole

Child in A&E with asthma attack, was given puffs of salbutamol. Now has a quiet chest, what do you do?

urgent senior help

Child with 6m of loose stools. Passed one hard blood streaked stool 10 days ago. What investigation?

nothing

Infant with episodes of throwing arms forward with fists clenched.

infantile spasms

Mother worried about 2.5 or 3? year old child’s bed wetting. Dry by day, wets bed at night. What do?

reassure

Child with fever of 39, high resp rate, nurse says chest is clear, what investigation do you do?

blood cultures

Child with fever, white exudate on one tonsil, diagnosis?

tonsillitis

Child with episodes of smelling strange things, hard to communicate with during these episodes, falls asleep for an hour after and doesn’t remember anything. Diagnosis?

Mother worried 5 year old? son has autism. Which would most support a diagnosis of autism? Child doesn’t make eye contact, child didn’t speak first words until 2 years old and goes to a speech and language therapist, brings a particular toy with him everywhere

Mother complains her young child is a fussy eater. She eats soft foods and drinks a lot of milk. Also has been feeling tired recently. Diagnosis?

iron deficiency anaemia

Baby is almost a month old and jaundiced. Parents say has been jaundiced since day 2. Stools are grey or white. Diagnosis?

biliary atresia

4 year old girl with a high fever that was followed by a rash which has small white dots on a red base. What is the most likely Dx?

measles

● Child suffers from fever. The fever disappears but she has now developed a rash. She subsequently has febrile convulsions.

roseola infantum

● Child appears severely unwell with a non-blanching rash…?

meningitis - urgent treatment

● Mother with cold sores has been kissing her child who has a background of eczema

eczema herpeticum

● Child has an URTI 2 weeks ago. Has now developed a rash over the back of the legs along with joint and abdominal pain.

henoch Schonlein purpura

● Nappy rash with satellite lesions Tx

fluconazole

● Nappy rash sparing flexures Tx

emollients

● Impetigo measuring 8mm Tx

fusidic acid

● Chicken pox uncomplicated Tx

conservative, paracetamol + calamine lotion

Kid with history of anal fissure - what is your first course of action? -

have a look, prescribe laxatives

A level student has recently come back from nigeria, with symptoms of jaundice, mild anaemia and fever with malaise,arthralgia.

Kid has pain in his outer ear, ear was protruding outwards, and there was a lump behind his ear. - was it otitis externa or mastoiditis?

mastoiditis

Kid with temp of 39, cap refill 6s, generally unwell + bulging fontanelles, no description of rash.

Meningococcal septicaemia

4yo kid having acute asthma attack, given iv salbutamol and hydrocortisone. Sats still low, no chest sounds on auscultation. What do you do/give next?

senior help

Kid with cervical lymphadenopathy, fever, sore throat, red tongue with white spots. What does she have?

scarlet fever - suggesting strawberry tongue here

4 month old, about to have 3 batch of primary vaccinations. Which would be a complete contraindication to having the vaccine?

acute fever

Perianal itching especially at night. What’s the best treatment option?

mebendazole

5 month old with cough, runny nose, fever. Examination of chest you hear wheeze. What’s the main pathogen that causes this RTI?

RSV

Unwell kid with indentable mass in left iliac fossa?

wilms (nephroblastoma)

Kid with URTI and generalised abdo tenderness

mesenteric adenitis

heart sound not heard, scaphoid chest.

diaphragmatic hernia

Baby was born at 41 weeks via emergency C section due to foetal distress. Needed ventilation straight away. X ray showed hyper inflated lungs with areas of consolidation. What does he have?

meconium aspiration

Baby born at 37 weeks, via forceps. Showing signs of resp distress. CXR shows areas of consolidation throughout.

meconium aspiration

Prem baby, resp distress, CXR looks like ground glass.

respiratory distress syndrome

Nappy rash flexure sparing. Tx

emollients

Nappy rash with Satellite lesions Tx

fluconazole

Anal itch, worst at night Tx

threadworms, mebendazole

Scabies Tx

5% permethrin cream (child and whole family)

Chickenpox Tx

supportive - emollients and calamine lotion

Grandmother brings boy in with swollen knee. Boy’s brother died young of a minor head injury

Haemophilia

Posterior rib fractures

NAI

Unwell and not able to weight bear, fever

septic arthritis

Recent URTI - not able to weight bear

transient synovitis

Infusion of Prostaglandin | keep the PDA open

3 months old baby with signs of HF, systolic murmur that radiates over the praecordium -

VSD???

What is the most important thing to look at in follow up of HSP?

urine protein

15 year old boy with short stature. Passing urine 10 times a day with no dysuria. Pale with heart rate at 78bpm, blood pressure at 158/88 and respiratory rate at 14. What is the likely diagnosis?

type 1 diabetes

6 year old child with 24 hour history of left peri-orbital swelling. Had an upper respiratory tract infection last week. Left proptosis, visual acuity was normal and had a fever of 38.9. What is the best diagnostic investigation? CT of nasal orbits, USS of nasal orbits, nasal endoscopy, intraocular pressure measurement, plain x-ray of nasal sinus

CT of nasal orbits

Boy with itchy bottom, what do you prescribe?

mebendazole (+one dose for family as well)

Child in A&E with asthma attack, was given puffs of salbutamol. Now has a quiet chest, what do you do?

call senior help, ITU admission consideration

Child with 6m of loose stools. Passed one hard blood streaked stool 10 days ago. What investigation? Colonoscopy, stool mc&s, anti TTG, DO NOTHING

do nothing

infant with episodes of throwing arms forward with fists clenched.

infantile spasm

Mother worried about 2.5 or 3? year old child’s bed wetting. Dry by day, wets bed at night. What do?

reassure

Child with fever of 39, high resp rate, nurse says chest is clear, what investigation do you do?

lumbar puncture

Child with fever, white exudate on one tonsil, diagnosis?

tonsillitis

Child with episodes of smelling strange things, hard to communicate with during these episodes, falls asleep for an hour after and doesn’t remember anything. Diagnosis?

focal seizure

Mother complains her young child is a fussy eater. She eats soft foods and drinks a lot of milk. Also has been feeling tired recently. Diagnosis?

iron deficiency anaemia

Baby is almost a month old and jaundiced. Parents say has been jaundiced since day 2. Stools are grey or white. Diagnosis?

biliary atresia

4 year old girl with a high fever that was followed by a rash which has small white dots on a red base. What is the most likely Dx?

measles | koplik spots

● Child suffers from fever. The fever disappears but she has now developed a rash. She subsequently has febrile convulsions. -

roseola infantum

● Child appears severely unwell with a non-blanching rash…?

meningitis

● Mother with cold sores has been kissing her child who has a background of eczema?

eczema herpeticum

● Child has an URTI 2 weeks ago. Has now developed a rash over the back of the legs along with joint and abdominal pain.

henoch Schonlein purpura

Paeds past questions 16-21 Flashcards

(284 cards)