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  • Question 1 - A 10-year-old girl comes to the clinic with a painful left ankle following...

    Incorrect

    • A 10-year-old girl comes to the clinic with a painful left ankle following a fall. An x-ray reveals a fracture that runs through the tibial growth plate and metaphysis. What Salter-Harris fracture classification does this injury fall under?

      Your Answer: IV

      Correct Answer: II

      Explanation:

      Type II Salter-Harris Fractures

      The Salter-Harris classification system is a way to categorize fractures that involve the growth plate or physis. These types of fractures are common in children and teenagers whose growth plates are still open. Type II Salter-Harris fractures are the most common, accounting for 75% of all growth plate fractures. This type of fracture involves a defect that runs through the growth plate and then the metaphysis.

      To put it simply, a Type II Salter-Harris fracture occurs when a bone breaks through the growth plate and into the surrounding bone tissue. This type of fracture is often caused by a sudden impact or trauma to the affected area. It is important to diagnose and treat Type II fractures promptly to prevent any long-term complications, such as growth abnormalities or joint problems.

      In summary, Type II Salter-Harris fractures are a common type of growth plate fracture that involves a defect running through the growth plate and then the metaphysis. These fractures can have long-term consequences if not treated properly, making prompt diagnosis and treatment essential.

    • This question is part of the following fields:

      • Paediatrics
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  • Question 2 - A 29-year-old woman, who is 30 weeks' pregnant, visits your clinic to discuss...

    Correct

    • A 29-year-old woman, who is 30 weeks' pregnant, visits your clinic to discuss breast feeding. She expresses her interest in trying to breast feed her baby but would like to know more about best practices in neonatal feeding.

      What are the recommendations of the World Health Organization regarding breast feeding?

      Your Answer: 6 months' exclusive breast feeding with gradual introduction of solid foods after this point

      Explanation:

      WHO Recommendations for Infant Feeding

      The World Health Organization (WHO) recommends early initiation of breast feeding, ideally from birth. Infants who are exclusively breast fed until six months have reduced risks of gastrointestinal infections compared to those who start weaning onto solid foods at three to four months. Breast feeding should continue on demand to 24 months or beyond, while solid food should be introduced gradually from six months. There should be a gradual increase in the consistency and variety of food offered. Infants who do not have ongoing breast feeding after six months will require fluid to be provided in an alternative form.

      In countries where there are particular risks of nutrient deficiencies, supplements can be provided. However, in most developed nations, nutrient supplements are not required. It is important to adhere to hygienic practices in the preparation of food. WHO recommends breast feeding in all situations, even for mothers who are HIV positive and infants who are HIV negative, provided that the mothers have satisfactory anti-retroviral therapy. In resource-poor situations, WHO considers that the positive benefits of breast feeding in a population causing improved infant mortality outweigh the risk of a minority of infants contracting HIV through breast milk.

    • This question is part of the following fields:

      • Paediatrics
      22.9
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  • Question 3 - A newly born boy appears pink centrally but blue peripherally after ten minutes.
    His...

    Correct

    • A newly born boy appears pink centrally but blue peripherally after ten minutes.
      His heart rate is 100 bpm and he is crying, with regular respirations and coughs between. He is moving all four limbs independently.
      What is his APGAR score?

      Your Answer: 8

      Explanation:

      The APGAR score is a method of assessing the well-being of a neonate during the first 10 minutes of life, named after Dr. Virginia Apgar. It measures five domains: Appearance, Pulse, Grimace, Activity, and Respiration, with each domain scored as 0, 1, or 2. The minimum score is 0 and the maximum is 10. The score is usually assessed at one minute, five minutes, and 10 minutes of life.

    • This question is part of the following fields:

      • Paediatrics
      58.9
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  • Question 4 - A 4-year-old boy visits the doctor complaining of occasional vomiting. He appears to...

    Incorrect

    • A 4-year-old boy visits the doctor complaining of occasional vomiting. He appears to be unstable while walking and his mother reports that he frequently complains of headaches. What is the probable diagnosis?

      Your Answer: Ataxia telangiectasia

      Correct Answer: Medulloblastoma

      Explanation:

      Diagnosis of a Posterior Fossa Tumor in a Young Girl

      This young girl is showing symptoms of a posterior fossa tumor, which affects the cerebellar function. Ataxia, slurred speech, and double vision are common symptoms of this type of tumor. Additionally, headaches and vomiting are signs of increased intracranial pressure. The most likely diagnosis for this young girl is medulloblastoma, which is the most frequent posterior fossa tumor in children.

      Craniopharyngioma is an anterior fossa tumor that arises from the floor of the pituitary, making it an unlikely diagnosis for this young girl. Acute myeloid leukemia is rare in children and has a low rate of CNS involvement, unlike acute lymphoblastic leukemia. Ataxia telangiectasia is a hereditary condition that causes degeneration of multiple spinal cord tracts, but it would not present with features of a space-occupying lesion. Becker’s muscular dystrophy is an X-linked condition that causes weakness in boys.

      In summary, this young girl’s symptoms suggest a posterior fossa tumor, with medulloblastoma being the most likely diagnosis. It is important to accurately diagnose and treat this condition to ensure the best possible outcome for the patient.

    • This question is part of the following fields:

      • Paediatrics
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  • Question 5 - What is the initial event that triggers puberty in girls? ...

    Incorrect

    • What is the initial event that triggers puberty in girls?

      Your Answer: Sudden increase in oestrogen production

      Correct Answer: Nocturnal rise in luteinising hormone (LH)

      Explanation:

      Puberty is triggered by endocrine changes that begin years before visible changes occur. The initial event is an increase in nocturnal LH secretion under the stimulation of GnRH. LH patterns of secretion change over time, resembling the adult pattern. In females, increased secretion of GnRH, LH, FSH, and estrogen causes the development of secondary sexual characteristics, adrenarche, gonadarche, thelarche, and menarche. The growth spurt for girls occurs in mid-puberty around the age of 12.

    • This question is part of the following fields:

      • Paediatrics
      7.6
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  • Question 6 - A boy born 12 hours ago is observed to have a heart rate...

    Correct

    • A boy born 12 hours ago is observed to have a heart rate of 180 beats per minute. He was delivered via normal vaginal delivery without any complications. He has no fever and responds well to supportive care after 24 hours. What advice should be given to the mother?

      Your Answer: There will be no long term consequences

      Explanation:

      Transient Tachypnoea of the Newborn (TTN) and its Consequences

      Transient tachypnoea of the newborn (TTN) is a condition that does not have any long-term consequences. During a normal delivery, the baby’s lungs get squeezed, which helps to remove fluid from the airspaces. However, during a caesarean section, this process does not occur, leading to a tachypnoeic response known as TTN in some infants. Although there are no signs of serious pathology, such as cyanosis, pyrexia, hypoglycaemia, or seizures, the neonate may take a few days to recover. After this, there are no further complications of TTN.

      To protect children with chronic lung disease from respiratory syncytial virus and bronchiolitis, a viral vaccine is given before the winter. Chronic lung disease is usually caused by surfactant deficient lung disease with prolonged ventilation. It is important to note that TTN is not infectious in origin, and the neonate does not exhibit any other signs of infection. Although a collapsed lung can occur due to various reasons, it is not a part of the pathology of TTN.

      In conclusion, TTN is a temporary condition that does not have any long-term consequences. It is important to monitor the neonate for any signs of serious pathology and provide appropriate treatment if necessary. Children with chronic lung disease should receive a viral vaccine to protect them from respiratory syncytial virus and bronchiolitis.

    • This question is part of the following fields:

      • Paediatrics
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  • Question 7 - A 28-year-old woman comes to your clinic. She is in her 12th week...

    Incorrect

    • A 28-year-old woman comes to your clinic. She is in her 12th week of pregnancy and is worried about her baby's health. Her friend had a premature baby who had to stay in the neonatal intensive care unit for several weeks. The patient wants to know what she can do to decrease the chances of having a premature baby.

      Some advice you can give her to reduce the risk of having a premature baby includes:
      - Avoiding smoking, alcohol, and drugs during pregnancy
      - Eating a healthy and balanced diet
      - Getting regular prenatal care
      - Managing chronic conditions such as diabetes or high blood pressure
      - Avoiding infections by washing hands frequently and avoiding sick people
      - Reducing stress through relaxation techniques or counseling
      - Avoiding certain activities such as hot tubs or saunas
      - Getting enough rest and sleep.

      It is important to reassure the patient that not all premature births can be prevented, but taking these steps can help reduce the risk.

      Your Answer: Iron supplementation

      Correct Answer: Smoking cessation

      Explanation:

      Low Birth Weight and Intrauterine Growth Retardation

      Low birth weight (LBW) is defined as a birth weight of less than 2500 g, regardless of gestational age. Intrauterine growth retardation (IUGR), also known as small-for-gestational-age (SGA) or small-for-dates, has no universally accepted definition. However, it is commonly defined as a birth weight less than the 10th or 5th percentile for gestational age, a birth weight less than 2500 g with a gestational age of 37 weeks or more, or a birth weight less than two standard deviations below the mean value for gestational age.

      Smoking is a significant modifiable risk factor for IUGR. Babies born to women who smoke weigh an average of 200 g less than those born to non-smokers. The incidence of low birth weight is twice as high among smokers as non-smokers. However, evidence shows that women who quit smoking during pregnancy can reduce the risk of having a low birth weight infant by around 20%.

      There are various support systems available to help smoking cessation during pregnancy, including routine antenatal care, community smoking cessation clinics, psychological therapies, and nicotine replacement therapies. Folate supplementation is recommended for reducing neural tube defects in pregnancy, but it has no proven role in preventing LBW. Iron supplementation is recommended for pregnant women who are anaemic but has no role in preventing LBW in non-anaemic women. Gentle exercise is recommended throughout pregnancy but has no proven role in reducing LBW births. A high protein diet is not thought to be beneficial in pregnancy and may even cause harm.

    • This question is part of the following fields:

      • Paediatrics
      53.9
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  • Question 8 - A 20-year-old male patient comes in with a low impact fracture of his...

    Correct

    • A 20-year-old male patient comes in with a low impact fracture of his right femur. Upon examination, an x-ray reveals a growth located at the metaphysis that elevates the periosteum and appears to extend into the surrounding soft tissues. What is the probable diagnosis?

      Your Answer: Osteosarcoma

      Explanation:

      Common Types of Bone Tumours

      Osteosarcomas are the most frequent primary bone malignancy, often occurring in the metaphysis around the knee. They are more common in boys and affect those aged between 14 and 20 years old. Symptoms include pain, low impact fracture, or a mass. On an x-ray, they appear as an area of new bone beneath the periosteum, lifting it up, known as Codman’s triangle. Another feature is sunray spiculation, where opaque lines of osteosarcoma grow into adjacent soft tissues.

      Chondrosarcoma is a malignant tumour of cartilage that usually develops from benign chondromas, often in hereditary multiple exostoses. Ewing sarcoma is a tumour of unknown origin that develops in limb girdles or the diaphysis of long bones. It has a characteristic onion appearance on x-ray, with concentric rings of new bone formation. Bone metastases are rare in children, and there are no features to suggest a primary tumour, although it should be considered.

      Osteoid osteoma is a benign cystic tumour that occurs in the long bones of young men and teenagers. It causes severe pain and shows as local cortical sclerosis but does not invade into soft tissues. the different types of bone tumours and their characteristics is crucial for early detection and treatment.

    • This question is part of the following fields:

      • Paediatrics
      24.5
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  • Question 9 - A 5-day-old girl is currently intubated and ventilated in the neonatal unit due...

    Incorrect

    • A 5-day-old girl is currently intubated and ventilated in the neonatal unit due to surfactant deficient lung disease. However, her oxygen saturations have suddenly dropped and she now requires higher ventilation pressures. What is the probable complication that has arisen?

      Your Answer: Acute pulmonary oedema

      Correct Answer: Pneumothorax

      Explanation:

      Pneumothorax as a Common Complication of Neonatal Ventilation

      Pneumothorax is a frequent complication of neonatal ventilation, particularly in cases where high pressures are required due to poor lung compliance in surfactant deficient lung disease. This condition occurs when air enters the interstitial space, increasing the risk of barotraumatic pneumothoraces. A sudden change in ventilation requirements is a sign of a physical process rather than a gradual inflammatory change, making it important to monitor neonates closely for this complication.

      Acute pulmonary oedema is another potential complication, but it usually occurs secondary to heart failure in neonates with severe cardiac malformations. Aspiration pneumonitis is unlikely if an endotracheal tube is in place, and hypoglycaemia is more common in neonates but would not present with increased ventilation pressure requirements. Pneumonia, on the other hand, would present more gradually and would not be the most prominent feature in cases of sudden changes in ventilation requirements. Overall, it is crucial to be aware of the risks associated with neonatal ventilation and to monitor patients closely for potential complications.

    • This question is part of the following fields:

      • Paediatrics
      23.8
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  • Question 10 - You are attending a seminar on adolescent eating disorders.
    What hormonal alteration is common...

    Incorrect

    • You are attending a seminar on adolescent eating disorders.
      What hormonal alteration is common in post-pubertal teenagers with extreme undernourishment?

      Your Answer: Reduced glucagon

      Correct Answer: Hypogonadotrophic hypogonadism

      Explanation:

      Endocrine System Adaptations during Starvation

      During periods of starvation or severe malnutrition, the body undergoes various adaptations to cope with reduced food intake. One of the systems affected is the endocrine system, which experiences several changes. Glucagon levels increase, stimulating gluconeogenesis, while aldosterone, epinephrine, norepinephrine, and growth hormone levels also rise. Conversely, insulin production decreases, and there is a reduction in free and total T3, contributing to a lower metabolic rate. Prolonged starvation can also lead to a decrease in free T4. Hypogonadotrophic hypogonadism may occur, causing infertility, menstrual disturbances, amenorrhea, premature ovarian failure, and osteoporosis in women. Men may experience infertility, erectile dysfunction, and osteoporosis.

      In summary, the endocrine system undergoes significant adaptations during starvation or severe malnutrition. These changes include alterations in hormone levels, such as increased glucagon and decreased insulin production, as well as reduced free and total T3. Hypogonadotrophic hypogonadism may also occur, leading to various reproductive and bone-related issues. these adaptations is crucial in managing individuals experiencing starvation or malnutrition.

    • This question is part of the following fields:

      • Paediatrics
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  • Question 11 - A 6-year-old boy presents to the clinic after experiencing his seventh fracture. Upon...

    Correct

    • A 6-year-old boy presents to the clinic after experiencing his seventh fracture. Upon examination, his x-rays reveal dense bones with multiple cortical layers. He also has a mild normocytic anemia and low platelets, but his sclera appear white. What is the probable diagnosis?

      Your Answer: Osteopetrosis

      Explanation:

      Osteopetrosis and its Distinction from Other Bone Disorders

      Osteopetrosis is a congenital condition that affects bone reabsorption, leading to the appearance of a ‘bone within a bone’ from multiple cortical layers. Despite the increased density, bones become brittle and prone to fracture, and there is no room for the marrow to grow, causing bone marrow failure and peripheral cytopenias. Additionally, bones expand and frequently cause neural compression symptoms.

      When diagnosing osteopetrosis, it is important to exclude non-accidental injury (NAI) due to the repeated bone injury, but NAI alone cannot account for the x-ray findings or the blood counts. However, a diagnosis of osteopetrosis does not rule out the possibility of NAI co-existing with the condition.

      Other bone disorders, such as acute lymphocytic leukemia and aplastic anemia, may present with peripheral cytopenias but not the x-ray appearances or multiple fractures. On the other hand, osteogenesis imperfecta (OI) is a congenital condition of brittle bones susceptible to multiple fractures due to a mutation in type I collagen. The most common form, type I OI, is inherited as an autosomal dominant condition and is associated with blue sclerae and neural deafness from bone overgrowth. X-rays show reduced bone density with cortical disorganization.

      In summary, the distinct features of osteopetrosis and its differentiation from other bone disorders is crucial in making an accurate diagnosis and providing appropriate treatment.

    • This question is part of the following fields:

      • Paediatrics
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  • Question 12 - An 8-year-old girl comes to the doctor complaining of leg pains. She cries...

    Incorrect

    • An 8-year-old girl comes to the doctor complaining of leg pains. She cries at night and her mother has to massage the painful areas to soothe her. Upon examination, there are no visible abnormalities. What is the probable diagnosis?

      Your Answer: Acute lymphoblastic leukaemia

      Correct Answer: Idiopathic pains

      Explanation:

      Idiopathic Limb Pains in Children

      Idiopathic limb pains, also known as growing pains, are a common occurrence in children between the ages of 3 and 9. These pains typically occur in the lower limbs and can be quickly settled with comforting. It is important to note that these pains are not associated with any abnormalities found during examination and the child should be growing normally.

      However, it is important to distinguish idiopathic limb pains from other conditions that may cause similar symptoms. Acute lymphoblastic leukaemia, for example, may cause limb pain due to bone marrow infiltration. Children with this condition may also exhibit signs of bone marrow failure and be systemically unwell.

      Langerhans histiocytosis is another condition that can cause painful bone lesions. This proliferative disorder of antigen presenting cells may be localised or systemic and can be difficult to diagnose. The systemic form of the condition may also present with a widespread eczematous rash and fevers.

      Non-accidental injury may also present with recurrent pains, but evidence of an injury would be expected. Primary bone malignancy is more common in teenage years and typically presents with unremitting pain, growth failure, weight loss, or pathological fractures.

      In summary, while idiopathic limb pains are relatively easy to settle and associated with a normal examination, it is important to consider other potential conditions that may cause similar symptoms. Proper diagnosis and treatment can help ensure the best possible outcome for the child.

    • This question is part of the following fields:

      • Paediatrics
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  • Question 13 - Which tumour is most frequently found in children who are less than one...

    Correct

    • Which tumour is most frequently found in children who are less than one year old?

      Your Answer: Neuroblastoma

      Explanation:

      Common Tumours in Children Under 1 Year Old

      Embryonal ‘-blastoma’ tumours are frequently found in children under 1 year old. These tumours include retinoblastoma, neuroblastoma, nephroblastoma, medulloblastoma, and hepatoblastoma. Among these, neuroblastoma is the most common and typically affects infants under 1 year old. It originates from neural crest cells in the adrenal medulla and often presents as a large abdominal mass in an otherwise healthy child.

      Acute lymphoblastic leukaemia (ALL) is the most common cancer in children overall, but it is less common in infants under 1 year old. Unfortunately, the prognosis for those who develop ALL before their first birthday is poorer. Astrocytomas, the most common type of CNS tumour, tend to affect slightly older children.

      Retinoblastomas are embryonal tumours of the retina, with half being spontaneous and the other half being familial due to an inherited mutation in the pRB tumour suppressor gene. Wilms’ tumour, also known as nephroblastoma, is another embryonal tumour that affects the kidneys and may present as an abdominal mass in infants.

      In summary, embryonal ‘-blastoma’ tumours are common in children under 1 year old, with neuroblastoma being the most prevalent. Other tumours, such as ALL and astrocytomas, tend to affect slightly older children. Early detection and treatment are crucial for improving outcomes in these young patients.

    • This question is part of the following fields:

      • Paediatrics
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  • Question 14 - A woman gives birth to a preterm baby weighing 1250 g at birth....

    Incorrect

    • A woman gives birth to a preterm baby weighing 1250 g at birth.

      What is the appropriate way to describe this body weight?

      Your Answer: Very low birth weight

      Correct Answer: Low birth weight

      Explanation:

      Low Birth Weight and Intrauterine Growth Restriction

      Low birth weight (LBW) is a condition where a baby is born weighing less than 2500 grams. Very low birth weight babies, on the other hand, weigh less than 1500 grams. LBW is a significant contributor to neonatal mortality in both developed and developing countries. Babies born with LBW are also at greater risk of developing diabetes, heart disease, and poor linear growth later in life. The causes of LBW include prematurity, multiple pregnancy, ethnicity, maternal smoking during pregnancy, and family socio-economic status.

      It is important to note that LBW and intrauterine growth restriction (IUGR) are not interchangeable terms. IUGR, also known as small-for-gestational-age or small-for-dates, has no generally accepted standard definition. However, it is commonly defined as a birth weight less than the 10th or 5th percentile for gestational age, a birth weight less than 2500 g and gestational age greater than or equal to 37 weeks, or a birth weight less than two standard deviations below the mean value for gestational age.

      It is crucial to assess the suitability of the weight to gestational age in IUGR, whereas in LBW, no allowance is made for prematurity. The World Health Organization estimates that 13 million children are born with IUGR every year. the difference between LBW and IUGR can help healthcare professionals provide appropriate care and interventions for newborns and their mothers.

    • This question is part of the following fields:

      • Paediatrics
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  • Question 15 - A previously healthy 8-year-old girl comes to the GP with a recent onset...

    Correct

    • A previously healthy 8-year-old girl comes to the GP with a recent onset limp. She experiences tenderness in her right leg during all hip movements. Blood tests reveal no abnormalities. An MRI scan shows an irregular femoral head. What is the probable underlying diagnosis?

      Your Answer: Legg-Calve-Perthes disease

      Explanation:

      Idiopathic Osteonecrosis of the Femoral Head in Children

      Idiopathic osteonecrosis of the femoral head, also known as Perthes disease, is a condition that primarily affects boys between the ages of 5 and 11. It is characterized by pain in the hip during movement and difficulty bearing weight. Unlike septic arthritis, the child is not systemically unwell. The cause of Perthes disease is unknown, although trauma may sometimes be a contributing factor.

      Examination findings can help localize the pathology to the hip, and irregularities in the femoral head may be visible on x-ray. However, MRI is the preferred imaging modality. Treatment options depend on the extent of the affected area. If less than 50% of the head is affected, bed rest and analgesia may be sufficient. If more than 50% is affected, surgery may be necessary.

      Other conditions that can cause a limping child include caisson disease, septic arthritis, sickle cell disease, and slipped upper femoral epiphysis (SUFE). However, each of these conditions has distinct characteristics that can help differentiate them from Perthes disease. For example, caisson disease is associated with nitrogen decompression sickness after diving, while SUFE tends to occur in teenagers and involves a fracture through the growth plate with a displaced femoral head.

    • This question is part of the following fields:

      • Paediatrics
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  • Question 16 - What is the initial event that triggers puberty in boys? ...

    Correct

    • What is the initial event that triggers puberty in boys?

      Your Answer: Nocturnal rise in luteinising hormone (LH)

      Explanation:

      The Process of Puberty in Males

      Puberty is a complex process that is not yet fully understood. The changes that lead to puberty begin years before any visible changes occur. The process starts with an increase in the secretion of luteinising hormone (LH) at night, which gradually leads to an increase in sex hormone production. This increase is stimulated by gonadotropin releasing hormone (GnRH), which causes LH secretion to change from being predominantly at night to being secreted during the day and night. Over time, the pattern of secretion starts to resemble the adult pattern of circadian variation.

      As GnRH secretion increases, levels of follicle stimulating hormone (FSH) also increase gradually. In males, this leads to an increase in testosterone levels, which causes the development of secondary sexual characteristics such as facial, pubic, and axillary hair, testicular growth, and vocal changes. The growth spurt for boys occurs in mid-puberty, around the age of 14 years.

      The process of puberty in males can be broken down into several stages. The first stage is adrenarche, which occurs around age 11-12 on average. This is when adrenal androgen production increases, causing acne, sexual hair production, and body odour. The second stage is gonadarche, which causes testicular enlargement and reddening of the scrotum. This occurs around the same time as adrenarche. The third stage is spermatogenesis, which occurs around age 13-14 on average. The final stage is the growth spurt, which starts in mid-puberty and reaches peak height velocity around the age of 14.

    • This question is part of the following fields:

      • Paediatrics
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  • Question 17 - A male infant is delivered at 37 weeks and has a birth weight...

    Incorrect

    • A male infant is delivered at 37 weeks and has a birth weight of 960 grams. The reason for his low birth weight is unknown. What health condition is he at risk for in the future?

      Your Answer: Epilepsy

      Correct Answer: Diabetes mellitus

      Explanation:

      Intrauterine Growth Restriction and its Long-Term Effects

      Intrauterine growth restriction (IUGR) is a condition where a fetus fails to reach its full growth potential due to various factors such as maternal, placental, or fetal issues. This results in low birth weight and poor growth, especially in the third trimester. The causes of IUGR can be congenital abnormalities, twins, pre-eclampsia, structural abnormalities in the placenta, smoking, alcohol consumption, and chronic diseases in the mother.

      Neonates with IUGR are at a higher risk of developing hypoglycemia, infections, and hypothermia. As they grow up, they are also more susceptible to obesity, cardiovascular disease, and diabetes mellitus. This is due to a phenomenon called pre-conditioning, where the body adapts to the conditions it experienced in the womb. However, there is no evidence to suggest that other conditions are increased in adults who were affected by IUGR.

      In conclusion, IUGR is a serious condition that can have long-term effects on an individual’s health. It is important for healthcare professionals to identify and manage IUGR early on to prevent complications in both neonates and adults.

    • This question is part of the following fields:

      • Paediatrics
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  • Question 18 - A 9-year-old boy presents to the paediatric outpatient clinic with a history of...

    Correct

    • A 9-year-old boy presents to the paediatric outpatient clinic with a history of duodenal atresia, clinodactyly, a wide nasal bridge, and a large tongue. What malignancy is he at an elevated risk for?

      Your Answer: Acute leukaemias

      Explanation:

      Down’s Syndrome and Associated Conditions

      Down’s syndrome, also known as trisomy 21, is characterized by several physical features such as a wide, flat nasal bridge, macroglossia, and clinodactyly. Other common features include a round face, hypothyroidism, a sandal gap between the toes, and a single palmar crease. Individuals with Down’s syndrome are predisposed to certain conditions such as Alzheimer’s disease and acute leukaemias. However, nephroblastomas, primary bone malignancies, soft tissue tumours, and solid CNS tumours are not directly related to Down’s syndrome. Nephroblastomas are associated with an absent iris, while primary bone malignancies have few predisposing factors except for rare cancer syndromes. Soft tissue tumours, such as rhabdomyosarcomas, are linked to familial retinoblastoma, while solid CNS tumours are increased in cancer syndromes like Li-Fraumeni. the associated conditions of Down’s syndrome can aid in early detection and treatment of these conditions.

    • This question is part of the following fields:

      • Paediatrics
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  • Question 19 - What is the primary reason for children to have a small stature? ...

    Incorrect

    • What is the primary reason for children to have a small stature?

      Your Answer: Growth hormone deficiency

      Correct Answer: Idiopathic short stature

      Explanation:

      Causes and Management of Short Stature in Children

      Short stature is a common condition in children that can be caused by various factors. The most common cause is idiopathic short stature, which includes familial short stature and constitutional delay of growth and puberty. Other causes include chronic diseases, nutritional problems, growth hormone deficiency, hypothyroidism, and chromosomal abnormalities. However, most children with short stature will attain a satisfactory adult height, and reassurance with a period of watchful waiting is often a reasonable approach.

      Further investigation is necessary when the child’s height deficit is less than the first percentile for age, the growth rate is abnormally slow, the predicted height differs significantly from midparental height, or the body proportions are abnormal. Growth hormone therapy is available for the treatment of children with growth hormone deficiency and idiopathic short stature, but the benefits are relatively modest and the treatment is expensive and inconvenient. Current evidence suggests that the use of growth hormone is safe in children, although there are reports of increased risks of intracranial hypertension, glucose intolerance, or a slipped capital femoral epiphysis.

    • This question is part of the following fields:

      • Paediatrics
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  • Question 20 - A 14-year-old boy with juvenile idiopathic arthritis is visiting the eye clinic for...

    Incorrect

    • A 14-year-old boy with juvenile idiopathic arthritis is visiting the eye clinic for a screening.

      What is the purpose of his visit and what complication is he being screened for?

      Your Answer: Keratitis

      Correct Answer: Chronic anterior uveitis

      Explanation:

      Complications of Juvenile Idiopathic Arthritis

      Patients with Juvenile Idiopathic Arthritis (JIA) are regularly screened for chronic anterior uveitis, which can lead to scarring and blindness if left untreated. However, this condition may be asymptomatic in some cases, making annual screening using a slit-lamp essential.

      One of the long-term complications of JIA is the development of flexion contractures of joints due to persistent joint inflammation. This occurs because pain is partly related to increased intra-articular pressure, which is at its lowest when joints are held at 30-50 degrees.

      While corticosteroids may be used to manage joint inflammation, they are used sparingly in children due to the risk of cataract development. Conjunctivitis is not typically associated with JIA, but reactive arthritis. Keratitis, on the other hand, tends to be an infective process caused by bacteria or viruses.

      Lastly, pterygium is an overgrowth of the conjunctiva towards the iris and is often seen in individuals exposed to windy or dusty conditions, such as surfers.

      In summary, JIA can lead to various complications, including chronic anterior uveitis, joint contractures, and cataract development. Regular screening and management are crucial to prevent long-term damage.

    • This question is part of the following fields:

      • Paediatrics
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  • Question 21 - A couple in their mid-40s with no known genetic disorders in their family...

    Correct

    • A couple in their mid-40s with no known genetic disorders in their family have a baby boy who exhibits asymmetrical growth. The child's head and torso are proportionate, but his arms and legs are significantly shorter than average, and his fingers are all the same length. What is the mode of inheritance for this condition?

      Your Answer: Autosomal dominant

      Explanation:

      Achondroplasia: A Congenital Condition Causing Impaired Bone Growth

      Achondroplasia is a congenital condition that affects bone growth, resulting in short arms and legs, fingers and toes of equal length, increased lumbar lordosis, and normal intellect and life expectancy. Although it is an autosomal dominant condition, most cases occur without a family history. The underlying defect is a mutation in fibroblast growth factor receptor 3 (FGFR3), which is responsible for membranous bone growth. However, 80% of all cases are sporadic mutations, with the most common cause being a de novo mutation. The risk of a de novo mutation is increased due to the age of the father.

      Increased paternal age promotes single gene mutations, while increased maternal age promotes non-dysjunction and chromosomal abnormalities. Despite the impaired bone growth, affected patients have normal-sized heads and trunks due to normal membranous bone growth. Achondroplasia is a congenital condition that can be diagnosed through genetic testing and managed through various treatments, including limb-lengthening surgeries and physical therapy.

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      • Paediatrics
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  • Question 22 - A 25-day-old girl is brought in with jaundice and inadequate weight gain. She...

    Incorrect

    • A 25-day-old girl is brought in with jaundice and inadequate weight gain. She presents with a swollen tongue, thick skin, and elevated unconjugated bilirubin levels. It is noted that she did not receive the heel prick blood test on day 5.

      What condition is the most probable diagnosis?

      Your Answer: Galactosaemia

      Correct Answer: Hypothyroidism

      Explanation:

      Congenital Hypothyroidism and Other Conditions Screened for in the UK

      Congenital hypothyroidism is a rare condition in the United Kingdom, often caused by inherited metabolic defects. It is important to diagnose and treat early, as untreated cases can lead to serious long-term consequences such as learning difficulties and growth restriction. Symptoms of congenital hypothyroidism include poor weight gain, a large tongue, thick skin, constipation, and coarse facies.

      In the UK, the Guthrie test is used to screen for five conditions on days four to five after birth. These conditions include cystic fibrosis, sickle cell disease, phenylketonuria (PKU), MCAD deficiency, and congenital hypothyroidism. Galactosaemia is another severe metabolic condition that affects neonates from their first milk feed.

      Cystic fibrosis is an autosomal recessive condition that results in thick bodily secretions due to a mutation in the chloride ion channel transporter proteins. MCAD deficiency leads to symptoms of hypotonia, hypoglycemia, and vomiting. PKU leads to symptoms of cognitive dysfunction, learning disability, and seizures. By screening for these conditions, healthcare professionals can identify and treat affected infants early, improving their long-term outcomes.

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      • Paediatrics
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  • Question 23 - A 16-year-old girl visits a rheumatologist with complaints of occasional joint pain. Despite...

    Incorrect

    • A 16-year-old girl visits a rheumatologist with complaints of occasional joint pain. Despite the absence of clinical synovitis, she has a Beighton score of 9 and is in good health. What is the most suitable course of action for her management?

      Your Answer: Ibuprofen as required

      Correct Answer: Physiotherapy

      Explanation:

      Joint Pain in Children and Hypermobility Syndrome

      Joint pain in children can have various causes, including hypermobility syndrome. This condition is characterized by increased flexibility, as opposed to hereditary connective tissue disorders. The Beighton score is a method used to assess hypermobility, which involves ten tests. A score of 9 indicates high flexibility and suggests susceptibility to hypermobility syndrome. Although there is no intrinsic joint disease or clinical synovitis, joint pain can be experienced. Physiotherapy can help strengthen the soft tissues supporting joints and reduce pain.

      In mild juvenile idiopathic arthritis (JIA), which may present similarly to hypermobility syndrome, ibuprofen is the first line of management. However, if joints show clinical synovitis, methotrexate may be considered for severe JIA. It is important to reassure the child and parents that the pain is not sinister, but it is not the optimal management for this condition. Genetic conditions causing hypermobility, such as Ehlers-Danlos and Marfan syndrome, may require referral for genetic counseling, but there are no other features of these syndromes present in hypermobility syndrome.

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      • Paediatrics
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  • Question 24 - A 2-day-old girl presents with sudden hypoxia, hypotension, and acidosis. Upon examination, pulses...

    Incorrect

    • A 2-day-old girl presents with sudden hypoxia, hypotension, and acidosis. Upon examination, pulses are found in the right upper limb but not in the left upper limb or legs. What congenital abnormality is the most likely cause of these symptoms?

      Your Answer:

      Correct Answer: Interruption of the aortic arch

      Explanation:

      Circulatory collapse in newborns on day 1 is often caused by duct-dependent cardiac defects such as interruption of the aortic arch or left hypoplastic heart syndrome. These defects cause hypoxia, acidosis, and hypotension. Interruption of the aortic arch presents with upper limb pulses, while left hypoplastic heart syndrome presents with absent upper limb pulses. Anomalous pulmonary venous circulation and tetralogy of Fallot are not associated with early circulation collapse. Coarctation is a non-cyanotic defect that may be detected by weak femoral pulses, upper limb hypertension, or a pansystolic subclavicular/subscapular murmur.

    • This question is part of the following fields:

      • Paediatrics
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  • Question 25 - In developed nations, what is the most significant modifiable risk factor for infants...

    Incorrect

    • In developed nations, what is the most significant modifiable risk factor for infants born with a low birth weight (<2500 g)?

      Your Answer:

      Correct Answer: Maternal smoking

      Explanation:

      Low Birth Weight and its Causes

      Low birth weight is a significant factor in neonatal mortality worldwide, and it can also lead to health problems later in life such as diabetes, heart disease, and poor growth. The causes of low birth weight include maternal smoking during pregnancy, prematurity, multiple pregnancies, ethnicity, and family socio-economic status. Maternal smoking during pregnancy is the most important modifiable contributor to low birth weight, and babies born to women who smoke weigh on average 200 g less than babies born to non-smokers. The incidence of low birth weight is twice as high among smokers as non-smokers. Pregnancy is a crucial time for public health interventions to reduce or prevent maternal smoking. Although many pregnant smokers quit during their pregnancy, many recommence smoking again after delivery.

      Overall, reducing the prevalence of maternal smoking during pregnancy is a crucial step in reducing the incidence of low birth weight and improving neonatal health outcomes. Other factors such as prematurity, multiple pregnancies, ethnicity, and socio-economic status are also important contributors to low birth weight, but they are not as easily modifiable. Therefore, public health interventions should focus on reducing maternal smoking during pregnancy to improve neonatal health outcomes.

    • This question is part of the following fields:

      • Paediatrics
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  • Question 26 - A premature 4-day-old girl is admitted with severe abdominal pain, swelling, vomiting and...

    Incorrect

    • A premature 4-day-old girl is admitted with severe abdominal pain, swelling, vomiting and not tolerating her feeds of formula milk. She becomes extremely unwell and requires artificial ventilation. What features are most likely to be seen on abdominal x-ray?

      Your Answer:

      Correct Answer: Distended bowel with intramural gas

      Explanation:

      Necrotising Enterocolitis (NEC)

      Necrotising enterocolitis (NEC) is a condition that affects newborns within the first few weeks of life. It is caused by a bacterial infection of the bowel wall, which becomes ischaemic. NEC is more likely to occur in infants who are fed cows’ milk. Symptoms include a distended bowel with thickened walls containing intramural gas, shock, abdominal signs, and passing bright red blood per rectum. The infection is in the wall of the bowel, and the implicated organisms are gas-forming, which is visible on an x-ray as thickened bowel walls with intramural gas. In severe cases, the bowel may perforate, and urgent surgery is required. After surgery, children may suffer from short bowel syndrome.

      Large bowel obstruction may occur in cases of anorectal malformation, but this tends to present in the first few days of life with failure to pass meconium. A sentinel loop of bowel is a single dilated loop of bowel overlying an inflamed organ, such as pancreatitis or appendicitis. Small bowel obstruction may occur due to intussusception, but it is more common at 1-2 years of age, and the presentation is less acute. Intussusception causes the ‘target sign’ of one loop of bowel inside another, but this is seen on ultrasound, not x-ray.

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      • Paediatrics
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  • Question 27 - A newborn is delivered at 34 weeks' gestation. The obstetrician suspects intrauterine growth...

    Incorrect

    • A newborn is delivered at 34 weeks' gestation. The obstetrician suspects intrauterine growth restriction.
      What sign indicates a possible diagnosis of intrauterine growth restriction?

      Your Answer:

      Correct Answer: Birth weight less than 10th percentile for gestational age

      Explanation:

      Low Birth Weight and Intrauterine Growth Restriction

      Low birth weight (LBW) and intrauterine growth restriction (IUGR) are two terms that are often used interchangeably, but they actually have different definitions. LBW refers to a birth weight of less than 2500 g, regardless of gestational age. On the other hand, IUGR is a condition where the baby’s weight is not suitable for their gestational age. This can be determined by assessing if the birth weight is less than the 10th or 5th percentile for gestational age, less than 2,500 g and gestational age greater than or equal to 37 weeks, or less than two standard deviations below the mean value for gestational age.

      It is important to note that LBW does not take into account prematurity, while IUGR requires an assessment of the baby’s weight in relation to their gestational age. While many babies with low birth weights can still be healthy, IUGR is considered pathological and can be caused by various factors such as placental diseases, pre-eclampsia, chromosomal abnormalities, congenital infections, maternal substance abuse, and maternal diseases.

      the difference between LBW and IUGR is crucial in identifying potential health risks for newborns. The World Health Organization estimates that 13 million children are born with IUGR every year, highlighting the importance of proper prenatal care and monitoring. By identifying and addressing the underlying causes of IUGR, healthcare providers can help ensure the healthy development of the baby and reduce the risk of complications during and after birth.

    • This question is part of the following fields:

      • Paediatrics
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  • Question 28 - A 7-year-old girl is being evaluated by paediatric endocrinology services due to concerns...

    Incorrect

    • A 7-year-old girl is being evaluated by paediatric endocrinology services due to concerns about her height. Her BMI measures 18 kg/m2.

      How should this child's weight be classified?

      Your Answer:

      Correct Answer: Normal weight

      Explanation:

      Assessing Stature and Obesity in Childhood

      The assessment of stature and obesity in childhood can be challenging due to various factors that affect growth, such as hormones, puberty, and nutrition. To address this, the World Health Organization recommends using age- and gender-specific BMI charts, with a cut-off of >85% percentile for overweight and >95th percentile for obesity. These values are similar to the BMI levels used for adults aged >18 years old.

      In general, healthy children aged 1-10 years old have BMIs ranging from 14-17 kg/m2. By age 12, the median BMI is around 18 kg/m2, and it increases to around 22 kg/m2 by age 18 years. However, there may be slight variations in the cut-offs used between countries, which can be found in appropriate charts. Overall, using these charts can aid in accurately assessing stature and diagnosing obesity in children.

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      • Paediatrics
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  • Question 29 - A 48-hour-old boy who was born by vaginal delivery has not passed meconium....

    Incorrect

    • A 48-hour-old boy who was born by vaginal delivery has not passed meconium.

      A patent anal orifice can be seen, but an abdominal x-ray reveals dilatation of the bowel proximal to the sigmoid colon. A rectal mucosa biopsy confirms the diagnosis.

      What is the probable condition affecting this infant?

      Your Answer:

      Correct Answer: Hirschsprung's disease

      Explanation:

      Hirschsprung’s Disease and Other Causes of Failure to Pass Meconium in Neonates

      There are various reasons why a newborn may fail to pass meconium within the first 24 hours of life. One of these is Hirschsprung’s disease, which is caused by a loss of function mutation in the RET oncogene resulting in the absence of ganglion cells. This condition is always present in the rectum and extends proximally for a varying distance. The affected area is immotile, and proximal to it is a dilated section of the colon known as megacolon. Diagnosis is made through a rectal biopsy that confirms the absence of ganglion cells.

      Chagas’ disease, on the other hand, is caused by infection with Trypanosoma cruzi and can also cause immotile megacolon, but it is not a condition that presents in newborns. Crohn’s disease, which usually presents with diarrhea rather than constipation, does not occur in neonates. Cystic fibrosis can cause meconium ileus, where thick meconium becomes lodged at the ileocecal valve, but the anatomical location is not correct in this case, and biopsy is not required. Congenital hypothyroidism may cause constipation, but it does not result in megacolon, and biopsy is not necessary.

    • This question is part of the following fields:

      • Paediatrics
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  • Question 30 - A febrile 5-day-old boy with surfactant deficient lung disease presents with a seizure....

    Incorrect

    • A febrile 5-day-old boy with surfactant deficient lung disease presents with a seizure. Subsequently, he exhibits variable consciousness and decreased limb tone. His blood glucose level is within normal limits. What is the most suitable initial test to establish the diagnosis?

      Your Answer:

      Correct Answer: USS cranium

      Explanation:

      Intraventricular Haemorrhage and Neonatal Seizures

      Ultrasound is the primary diagnostic tool used to investigate intraventricular haemorrhage (IVH), a common cause of neonatal seizures. IVH occurs when the blood vessels in the ventricle walls rupture, which is more likely to happen in neonates who require ventilation for lung disease. This condition can lead to hydrocephalus and damage to the surrounding neural tissue, resulting in temporary changes in tone and conscious level. The most severe complication of IVH is periventricular leukomalacia, which can progress to spastic diplegic cerebral palsy.

      To diagnose IVH, an ultrasound scan through the anterior fontanelle is a quick and effective method of examining for blood in the ventricles or hydrocephalus. Blood cultures may also be taken to rule out sepsis, another cause of neonatal seizures. However, chest x-rays may be necessary if there are changes in ventilation pressures or hypoxia due to chest infection or pneumothorax.

      It is important to avoid CT head scans if possible due to the radiation exposure to the neonate. Instead, MRI may be a reasonable investigation at a later date to determine the extent of the damage. Overall, early detection and management of IVH is crucial in preventing long-term complications such as cerebral palsy.

    • This question is part of the following fields:

      • Paediatrics
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