Questions

Question 1

A 4-year-old child presents with a high fever, difficulty breathing, and a muffled “hot potato” voice. The child is sitting upright, drooling, and appears anxious, with inspiratory stridor noted on examination.

Upon examination he has a throat that looks like this.

What is the dx and tx? [2]

Answer 1

Inflamed epiglottis, suggestive of acute epiglottitis

Management:
- The priority of acute epiglottitis treatment is airway management by an experienced clinician trained in paediatric airways
- Abx
- IV steroids and adrenaline nebulisers
- IV fluids
- Hib Vaccination

Question 2

A mother has polyhydromanios.

Which imaging should is indicated and what are you investigating for? [2]

Answer 2

Risk factor for oeseophageal atresia
- Do US
- Then fetal MRI: oesophageal pouch and / or smal stomach

Question 4

Haemophilia A is an [] disease. This means that all female offspring of affected men will be [] and have a []% chance of these females passing the gene on and []% chance of these males passing the gene on

Answer 4

Haemophilia A is an X-linked recessive disease. This means that all female offspring of affected men will be carriers
50% chance of these females passing the gene on
0% chance of males passing it on .

Question 6

An oral rotavirus vaccine has recently been introduced into the NHS immunisation schedule. When should it be given?

2 months + 4 months
2 months + 3 months
3 months + 12-13 months
3 + 4 months
4 months + 12-13 months

Answer 6

2 months + 3 months

Question 7

[2] are commonly associated with malrotation.

Answer 7

Exomphalos and diaphragmatic herniae are commonly associated with malrotation.

Question 8

At what age would the average child acquire the ability to sit without support? [1]

Answer 8

6-8months

Question 9

Which of the following is most likely to be ANA+ve?

Systemic JIA
Polyarticular JIA (RF-negative and RF-positive)
Oligoarticular JIA
Enthesitis-Related Arthritis (ERA)
Psoriatic JIA

Answer 9

Oligoarticular JIA

Question 10

Describe a skin manifestation of Turner’s syndrome [1]

Answer 10

Melanocytic naevi

Question 11

Which of the following conditions also exhibit genetic anticipation?

Marfan syndrome
Duchenne muscular dystrophy
Myotonic dystrophy
Homocystinuria
Trisomy 21

Answer 11

Myotonic dystrophy

Question 12

How do you differentiate between the presentation of Hirschprungs and a meconium ileus via XR? [2]

Answer 12

Hirschprungs:
- The delayed passage of meconium together with distension of abdomen is the usual clinical presentation
- A plain abdominal x ray will demonstrate dilated loops of bowel with fluid levels and a barium enema can be helpful when it demonstrates a cone with dilated ganglionic proximal colon and the distal aganglionic bowel failing to distend

Meconium ileus:
- his condition presents during the first days of life with gross abdominal distension and bilious vomiting.
- x Ray of the abdomen shows distended coils of bowel and typical mottled ground glass appearance. Fluid levels are scarce as the meconium is viscid.

Question 13

[] is the most common cause of primary headache in children

Answer 13

Migraine is the most common cause of primary headache in children

Question 14

Describe what a venous hum sounds like [2]

Answer 14

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

Question 15

You diagnose her with hand, foot and mouth disease. The mother asks if she needs to stay off school. What advice will you give her regarding school exclusion?

Stay off school for 48 hours from onset of symptoms
No need to stay off school if she feels well
Stay off school for 48 hours from onset of rash
Stay off school until rash has subsided
Stay off school until all symptoms have subsided

Answer 15

No need to stay off school if she feels well

Question 16

What is a good way of remembering school exclusions for:
- Chickenpox
- D&V
- Mumps
- Rubella
- Measles
- Whooping cough

Answer 16

This helps me remember things kinda so hope this helps you too:
- Chicken pox –> Off school til lesions have crusted (typically ~5 days)

• Diarrhoea and Vomiting –> 2 things so can only come back to school 2 days symptom free
• Mumps –> 5 letters in mumps so 5 days after swelling onset (If part of MMR so now can remember these are all ~ around 5 days after a sx onset)
• Rubella –> Part of MMR so can remember 5 days after rash onset
• Measles –> Part of MMR so can remember ~5 days after rash onset (it’s actually specifically 4 lmao)
• Whooping cough (Pertussis) –> ‘whoop whoop, sound of the alarm’, 2 whoops so can return to school 2 days after antibiotics

Question 17

How do you tx PDA depending on when baby is born / timing of tx? [2]

Answer 17

In term infants with moderate to large PDAs, transcatheter closure is the treatment of choice according to current UK guidelines.

While prostaglandin inhibitors like ibuprofen are effective for PDA closure in premature infants, they have very limited efficacy in term infants, especially by 3 months of age.

Question 18

Upper and lower pole renal scarring associated with cortical thinning → ?[]

Answer 18

Upper and lower pole renal scarring associated with cortical thinning → ?reflux nephropathy

Question 19

Which virus causes croup? [1]

Answer 19

crouP - Parainfluenza - saw this as a comment on another question, helped me remember since

Question 20

Answer 20

This image demonstrates grade V vesicoureteric reflux - gross dilatation of the ureter, pelvis and calyces with ureteral tortuosity. A DMSA scan is needed to identify renal scarring.

Question 21

Describe how you tx Perthes depending on age [2]

Answer 21

If less than 6 years = observation
Older = surgical management with moderate results

Question 22

Asides from suppresion of appetite, what are common side effects of methlyphenidate? [2]

Answer 22

insomnia, suppression of appetite and depression.

Question 23

A 13-year-old female attends the General Practitioner (GP) with her mother. Her mother is concerned as she has noticed scratch marks on her daughter’s arms, and after a long chat her daughter has admitted to cutting herself repeatedly. The GP agrees to refer the girl to CAMHS (Child and Adolescent Mental Health Services).

Which of the following is the most suitable intervention to reduce the risk of recurrence of self-harm?

Citalopram
Cognitive behavioural therapy
Counselling
Family therapy
Sertraline

Answer 23

Cognitive behavioural therapy

Question 25

A 33-year-old mother had a natural birth at home. Seven days later, she brought her newborn to the Emergency Department, complaining of a musty odour of the skin and urine. Examination reveals hypopigmentation and eczema. Genetic testing revealed an autosomal recessive genetic disorder. Which of the following is most likely linked to the condition of the newborn? Defect in the transporter for cysteine Decreased α-ketoacid dehydrogenase Defect in phenylalanine hydroxylase Deficiency in homogentisic acid oxidase Defect in tyrosinase

Answer 25

A 33-year-old mother had a natural birth at home. Seven days later, she brought her newborn to the Emergency Department, complaining of a musty odour of the skin and urine. Examination reveals hypopigmentation and eczema. Genetic testing revealed an autosomal recessive genetic disorder. Which of the following is most likely linked to the condition of the newborn? **Defect in phenylalanine hydroxylase** - This is a typical presentation of phenylketonuria. An excess of phenylalanine leads to an excess of phenylketones in the urine. A musty odour of the skin and hair is due to phenylacetate (a phenylketone) accumulation.

Question 26

A two-year-old child is admitted to the paediatric Emergency Department with malaise, rash, vomiting and fever. Her mother reports that she has been off her food for 24 hours and has been running a low-grade temperature. She also points to a partial thickness burn over her arm that has been de-roofed and treated with dressings by her General Practitioner. What is the most likely diagnosis? [1]

Answer 26

An **unwell child with an unhealed burn must be treated for toxic shock syndrome** until proven otherwise. Treatment will require management in the intensive care department with input from a paediatric consultant and the plastic surgery team. **Circulatory support with cryoprecipitate may be necessary.**

Question 27

A 12-year-old child developed headaches, vomiting and a staggering gait. A cerebellar neoplasm was diagnosed. Which is the most common cerebellar neoplasm of childhood? Ependymoma Glioblastoma multiforme Neuroblastoma Astrocytoma Oligodendroglioma

Answer 27

**Astrocytoma**

Question 28

This child has an atypical UTI, given that it was proven to be secondary to Enterococcus infection (non-E. coli) and took 72 hours to respond to the antibiotic treatment. They are 5 months old. Which investigations (and when) should be initiated?

Answer 28

**Urgent USS during the acute infection with routine DMSA and MCUG** - in children younger than 6 months of age with an atypical UTI, an urgent USS is required during the acute infection, looking for any structural abnormalities in the urinary tract. Once the acute infection has resolved, 4–6 months later, a routine DMSA is performed (looking for a scar in the kidney, renal agenesis or a duplex system) and an MCUG (looking for vesico-ureteric reflux or a posterior urethral valve).

Question 29

A concerned mother visits her General Practitioner to discuss her six-week-old baby. She is concerned that he is not feeding well, his urine has a musty smell, and he has very dry skin all over his trunk, which does not respond to regular emollients What is the most likely dx? [1] Describe the basic pathophysiology [2]

Answer 29

**Phenylketonuria (PKU)** is an autosomal recessive condition which affects amino acid metabolism. There is deficiency of the enzyme **phenylalanine hydroxylase.** If not treated with a specific diet, those affected may have behavioural problems, seizures or learning disability. **Patients may also present with eczema that does not respond to standard treatment, and parents may notice a musty smell in the child’s urine or breath**. This condition is screened for with the newborn heel prick test, but further investigation may be indicated if symptoms or family history support a diagnosis.

Question 30

A 7-year-old child is seen in paediatrics for episodes of making incomprehensible noises while asleep, occurring twice in the last three months and resolving spontaneously. He also experienced slurred speech, left-sided facial twitching, and lip-tingling one morning. He has no notable medical history. His older sister had febrile convulsions as a child. What is the most likely diagnosis? Benign rolandic epilepsy Juvenile myoclonic epilepsy Nightmares Night terrors Pseudo-seizures

Answer 30

A 7-year-old child is seen in paediatrics for episodes of making incomprehensible noises while asleep, occurring twice in the last three months and resolving spontaneously. He also experienced slurred speech, left-sided facial twitching, and lip-tingling one morning. He has no notable medical history. His older sister had febrile convulsions as a child. What is the most likely diagnosis? **Benign rolandic epilepsy** Juvenile myoclonic epilepsy Nightmares Night terrors Pseudo-seizures

Question 31

**[]** is the most appropriate initial investigation in a child with delayed puberty. Why? [1]

Answer 31

**Bone age assessment** is the most appropriate initial investigation in a child with delayed puberty **to determine if their skeletal maturation is consistent with their chronological age.** A delayed bone age compared to chronological age can suggest a constitutional delay in growth and puberty, which is the most common cause of delayed puberty. It can also help identify any endocrinological issues affecting growth.

Question 32

Describe the advice should give for impetigo treatment and school exclusion [2]

Answer 32

A child with **impetigo** should be **excluded from school until the lesions are crusted and healed** OR **48 hours after commencing antibiotic treatment**

Question 33

At their 1st birthday party... * gross motor: [1] * fine motor: [2] * social: [1] * speech and language: [2]

Answer 33

At their 1st birthday party... * gross motor: **walk/cruise** * fine motor: **pincer grip their cake and bangs their new toys together** * social: **stranger anxiety (meeting family for 1st time)** * speech and language: **knows and responds to their own name + can say muma/dada**

Question 34

You are doing the six week check on a baby girl. Which one of the following best describes the Barlow test for developmental dysplasia of the hip? Attempts to relocate a dislocated femoral head Upward pressure on the femur with the hip flexed at 90 degrees Observation of the relative height of the knees with the hips flexed at 90 degrees Observation for buttock crease asymmetry with the hips flexed at 90 degrees Attempts to dislocate an articulated femoral head

Answer 34

**Attempts to dislocate an articulated femoral head**

Question 35

Infantile colic normally improves around **[]** months of age and resolves around **[]** months of age

Answer 35

Infantile colic normally improves around 3-4 months of age and resolves around **6 months of age**

Question 36

The Men B vaccine is given at [3] months.

Answer 36

The Men B vaccine is given at **2, 4 and 12-13** months.

Question 37

Neonate; 39 weeks Chest X-ray: hyperinflation and a thin fluid line in the right horizontal fissure. Given the likely diagnosis, what is the most significant risk factor? [1]

Answer 37

**Delivery by caesarean section** is a risk factor for **transient tachypnoea of the newborn**

Question 38

the neonatal team decide on the most appropriate step in management as they are concerned about hypoxic brain injury. Which intervention is most important for this baby? A sodium bicarbonate correction Blood transfusion Skin to skin contact with mum Therapeutic cooling Vitamin K administration

Answer 38

**Therapeutic cooling at 33-35 degrees** attempts to reduce the chances of severe brain damage in neonates with hypoxic injury

Question 39

A 6-year-old boy is noted to have pectus excavatum and pulmonary stenosis during a cardiorespiratory exam. What is the most likely diagnosis? Noonan syndrome Pierre-Robin syndrome Edward's syndrome William's syndrome Patau syndrome

Answer 39

A young boy is noted to have a webbed neck, pulmonary stenosis, ptosis and short stature. The karyotype is normal - **Noonan syndrome**

Question 40

Unilateral undescended testicle - review at **[]** months - if persistent refer What is the management for bilateral? [1]

Answer 40

**Unilateral undescended testis** * referral should be considered from around **3 months** of age, with the baby ideally seeing a urological surgeon before 6 months of age **Bilateral undescended testes** * Should be reviewed by a senior paediatrician within 24hours as the child may need urgent endocrine or genetic investigation

Question 41

His temperature is 39.5ºC and he has erythema, warmth, tenderness, and blistering on his right leg. Light palpation causes severe pain and there is crepitus beneath the skin when examining the surrounding tissues. Which option is the most likely causative organism? [1]

Answer 41

Chickenpox is a risk factor for invasive group A streptococcal soft tissue infections including necrotizing fasciitis - **steptococcus pyogenes**

Question 43

At what age would the average child start to smile? Birth 2 weeks 6 weeks 3 months 4 months

Answer 43

6 weeks

Question 44

You review a 7-year-old girl who has cerebral palsy. She is having ongoing problems with spasticity in her legs which is causing pain and contractures. On speaking to her mother you ascertain that she is having regular physiotherapy, using the appropriate orthoses and has tried oral diazepam in the past. Which one of the following treatments may she be offered to try and improve her symptoms? Baclofen Clozapine Clonidine Dantrolene Glyceryl trinitrate

Answer 44

The correct answer is **Baclofen**. Baclofen is a muscle relaxant and antispastic agent, which works by inhibiting the release of excitatory neurotransmitters in the spinal cord. It is commonly used to manage spasticity in patients with cerebral palsy, particularly when it causes pain or functional impairment. Baclofen can be taken orally or administered intrathecally for more severe cases.

Question 45

Hypospadias surgery is typically performed at around **[]** months of age

Answer 45

Hypospadias surgery is typically performed at around **12 months of age**

Question 46

Congenital rubella presents with which two key characteristics? [2]

Answer 46

**Congenital rubella** * sensorineural deafness * congenital cataracts

Question 47

Ambiguous genetalia - **[]** is most common cause in newborns

Answer 47

Ambiguous genetalia - **congenital adrenal hyperplasia** is most common cause in newborns

Question 48

A **[abx]** should be used for children with pneumonia if **mycoplasma** is suspected

Answer 48

A **macrolide e.g. erythromicin** should be used for children with pneumonia if mycoplasma is suspected - **MycoPLASMAs lack a cell wall**. Penicillins are b-lactam antibiotics so inhibit cell wall synthesis, therefore would be ineffective.

Question 49

*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 dx? [1]

Answer 49

**rises on protrusion of the tongue** = **thyroglossal cysts**

Question 50

Bow legs in a child < **[]** is a normal variant and usually resolves by the age of **[] years**

Answer 50

Bow legs in a child **< 3** is a normal variant and usually resolves by the age of **4 years**

Question 51

If a newborn baby has an abnormal hearing test at birth they are offered the **[]** - What does a positive result mean? [1]

Answer 51

If a newborn baby has an abnormal hearing test at birth they are offered the **auditory brainstem response test** - The procedure entails placing a small, soft-tipped earpiece in the baby's ear to emit gentle clicking sounds. **An audible soft echo suggests a functioning cochlea.** However, in this instance, the absence of an echo on two occasions raises concerns about potential hearing impairment.

Question 52

*On examination, she is noted to have microcephaly, moderate hepatosplenomegaly and a petechial rash. Shortly after admission to the neonatal intensive care unit, she has a seizure.* What is the likely infective agent that caused this presentation? [1]

Answer 52

**Congenital CMV** manifests with hearing loss, low birth weight, petechial rash, microcephaly and seizures

Question 53

A respiratory rate of >[] per minute (at any age) is a red flag according to the NICE paediatric traffic light system

Answer 53

A respiratory rate of **>60 per minute** (at any age) is a red flag according to the NICE paediatric traffic light system

Question 55

At what age should a child be able to pincer grip? [1] What other fine motor activity should they be able to do at this age? [1]

Answer 55

**12 months:** - pincer grip - Bang toys together

Question 56

At 3 months, which fine motor activites should a child be able to achieve? [4]

Answer 56

* Reaches for object * Holds rattle briefly if given to hand * Visually alert, particularly human faces * Fixes and follows to 180 degrees

Question 57

At what age should a child be able to hold in palmar grasp? [1]

Answer 57

**6 months**

Question 58

At what age should a child be able to pass objects from one hand to another? [1]

Answer 58

**6 months**

Question 59

At what age should a child be able to look around in every direction? [1] ## Footnote q

Answer 59

6 months

Question 60

What fine motor activities are expected of a 6 month old? [3]

Answer 60

Follow every direction Pass objects from one hand to another Holds in palmar grasp

Question 61

What fine motor activities are expected of a 9 month old? [2]

Answer 61

Point with finger Early pincer

Question 62

Of the following, which is more common in child physical abuse? Humeral fracture Scaphoid fracture Tibial fracture Pelvic fracture Ankle fracture

Answer 62

**Humeral fracture**

Question 63

The most common fractures associated with child abuse are [3]

Answer 63

The most common fractures associated with child abuse are: - **Radial** - **Humeral** - **Femoral**

Question 64

What advise do you give to parents of CF about interacting with other kids with the same conditon? [1] Why? [1]

Answer 64

patients with CF should try to minimise contact with each other to **prevent cross infection** with **Burkholderia cepacia complex** and **Pseudomonas** **aeruginosa**

Question 65

patients with CF should try to minimise contact with each other to **prevent cross infection** with [**2**]

Answer 65

patients with CF should try to minimise contact with each other to **prevent cross infection** with **Burkholderia cepacia complex** and **Pseudomonas** **aeruginosa**

Question 66

A 7-year-old girl presents to the emergency department accompanied by her mother. While trying to wake her up this morning, her mother noticed her face twitching and mouth drooling. This episode lasted for 30 seconds and the girl was fully aware of what was happening. The girl was drowsy and confused for the subsequent 15 minutes. She has been well in herself and has no conditions. The pregnancy and vaginal birth have been uncomplicated. Her mother is worried that she has been tired as she has been going to bed later than usual for the past couple of weeks. **What is the most likely diagnosis?** [1]

Answer 66

**Benign rolandic epilepsy** is characterised by partial seizures at night

Question 67

Partial seizures at night time in childhood = ? [1]

Answer 67

**Benign rolandic epilepsy**

Question 68

Describe the features of Benign rolandic epilepsy [3]

Answer 68

**Seizures that occur at night / during sleep:** - Hemifacial parasthesias - Oropharyngeal manifestations (strange noises) - Hypersalivation

Question 69

State three cardiac complications of 45XO [3]

Answer 69

Bicuspid aortic valve CoA Aortic dissection

Question 70

Mother has bipolar that is treated during pregnancy What cardiac complication might be seen in newborn? [1]

Answer 70

**Ebsteins abnormality**

Question 71

What would indicate an admission of croup? [1]

Answer 71

**Audible stridor at rest**

Question 72

How do you adapt the position of a child when giving rescue breathes depending on the age of the child? [1]

Answer 72

use **neutral position** for rescue breath for infant, if **over 1 use head tilt and chin lift**

Question 73

# Wh What is the most common complication of roseola infantum? [1]

Answer 73

**Febrile convulsions**

Question 74

What are three key features of Fragile X syndrome? [3]

Answer 74

**Fragile X** - XL Head - XL Balls - XL ears

Question 75

What would indicate a baby to have an US of hips at 6 weeks? [2]

Answer 75

**Born in breech position at 36+ weeks** **Required external cephalic version**

Question 76

What is this? [1]

Answer 76

**Epstein pearl** - congenital cyst found in the mouth - commonly on hard palate - can be mistaken for erupting tooth if found on gum - will spontaneously resolve ## Footnote **P**earls relate to **p**alate

Question 77

What is this? [1]

Answer 77

**Bohns nodule** - found in inner labial aspect of maxillary alveolar ridges

Question 78

Describe key features of Pierre-Robin syndrome [3]

Answer 78

**'Robin' me of my airway'** - Small mandible & Tongue retraction --> airway obstruction

Question 79

Which investigation is used to confirm a dx of pertussis? [1]

Answer 79

**Per nasal swab**

Question 80

At a NIPE a boy is detected as having an undescended teste. What is the management plan for this baby? [3] How would this mx plan change if the baby had bilateral undescended testes? [1] Why? [1]

Answer 80

**Review at 3 months** - If still has undescended teste **refer to urology** due to risk of **torsion or hernia** NB: if **bilateral undescended testes** - **referral to senior paediatrician within 24hrs** as child may need **endocrine or genetic investigation**

Question 81

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? Father Mother's brother Father's sister Mother Father's brother

Answer 81

The correct answer is **Mother's brother** (maternal uncle). Haemophilia A is an X-linked recessive condition

Question 82

How do you manage neonatal hypoglycaemia depending on whether the child is symptomatic or not? [2]

Answer 82

**Asymptomatic**: - encourage normal feeding - monitor blood glucose **Symptomatic**: * admit to the neonatal unit * intravenous infusion of 10% dextrose

Question 83

Sign? [1] Dx? [1]

Answer 83

**Bowel loops** can be seen in the left side of the thoracic cavity = **Congenital diaphragmatic hernia**

Question 84

Which FBC finding (alongside the clinical picture) would indicate Kawasaki's disease? [1]

Answer 84

**Raised platelets**

Question 85

What is a mneumonic for remembering red flag symptoms for paeds? [5]

Answer 85

**Really Sick Babies Get Antibiotics** 1. **R**ecessions (moderate or severe chest wall recessions) 2. **S**kin turgor reduced 3. **B**lue or mottled appearance 4. **G**runting 5. **A**sleep (does not wake if aroused)

Question 86

A baby is detected as having exomphalos antenatally. How would you manage this situation? [2]

Answer 86

**Caesarian section and staged repair** - caesarian reduces the risk of sac rupture, and surgery is non-urgent.

Question 87

Under which situations would you offer a baby a 6 week US for DDH? [1]

Answer 87

All **breech babies** at or after **36 weeks** gestation require USS for DDH screening at **6 weeks regardless of mode of delivery**

Question 88

What is the triad that makes up shaken baby syndrome? [3]

Answer 88

Shaken Baby Syndrome triad: ERS **Encephalopathy** **Retinal haemorrhages** (bilateral) **Subdural Haematoma**

Question 89

Chickenpox is a risk factor for invasive **[]** **infections** including **necrotizing fasciitis**

Answer 89

Chickenpox is a risk factor for **invasive group A streptococcal soft tissue infections** including necrotizing fasciitis ## Footnote **GAS** - strep pyogenes

Question 90

# Lecture What fluid bolus do you give paeds. patients in shock? [1]

Answer 90

Give fluid bolus – **10ml/kg 0.9% Sodium Chloride**

Question 91

# Lecture What GCS would you consider intubation in a child? [1] What treatment would you give for a child with blood sugar < 3mmol/L? [2]

Answer 91

**If GCS < 8** (P or less on AVPU scale) – consider intubation * **2ml/kg 10% Dextrose if blood sugar < 3 mmol/L**

Question 92

# Lecture What are respiratory [6] and cardiac [6] causes of children arrest?

Answer 92

Question 93

Describe the treatment plan for tet spells [4]

Answer 93

* Initial measures include **positioning the infant on their back** and **flexing their knees.** * **Oxygen** should be administered in hospitals. * Prophylactic use of **propranolol** is practised in some centres. * **Severe 'Tet spells'** (exacerbation of Tetralogy of Fallot symptoms during periods of distress) can be managed with a vaso-constrictive agent e.g. **phenylephrine**, as a 'last line' medical therapy. *

Question 94

How do you differentiate between a reflex anoxic seizure and a vasovagal episode?

Answer 94

**Reflex anoxic seizures **are paroxysmal self limited periods of asystole that are **triggered by pain, fear or anxiety** - During these episodes the child becomes extremely **pale**, there may also be **clonic movements, upward eye deviation, urinary incontinence and rigidity** **Vasovagal Syncope** - history of feeling **light headed and sweaty** is classically seen during **vasovagal episodes** - **brief** **convulsions** may occur if there is **hypoperfusion** to the brain due to a **sudden drop in blood pressure.**

Question 95

A 3 month old boy, corrected for gestational age, born in May, with trisomy 21 has a ventricular septal defect. He is currently on a high-calorie nastrogastric feed and furosemide. What prophylactic therapy is indicated for this patient? Penicillin Spironolactone Palivizumab Co-trimoxazole Aspirin

Answer 95

**Palivizumab** - This is a premature boy under the age of six months (corrected) approaching bronchiolitis season. He has significant acyanotic heart disease, requiring furosemide to prevent from him being symptomatic. He meets the indications for RSV prophylaxis. Palivizumab is a monoclonal antibody that minimises the risk of infection by RSV. It is given subcutaneously once a month during bronchiolitis season

Question 96

Which of the following complications is most commonly associated with sickle cell disease in children? Acute chest syndrome 1 Vaso-occlusive crisis 2 Stroke 3 Aplastic crisis 4 Priapism 5

Answer 96

**Vaso-occlusive crisis**

Question 97

What heart sounds would indicate TGA? [1]

Answer 97

**heart sounds are normal apart from a loud S2.**

Question 98

An 11 year old girl is brought to the GP because her mother is 'beyond despair with her'. The mother reports that her daughter is consistently hostile and angry towards her. She always does the opposite of what she asks her to do, shouts at her mother if she tries to get her to do anything, and insults her mother at every opportunity. Otherwise, the girl is fit and well. She has not yet reached puberty. She is getting on well at school, although occasionally her report card mentions that she talks back to teachers. She has lots of friends and gets on well with her younger brother. **What is the most likely diagnosis?**

Answer 98

Oppositional defiant disorder

Question 99

**[]**, is suspected. This is confirmed with an oral contrast study.

Answer 99

**Malrotation with small bowel obstruction,** is suspected. This is confirmed with an oral contrast study.

Question 100

Describe the difference in conduct and oppositional defiant disorder [2]

Answer 100

**Conduct disorder** is characterised by **repetitive** and **persistent** **behavioral** **patterns** that** violate the rights of others and social norms**, and aggressive behavior towards people and animals. **Substance use and delinquency** are common associated features of the condition **Oppositional defiant disorder** is characterised by a pattern of **negative, hostile, and defiant behavior towards authority figures** **without** **violating** the **rights** of others. Children with ODD may **argue, refuse to comply with request**s, and **deliberately annoy others**. **Substance** **use** and delinquency are **less** **common** associated features of ODD.

Question 101

Describe the UTI Mx in children [3+]: - Under 6 months - 6 months - 3 years - 3+ yrs

Answer 101

**Under 6 months** - all children get an **ultrasound within 6** weeks. - If it is **atypical** **UTI** or **recurrent** you do **ultrasound** during **infection**. - Atypical and recurrent UTIs also receive **DMSA scan 4-6 months** after for **renal scarring as well as MCUG.** **6months - 3 yrs** - children with **atypical UTI have ultrasound during infection**. - Children with **recurrent** UTI have **ultrasound 6 weeks after infection**. - Both c**hildren with atypical or recurrent receive DMSA 4-6 months after**. - Dont typically offer MCUG unless suspicious. **3yrs+** - **atypicals have ultrasound during infection**. - **Recurrent** have **ultrasound** at **6 weeks**. - **Recurrent also have DMSA 4-6 months** after. Dont typically offer MCUG.

Question 102

Malrotation with small bowel obstruction, is suspected. This is confirmed with an oral contrast study. What is the definitive management of this condition? [1]

Answer 102

**Ladd's operation** - This is performed, either open or laparoscopically, by untwisting the midgut volvulus, fixing the malrotated bowel in the correct location, removing Ladd's bands (congenital adhesions) and performing an appendicectomy

Question 103

The diagnosis is Developmental Dysplasia of the Hip with a subsequent leg length discrepancy. **[]** is used to indicate whether the shortening is femoral or tibial

Answer 103

**Galeazzi's test** is used to indicate whether the shortening is femoral or tibial

Question 104

A child has ?TLS due to their chemotherapy for ALL. Which electrolyte changes would you suspect to see? [4]

Answer 104

PUKE Calcium **P**hosphate **U**ric acid **K** **E**levated **Low Calcium** (binds to the free phosphates)

Question 105

A 10 year old boy with a diagnosis of attention-deficit hyperactivity disorder (ADHD) attends the outpatient psychiatry clinic for review. He was recently started on Methylphenidate to control his symptoms. His behaviour has improved, however, he has developed facial tics which he finds distressing. Which of the following is the most appropriate drug to switch to for long-term management of his condition? Atomoxetine Ritalin Sertraline Risperidone Melatonin

Answer 105

**Atomoxetine** is a noradrenaline reuptake inhibitor. It is recommended for ADHD refractory to Methylphenidate or in those who it is not appropriate due to risk factors or development of side effects. Development of facial tics is an indication to change medications

Question 106

# ild ha

Question 107

A 21-day old baby presents with jaundice. He was full-term, normal birth weight and appeared well until recently. Blood results show a conjugated hyperbilirubinaemia. What is the most likely diagnosis? [1]

Answer 107

This neonate is jaundiced with a conjugated hyperbilirubinaemia. Cystic fibrosis (CF) may also cause these two in conjunction but would likely represent with weight loss or failure to thrive and/or other ciliary disorder symptoms. **Biliary atresia is therefore the correct answer**. Incidence is approximately 1 in 10 000 and may be associated with other congenital malformations such as intestinal atresia and imperforate anus. It is surgically treated with the Kasai procedure. Many will also go on to require a liver transplant

Question 108

In a jaundiced neonate presenting with lethargy and feeding difficulties, **[]** **should be performed urgently**

Answer 108

In a jaundiced neonate presenting with lethargy and feeding difficulties, a **septic screen should be performed urgently** - sepsis is a potentially life-threatening condition that can present nonspecifically.

Question 109

A patient takes ciprofloxacin. 5 days later he has very dark urine. Blood examinations demonstrate a reduced haemoglobin and an elevated urea and bilirubin, alongside deranged liver function tests. What is the likely dx? [1]

Answer 109

**G6PD deficiency.**

Question 110

A patient takes ciprofloxacin. 5 days later he has very dark urine. Blood examinations demonstrate a reduced haemoglobin and an elevated urea and bilirubin, alongside deranged liver function tests. What is the likely blood film results? [2]

Answer 110

**Red-cell fragments and Heinz bodies**

Question 111

Name this finding [1]

Answer 111

**Brushfield spots** are small, white-grey aggregations of connective tissue at the peripheral iris

Question 112

Which genetic condition are Brushfield spots most likely to be found in? [1]

Answer 112

Trisomy 21

Question 113

**painless** rectal bleeding in children - suspect? [1]

Answer 113

**Meckel’s diverticulum**

Question 114

A child is started on Methylphenidate. Which of the following is the most appropriate monitoring while on this medication? Measure blood pressure every 3 months Monitoring BMI Measure height every 6 months ECG every 3 months Measure weight every 6 months

Answer 114

This medication can **stunt growth** through **appetite suppression**, and so NICE advise the following: **checking height every 6 months**

Question 115

What do NICE recommend how to monitor patients if they're on. methlyphenidate? [+]

Answer 115

* **measure height every 6 months in children and young people** * **measure weight every 3 months in children 10 years and under** * **measure weight at 3 and 6 month**s after **starting treatment in children over 10 years and young people, and every 6 months thereafter, or more often if concerns arise** * **measure weight every 6 months in adult**s * **plot height and weight of children and young people on a growth chart and ensure review by the healthcare** professional responsible for treatment

Question 116

The most sensitive view for SUFE is the **[]** view as typically the slip is **[anterior/posterior]**

Answer 116

The most sensitive view for SUFE is the **frog-leg view** as typically the slip is **posterior**

Question 117

Children with SCD should recieve which vaccines? [3]

Answer 117

Meningococcal conjugate vaccine annual pneumococcal immunisations Get the influenza vaccine annually from 6 months of age

Question 118

How do you differentiate between Edwards and Patau syndromes? [+]

Answer 118

**Patau syndrome**: - microcephaly, cleft li**p** and **p**alate, **p**olydactyly, and cardiac defects. **Edwards syndrome** - clenched hands, rocker-bottom feet, and low-set ears.

Question 119

In Paediatrics, the Pierre Robin sequence is characterised by a [3]

Answer 119

In Paediatrics, the Pierre Robin sequence is characterised by a **cleft palate, retracted tongue, and a small lower jaw**

Question 120

A child has ?ALL What would be diagnostic of this on bone marrow biopsy? [1]

Answer 120

The key diagnostic feature of ALL is the presence of greater than **20% blast cells in the bone marrow**. This significant blast count differentiates it from other conditions like myelodysplastic syndromes, where the blast count is usually lower.

Question 121

he decision is made to start Ritalin. Which of the following regular investigations should be performed to monitor patients on this drug? Height and weight measurement 1 Neurological examination 2 Echocardiogram 3 Full Blood Count 4 ECG and BP measurement

Answer 121

Height and weight measurement

Question 122

A patient has ADHD. They have regular 6 month height and weight checks for their ritalin use. What would indicate a change of medication? [1]

Answer 122

A change that **crosses 2 percentile lines** should **prompt consideration of a drug holiday** to allow catching up, or a **medication change.**

Question 123

A neonate has grunting, nasal flaring and a RR of 70. They have a CXR. What is the most likely diagnosis based off this clinical picture? [1]

Answer 123

**Transient tachypnoea of the newborn** **Imaging Findings:** * **Hyperinflation** of the lungs * **Fluid** in the **fissures** * **Laminar effusions** * **Fuzzy vessels**

Question 124

Evidence of **bowel sounds** in a **respiratory exam of a neonate** in **respiratory** distress should make you consider a **[]**

Answer 124

Evidence of bowel sounds in a respiratory exam of a neonate in respiratory distress should make you consider a **diaphragmatic hernia**

Question 125

What is the pathophysiology of congenital diaphragmatic hernia? [1] How does it present? [2]

Answer 125

usually represents a **failure of the pleuroperitoneal canal to close completely** - It is characterised by the **herniation of abdominal viscera into the chest cavity** due to incomplete formation of the diaphragm. This can result in **pulmonary hypoplasia and hypertension** which causes **respiratory distress shortly after birth**.

Question 126

Describe the managment of CDH [3]

Answer 126

**Initial management** is through the insertion of a **nasogastric tube** with the aim of **keeping air out of the gut**. Therefore for cyanosed pt the best way to assist breathing is to **intubate and ventilate**. The child needs **definitive management in the form of surgical repair of the diaphragm**.

Question 127

You are asked to attend an elective Caesarean section for macrosomia and maternal diabetes. At what times should you assess the APGAR scores? 1, 2 minutes 2, 5 minutes 0, 5 minutes 1, 5 minutes 2, 4 minutes

Answer 127

**1, 5 minutes**

Question 128

What are the components of the APGAR score? [5]

Answer 128

**Pulse**, **respiratory effort**, **colour**, **muscle tone**, **reflex irritability**

Question 129

**[polyhydramnios / oligohydramnios]** causes developmental dysplasia of the hip (DDH). Why? [1]

Answer 129

The correct answer is **oligohydramnios**. Polyhydramnios refers to a spectrum of disorders that range from subtle acetabular dysplasia to complete dislocation of the hip. - **Oligohydramnios**, which is a condition characterised by low amniotic fluid in pregnancy, can **lead to DDH as it restricts foetal movement and thus normal development of the hip joint**.

Question 130

You are working on the paediatric ward and are called to see a child who the nurses have noticed is persistently 'floppy'. You assess the child and find no acute cause for concern and wonder whether there might be an underlying issue. Which of the following is most likely to be the underlying cause of neonatal hypotonia in this case? Pierre-Robin syndrome Becker Muscular Dystrophy Duchenne Muscular Dystrophy Congenital Talipes Equinovarus Prader-Willi syndrome

Answer 130

**Prader-Willi syndrome** - floppy baby can be due to prader-willi, cus think of a floppy willy

Question 131

A diagnosis of croup is made and treatment is commenced. What is the most suitable first-line treatment for this child? Nebulised salbutamol Oral dexamethasone Humidified oxygen IV hydrocortisone Broad spectrum antibiotics

Answer 131

**Oral dexamethasone** - Croup - A single dose of **oral dexamethasone (0.15 mg/kg)** is to be taken immediately regardless of severity

Question 132

Describe the difference in timelines for management for Exomphalos vs Gastroschisis? [2]

Answer 132

**Exomphalos** should have a **gradual repair** to prevent respiratory complications - **Staged closure starting immediately with completion at 6-12 months**. **Gastroschisis** requires **urgent correction** - newborns should go to theatre as soon as possible after delivery, e.g. within 4 hours

Question 133

Describe how you distinguish between NRDS and TTN with regards to presentation time [1] and CXR findings [1]

Answer 133

**Neonates with NRDS** - usually **present** with **respiratory distress shortly after birth** which usually **worsens** over the **next few days**. - CXR in NRDS the characteristic features are a **diffuse ground glass lungs with low volumes** and a **bell-shaped thorax** **TTN** - usually presents with **tachypnoea shortly after birth** and **often fully resolves within the first day of life** - In TTN the **CXR** depicts a **heart failure type pattern** (e.g. interstitial oedema and pleural effusions) but key distinguishing features from congenital heart disease are a **normal heart size and rapid resolution of the failure type pattern within days.**

Question 134

*You detect a continuous machinery murmur over the upper left sternal edge. The murmur does not vary with position or radiate* Which of the following is this murmur most likely to reflect? Innocent murmur Patent ductus arteriosus Pulmonary stenosis Coarctation of the aorta Tetralogy of Fallot

Answer 134

**Patent ductus arteriosus:** machinery murmur at the upper left sternal edge

Question 135

At what age do you suggest that nocturnal enuresis can be managed from reassurance and advice to an alarm? [1]

Answer 135

Children **under the age of 5 years** who have nocturnal enuresis can be **managed with reassurance and advice** - Offer an enuresis alarm system usually reserved for children **over the age of 7 years who have persistent nocturnal enuresis**

Question 136

**[]** should be given to maintain a patent ductus arteriosus in **cyanotic congenital heart diseases**

Answer 136

**Prostaglandin E1 (AKA alprostadil)** should be given to maintain a patent ductus arteriosus in **cyanotic congenital heart diseases**

Question 137

What is the most appropriate way to confirm a diagnosis of pertussis? Blood cultures Sputum culture Per nasal swab Urine for serology Throat swab

Answer 137

What is the most appropriate way to confirm a diagnosis of pertussis? Blood cultures Sputum culture **Per nasal swab** Urine for serology Throat swab

Question 138

Which ear testing is performed at school? [1] How does it work? [1]

Answer 138

**Pure tone audiometry** is done at school entry in most areas of the UK - This involves wearing headphones and asking the child to raise a hand or press a button when they hear a beep. Usually, the sounds played will vary in pitch and be played in each ear to assess left and right hearing.

Question 139

A baby of 8 hrs presents with jaundice. What would be your initial investigation? [1] Why not a different one? [1]

Answer 139

**Measure serum bilirubin within 2 hours** **transcutaneous bilirubinometer** * Very important info that **< 24hrs transcutaneous Billi can't be measured.**

Question 140

Which one of the following best describes the typical distribution of atopic eczema in a 10-month-old child? Nappy area and flexor surfaces of arms and legs Face and trunk Nappy area and trunk Flexor surfaces of arms and legs Scalp and arms

Answer 140

**Face and trunk** - This distribution is due to the fact that these areas are more exposed to environmental allergens and irritants. The cheeks, forehead, and extensor surfaces of the limbs are common sites. The nappy area is usually spared because it is covered and protected from these factors.

Question 141

A baby is born with micrognathia, low-set ears, rocker bottom feet and overlapping of fingers -**[]** syndrome

Answer 141

A baby is born with micrognathia, low-set ears, rocker bottom feet and overlapping of fingers - **Edward's syndrome**

Question 142

**[]** criteria is used to assess the probability of septic arthritis in children

Answer 142

**Kocher**'s **criteria** is used to assess the probability of septic arthritis in children

Question 143

What are 4 signs of non-innocent murmurs? [4]

Answer 143

Signs of NOT innocent murmrs: - Symptomatic - Pan-systolic or diastolic - Harsh, loud, thrills - Radiates

Question 144

What are the 8'S of innocent murmurs? [8]

Answer 144

**8S's of an innocent murmur:** - **Soft** - **Systolic** - **Short** - **S1 & S2 normal** - **Symptomless** - **Special tests normal** - **Standing/sitting** (postural variation) - **Sternal depression** (i.e. pectus excavatum apparently)

Question 145

**Infantile spasms** - classically characterised by repeated [] followed by [] How old are patients generally? [1]

Answer 145

Infantile spasms - classically characterised by repeated **flexion of head/arms/trunk** followed by **extension of arms** - This is a type of epilepsy **presenting at 4-8 months**

Question 146

How would infantile spasms present on EEG? [1]

Answer 146

On EEG, this would show a **dramatic hypsarrhythmia appearance.**

Question 147

What is the exact anatomical position of where a hypospadias is most likely to be? [1]

Answer 147

On the **distal ventral surface of the penis**

Question 148

What Ix choice is used to dx vesicoureteric reflux [1] and the complications associated with it such as renal scarring? [1]

Answer 148

**vesicoureteric reflux:** **micturating cystourethrogram** (**MCUG**) - fluoroscopic visualisation of the bladder and urethra during voiding after instillation of contrast material into the bladder through a catheter **renal scarring in a child with vesicoureteric reflux: Radionuclide scan using dimercaptosuccinic acid (DMSA)** - administering a radiopharmaceutical agent, dimercaptosuccinic acid (DMSA), which is taken up by healthy renal tubular cells and allows for imaging of the kidneys. - Areas that do not take up DMSA represent scars or non-functioning kidney tissue.

Question 149

Indomethacin and ibuprofen are both used to treat PDA. What would indicate indomethacin / contraindicate ibuprofen? [1]

Answer 149

**significant hyperbilirubinaemia**: increasing the risk of kernicterus. - **Ibuprofen** can **displace** **bilirubin** from **albumin-binding sites**, leading to **increased free bilirubin**, which can cross the **blood-brain barrier and cause neurotoxicity.**

Question 150

Turner's syndrome is associated with an **[]** murmur due to **[heart defect]**

Answer 150

Turner's syndrome is associated with an** ejection systolic murmur** due to **bicuspid aortic valve**

Question 151

Management of a SCFE: **[3]**

Answer 151

Management of a SCFE: **internal fixation** (this prevents the slip from worsening) - A **slipped upper femoral epiphysis is an emergency**, as there is a **risk of avascular necrosis of the femoral head.** - In the meantime, the child **should not weight bear** and should be **made comfortable with analgesia**

Question 152

A child falling over and having a head injury x vomiting is normal. When would NICE rec. that a CT is indicated? [1] How quickly should you try and give? [1]

Answer 152

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

Question 153

On examination, the child appears well and there is erythema and excoriation around the anus or perineal area with no other abnormalities noted. Given the likely diagnosis, what is the causative organism? Enterobius vermicularis Molluscum contagiosum birus Pediculus humanus capitis Trichophyton rubrum Staphylococcus aureus

Answer 153

**Enterobius vermicularis** (threadworms)

Question 154

**[]** is first line therapy for treatment of threadworm - Do you treat the indiviudal or whole house? [1]

Answer 154

**Mebendazole** is first line therapy for treatment of threadworm - **Treat household**

Question 155

What is the first sign of puberty in boys? Development of axillary hair Height spurt Development of pubic hair Increase in penis length Increase in testicular volume

Answer 155

**increase in testicular volume.**

Question 156

whats a good mneumonic for remembering the order of development of puberty in boys [4] and girls [4]

Answer 156

**Boys**: * Grapes (testicles) * drapes (hair) * grow * blow (ejaculation) **Girls**: * Boobs * Pubes * Grow * Flow

Question 157

TOF - What feature of his condition would most determine the degree of cyanosis and clinical severity? Overriding aorta Patent ductus arteriosus Right ventricular hypertrophy Right ventricular outflow obstruction Ventricular septal defect

Answer 157

**Right ventricular outflow obstruction** - If there is significant stenosis, deoxygenated blood entering the right ventricle can only travel into the arterial circulation via the overriding aorta (i.e. it cannot travel into the pulmonary circulation like normal due to the stenosis of the pulmonary valve). This will lead to an increased amount of deoxygenated blood in the arteries, causing a bluish-tinge to the skin (i.e. cyanosis). If the degree of pulmonary stenosis is less, deoxygenated blood entering the right ventricle can travel into the pulmonary circulation and not into the aorta, thus allowing oxygenation and less severe cyanosis.

Question 158

Describe the treatment plan for umbilical hernias in children [2]

Answer 158

Umbilical hernias: - **Usually self-resolve**, but if large or symptomatic **perform elective repair at 2-3 years of age**. - If **small and asymptomatic peform elective repair at 4-5 years of age.**

Question 159

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

Answer 159

If a newborn baby has an abnormal hearing test at birth they are offered the **auditory brainstem response test**

Question 160

*On examination, the child is slim built but has disproportionately large calves. When asked to walk across the room he does so on his tiptoes. Gowers test is positive.* What is the most likely Dx [1] and initial Ix? [1]

Answer 160

**Duchenne muscular dystrophy**: - **genetic testing** rather than a muscle biopsy is now used to make a diagnosis

Question 161

When would you consider a pneumonia versus bronchiolitis in a presenting infant? [2]

Answer 161

.NICE state the following: Consider a diagnosis of pneumonia if the child has: * **high fever (over 39°C) and/or** * **persistently focal crackles.** ## Footnote **NB**: **A low-grade fever** is typical in **bronchiolitis**.

Question 162

[respiratory sign] is a red flag in paediatric patients with a **fever** [1]

Answer 162

**Moderate or severe intercostal recession** is a red flag in paediatric patients with a fever

Question 163

What are the red signs for NICE traffic light system? [5]

Answer 163

* **Moderate** or **severe** **chest** **wall** recession * **Does not wake if roused** * **Reduced skin turgor** * **Mottled or blue appearance** * **Grunting**

Question 164

A breastfed baby with GORD should have a trial [] first line

Answer 164

A breastfed baby with GORD should have a trial an **alginate (e.g. .Gaviscon)** first line

Question 165

Roseola infantum is most likely to be caused by: HHV-4 HHV-5 HHV-6 HHV-7 HHV-8

Answer 165

**HHV-6**

Question 166

Which cause of a rash is most likely to be associated with suboccipital lymphadenopathy? [1] Rubella Measles Roseola Hand, foot and mouth Chickenpox

Answer 166

Which cause of a rash is most likely to be associated with suboccipital lymphadenopathy? [1] **Rubella** Measles Roseola Hand, foot and mouth Chickenpox

Question 167

Low vitamin A is a risk factor for which of the following? Rubella Measles Roseola Hand, foot and mouth Chickenpox

Answer 167

**Measles**

Question 168

A rash followed by acute kidney symptoms 10 days after the rash started is most likely caused by which pathology? [1]

Answer 168

Scarlet Fever

Question 169

A patient has vesicular rash. They then present with symptoms of a pneumonia. On CXR they have calcifications in the lung What is the most likely cause? [1]

Answer 169

VZV induced pneumonia

Question 170

Rash x thrombocytopenia = ? [1]

Answer 170

**Rubella**

Question 171

**[]** can be used for short term control of enuresis

Answer 171

**Desmopressin** can be used for short term control of enuresis

Question 172

The key investigation in pyloric stenosis is **[]**

Answer 172

The key investigation in pyloric stenosis is **ultrasound**

Question 173

Which vaccines are live? [7]

Answer 173

**MIBOOTY** - MMR, influenza (intranasal), BCG, oral polio, oral rota, typhoid, yellow fever

Question 174

State 5 key physical features of foetal alcohol syndrome [5]

Answer 174

Foetal alcohol syndrome is a common cause of **microcephaly**, with other physical features including: **smooth philtrum** (flat area of skin between the upper lip and the base of the nose, without a ridge in the middle), **hypoplastic upper lip** and **epicanthic folds** (skin fold of the upper eyelid that covers the inner corner (canthus) of the eye)

Question 175

If foetus is detected to have exomphalos. What would best management be for the baby? [1]

Answer 175

**C-section at 37 weeks**

Question 176

Whilst talking to his parents, you observe the son has a bubbly outgoing personality, and contemplate whether this might be a case of William's syndrome. What physical feature would most support this diagnosis? Rocker-bottom feet Flattened philtrum Tall, slender stature Webbing of the neck Elfin facies

Answer 176

Whilst talking to his parents, you observe the son has a bubbly outgoing personality, and contemplate whether this might be a case of William's syndrome. What physical feature would most support this diagnosis? **Elfin facies** ## Footnote Will turner = legolas = Elf

Question 177

**[]** is present in around 10% of patients with hypospadias

Answer 177

**Cryptorchidism** is present in around 10% of patients with hypospadias - This reflects an underlying defect in embryological urogenital migration thought to be associated with endocrine disturbances, such as low serum androgens, during pregnancy.

Question 178

Aside from measuring the child's length, what physical feature might suggest achondroplasia in this child? Low set ears Sandal-gap deformity Trident hand deformity Single palmar crease Microcephaly

Answer 178

**Trident hands** - feature of achondroplasia

Question 179

Non-bilious vomiting in first few weeks of life is consistent with pyloric stenosis You run a gas to look at their ion picture. What would you expect? [1]

Answer 179

**Hypochloremic hypokalemic metabolic alkalosis** - Due to vomiting up stomach contents which is acidic (hydrogen chloride - HCl), the patient will be hypochloraemic. Potassium is also lost in the vomitus.

Question 180

What marker would indicate that a baby has exomphalos (and what would two differentials be) [3]

Answer 180

**Raised AFP** - But also in **multiple gestation and NTD**

Question 181

ToF has which murmur? [1]

Answer 181

**Ejection systolic** (the VSD is so big that it doesn't cause a murmur)

Question 182

Turner's syndrome has which congenital heart defect as most likely? [1]

Answer 182

Bicuspid aortic valve [1]

Question 183

Development / disruptive behaviour x long ears x protruding ears = ? [1]

Answer 183

Fragile X syndrome

Question 184

Fever that resolves in an 1 year old, followed by a rash. They then go onto develop a seizure. What is the most likely dx? [1]

Answer 184

**Roseola infantum**

Question 185

What are the critical features to note in **Roseola infantum**? [3]

Answer 185

**6months - 2 yrs** (**Infantum**) **Fever** that **resolves**, but then a **rash occurs** Risk of **febrile seizures**

Question 186

What would make you suspect toddlers diarrhoea in a patient / presenting case? [1]

Answer 186

**chronic diarrhoea** in infants - diarrhoea that **contains lots of undigested food.**

Question 187

Which vitamins are cystic fibrosis patients most likely to be deficient in? [3]

Answer 187

**ADEK** - fat soluble vitamins (due to pancreatic sufficiency)

Question 188

He receives a diagnosis of Attention Deficit Hyperactivity Disorder (ADHD) and is started on first-line pharmacological therapy for this. Which will be the most important side effect to monitor for during the course of treatment with this drug? Excessive sleepiness Constipation Urinary retention Growth impairment Psychosis 5

Answer 188

**Growth impairment** - First-line pharmacological therapy for ADHD is Methylphenidate, a central nervous stimulant. One of the most important and common side effects of **Methylphenidate is appetite suppression** and subsequent growth suppression. This may also be associated with weight loss

Question 189

'halo sign' in the oesophagus indicates what has happened? [1] What is the next step in management? [1]

Answer 189

**halo sign** suggest that this child has swallowed a **button battery.** - The next best management step is to perform an **urgent endoscopy under general anaesthetic to remove the battery** and decide if further treatment is needed, for example, if the battery has caused a tracheo-oesophageal fistula.

Question 190

Which pathogen are the most common cause of: - early neonate sepsis (first 72hrs) - late neonate sepsis (after 72hrs)

Answer 190

**Early neonate:** - S. aureus is the most common cause of late-onset neonatal sepsis (after 72 h of life). **Late neonate** - S. agalactiae, or group B streptococcus

Question 191

You are assessing a baby's pulse because they are unresponsive. Which is the most appropriate pulse to feel if: - the child < 1 year [1] - the child > 1 year? [1]

Answer 191

**brachial pulse** if **< 1 year** The **carotid pulse** is the standard site for **assessing circulation in children older than one year and adults**.

Question 192

*An ultrasound scan shows concentric echogenic and hypoechogenic bands.* What does this likely indicate? [1]

Answer 192

**Intussusception** An ultrasound scan shows concentric **echogenic** and **hypoechogenic** bands - aka **target sign**

Question 193

What is the age limit of normal for sitting up unsupported? [1]

Answer 193

if beyond 9months and can't sit upright by themselves - gross motor incompetence

Question 194

If a child is young, having stridor and is foreign - what should you suspect? [1]

Answer 194

**Epiglottis**

Question 195

An 18-year-old man was evaluated for social anxiety and repetitive speech patterns. On examination, he had a long face, large ears, a prominent jaw, and hypermobile joints. The family history reveals other male relatives with similar behavioural issues and learning difficulties. What is the diagnosis? [1] What is the underlying genetic abnormality? [1]

Answer 195

**Fragile X syndrome** - expanded CGG repeat in the FMR1 gene

Question 196

What is the initial investigations for oesophageal atresia? [2]

Answer 196

the initial investigation of choice is N**G tube insertion followed by a chest X-ray to visualise the level of the tube tip and confirm the atresia.**

Question 197

*On examination of the baby, there is upslanting palpebral fissures and a sandal toe gap.* What is this most likely to suggest? [1]

Answer 197

Trisomy 21

Question 199

A newborn baby is noted to have low-set ears, rocker bottom feet and overlapping of her fingers. What is the most likely diagnosis? Patau syndrome Edward's syndrome William's syndrome Fragile X Pierre-Robin syndrome

Answer 199

A newborn baby is noted to have low-set ears, rocker bottom feet and overlapping of her fingers. What is the most likely diagnosis? Patau syndrome **Edward's syndrome** William's syndrome Fragile X Pierre-Robin syndrome

Question 200

NICE has also recently recommended in view of emerging research that **[]** should be the first line investigation in all children presenting with global developmental delay

Answer 200

NICE has also recently recommended in view of emerging research that **genetic karyotyping** should be the first line investigation in all children presenting with global developmental delay

Question 201

A CT head shows a heterogeneous single mass in both the right and left frontal lobes. Which of the following is the most likely diagnosis? Craniopharyngioma 1 Pilocytic astrocytoma 2 Ependymoma 3 Meningioma 4 Glioblastoma multiforme

Answer 201

**Glioblastoma multiforme** - A frontal mass on CT that crosses the midline, in a patient presenting with a seizure, is most likely to be a grade 4 astrocytoma (known as glioblastoma multiforme).

Question 202

What is the 4D, 3C of measles? [1]

Answer 202

4 days of fever Cough, Conjunctivitis, Coryzal symptoms + Rash that starts behind ears

Question 203

This baby with prolonged jaundice (>14 days) with pale stools, dark urine and a conjugated hyperbilirubinaemia is highly suspicious for **[]**

Answer 203

This baby with prolonged jaundice (>14 days) with pale stools, dark urine and a conjugated hyperbilirubinaemia is highly suspicious for **obstructive jaundice**

Question 204

This baby with prolonged jaundice (>14 days) with pale stools, dark urine and a conjugated hyperbilirubinaemia is highly suspicious for obstructive jaundice. The ultrasound findings of echogenic hepatic fibrosis suggest **[]**

Answer 204

This baby with prolonged jaundice (>14 days) with pale stools, dark urine and a conjugated hyperbilirubinaemia is highly suspicious for obstructive jaundice. The ultrasound findings of echogenic hepatic fibrosis suggest **biliary atresia**

Question 205

Biliary atresia is definitively diagnosed with **[]**, which will fail to show the biliary tree

Answer 205

Biliary atresia is definitively diagnosed with **cholangiography**, which will fail to show the biliary tree

Question 206

What's the mneumonic for Kawasaki's presentation? [+]

Answer 206

**CRASH and BURN** **Conjuctivitis** (bilateral, bulbar, non-purulent) **Rash** (anything but vesicles or bullae **Adenopathy** (cervical, > 1.5cm) **Strawberry tongue** (other skin changes - lip cracking) **Hand and feet swelling** (and peeling) **BURN - 5 days of fever**

Question 207

A 2-week-old premature infant presents with abdominal distension, feeding intolerance, and bloody stools. Abdominal X-ray shows pneumatosis intestinalis. What is the most likely diagnosis? Malrotation Intussusception Necrotising enterocolitis Gastroesophageal reflux disease Hirschsprung disease

Answer 207

A 2-week-old premature infant presents with abdominal distension, feeding intolerance, and bloody stools. Abdominal X-ray shows pneumatosis intestinalis. What is the most likely diagnosis? Malrotation Intussusception **Necrotising enterocolitis** Gastroesophageal reflux disease Hirschsprung disease ## Footnote red arrows = pneumatosis intestinalis yellow arrows = Riger sign

Question 208

A patient has headlice. Do they need school exclusion? [1]

Answer 208

No

Question 209

Given the underlying congenital syndrome (trisomy 21), which of the following ENT manifestations would you expect in this patient? Choanal atresia Micrognathia Large ears Cleft lip/palate Flat nasal bridge

Answer 209

ENT manifestations in Down's syndrome include: small nose with a **flat nasal bridge, small and low set ears, hearing issues and ear infections, and hypothyroidism**

Question 210

Describe the difference in deterioration of sx in bronchiolitis vs viral wheeze [1]

Answer 210

Viral wheeze is more immediate, bronchiloitis has worse sx at day 3-5

Question 211

Which genetic conditions increase the liklihood of a cleft palate? [2]

Answer 211

DiGeorge syndrome and Patau syndrome (trisomy 13)

Question 212

Large ears are a feature of [genetic condition]

Answer 212

Large ears are a feature of **Fragile X syndrome**.

Question 213

. Micrognathia (undersized jaw) occurs in congenital syndromes such as **[1]**

Answer 213

**Edward’s syndrome (trisomy 18)**

Question 214

**[]** is now the first-line investigation for suspected asthma - What would be a positive result in children? [1]

Answer 214

**FeNO** (fractional exhaled nitric oxide) is now the first-line investigation for suspected asthma - In children, a **positive value is a ppb of ≥ 35.**

Question 215

What are the doses of adrenaline for < 6 months, 6month-6years, 6-12years and 12+ for anaphylaxis? [4]

Answer 215

Child > 12 years: 500 micrograms IM (0.5 mL) Child 6-12 years: 300 micrograms IM (0.3 mL) Child 6 months - 6 years: 150 micrograms IM (0.15 mL) Child < 6 months: 100-150 micrograms IM (0.1-0.15 mL)

Question 216

all children with croup should receive a dose of [1]

Answer 216

all children with croup should receive a dose of **oral** **dexamethasone** if tolerated (otherwise nebulised or IM).

Question 217

Ptx with ADHD: What area of the brain shows reduced function in the boy's condition? Frontal lobe Parietal lobe Hippocampus Wernicke's area Broca's area

Answer 217

The theory is that, as executive function controls the ability to focus attention and inhibit impulsive behaviours, a reduced function of the **frontal lobe** results in inattention and impulsivity

Question 218

Describe what is meant by a reflex anoxic seizure? [1]

Answer 218

**A reflex anoxic seizure** is caused by **overactivity of the vagus nerve,** causing **vasodilation** and a **collapse** from a **temporary reduction in cerebral perfusion**

Question 219

A 7-year-old presents to the paediatric accident and emergency department complaining of "pain in my tummy". His father says his son had a sore throat a few days ago. On examination there is pain in the right iliac fossa, but there is no guarding. Urine dipstick is normal. What is the most likely diagnosis?

Question 220

Given the likely diagnosis of acute epiglottitis, which of the following is the best next step in the management of this patient? Prescribe intravenous broad-spectrum antibiotics Perform an ENT exam Prescribe oral Dexamethasone Endotracheal intubation Give intramuscular Adrenaline

Answer 220

Endotracheal intubation

Question 221

A child has anosmia. Which genetic conditon are they likely to have? [1] Name some other presenting features [2]

Answer 221

**Kallmann syndrome** - hypogonadotropic hypogonadism - amenorrhoea -

Question 222

Which of the following is a hearing, speech and language milestone for a 6-month-old baby? Saying 1-3 words 1 Startles to noise 2 Responding to own name 3 Turns head towards loud sounds 4 Saying 'mama' or 'dada'

Answer 222

Turns head towards loud sounds

Question 223

Paediatric intestinal malrotation with volvulus → treatment? [1]

Answer 223

Paediatric intestinal malrotation with volvulus → **Ladd's procedure** (includes division of Ladd bands and widening of the base of the mesentery)

Question 224

A 2-day-old baby has not passed meconium yet. Your consultant tells you they believe that the child has Hirschsprung's disease, and asks you what your initial management would be. Until a firm diagnosis can be made and more definite treatment given, which of these is the best initial treatment for this child? Anorectal Pull through Bowel Irrigation Full Thickness Rectal Biopsy Lactulose Vancomycin

Answer 224

**Bowel Irrigation** If Hirschsprung;s disease is suspected, a full thickness rectal biopsy should be performed as investigation. However, while this is being organised etc, bowel washouts should be performed to allow the baby to pass meconium, so this is the initial treatment. **Once a diagnosis has been made**, an **anorectal pull through is generally performed as definitive management.**

Question 225

What are exam findings in bronchiolitis? [2]

Answer 225

Widespread polyphonic wheeze Crepitations

Question 226

At what age would the average child start to say 'mama' and 'dada'? 3 months 4-5 months 6-7 months 9-10 months 13-14 months

Answer 226

9-10 months

Question 227

Turner's syndrome is associated with an **[]** murmur due to **[heart condition]**

Answer 227

Turner's syndrome is associated with an **ejection systolic murmur** due to **bicuspid aortic valve**

Question 228

The consultant suspects the patient may have vesicoureteral reflux. Which investigation is used to confirm the diagnosis? [1]

Answer 228

**Micturating cystourethrogram** - injecting dye through a urinary catheter to visualise the direction of flow of urine. **DMSA scan** is used to confirm if renal scarring has occurred

Question 229

In neonates, [1] is the most common cause of cardiac arrest

Answer 229

In neonates, **respiratory arrest **is the most common cause of cardiac arrest

Question 230

In neonates, respiratory arrest is the most common cause of cardiac arrest. How do you manage this? [1]

Answer 230

Necessitating immediate administration of inflation breaths for resuscitation - **Five gentle breaths with a resuscitation device establish lung inflation**, stimulate breathing, and open airways before further interventions if needed.

Question 231

A 6 year old patient is recovered from a local swimming pool and is found to be unconscious, and not breathing. What is the most appropriate initial management of this patient? 2 rescue breaths Chest compressions 30:2 Chest compressions 15:2 Place in recovery position 5 rescue breaths

Answer 231

**5 rescue breaths** - Children are more likely to suffer a respiratory arrest, especially in cases of drowning. - Therefore, prior to starting chest compressions, the **first treatment in these patients is five rescue breaths** - Chest compressions and breaths thereafter are done in a ratio of **15:2** in paediatric patients

Question 232

A 15-year-old boy initially presented with shin pain, attributed to growing pains. The pain persisted, and he developed intermittent fevers, night sweats, and swelling in his left shin. A plain film showed a lamellated periosteal reaction and reduced bone matrix in the proximal tibia. He is referred for MRI and biopsy. The results are reported below: **MRI**: - A mass is noticeable in the proximal left tibia which is 4cm in diameter. A small area of necrosis is visible at the centre. There is minimal evidence of cortical damage in the proximal tibia . **Bone biopsy:** - Histology: Small blue round cells are present and have a clear cytoplasm on haematoxylin and eosin staining. What is the most likely diagnosis?

Answer 232

**Ewing's sarcoma** typically presented with the lamellated (onion skinning) periosteal reaction which is visible on x-ray. MRI typically shows a large mass with evidence of necrosis and on histology small blue round cells are visible with clear cytoplasms on haematoxylin and eosin staining

Question 233

A two-week-old boy is admitted following a five day history of vomiting, abdominal distension and passage of blood stained stools. He was born at 32 weeks due to ruptured membranes. Dx? [1]

Answer 233

**Necrotising Enterocolitis** The clinical signs described and prematurity point towards a diagnosis of necrotising enterocolitis (NEC). **Pneumatosis intestinalis or gas in the gut wall is pathognomonic**

Question 234

Severe pyloric stenosis can lead to **[acid/base change]** due to excessive vomiting

Answer 234

Severe pyloric stenosis can lead to **hypochloraemic hypokalaemic metabolic alkalosis** due to excessive vomiting - so hypokalaemia may be present.

Question 235

Due to the breech birth, this child is at higher risk of **[]**

Answer 235

Due to the breech birth, this child is at higher risk of having **developmental dysplasia of the hip**

Question 236

juvenile idiopathic arthritis (JIA) patients are at risk of which complications?

Answer 236

**chronic anterior uveitis** **Flexion contractures:** May require physical therapy and splinting. **Joint destruction**: May necessitate prostheses at a young age. **Growth failure:** This can occur as a result of chronic disease and steroid use. **Macrophage Activation Syndrome (MAS)** - Hyperinflammation syndrome of fever, hepatosplenomegaly, encephalopathy, raised liver enzymes and high ferritin. **Osteoporosis**

Question 237

In an adolescent, **localised pain of several months duration with no traumatic event or associated injury** and an associated mass on examination is highly suggestive of **[]**.

Answer 237

In an adolescent, **localised pain of several months duration with no traumatic event or associated injury** and an associated mass on examination is highly suggestive of **osteosarcoma**.

Question 238

A 4 year old boy is referred for an urgent MRI due to ongoing headaches and nausea. He is otherwise well, with no past medical history. He is growing well and hitting all of his developmental milestones. The MRI report says there is a cerebellar lesion that is most likely benign. What is the most likely diagnosis? Ependymoma Medulloblastoma Pilocytic Astrocytoma Craniopharyngioma Glioblastoma

Answer 238

**Pilocytic astrocytoma** is the most common benign brain tumour in children, often arising in the **cerebellum**.

Question 239

How do pilocytic astrocytomas present on an MRI? [1]

Answer 239

It presents with signs of raised intracranial pressure (headaches and nausea) and is frequently detected on **imaging as a well-demarcated cerebellar lesion**. These tumours typically have a good prognosis with surgical resection.

Question 240

Pilocytic Astrocytoma is a tumour seen in children, often found in the cerebellar. Name another tumour often found in the cerebellar and how you would distinguish between them?

Answer 240

**Medulloblastoma** is the most common **malignant brain tumour** in children and **arises in the posterior fossa**, often involving the **cerebellum** - **raised intracranial pressure **but is more likely to cause **ataxia** and other **cerebellar signs** - **distinguishable on MRI**

Question 241

Describe the symptoms that a craniopharyngioma would present with [3] and why this occurs? [1]

Answer 241

**Craniopharyngiomas** arise from **Rathke**'s **pouch** remnants and typically present with symptoms of **endocrine dysfunction** (e.g., **growth failure due to hypothalamic or pituitary involvement**) or **visual disturbances due to proximity to the optic chiasm.**

Question 242

Which type of brain tumours commonly cause hydrocephalus in children ? [1]

Answer 242

**Ependymomas** are glial tumours that often arise from the ependymal lining of the ventricles, particularly in the posterior fossa in children. These tumours may obstruct cerebrospinal fluid flow, causing hydrocephalus

Question 243

**[]** is the most common cause of hip pain in children

Answer 243

**Transient synovitis** is the most common cause of hip pain in children - Limited range of motion, specifically extension and internal rotation of the hip can be found. It is confirmed using a hip x-ray and ultrasound, which shows synovitis. - It is treated using NSAIDs and bedrest. It usually clears in 7-10 days.

Question 244

A newborn born at 38+2 weeks by normal vaginal delivery, with complications of umbilical cord prolapse. Which of the following is the most appropriate management to reduce the risk of secondary reperfusion injury? Mechanical ventilation Therapeutic cooling to 33–34 °C Phenobarbital 20 mg/kg High-flow oxygen supplementation Fluid restriction to 40 ml/kg/day

Answer 244

**Therapeutic cooling to 33–34 °C** - Therapeutic cooling slows cerebral metabolism and subsequently slows neurotransmitter and oxygen free-radical release. The reduction in cerebral oxygen requirements is thought to reduce the risk of secondary neuronal death.

Question 245

Meningococcal infection is caused by Neisseria meningitidis, a gram-negative intracellular diplococcus. Describe the basic pathophysiology that this causes [2]

Answer 245

The **pathological process is triggered by bacteria entering the circulation**, initiating inflammatory processes leading to **capillary leakage and intravascular thrombosis**. This consumes the clotting factors rendering people coagulopathic - This coagulation **leads to consumption of platelets, rather than decreased production**

Question 246

Which x-ray changes would you expect to see in rickets? [1]

Answer 246

In rickets, as there is an excess of non-mineralised osteoid bone, there is widening of the growth plates, commonly seen in the wrist.

Question 247

How do you differentiate between transient tachypnea of the newborn and NRDS?

Answer 247

**Neonatal respiratory distress syndrome:** - presents with **increased work of breathing shortly after birth**, and the **chest x-ray** demonstrating diffuse **granular opacities** is characteristic of neonatal respiratory distress syndrome **TToN**: - Transient tachypnea of the newborn is commonly seen after **C-section deliveries due to delayed resorption of lung fluid**. - It is also more common in **term** **babies**

Question 248

Frequent attendence to which point of care would point towards child abuse? [1]

Answer 248

**Frequent attendance to the A&E** department, rather than GP, may point towards child abuse as parents presume they will see a different doctor each time, making it less likely suspicions will be aroused

Question 249

What are features of growing pains? [+]

Answer 249

* **never** present at the **start of the day** after the child has woken * **no limp** * **no limitation of physical activity** * **systemically well** * normal physical examination * motor milestones normal * symptoms are often intermittent and **worse after a day of vigorous activity**

Question 250

**[]** is generally used first-line for nocturnal enuresis if general advice has not helped

Answer 250

**An enuresis alarm** is generally used first-line for nocturnal enuresis if general advice has not helped

Question 251

Describe what is meant by Toddler's diarrhoea [1]

Answer 251

**Toddler's diarrhoea** is a benign condition that causes the child no problems. It is** due to the fast transit through their digestive system and often contains undigested food**. It requires no treatment ## Footnote Toddler + diarrhoea = Toddler's diarrhoea

Question 252

*A boy is noted to have a webbed neck and pectus excavatum* Which childhood syndrome is this? [1]

Answer 252

**Noonan syndrome**

Question 253

*An infant is found to have small eyes and polydactyly* Which childhood syndrome is this? [1]

Answer 253

Patau syndrome

Question 254

*A 7-year-old boy with learning difficulties and macrocephaly* Which childhood syndrome is this? [1]

Answer 254

Fragile X

Question 255

If a formula-fed baby is suspected of having mild-moderate cow's milk protein intolerance then a **[]** formula should be tried

Answer 255

If a formula-fed baby is suspected of having mild-moderate cow's milk protein intolerance then a **extensive hydrolysed formula** should be tried - This formula is tolerated by 90% of infants with cow's milk protein intolerance. In this formula, the **proteins that trigger allergy are hydrolysed into peptides which make them less allergenic.**

Question 256

Patent ductus arteriosus - which three key signs? [3]

Answer 256

Patent ductus arteriosus - **large volume, bounding, collapsing pulse**

Question 257

The most appropriate management for primary nocturnal enuresis (bedwetting) in this case is the use of desmopressin. What is the MoA? [1]

Answer 257

**ADH analogue**

Question 258

When can phototherapy be stopped for hyperbilirubinaemia? [1]

Answer 258

Once bilirubin levels have **fallen over 50 micromoles/L below treatment threshold**, phototherapy can be stopped.

Question 259

Question3/20 A 5 year old girl with Trisomy 21 is seen in the paediatric cardiology clinic. She has no cardiac symptoms, and on auscultation, a systolic murmur is heard at the upper left sternal edge which radiates to the back. There is fixed splitting of the second heart sound. What is the most likely cause of her examination findings? Mitral stenosis Pulmonary stenosis Tetralogy of Fallot Ventricular septal defect Atrial septal defect

Answer 259

Question 260

You are in a genetics clinic and explaining to a mother and father the reasoning why their son has Prader-Willi syndrome. What is the term we use to describe the mode of inheritance for Prader-Willi syndrome? Autosomal recessive Autosomal dominant Imprinting Pleiotropy Variable expressivity

Answer 260

**Imprinting** - In the case of prader-willi the father's copy of the gene is not present, and the mother's copy of the gene is present but epigenetically silenced and therefore not expressed, resulting in the prade-willi phenotype.

Question 261

When is hand preference abnormal in a developing child? [1]

Answer 261

Hand preference before 12 months is abnormal

Question 262

At what age are children expected to share toys by? [1]

Answer 262

Playing alone is normal at this age. Children are only expected to begin to share toys by **3 years of age**.

Question 263

How long should you exclude a child from school for whooping cough? [1]

Answer 263

48hrs following commencement of abx

Question 264

Describe the presenting features of roseola infantum [3] Which organism causes it? [1]

Answer 264

Roseola infantum is a common viral illness that causes a characteristic **3 day fever** and then **emergence of a maculopapular rash on the 4th day**, **following** the **RESOLUTION** of the **fever**. - the fever is **typically rapid onset** and can often **predispose to febrile convulsions.** - rash **doesn't scab over** - The rash typically **starts on the trunk and limbs** (this is different to chickenpox which is typically a central rash) - Caused by **human herpes virus 6**

Question 265

Why can febrile fits occur after roseola infantum? [1]

Answer 265

HHV6 is **neurotropic** (attacks the nervous system) and **thus a rare complication is encephalitis and febrile fits** (after cessation of the fever).

Question 266

How would you determine a child is suffering from whooping cough and not bronchiolitis [2] What are the othe features? [+]

Answer 266

**whooping**: - coughs in **bouts** that are so **severe turns red.** Vomiting. No wheeze is then unlikely bronchiolitis

Question 267

Diagnostic criteria Whooping cough should be suspected if a person has an acute cough that has lasted for 14 days or more without another apparent cause, and has one or more of the following features: [4]

Answer 267

Paroxysmal cough. Inspiratory whoop. Post-tussive vomiting. Undiagnosed apnoeic attacks in young infants.

Question 268

A 2-day-old infant presents to the emergency department with tachypnea & poor feeding. Examination reveals pronounced cyanosis, weak pulses, and signs of circulatory failure. Echocardiography confirms a congenital heart disease and surgery is scheduled for 4 days later. What medication will the patient be given to maintain circulation until surgical correction? Ibuprofen Indomethacin Prostaglandin E1 (PGE1) Prostaglandin E2 (PGE2) Prostaglandin F2α (PGF2α)

Answer 268

Prostaglandin E1 (PGE1)

Question 269

[] is the investigation of choice for intussusception

Answer 269

**Ultrasound** is the investigation of choice for intussusception - may show a target-like mass

Question 270

A patient with PDA that is haemodynamically significant. What initial treatment should be started to manage this condition? Emergency surgery Indomethacin Beta-blockers Intravenous fluids Prostaglandins

Answer 270

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

Question 271

A 9-year-old girl is brought to surgery as her mother is concerned that she is too fat. This has now been a problem for over two years and mum feels this is holding her back at school. What is the most appropriate method to ascertain how obese she is? Body mass index Body mass index percentile adjusted to age and gender Weight plotted on percentile chart Mother's perception Waist circumference

Answer 271

Body mass index percentile adjusted to age and gender

Question 272

According to the UK immunisation guidelines, all babies, including those born prematurely, should receive their first set of vaccinations at **[]** weeks from birth

Answer 272

According to the UK immunisation guidelines, all babies, including those born prematurely, should receive their first set of vaccinations at **8 weeks from birth** - '**Give as per normal timetable'** - This is because premature babies are at higher risk of infections and therefore need protection provided by vaccines as soon as possible

Question 273

This child has **scarlet fever** and has initiated antibiotic therapy. According to current guidelines, children with scarlet fever are advised to return to school **[]** hours after starting antibiotics.

Answer 273

This child has scarlet fever and has initiated antibiotic therapy. According to current guidelines, children with scarlet fever are advised to return to school **24 hours after starting antibiotics.**

Question 274

**[]** is the most common cause of **painless massive GI bleeding** requiring a transfusion in children between the ages of 1 and 2 years

Answer 274

**Meckel's diverticulum** is the most common cause of painless massive GI bleeding requiring a transfusion in children between the ages of 1 and 2 years

Question 275

A 12 week baby is being fed formula feed, but is experiencing episodes of regurgitation and vomiting after most feeds and ongoing diarrhoea which contains significant amounts of mucus. What is the next appropriate step? [1]

Answer 275

**Trial of extensively hydrolysed formula** is the best option here as the baby's symptoms of vomiting mucus stool and 'colic'-type episodes fit most with **cow's milk protein allergy**. If the extensively hydrolysed formula resolves the symptoms then this essentially confirms this diagnosis and must be continued instead of normal formula milk. If it does not, amino acid-based formula (AAF) may be trialled and/or further investigations may be required.

Question 276

What bone marrow biopsy results would you expect to see in ALL? (*the most common type of childhood leukaemia*)

Answer 276

characterised by pancytopaenic symptoms and bone marrow with **blast predominance (>20%).**

Question 277

You suspect a patient has transient synovitis. Which age group is this most likely in? [1]

Answer 277

Pre-puberty children

Question 278

You suspect a patient has transient synovitis. What causes this condition? [1] Describe the classical presentation [2]

Answer 278

It occurs when a **viral infection,** such as an upper respiratory infection, moves to and **settles in the hip joint** **Limited range of motion,** specifically **extension and internal rotation of the hip** can be found.

Question 279

How would you confirm a case of transient synovitis? [1] How do you tx? [1]

Answer 279

**It is confirmed using a hip x-ray** (which will be normal) and u**ltrasound which shows synovitis**. It is treated using **NSAIDs** and **bedrest for up to 6 weeks**

Question 280

In young children presenting with leukocoria (white pupillary reflection), what is the most common [1] and serious [1] causes?

Answer 280

Most common: **congenital cataracts** Most serious: **retinoblastoma**

Question 281

A 7-year-old boy presents to the GP clinic with a 1-month history of progressive weakness, fever and weight loss of 4 kg. His parents also reported 2 episodes of nosebleeds without any apparent injury. On physical examination, he has non-palpable pinpoint macules on his skin and a palpable spleen 2 cm below the left costal margin. What is the most likely genetical abnormality causing this presentation? [1]

Answer 281

acute lymphoblastic leukaemia (ALL). The most common cytogenetic abnormality in paediatric ALL is the **t(12:21) translocation**

Question 282

How long to return to school after Abx treatment for impetigo? [1]

Answer 282

48hrs

Question 283

A young child presenting with fever, ear rubbing, and **bilateral otorrhea** is most likely to have [1] What is the treatment? [1]

Answer 283

A young child presenting with fever, ear rubbing, and **bilateral otorrhea** is most likely to have acute otitis media, requiring antibiotic treatment with **amoxicillin**.

Question 284

**[]** is now the most common cause of acute onset of vomiting and diarrhoea in children.

Answer 284

**Norovirus gastroenteritis** is now the most common cause of acute onset of vomiting and diarrhoea in children.

Question 285

Describe a typical social developemntal milestone for a 2.5 yr old child [1]

Answer 285

**Parallel play**, where children play alongside each other without much interaction, is a typical social developmental milestone for a 2 and a 1/2-year-old child

Question 286

What age is having imaginary friends seen as normal social development? [1]

Answer 286

having imaginary friends is more common among slightly older children, around the **ages of 4 to 6**.

Question 287

A neonate fails to pass meconium within first week of life. How do you determine if this is from Hirschprungs vs cystic fibrosis from the clinical picture? [1] How would you confirm this? [1]

Answer 287

**Hirschsprung’s** is more likely if the **patient fails to pass stool unless a finger is passed per rectum** - **A rectal suction biopsy** is the gold standard for diagnosis because it allows direct sampling of the rectal mucosa to check for the absence of ganglion cells, which is diagnostic of Hirschsprung’s disease.

Question 288

Describe what is meant by a Ladd's procedure and what is indicated for [2]

Answer 288

**Ladd's procedure** is where the **surgeon straightens out the bowel** and **divides any abnormal peritoneal bands** (Ladd bands). - for **intestinal malrotation**

Question 289

Ptx with MCD doesn't respond to prednisolone. What is the next management step? [1]

Answer 289

High-dose steroids are the first-line treatment for most children with NS, as the majority respond well to corticosteroids. However, in this case, the patient has not responded to high-dose steroids, indicating steroid-resistant nephrotic syndrome (SRNS). The next appropriate step in managing SRNS is to s**top steroids and start an alternative immunosuppressant like ciclosporin, which is a calcineurin inhibitor**

Question 290

What is the first and second line treatment for [2] *A 6 day old baby was born prematurely at 33 weeks. He has been suffering from respiratory distress syndrome and has been receiving ventilatory support on NICU. He has developed abdominal distension and is increasingly septic. Ultrasound of the abdomen shows free fluid and evidence of small bowel dilatation. His blood pressure has remained labile despite inotropic support*

Answer 290

**necrotising enterocolitis** and whilst this is often **initially managed medically** a **laparotomy** is required if the situation deteriorates.

Question 291

What is the first line treatment for the clinical scenario below? [1] *A 5-year-old child has been unwell with a sore throat and fever for several days. He progresses to develop periumbilical abdominal discomfort and passes diarrhoea. This becomes blood stained. The paediatricians call you because the ultrasound has shown a 'target sign'.*

Answer 291

The correct answer is: **Pneumatic reduction under fluoroscopic guidance** - This child has an **intussusception**. The lymphadenopathy will have initiated it. A target sign is seen on ultrasound and is the side on view of multiple layers of bowel wall. **Reduction using fluoroscopy with air is the usual first line management**. Ileo-colic intussceceptions are generally most reliably reduced using this method, long ileo-ileal intussceceptions usually result in surgery.

Question 292

Describe a typical case of paediatric intestinal malrotation [+]

Answer 292

A **1-year-old child** is brought to the emergency department by his parents. The parents have noticed that **he is clutching his stomach**. He has **not eaten or drank any fluids** for the entire day and he has **vomited twice**. His mother states the vomit was **green** in **colour**.

Question 293

What is the first line tx for paediatric intestinal malrotation with volvulus? [1]

Answer 293

**Ladd's procedure**

Question 294

A child is still bedwetting. Describe how age would help determine their treatment plan after advise about lifestyle measures such as decreasing fluid intake and toileting before bed have already been tried? [2]

Answer 294

The current first-line treatment is an enuresis alarm. If the **child is aged under 7, it must be tried before other measures are considered.** **Desmopressin** may be **used first-line if the child is over the age of 7** and **does not wish to use the enuresis alarm or if a short term solution is required**. This is not the case in this scenario and so would not be the correct answer.

Question 295

Which genetic syndrome is haemophilia linked with? [1] Why? [1] Turner's syndrome Down's syndrome Ataxia telangiectasia Hunter's syndrome Coeliac disease

Answer 295

Which genetic syndrome is haemophilia linked with? [1] **Turner's syndrome** - Haemophilia is a X-linked recessive disorder and would hence be **expected only to occur in males**. As patients with **Turner's syndrome only have one X chromosome** however, they may **develop X-linked recessive conditions**

Question 296

**[]** test is used to screen newborns for hearing problems

Answer 296

**Otoacoustic emission test** is used to screen newborns for hearing problems - The OAE test is used to find out how well your inner ear, or cochlea, works. It measures otoacoustic emissions, or OAEs. These are sounds given off by the inner ear when responding to a sound. There are hair cells in the inner ear that respond to sound by vibrating. The vibration produces a very quiet sound that echoes back into the middle ear. This sound is the OAE that is measured. - If you have normal hearing, you will produce OAEs. If your hearing loss is greater than 25–30 decibels (dB), you will not produce these very soft sounds.

Question 297

Cardiology reports a ventricular septal defect (VSD). His mother becomes very anxious when she finds out and is keen to find out more about VSD. She asks about the risks to her son. Which one of the following is he at a high risk of? [1] Explain your answer [1] Essential hypertension Aortic aneurysm Carotid dissection Endocarditis Papillary muscle atrophy

Answer 297

Cardiology reports a ventricular septal defect (VSD). His mother becomes very anxious when she finds out and is keen to find out more about VSD. She asks about the risks to her son. Which one of the following is he at a high risk of? **Endocarditis** - **Blood moves at high velocity** across defects such as VSD's, stenotic or leaky valves, and PDA's. This high velocity flow **facilitates the sticking of the blood's clotting elements** to these defects. If **bacteria** are in the **blood stream**, they become **enveloped in the clot** **adhering** to the **defect** and **endocarditis** may develop there.

Question 298

A child presents with bowed legs. When is this a normal variant till? [1]

Answer 298

**Bow legs in a child < 3 is a normal variant** and usually **resolves by the age of 4 years**

Question 299

A patient presents like this - what is the usual age of presentation? [1] When is this a normal variant till? [1]

Answer 299

**Knock knees (genu valgum)** - usually present at **3rd-4th year** and **spontaneously recover by 8 years old**

Question 300

A patient presents like this. What is the name for this presentation? [1] When does it usually present? [1] What is the usual cause? [1] When is intervention required? [1]

Answer 300

**Out toeing** - Common in **early infancy** and usually **resolves** **by the age of 2 years** - Usually due to **external tibial torsion** - Intervention may be **appropriate if doesn't resolve as increases risk of patellofemoral pain**

Question 301

A patient presents like this. What is the name for this presentation? [1] When does it usually present? [1] What are the usual causes? [3]

Answer 301

**Usually presents in 1st year** Possible causes: * **metatarsus adductus**: abnormal heel bisector line. 90% of cases resolve spontaneously, severe/persistent cases may require serial casting * **internal tibial torsion**: difference the thigh and foot ankle: resolves in the vast majority * **femoral anteversion:** 'W' sign resolves in around 80% by adolescence, surgical intervention in the remaining not usually advised

Question 302

A patient presents with flat feet. What is the usual age of presentation? [1] How do you manage? [1]

Answer 302

Presents at all ages * Typically **resolves** between the **ages of 4-8 years** * **Orthotics** are **NOT** recommended * **Parental reassurance appropriate**

Question 303

Following an emergency Caesarian-section for foetal distress, the consultant obstetrician hands the paediatrician a normal term male neonate. You note that the neonate is apnoeic, floppy and blue in colour. What should be your first action? Administer atropine Initiate cardiopulmonary resuscitation Give two rescue breaths Intubate and ventilate Dry the neonate

Answer 303

**Dry the neonate**

Question 304

Describe in neonatal guidelines for resuscitation [+]

Answer 304

**Neonatal resuscitation guidelines** * **Birth**: Dry the baby, remove any wet towels and cover and start the clock or note the time. * **Within 30 seconds:** Assess tone, breathing and heart rate. * **Within 60 seconds:** If gasping or not breathing - open the airway and give 5 inflation breaths * **Re-assess**: If no increase in heart rate look for chest movement * **If chest not moving**: Recheck head position, consider 2-person airway control and other airway manoeuvres, repeat inflation breaths and look for a response. * **If no increase in heart rate** look for chest movement * **When the chest is moving:** If heart rate is not detectable or slow (< 60 min-1) - start chest compressions with 3 compressions to each breath. * **Reassess heart rate every 30 seconds**. If heart rate is not detectable or slow (< 60 beats per minute) consider venous access and drugs *

Question 305

Pulmonary hypoplasia is a term used for newborn infants with underdeveloped lungs Causes include [2]

Answer 305

Pulmonary hypoplasia is a term used for newborn infants with underdeveloped lungs Causes include **oligohydramnios** **congenital diaphragmatic hernia**

Question 306

What are the two most common types of cardiac conditions seen in Turner's syndrome and how would their murmurs present? [2]

Answer 306

**Bicuspid aortic valve** (most common) - Aortic stenosis caused by valve causes **ejection systolic murmur** **Coarctation of aorta** - mid-systolic murmur - also radio-femoral delay

Question 307

A patient has DKA and is in shock. She is 20kg. What bolus fluids what you prescribe? [1]

Answer 307

**200ml 0.9% NaCl** - **initial 10 ml/kg of 0.9% sodium chloride as a bolus** (NICE), to children in shock with DKA,

Question 308

Fluid replacement in children Fluid for **shock**: - **[]** ml/kg of 0.9% NaCl **DKA**: - **[]** ml/kg of 0.9% NaCl In less than 10 mins

Answer 308

Fluid replacement in children **Fluid for shock:** * **20ml/kg of 0.9% NaCl** **DKA 10ml/kg** of **0.9% NaCl** * In less than 10 mins

Question 309

What are the cardinal signs of Wilm's tumour? [4]

Answer 309

**haematuria, hypertension, fever and an abdominal mass**.

Question 310

**[]** is the definitive treatment for pyloric stenosis - Desribe this procedure [1]

Answer 310

**Pyloromyotomy** is the definitive treatment for pyloric stenosis - The procedure involves **dividing the hypertrophied pylorus muscle down to the level of the mucosa whilst leaving the mucosa intact**.

Question 311

Neonatal Respiratory Distress Syndrome is treated with **[mode of delivery]** of artificial surfactant.

Answer 311

Neonatal Respiratory Distress Syndrome is treated with **intratracheal instillation of artificial surfactant**.

Question 312

You suspect someone has transient synovitis. What investigation do you need to rule a key ddx? [1]

Answer 312

**Joint aspiration with microscopy, culture and sensitivities** may be necessary to distinguish between transient synovitis and **septic arthritis.**

Question 313

Describe the potential electrolyte changes of untreated vesicoureteric reflux in childhood [2]

Answer 313

Untreated vesicoureteric reflux in childhood can result in kidney damage leading to **chronic kidney disease** with **impaired renal function, manifested by elevated creatinine and urea levels**, as well as **low calcium and high phosphate due to impaired excretion.**

Question 314

**[]**, a selective-serotonin-reuptake inhibitor, is the only antidepressant medication licensed for children and has the best evidence base for use in children.

Answer 314

**Fluoxetine**, a selective-serotonin-reuptake inhibitor, is the only antidepressant medication licensed for children and has the best evidence base for use in children.

Question 315

*You are junior doctor at a GP practice. Your next patient is a 3-year-old girl who is notably irritable and teary. Her father explains that she has had a reduced appetite for the past couple of days* *On examination you note multiple vesicles over both palms and around the mouth. She is also pyrexial.* What is the dx and tx? [2]

Answer 315

**Hand, foot and mouth** **disease** requires **symptomatic treatment only**

Question 316

Describe a sign with regards to hand preferances that would indicate cerebral palsy [1]

Answer 316

**Hand preference before 12 months is abnormal** - it could be an indicator of cerebral palsy

Question 317

Describe what innocent murmurs in children are caused by [1] How do they present [2]

Answer 317

**Venous hums** - Due to the **turbulent blood flow in the great veins** returning to the heart. - Heard as a **continuous blowing noise** heard **just below the clavicles** **Still's murmur** - Low-pitched sound heard at the lower left sternal edge

Question 318

A young child is vomiting. Describe how you would differentiate if this was caused by pyloric stenosis, malrotation or intestinal atresia [3+]

Answer 318

**Pyloric stenosis** - Projectile, non-bilious vomiting at 4-6 wks old **Malrotation** - Bilious vomiting, abdominal pain, acutely unwell **Intestinal atresia** - Bilious vomiting if distal to ampulla of Vater, usually hours-days old

Question 319

**Jaundice x 6 week old baby** = ? [1] - On exposure, you note multiple small bruises on the torso.

Answer 319

**Biliary atresia** - The most concerning underlying condition here is biliary atresia. The jaundice (later than that of physiological, breast milk or breastfeeding jaundice) and bruising support a diagnosis of biliary atresia. Measurement of total bilirubin (which would be elevated) and conjugated bilirubin (which would also be elevated as it is going into the bloodstream instead of the bowel lumen) would support this diagnosis.

Question 320

According to the 2024 NICE guidelines, children aged 5 to 11 with asthma that remains uncontrolled on twice-daily low-dose ICS and PRN SABA should have their treatment escalated with [1]

Answer 320

According to the 2024 NICE guidelines, children aged 5 to 11 with asthma that remains uncontrolled on twice-daily low-dose ICS and PRN SABA should have their treatment escalated to a **paediatric low-dose MART (maintenance and reliever therapy) regimen**

Question 321

Which of the following emerging blood tests is most specific to bacterial sepsis? Potassium Red blood cell count Lactate Procalcitonin White cell count

Answer 321

**Procalcitonin** - Procalcitonin is an emerging blood test that shows specificity for inflammatory markers and can help detect bacterial sepsis.

Question 322

**[]** is a recognised risk factor for slipped capital femoral epiphysis (SCFE)

Answer 322

**Growth hormone supplementation** is a recognised risk factor for **slipped capital femoral epiphysis (SCFE)** - SCFE is associated with **increased body weight, adolescent growth spurts, and sometimes with endocrine disorders or exogenous growth hormone therapy**, all of which can increase stress on the developing growth plate, leading to epiphyseal slippage.

Question 323

The most common type of heart block in children is **[1]**

Answer 323

The most common type of heart block in children is **complete heart block, also called third-degree heart block.**

Question 324

What are classic presenting features of NEC? [4]

Answer 324

patient's **premature birth, bilious vomiting, reduced feeding**, and **blood in stools** are classic features of necrotising enterocolitis (**NEC**)

Question 325

What investigation would you perform for suspected NEC and what results would indicate this pathology? [3]

Answer 325

**Abdominal X-ray** is the first-line investigation for suspected NEC. Classic findings include **pneumatosis intestinalis (gas within the intestinal wall), portal venous gas**, and possibly **free air** if there is bowel perforation

Question 326

A 4 year old girl presents to the GP with her mother after developing a rash. Her mother reports that the patient has had a fever for the past 48 hours and has been complaining of a sore throat. On examination she has a fine punctate erythematous rash across her trunk which spares her palms. The GP notes that, although her face appears flushed, the area around her mouth appears pale. **What is the best treatment? [1]**

Answer 326

A **10-day course phenoxymethylpenicillin** is the first-line treatment for scarlet fever

Question 327

A patient has ?whooping cough. What is the best first line investigation? [1]

Answer 327

PCR

Question 328

A 4 year old girl presents to the GP with her mother after developing a rash. Her mother reports that the patient has had a fever for the past 48 hours and has been complaining of a sore throat. On examination she has a fine punctate erythematous rash across her trunk which spares her palms. The GP notes that, although her face appears flushed, the area around her mouth appears pale. **What is the first line treatment? [1]**

Answer 328

A 10-day course phenoxymethylpenicillin is the first-line treatment for scarlet fever

Question 329

A newborn baby is examined by the paediatrician after birth. The main findings on examination are low-set ears, microcephaly and omphalocele. Also has cleft palate and polydactyly. What is the most likely diagnosis? [1]

Answer 329

**Patau syndrome**

Question 330

A new mother presents to the GP with her 6-week-old infant for her 6-8-week health check. The infant looks well and is meeting all developmental milestones so far. However, the mother is concerned about a red rash on her daughter's scalp. She explains that it is often flaky and is a little bit scaly. It does not seem to be bothering the child. **Dx and Tx? [2]**

Answer 330

**infantile seborrhoeic dermatitis (cradle cap)** - self-limiting condition which usually resolves by 4 months of age. - The first line treatment is applying baby oil, vegetable oil or olive oil and then gently brushing the scalp, then washing the oil off.

Question 331

At what age does pyloric stenosis most likely occur? [1

Answer 331

typically presenting around **3-6 weeks of age.**

Question 332

Because of abnormal expression of genes on chromosome 21, patients with Down's syndrome are also at increased risk of developing **[2]**

Answer 332

Because of abnormal expression of genes on chromosome 21, patients with Down's syndrome are also at increased risk of developing **Alzheimer's disease and acute lymphoblastic leukaemia**

Question 333

A 6-month-old exclusively breastfed infant presents with bruising, bleeding from gums and nose, and blood in the diaper. What is the most likely cause of his symptoms?

Answer 333

Question 334

The medical team is concerned that the infant has developed an **acute bilirubin encephalopathy.** What is the basic pathophysiology of this condition? [1]

Answer 334

Question 335

Describe the difference in treating bullous and non-bullous impetigo [2]

Answer 335

**Bullous impetigo** typically requires systemic antibiotics due to the deeper involvement of the skin and the risk of bacterial spread. - **Flucloxacillin** is the first-line treatment - **Clarithromycin** **Non-bullous**: - **hydrogen peroxide 1% cream** is first line - If widespread: topical (fusidic acid/mupirocin) or oral antibiotics for 5 days, such as **flucloxacillin**

Question 336

*X-ray signs include hyperinflation, and fluid in the horizontal fissure* What does this indicate? [1]

Answer 336

**Transient tachypnoea of the newborn (TTN)**

Question 337

This baby has which genetic condition? [1]

Answer 337

**Edwards** - Rocker bottom feet

Question 338

What does this image show. [1] Which condition can they be considered to be in? [1]

Answer 338

**Cafe au lait spots** - Seen in **Neurofibromatosis**

Question 339

Which genetic condition is this person most likely to have? [1]

Answer 339

Down's syndrome

Question 340

Which condition does this baby have? [1]

Answer 340

**Edwards**: - Rocker bottom feet - Small chin - Fixed overlapping fingers

Question 341

Which genetic condition does this child have? [1]

Answer 341

**Pataus** Cleft palate Polydactyl Small eyes

Question 342

A baby is detected as having gastroschisis via antenatal US. What would be the managemnt plan? [1]

Answer 342

**vaginal delivery with immediate repair** - NB: exomphalos is C section x stage repair

Question 343

Chickenpox is a risk for which subsequent skin infections? [2]

Answer 343

**GAS** which can lead to **necrotising fasciitis**

Question 344

When is MMR vaccine typically given? [1]

Answer 344

At one

Question 345

3month x acute limp = [next step?]

Answer 345

**Immediate assessment** - concerned about septic arthritis

Question 346

Neonate born at term. Their O2 sats at 87%. What is next step? [1]

Answer 346

**Observe for 10mins** - can be supoptimal in first 10 mins for healthy neonate

Question 347

How long should you give prednisolone for after acute asthma in children? [1]

Answer 347

**3-5 days**