pm

Question 1

child under 3 mild limp

Answer 1

Urgent assessment should be arranged for a child < 3 years presenting with an acute limp

Question 2

neonatal sepsis commonest presentson

Answer 2

Grunting and other signs of respiratory distress are the most common presentation of neonatal sepsis

Question 3

INITIAL fluid prescription Her weight is 22 kg.

Answer 3

initial = bolus = 10ml/kg = 220ml 0.9% NaCl over 10 mins or less

Question 4

does tonsillitis cause snoring

Answer 4

Yes

not kallmans

Question 5

Women who are between 16-32 weeks pregnant are offered the

Answer 5

pertussis vaccine and influenza

Question 6

how does methylphenidate stunt growth

Answer 6

appetite suppression leading to reduced caloric intake, which secondarily affects weight gain and linear growth.

Question 7

A 10-year-old boy is found to have haemophilia A following investigation for a haemoarthrosis. Which one of his relatives is most likely to have the condition?

Answer 7

mother brother

x linked recessive

Question 8

normal co2 in asthma attack

Answer 8

A normal pCO2 in an acute asthma attack indicates it is life-threatening

severe = low
near death = high

Question 9

ALL poor prognosis

Answer 9

presenting <2 years or >10 years; having B or T cell surface markers; and having a WCC > 20 * 10^9/l at diagnosis.

male

Question 10

what condition can cause DM

Answer 10

CF

Question 11

when to CT head on child

Answer 11

Head injury in a child: Vomiting is common - NICE recommend an immediate CT scan if 3 or more episodes of vomiting

within 1 hr

Question 12

You are asked to review a 1-hour-old neonate on the delivery suite. They were born via elective Caesarean section. Maternal antenatal history is significant for gestational diabetes. A heel prick test shows the baby’s blood glucose is 2.2 mmol/L. What is the next step in management?

Answer 12

observe and encourage early feeding
Transient hypoglycaemia in the first hours after birth is common

Question 13

what can be given instead of buccal midazolam

Answer 13

Rectal diazepam

Question 13

measles vs rubella exclusion

Answer 13

4 days measles 5 days rubella

Question 14

measles vs rubella presentation and features

Answer 14

Question 15

DKA first mx step

Answer 15

10ml/kg bolus

Question 16

VSD increases risk of

Answer 16

endocarditis

Question 17

An 11-year-old boy presents to his general practitioner with unilateral hip and knee pain of 2 weeks after being involved in a tackle whilst playing football. He has a marked limp that has recently worsened. On examination, there is the loss of internal rotation of the leg in flexion. He has no fever and his observations are stable.

Answer 17

sufe

Question 18

A 3-month-old girl is brought to the emergency department with a cough, poor feeding and fever. The infant is alert and responsive. She has had all routine vaccines offered. Her observations are temperature 38.1ºC, heart rate 154 bpm, respiratory rate 40/min, and oxygen saturation 91% on air. On examination, there is increased work of breathing. Coarse crackles and a wheeze can be heard across her chest. The infant’s heart sounds and ECG are normal. A lumbar puncture is performed and reported as unremarkable. An hour later, the patient has a cardiac arrest.

What is the most likely underlying cause of this arrest?

Answer 18

bronchiolitis - commonest causes of arrest = respiratory

Question 19

vague signs in neonate think

Answer 19

sepsis

Question 20

At 9 months, it’s not unusual for a child not to

Answer 20

move around much.

Question 21

Exomphalos vs gastroschisis

Answer 21

staged closure starting immediately with completion 6-12 months - Exomphalos should have a gradual repair to prevent respiratory complications.

Gastroschisis requires urgent correction

Question 22

under 5 w enuresis

Answer 22

reassurance

Question 23

fragile x heart

Answer 23

Fragile X - associated with mitral valve prolapse

Question 24

continuous blowing noise heard below the clavicles

Answer 24

Venous hum is a benign murmur heard in children and sounds like a continuous blowing noise heard below the clavicles

Question 25

If a newborn baby has an abnormal hearing test at birth they are offered the

Answer 25

§auditory brainstem response test

Question 26

A 42-year-old man has recently been diagnosed with Huntington disease and is concerned that he may have passed the condition on to his children. The children's mother is unaffected by the disease. What is the percentage likelihood that each of the patient's children will have inherited the disease?

Answer 26

50%

Question 27

does CF cause floppiness

Answer 27

Cystic fibrosis is a multi-system genetic disorder affecting the lungs and digestive system, among others. It can cause failure to thrive in infants due to malabsorption, however, it does not typically present with hypotonia or 'floppiness'

Question 28

measles vs kawasaki

Answer 28

Question 29

nits

Answer 29

wet combing then permethrin

Question 30

A 4-day-old girl who was diagnosed prenatally with Down's syndrome and born at 38 weeks gestation presents with bilious vomiting and abdominal distension. She is yet to pass meconium. What is the most likely diagnosis?

Answer 30

hirschprungs - delay in meconium

Question 31

partial seizures at night

Answer 31

Benign rolandic epilepsy is characterised by partial seizures at night

Question 32

A 13-year-old girl presents to the emergency department complaining of coryzal symptoms. She has been experiencing a fever, runny nose, headache and a non-productive cough for several days. She appears comfortable, alert and well hydrated. Her mother is concerned because despite giving her paracetamol and ibuprofen, her temperature does not seem to be coming down. She took the last dose of antipyretics one hour ago. On examination, her temperature is 38.9ºC, her heart rate is 110bpm, her blood pressure is 90/70mmHg and her respiratory rate is 26 breaths per minute. Her chest sounds clear, her throat is slightly red with no signs of tonsillitis. Her ears are non-tender and otoscopy shows no abnormalities. She does not have any rashes and shows no signs of photophobia or neck stiffness. How should this patient be managed?

Answer 32

initiate sepsis 6

Question 33

screen for what in sports downs

Answer 33

Screen for atlanto-axial instability in people with Down syndrome who participate in sports that may carry an increased risk of neck dislocation (e.g. trampolining, gymnastics, boxing, diving, rugby and horse riding)

Question 34

Dyskinetic cerebral palsy results from damage to the

Answer 34

basal ganglia and the substantia nigra

Question 35

social smile

Answer 35

6 weeks

Question 36

You are the FY1 on a paediatric ward, one of your patients is a 14-year-old female with anorexia. She is currently refusing to be tube fed. You assess her capacity and deem that she has the capacity to refuse. However, neither of her parents agree with her decision. What do you do?

Answer 36

under 16 - cannot refuse treatment

Question 37

Bow legs in a child < 3 is

Answer 37

a normal variant and usually resolves by the age of 4 years

Question 38

what age: hops on one leg pull to standing squat to pick up ball

Answer 38

3-4yrs 8-10 months 18months

Question 39

You are discussing conception with two parents who both have achondroplasia. They ask you what the chances are that a child of theirs would be of normal height. What is the correct response?

Answer 39

25%

Question 40

A 2-year-old boy is seen by his GP with an enlarging neck swelling that has been present for the past year. On examination you note a smooth midline lesion which is round and located just below the hyoid bone. It measures 2.5 cm x 2 cm and rises on protrusion of the tongue. What is the most likely diagnosis?

Answer 40

thyroglossal cyst

Question 41

An 18-month old child presents to the GP with his worried parents. They have just noticed that his foreskin swells when he urinates and they cannot retract the foreskin. Which of the following is the best immediate management of this condition?

Answer 41

In phimosis forcible retraction should be avoided in younger children reassure and review in 6months

Question 42

A 2-hour-old newborn boy is brought to the neonatal unit with increasing respiratory distress since birth. He was delivered via elective caesarean section at 39 weeks gestation following an uneventful pregnancy. On examination, his respiratory rate is 80 breaths per minute, with nasal flaring and mild intercostal retractions. Oxygen saturation is 93% on room air, and bilateral air entry is equal without added sounds. Given the most likely diagnosis, what would most likely be seen on the chest X-ray?

Answer 42

Chest x-ray in transient tachypnoea of the newborn may show hyperinflation and fluid in the horizontal fissure RDS ground glass would be preterm

Question 43

Upper and lower pole renal scarring associated with cortical thinning →

Answer 43

?reflux nephropathy

Question 44

do household contacts need treating for lice

Answer 44

only if infected

Question 45

CF treatment

Answer 45

Lumacaftor/Ivacaftor (Orkambi) can be used to treat cystic fibrosis patients who are homozygous for the delta F508 mutation

Question 46

ou see a worried mum with her 6 month old baby boy. She is concerned that his skull shape is not normal. His development and birth have been normal and there are no conditions in the family. On examination his head circumference is at the 40th centile with his height and weight at the 30th centile. His occiput is flattened on the left, his left ear mildly protruding forward and his left forehead more prominent than the right. No other abnormality is detected. What is the most appropriate management?

Answer 46

reassurance Plagiocephaly is more common since there have been campaigns to encourage babies to sleep on their back to reduce the risk of sudden infant death syndrome (SIDS). Plagiocephaly is a skull deformity producing unilateral occipital flattening, which pushes the ipsilateral forehead ear forwards producing a 'parrallelogram' appearance. The vast majority improve by age 3-5 due to the adoption of a more upright posture. Helmets are not usually recommended as there was no significant difference between groups in a randomised controlled trial. Turning the cot around may help the child look the other way and take the pressure off the one side. Other simple methods include giving the baby time on their tummy during the day, supervised supported sitting during the day, and moving toys/ mobiles around in the cot to change the focus of attention. Ensure all advice is in line with prevention of SIDS.

Question 47

A 4-year-old boy presents with his mother who is worried, as she notices that his urine is often a dark reddish colour. She is also concerned that he has begun to eat less and less over the past couple of weeks. On examination he is afebrile and there is no history of any recent illness. The mother mentions that his father and grandfather both had kidney trouble but is unsure of what their diagnosis was. Examination reveals a distended abdomen which is soft and non-tender. A palpable mass is felt in the right flank. What is the most likely diagnosis?

Answer 47

wilms tumour

Question 48

SUFE Mx

Answer 48

Refer to orthopaedics for in situ fixation with a cannulated screw.

Question 49

what

Answer 49

vesicoureteric reflux - gross dilation

Question 50

A premature infant is admitted to hospital following signs of heart failure soon after birth. She has poor feeding associated with heavy sweating and tiring out. This has resulted in her not gaining weight as expected. Her parents also report irritability and periods of apnoea. On examination, bounding peripheral pulses and a continuous machinery murmur are identified. An echocardiogram shows left ventricular enlargement and a shunt between two of the great vessels. A patent ductus arteriosus (PDA) is suspected. What non-surgical intervention could be used to manage this patient?

Answer 50

indomethacin

Question 51

A 3-day-old male is admitted to the neonatal unit with bilious vomiting and reduced feeding. He was born at 30 weeks gestation via an uncomplicated delivery. An abdominal X-ray is requested that shows intramural gas. Oral feeding is stopped and he is started on broad-spectrum antibiotics. Which of the following is the most likely diagnosis?

Answer 51

NEC - Pneumatosis intestinalis is a hallmark feature of necrotising enterocolitison AXR

Question 52

A 15-year-old teenage girl presents with delayed puberty, having not commenced her menses. She is well in her self generally, with no significant medical history. On examination, she is of slim build, with small breasts. There is no pubic hair present. Her abdomen is soft and non-tender, though there are marble-sized groin swellings bilaterally. What is the most likely explanation for this presentation?

Answer 52

androgen insensitivity Congenital adrenal hyperplasia would likely be diagnosed much earlier than puberty and is typically characterised by ambiguous genitalia and other symptoms of adrenal insufficiency, such as arrhythmias and vomiting.

Question 53

An 18-month-old boy is brought to the GP by his mother as she is concerned about his breathing. Three days ago he started with fever, cough and rhinorrhoea. For the past 24 hours his mother reports that he has been 'wheezy'. On examination his temperature is 37.9ºC, heart rate 126/min, respiratory rate 42/min and a bilateral expiratory wheeze is noted. You prescribe a salbutamol inhaler along with a spacer. Two days later the mother represents noting the inhaler has made little difference to the wheeze. Clinical findings are similar, although his temperature today is 37.4ºC. What is the most appropriate next step in management?

Answer 53

oral montelukast or ICS

Question 54

A 5-year-old boy presents with a painful limp. The symptoms have been present for 8 weeks. Two hip x-rays have been performed and appear normal.

Answer 54

MRI for perthes

Question 55

A 10-day-old boy presents with poor feeding, a failure to gain weight, and shortness of breath. He was born at 28 weeks' gestation. On examination, he has bounding peripheral pulses and a widened pulse pressure. On auscultation, he has a continuous murmur heard throughout systole and diastole, best heard at the left infraclavicular area. A chest X-ray shows cardiomegaly and evidence of pulmonary oedema. Echocardiography confirms the diagnosis. Which option is the best next step?

Answer 55

Preterm infants with haemodynamically significant patent ductus arteriosus 1 week after birth - give ibuprofen/indomethacin to promote duct closure

Question 56

A 2-year-old boy is brought to the clinic by his mother who has noticed that he has developed a small mass. On examination; a small smooth cyst is identified which is located above the hyoid bone. On ultrasound the lesion appears to be a heterogenous and multiloculated mass.

Answer 56

dermoid cyst

Question 57

A 3-year-old boy is rushed to the emergency department by his parents who are reporting that he is unresponsive. On examination, the child shows no response and no airway obstruction is identified. On auscultation and palpation of the chest, no breath sounds are identified. Following five rescue breaths, there is still no sign of life. What is the most appropriate next step?

Answer 57

Administer chest compressions over the lower half of the sternum using the heel of your hand is correct. encircler technique is for 2 people on infant

Question 58

measles vs rubella

Answer 58