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  • Question 1 - A 16-week-old infant is brought to the GP by their mother due to...

    Correct

    • A 16-week-old infant is brought to the GP by their mother due to regurgitation and vomiting after most feeds, ongoing diarrhea with significant amounts of mucous, and difficulty settling. The mother also reports that the infant often pulls their legs up to their chest during crying episodes. The infant was born at full term, had a healthy weight at birth, and is formula-fed. They have a history of eczema managed with emollients. What is the recommended next step in management?

      Your Answer: Trial of extensively hydrolysed formula

      Explanation:

      In case of mild-moderate cow’s milk protein intolerance in a baby who is fed with formula, it is recommended to switch to an extensively hydrolyzed formula.

      Understanding Cow’s Milk Protein Intolerance/Allergy

      Cow’s milk protein intolerance/allergy (CMPI/CMPA) is a condition that affects around 3-6% of children, typically presenting in the first 3 months of life in formula-fed infants. Both immediate and delayed reactions can occur, with CMPA used for immediate reactions and CMPI for mild-moderate delayed reactions. Symptoms include regurgitation, vomiting, diarrhea, urticaria, atopic eczema, colic symptoms, wheeze, chronic cough, and rarely, angioedema and anaphylaxis. Diagnosis is often clinical, with investigations including skin prick/patch testing and total IgE and specific IgE (RAST) for cow’s milk protein.

      Management for formula-fed infants includes using extensive hydrolyzed formula (eHF) milk as the first-line replacement formula for mild-moderate symptoms and amino acid-based formula (AAF) for severe CMPA or if no response to eHF. Around 10% of infants are also intolerant to soya milk. For breastfed infants, mothers should eliminate cow’s milk protein from their diet and consider prescribing calcium supplements to prevent deficiency. eHF milk can be used when breastfeeding stops until at least 6 months and up to 12 months of age.

      The prognosis for CMPI is usually good, with most children becoming milk tolerant by the age of 3-5 years. However, a challenge is often performed in a hospital setting as anaphylaxis can occur. It is important to refer infants with severe symptoms to a pediatrician for management. Understanding CMPI/CMPA and its management can help parents and healthcare providers provide appropriate care for affected children.

    • This question is part of the following fields:

      • Paediatrics
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  • Question 2 - A 5-year-old boy is brought to the pediatrician by his concerned mother due...

    Incorrect

    • A 5-year-old boy is brought to the pediatrician by his concerned mother due to a fever that has lasted for 72 hours and has now developed a rash on his face and torso. The mother describes the rash as appearing in clusters. The boy is not eating much but is drinking well and has no changes to his bowel or urinary movements. He has no significant medical history and his immunizations are up to date. No one else in the family has been sick recently, but the mother does mention that her son has recently started attending school and a few of the other children have had a similar rash.

      During the examination, the boy's temperature is 38.8ºC, and he has scabbed lesions on his right cheek and erythematous vesicles on his trunk. What is the most appropriate management for this child?

      Your Answer: Acyclovir

      Correct Answer: Topical calamine lotion

      Explanation:

      Varicella zoster virus causes chickenpox, a highly contagious disease that commonly affects children. The onset of the disease is marked by a prodrome of elevated temperature, followed by the appearance of clusters of red blisters on the face and torso. Children remain infectious until all the blisters have scabbed over, and should stay away from school or nursery until this point. Treatment involves supportive measures such as calamine lotion to relieve itching and paracetamol to control fever. Immunodeficient children may require acyclovir to prevent complications such as pneumonia and meningitis. Scabies, which mainly affects the fingers’ web spaces, is treated with permethrin. Flucloxacillin is recommended for bacterial infections that occur on top of chickenpox. It is advisable to avoid ibuprofen in chickenpox, as there is a link between the use of NSAIDs and the development of necrotising fasciitis.

      Chickenpox: Causes, Symptoms, and Management

      Chickenpox is a viral infection caused by the varicella zoster virus. It is highly contagious and can be spread through respiratory droplets. The virus can also reactivate later in life, causing shingles. Chickenpox is most infectious four days before the rash appears and until five days after the rash first appears. The incubation period is typically 10-21 days. Symptoms include fever, an itchy rash that starts on the head and trunk before spreading, and mild systemic upset.

      Management of chickenpox is supportive and includes keeping cool, trimming nails, and using calamine lotion. School exclusion is recommended during the infectious period. Immunocompromised patients and newborns with peripartum exposure should receive varicella zoster immunoglobulin (VZIG). If chickenpox develops, IV acyclovir may be considered. Secondary bacterial infection of the lesions is a common complication, which may be increased by the use of NSAIDs. In rare cases, invasive group A streptococcal soft tissue infections may occur, resulting in necrotizing fasciitis. Other rare complications include pneumonia, encephalitis, disseminated haemorrhagic chickenpox, arthritis, nephritis, and pancreatitis.

      Radiographic Findings in Varicella Pneumonia

      Varicella pneumonia is a rare complication of chickenpox that can occur in immunocompromised patients or adults. Radiographic findings of healed varicella pneumonia may include miliary opacities throughout both lungs, which are of uniform size and dense, suggesting calcification. There is typically no focal lung parenchymal mass or cavitating lesion seen. These findings are characteristic of healed varicella pneumonia.

    • This question is part of the following fields:

      • Paediatrics
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  • Question 3 - A 5-year-old girl visits her pediatrician with a fever, red tongue, and a...

    Incorrect

    • A 5-year-old girl visits her pediatrician with a fever, red tongue, and a rash that started on her torso and has now spread to the soles of her feet. The rash has a rough texture like sandpaper. The doctor prescribes oral antibiotics for ten days. The girl's mother is worried about her daughter's absence from school and asks when she can return.
      What is the appropriate time for the girl to go back to school?

      Your Answer: 48 hours after commencing antibiotics

      Correct Answer: 24 hours after commencing antibiotics

      Explanation:

      Children diagnosed with scarlet fever can go back to school 24 hours after starting antibiotics.

      Scarlet fever is a condition caused by erythrogenic toxins produced by Group A haemolytic streptococci, usually Streptococcus pyogenes. It is more prevalent in children aged 2-6 years, with the highest incidence at 4 years. The disease spreads through respiratory droplets or direct contact with nose and throat discharges, especially during sneezing and coughing. The incubation period is 2-4 days, and symptoms include fever, malaise, headache, nausea/vomiting, sore throat, ‘strawberry’ tongue, and a rash that appears first on the torso and spares the palms and soles. The rash has a rough ‘sandpaper’ texture and desquamation occurs later in the course of the illness, particularly around the fingers and toes.

      To diagnose scarlet fever, a throat swab is usually taken, but antibiotic treatment should be initiated immediately, rather than waiting for the results. Management involves administering oral penicillin V for ten days, while patients with a penicillin allergy should be given azithromycin. Children can return to school 24 hours after commencing antibiotics, and scarlet fever is a notifiable disease. Although usually a mild illness, scarlet fever may be complicated by otitis media, rheumatic fever, acute glomerulonephritis, or rare invasive complications such as bacteraemia, meningitis, or necrotizing fasciitis, which may present acutely with life-threatening illness.

    • This question is part of the following fields:

      • Paediatrics
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  • Question 4 - A newborn delivered at 36 weeks gestation through a normal vaginal delivery is...

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    • A newborn delivered at 36 weeks gestation through a normal vaginal delivery is exhibiting irritability and has experienced a convulsion 72 hours after birth. No visible head trauma or swelling is present. What type of cranial injury is most probable in this case?

      Your Answer: Intraventricular haemorrhage

      Explanation:

      Caput succedaneum is a condition that occurs when pressure is applied to the fetal scalp during birth, resulting in a swollen and bruised area. This condition typically resolves on its own within a few days and does not require treatment.

      Cephalohaematoma, on the other hand, can occur after a vaginal delivery or due to trauma from obstetric tools. This condition results in bleeding between the skull and the periosteum, causing a tense swelling that is limited to the outline of the bone. Cephalohaematoma typically resolves over a period of weeks to months.

      Subaponeurotic haemorrhage, also known as subgaleal haemorrhage, is a rare condition that can occur due to a traumatic birth. This condition can result in significant blood loss in the infant.

      Intracranial haemorrhage refers to bleeding within the brain, including subarachnoid, subdural, and intraventricular haemorrhages. Subarachnoid haemorrhages are common and can cause irritability and convulsions in the first few days of life. Subdural haemorrhages can occur due to the use of forceps during delivery. Intraventricular haemorrhages are most common in preterm infants and can be diagnosed using ultrasound examinations.

      Understanding Intraventricular Haemorrhage

      Intraventricular haemorrhage is a rare condition that involves bleeding into the ventricular system of the brain. While it is typically associated with severe head injuries in adults, it can occur spontaneously in premature neonates. In fact, the majority of cases occur within the first 72 hours after birth. The exact cause of this condition is not well understood, but it is believed to be a result of birth trauma and cellular hypoxia in the delicate neonatal central nervous system.

      Treatment for intraventricular haemorrhage is largely supportive, as therapies such as intraventricular thrombolysis and prophylactic cerebrospinal fluid drainage have not been shown to be effective. However, if hydrocephalus and rising intracranial pressure occur, shunting may be necessary. It is important for healthcare professionals to be aware of this condition and its potential complications in order to provide appropriate care for affected patients.

    • This question is part of the following fields:

      • Paediatrics
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  • Question 5 - A 4-month old baby presents with a murmur and cyanosis. What is the...

    Correct

    • A 4-month old baby presents with a murmur and cyanosis. What is the most probable diagnosis?

      Your Answer: Fallot's tetralogy

      Explanation:

      Causes of Cyanotic Congenital Cardiac Disease

      Cyanotic congenital cardiac disease is a condition that causes a lack of oxygen in the body, resulting in a blue or purple discoloration of the skin. The most common cause of this condition that does not present in the first few days of life is Fallot’s tetralogy. However, transposition of the great arteries is almost as common, but it presents in the first few days. Other causes of cyanotic congenital cardiac disease include tricuspid atresia, single ventricle, and transposition of the great vessels. As the condition progresses, Eisenmenger’s syndrome may develop due to the switch to right to left flow associated with deteriorating VSD. It is important to identify and treat these conditions early to prevent further complications.

    • This question is part of the following fields:

      • Paediatrics
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  • Question 6 - At what age would a typical toddler develop the skill to walk without...

    Correct

    • At what age would a typical toddler develop the skill to walk without any support?

      Your Answer: 13-15 months

      Explanation:

      Gross Motor Developmental Milestones

      Gross motor skills refer to the ability to use large muscles in the body for activities such as crawling, walking, running, and jumping. These skills are essential for a child’s physical development and are achieved through a series of developmental milestones. The table below summarizes the major gross motor developmental milestones from 3 months to 4 years of age.

      At 3 months, a baby should have little or no head lag when pulled to sit and should have good head control when lying on their abdomen. By 6 months, they should be able to lift and grasp their feet when lying on their back, pull themselves to a sitting position, and roll from front to back. At 9 months, they should be able to pull themselves to a standing position and crawl. By 12 months, they should be able to cruise and walk with one hand held. At 18 months, they should be able to walk unsupported and squat to pick up a toy. By 2 years, they should be able to run and walk up and down stairs holding onto a rail. At 3 years, they should be able to ride a tricycle using pedals and walk up stairs without holding onto a rail. By 4 years, they should be able to hop on one leg.

      It is important to note that while the majority of children crawl on all fours before walking, some children may bottom-shuffle, which is a normal variant that runs in families. These milestones serve as a guide for parents and healthcare professionals to monitor a child’s physical development and identify any potential delays or concerns.

    • This question is part of the following fields:

      • Paediatrics
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  • Question 7 - A 2-week-old girl has her hearing checked through the Newborn Hearing Screening program....

    Incorrect

    • A 2-week-old girl has her hearing checked through the Newborn Hearing Screening program. She had a normal delivery at 40 weeks and was discharged home with her parents. The hearing screening was abnormal and a follow-up test is required to confirm. What is the follow-up test in this scenario?

      Your Answer: Newborn otoacoustic emission test

      Correct Answer: Auditory brainstem response test

      Explanation:

      When a newborn baby’s hearing test at birth shows an abnormal result, they are offered an auditory brainstem response test as a follow-up. This test involves placing electrodes on the baby’s scalp to measure their auditory evoked potentials in response to sounds. If there is no response, it may indicate reduced hearing ability.

      It is not appropriate to use a distraction test on a newborn as they are not yet developed enough for this type of testing. This test is typically used for toddlers aged 6-9 months and requires two staff members. The test involves producing sounds to the right or left of the baby, out of their field of view, and assessing the loudness required for them to react.

      Newborn otoacoustic emission testing is the initial screening assessment for hearing in newborns. However, this is only a screening test and further investigations are required to confirm any hearing loss. The test works by generating a click sound through an earpiece and measuring for the presence of a soft echo, which indicates a healthy cochlea.

      Pure tone audiometry is not an appropriate second-line hearing investigation for newborns. This test requires the participant to indicate when they hear specific sounds and is typically used in school-aged children. Therefore, it is not useful for newborns.

      Hearing Tests for Children

      Hearing tests are important for children to ensure that they are developing normally. There are several tests that may be performed on children of different ages. For newborns, an otoacoustic emission test is typically done as part of the Newborn Hearing Screening Programme. This test involves playing a computer-generated click through a small earpiece and checking for the presence of a soft echo, which indicates a healthy cochlea. If the results of this test are abnormal, an Auditory Brainstem Response test may be done.

      For infants between 6-9 months, a Distraction test may be performed by a health visitor with the help of two trained staff members. For children between 18 months to 2.5 years, a Recognition of familiar objects test may be used, which involves using familiar objects like a teddy or cup and asking the child simple questions like where is the teddy? For children over 2.5 years, Performance testing and Speech discrimination tests may be used, such as the Kendall Toy test or McCormick Toy Test. Pure tone audiometry is typically done at school entry in most areas of the UK for children over 3 years old.

      In addition to these tests, there is also a questionnaire for parents in the Personal Child Health Records called Can your baby hear you? It is important for parents to be aware of these tests and to have their child’s hearing checked regularly to ensure proper development.

    • This question is part of the following fields:

      • Paediatrics
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  • Question 8 - You are a junior doctor in paediatrica and have been asked to perform...

    Correct

    • You are a junior doctor in paediatrica and have been asked to perform a newborn exam. Which statement is true regarding the Barlow and Ortolani manoeuvres?

      Your Answer: It relocates a dislocation of the hip joint if this has been elicited during the Barlow manoeuvre

      Explanation:

      Understanding the Barlow and Ortolani Manoeuvres for Hip Dislocation Screening

      Hip dislocation is a common problem in infants, and early detection is crucial for successful treatment. Two screening tests commonly used are the Barlow and Ortolani manoeuvres. The Barlow manoeuvre involves adducting the hip while applying pressure on the knee, while the Ortolani manoeuvre flexes the hips and knees to 90 degrees, with pressure applied to the greater trochanters and thumbs to abduct the legs. A positive test confirms hip dislocation, and further investigation is necessary if risk factors are present, such as breech delivery or a family history of hip problems. However, a negative test does not exclude all hip problems, and parents should seek medical advice if they notice any asymmetry or walking difficulties in their child.

    • This question is part of the following fields:

      • Paediatrics
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  • Question 9 - Liam, a 13-year-old with learning difficulties, visits his GP clinic. Following a practice...

    Correct

    • Liam, a 13-year-old with learning difficulties, visits his GP clinic. Following a practice meeting, it is concluded that Liam does not possess the capacity to make decisions regarding his medical treatment. What principles should be prioritized when making decisions for Liam?

      Your Answer: Consent may be given by one parent for the treatment that is in her best interests

      Explanation:

      The GMC provides comprehensive guidance on obtaining consent from children. In cases where a child is incapable of giving consent, the agreement of one parent is adequate for treatment to be administered, provided it is in the child’s best interests. It is also crucial to involve Dawn in the decision-making process, despite her incapacity.

      Guidelines for Obtaining Consent in Children

      The General Medical Council has provided guidelines for obtaining consent in children. According to these guidelines, young people who are 16 years or older can be treated as adults and are presumed to have the capacity to make decisions. However, for children under the age of 16, their ability to understand what is involved determines whether they have the capacity to decide. If a competent child refuses treatment, a person with parental responsibility or the court may authorize investigation or treatment that is in the child’s best interests.

      When it comes to providing contraceptives to patients under 16 years of age, the Fraser Guidelines must be followed. These guidelines state that the young person must understand the professional’s advice, cannot be persuaded to inform their parents, is likely to begin or continue having sexual intercourse with or without contraceptive treatment, and will suffer physical or mental health consequences without contraceptive treatment. Additionally, the young person’s best interests require them to receive contraceptive advice or treatment with or without parental consent.

      Some doctors use the term Fraser competency when referring to contraception and Gillick competency when referring to general issues of consent in children. However, rumors that Victoria Gillick removed her permission to use her name or applied copyright have been debunked. It is important to note that in Scotland, those with parental responsibility cannot authorize procedures that a competent child has refused.

    • This question is part of the following fields:

      • Paediatrics
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  • Question 10 - A 16-year-old girl visits your GP practice seeking contraception. After counseling her, you...

    Correct

    • A 16-year-old girl visits your GP practice seeking contraception. After counseling her, you both agree that the implant would be the most suitable option. You believe that she has the ability to make this decision and give her consent for the insertion. However, during previous consultations, you have found her to lack capacity for certain decisions and have involved her parents. According to the GMC, what is necessary to proceed with the implant insertion?

      Your Answer: Just the patient's consent.

      Explanation:

      Capacity to make decisions is dependent on both time and the individual’s ability to make decisions. If the patient did not have the capacity to make a decision in the past, but currently has the capacity to do so, their consent is the only one required. It is advisable to involve parents in the decision-making process for pediatric patients, especially in cases involving contraception. However, if the patient is not convinced, the treatment can still proceed as long as they have the capacity to make the decision. If there are doubts, it is good practice to involve another healthcare team member, but if the patient is deemed capable of making the decision, their capacitous consent is sufficient according to the GMC. There is no requirement for a time gap between consultations to allow for decision-making.

      Guidelines for Obtaining Consent in Children

      The General Medical Council has provided guidelines for obtaining consent in children. According to these guidelines, young people who are 16 years or older can be treated as adults and are presumed to have the capacity to make decisions. However, for children under the age of 16, their ability to understand what is involved determines whether they have the capacity to decide. If a competent child refuses treatment, a person with parental responsibility or the court may authorize investigation or treatment that is in the child’s best interests.

      When it comes to providing contraceptives to patients under 16 years of age, the Fraser Guidelines must be followed. These guidelines state that the young person must understand the professional’s advice, cannot be persuaded to inform their parents, is likely to begin or continue having sexual intercourse with or without contraceptive treatment, and will suffer physical or mental health consequences without contraceptive treatment. Additionally, the young person’s best interests require them to receive contraceptive advice or treatment with or without parental consent.

      Some doctors use the term Fraser competency when referring to contraception and Gillick competency when referring to general issues of consent in children. However, rumors that Victoria Gillick removed her permission to use her name or applied copyright have been debunked. It is important to note that in Scotland, those with parental responsibility cannot authorize procedures that a competent child has refused.

    • This question is part of the following fields:

      • Paediatrics
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SESSION STATS - PERFORMANCE PER SPECIALTY

Paediatrics (7/10) 70%
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