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Question 1
Incorrect
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A 2-year-old boy's illness started with a 4-day history of fever and cough. Crepitations are noted upon auscultation. Other examination results are temperature 38.9C, O2 sats 94% on air, respiratory rate is 45/min, and capillary refill time 1 sec. Urine is also negative on dipstick. What is the single investigation most likely to lead to a diagnosis?
Your Answer: Chest X Ray
Correct Answer: Blood for culture and sensitivity
Explanation:Blood culture and sensitivity will distinguish the bacteria that is responsible for the infection and the effective antibiotic treatment to which the bacteria is sensitive.
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This question is part of the following fields:
- Child Health
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Question 2
Incorrect
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An 8-month-old baby was investigated for failure to thrive. On examination, he was irritable with evidence of weight loss. His stools were pale, bulky and malodorous. What is the most appropriate test that can be done to confirm the diagnosis?
Your Answer: Sweat Test
Correct Answer: Jejunal Biopsy
Explanation:Pale, bulky, malodorous stools are evidence of fat malabsorption syndrome. The diagnostic test is jejunal biopsy to rule out other differential diagnoses such as celiac disease, giardiasis or Crohn’s disease etc.
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This question is part of the following fields:
- Child Health
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Question 3
Incorrect
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Which of the following are not a recognized feature of Down's syndrome?
Your Answer: A third fontanelle
Correct Answer: Ataxic gait
Explanation:Ataxic gait is not a direct association of Down’s syndrome. All other given responses are associated with Down’s syndrome.
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This question is part of the following fields:
- Child Health
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Question 4
Correct
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A mother came to the clinic, with her 7 month old baby. She anxiously explained that he was not responding to loud sounds. He was vocalizing at the presentation and he had normal motor milestones. Which of the following is the most appropriate management?
Your Answer: Arrange Hearing test
Explanation:History is suggestive of a possible hearing impairment. As the baby is vocalizing and has normal motor development, an isolated hearing problem is possible. A hearing test will confirm the diagnosis.
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This question is part of the following fields:
- Child Health
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Question 5
Correct
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A 10 year old boy presents with generalized swelling. This includes puffiness in the face and swollen ankles - these symptoms have been present for 4 days. The swelling began just a few days after he suffered from a mild cold with a runny nose. His only past medical history is that of eczema. His urine analysis showed the following: haematuria; proteinuria (10g/24h); creat60umol/l; and albumin of 15g/l. From the list of options, what is the single most likely diagnosis for this patient?
Your Answer: IgA nephropathy
Explanation:A 10 year old child, with a history of URTI and haematuria, presents a picture consistent with a diagnosis of IgA nephropathy. This condition can present with proteinuria and generalized swelling. However, an important differentiating point from rapidly progressive GN is the duration. IgA nephropathy is usually <10 days (commonly 4-5 day history of infection).
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This question is part of the following fields:
- Child Health
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Question 6
Correct
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A term infant delivered via C-section develops tachypnoea, grunting, flaring, and intercostal retractions 10 minutes after birth. A chest radiograph reveals well-aerated lungs with fluid in the fissure on the right, prominent pulmonary vascular markings, and flattening of the diaphragm. His oxygen saturation is 90%. He improves within a few hours and requires no oxygen. What condition is this infant most likely suffering from?
Your Answer: Transient tachypnoea of the new-born
Explanation:Transient tachypnoea of the new-born is a condition associated with the delayed clearance of amniotic fluid from the new-born. The X-ray findings are typical of this condition. As the name implies and was noted in this patient, it is not a lasting condition and resolves within 24-72 hours after birth. The differential diagnoses usually present with different chest X-ray findings:
– Aspiration pneumonia shows infiltrates in the lower lobes of the lungs
– Congenitally acquired pneumonia shows patchy, asymmetrical densities
– Meconium aspiration shows hyperinflation and patchy asymmetric airspace disease
– Pulmonary oedema shows cephalization of pulmonary veins and indistinctness of the vascular margins. -
This question is part of the following fields:
- Child Health
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Question 7
Incorrect
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A 5-month-old baby presents with symptoms of irritability, blood in the stools and vomiting. Examination reveals a rigid abdomen and drawing of knees upon palpation. Which is the most appropriate action you should take for this baby?
Your Answer: Abdominal x ray
Correct Answer: Refer to paediatric surgeons
Explanation:Intussusception is the most suggested case here based on the child’s symptoms. The urgent course of treatment is to bring the child to a paediatric surgical unit. If air reduction attempts fail, surgery will have to be done. Risk factors for intussusception include viral infection and intestinal lymphadenopathy.
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This question is part of the following fields:
- Child Health
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Question 8
Correct
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A 10 month infant was brought in a drowsy condition with a 4 day history of vomiting and diarrhoea. His skin turgor was reduced and skin appeared mottled. Vital signs showed decreased BP, reduced capillary refill and a heart rate of 145/min. The best choice of treatment in this case would be?
Your Answer: IV fluid bolus over 20 minutes
Explanation:According to WHO, the treatment protocol in severely dehydrated children, is to infuse a bolus of isotonic crystalloid over 20-30 min at 30ml/kg to children less than 12 months of age followed by giving the remaining fluid over 5 hours for infants. Reference: World Health Organisation, the treatment of diarrhoea, a manual for physical and senior health workers.
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This question is part of the following fields:
- Child Health
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Question 9
Correct
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A 6 year old boy presents with a history of repeated respiratory and gastro-intestinal infections since birth. His birth was, however, uncomplicated. His mother claims that he's not growing as he should for his age. What is the most likely diagnosis?
Your Answer: Cystic fibrosis
Explanation:Cystic fibrosis is a genetic disease that interferes with the normal development of the child. It manifests with recurrent episodes of pneumonia accompanied by coughing, wheezing and dyspnoea. The appetite is normal but weight gain seems difficult. This condition also affects bowel habits with repeated gastrointestinal infections. The gold standard for the diagnosis is considered the sweat test which reveals abnormally high levels of Cl-.
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This question is part of the following fields:
- Child Health
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Question 10
Correct
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A 6-month-old baby boy presented to the paediatrician with yellow discolouration of his skin and sclera. His mother says his stools are pale. On examination, he was found to be below average weight. What is a likely diagnosis?
Your Answer: Biliary atresia
Explanation:Pale stools suggest obstructive jaundice. Initially, the symptoms of biliary atresia are indistinguishable from those of neonatal jaundice, a usually harmless condition commonly seen in infants. However, infants with biliary atresia develop progressive conjugated jaundice, pale white stools and dark urine.
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This question is part of the following fields:
- Child Health
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Question 11
Correct
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A 1-week-old baby presents with a large blue bruise-like mark on his back. His mother noticed the mark that same morning and she is concerned about its severity. What is the most probable diagnosis?
Your Answer: Mongolian spot
Explanation:Mongolian spots, otherwise called congenital dermal melanocytosis, are pigmented birthmarks. They are usually located on the buttocks or back and although they’re usually present at birth, they may appear soon after. They are flat and have a blue-grey colour (bruise-like). They are benign and present no health risk.
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This question is part of the following fields:
- Child Health
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Question 12
Incorrect
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A 12-month-old baby with HIV is scheduled for his MMR vaccine. What is the most appropriate action?
Your Answer: Proceed with standard immunization schedule
Correct Answer: Don’t give the vaccine
Explanation:Live attenuated vaccines such as the MMR, should be avoided in HIV+ patients.
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This question is part of the following fields:
- Child Health
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Question 13
Correct
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All of the following conditions because feeding problems for a neonate except for which one?
Your Answer: Physiological jaundice
Explanation:Physiological jaundice is the condition in which there is a yellow discolouration of the eyes and the skin of the baby caused by the build up of bilirubin in the blood due to an immature liver. No other symptoms accompany physiological jaundice, thus it will not present with difficulty in feeding. All the other conditions listed can present with feeding problems.
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This question is part of the following fields:
- Child Health
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Question 14
Correct
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An 8-year-old girl returns from holiday in Greece, complaining of ear discharge and tragal tenderness. The exam shows a normal tympanic membrane and ear cleaning was done. What is the next step in management?
Your Answer: Antibiotic drop with steroid
Explanation:The symptoms and signs described are suggestive of otitis externa. The key treatment for otitis externa is ear cleaning and antibiotic drops with steroid.
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This question is part of the following fields:
- Child Health
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Question 15
Correct
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A baby boy born 5 weeks ago with a birth weight of 3.5kg presents to the clinic with jaundice. He is being breastfed and his current weight is 4.5kg. Which of the following is most likely responsible for the baby's jaundice?
Your Answer: Breast Milk Jaundice
Explanation:Breast milk jaundice is associated with breast-feeding. It typically occurs one week after birth and can sometimes last up to 12 weeks, but it rarely causes complications in healthy, breast-fed infants. The exact cause of breast milk jaundice isn’t known. However, it may be linked to a substance in the breast milk that prevents certain proteins in the infant’s liver from breaking down bilirubin. The condition may also run in families. Breast milk jaundice is rare, affecting less than 3 percent of infants. When it does occur, it usually doesn’t cause any problems and eventually goes away on its own. It is safe to continue breast-feeding.
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This question is part of the following fields:
- Child Health
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Question 16
Incorrect
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What would you administer to a child with a clean wound that has never been immunized before, assuming there is no contraindication to immunization?
Your Answer: Only immunoglobin
Correct Answer: Full course of diphtheria, tetanus, polio
Explanation:A not immunized patient with a clean wound requires an immediate vaccination against diphtheria, tetanus and polio, according to the Green Book of Immunisation against infectious disease. (The Green Book has the latest information on vaccines and vaccination procedures, for vaccine preventable infectious diseases in the UK.)
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This question is part of the following fields:
- Child Health
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Question 17
Incorrect
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A 7 year old boy who never had a history of incontinence presented with bed-wetting. Which of the following is the best approach?
Your Answer: Reassure
Correct Answer: Sleep alarms
Explanation:As this boy didn’t have a previous history, a structural abnormality is unlikely. Parents should be asked to take the child to the bathroom to void before bedtime. Either alarm therapy or pharmacologic therapy should be considered if the above method doesn’t work after 3 months. From the above 2 therapies, neither one is superior than the other, so alarm therapy should be tried first.
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This question is part of the following fields:
- Child Health
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Question 18
Incorrect
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A 12 year old boy has a high HbA1c and is being checked by the diabetic specialist nurse. He has been skipping meals lately and his school teachers have noticed that he's been unhappy. Who do you suggest his parents take him to?
Your Answer: GP
Correct Answer: Clinical psychologist
Explanation:The boy is most probably a type 1 diabetic patient. Such a condition can affect the behaviour and psychological state of a young child reflected in their behaviour. The parents should seek the help of a clinical psychologist.
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This question is part of the following fields:
- Child Health
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Question 19
Correct
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A 4 year old girl is brought to the emergency due to fever and urinary urgency. The temperature is recorded to be 39C. Which of the following is the best investigation in this case?
Your Answer: Clean catch of urine
Explanation:Urine culture and sensitivity is used to diagnose a urinary tract infection (UTI). A mid-stream clean catch urine sample is the most common type of sample collected. It is important to follow the clean catch process to have accurate results from an uncontaminated sample. Urine cultures can also check for infections of the bladder or kidney.
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This question is part of the following fields:
- Child Health
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Question 20
Incorrect
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A 3-year-old girl presents to A&E following a few days of being lethargic, having runny nose, sore throat, and fever. She has unceasing stridor and drooling of saliva while her body is inclined forward. What is the most important next step in her management?
Your Answer: Call Anaesthetist
Correct Answer: Call ENT specialist
Explanation:A consultation with an ENT is required to establish the reason for the child’s drooling and stridor indicating and obstructive process. Enlarged tonsils and adenoids should be checked.
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This question is part of the following fields:
- Child Health
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Question 21
Correct
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A 10 year old boy is being bullied by his classmates because he's obese and he is the shortest in his class. His mother is worried and brings him in to the clinic. History reveals he had a renal transplant last year. What is the most likely diagnosis?
Your Answer: Cushing’s syndrome
Explanation:The boy had a renal transplant, for which he needs immune suppression. For the exogenous immune suppression an exogenous steroid is needed, which in this case is responsible for the primary Cushing syndrome manifesting with short stature. The administration of steroids before the physiological fusion of the growth plate can lead to premature fusion with permanent cessation of bone growth.
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This question is part of the following fields:
- Child Health
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Question 22
Correct
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An 8 year old boy presented with easy bruising following falls. FBC showed leucocytosis and thrombocytopenia with normal haemoglobin levels. His ESR was high and Paul-Bunnell test was positive. Which of the following is the most probable diagnosis?
Your Answer: Glandular fever
Explanation:Glandular fever (Infectious Mononucleosis) is caused by Epstein–Barr virus (EBV). Leucocytosis rules in infectious mononucleosis and thrombocytopenia is not an uncommon association. ESR is elevated in most of the cases. Paul-Bunnell test is a rapid test for infectious mononucleosis due to Epstein–Barr virus (EBV).
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This question is part of the following fields:
- Child Health
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Question 23
Incorrect
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A Blood group A-ve mother gives birth to a baby who develops severe jaundice within the first 24 hours of delivery. What is the most probable diagnosis?
Your Answer: ABO incompatibility
Correct Answer: Rh incompatibility
Explanation:Jaundice is considered pathologic if it presents within the first 24 hours after birth. Although up to 60 percent of term new-borns have clinical jaundice in the first week of life, few have significant underlying disease.1,2 However, hyperbilirubinemia in the new-born period can be associated with severe illnesses such as haemolytic disease, metabolic and endocrine disorders, anatomic abnormalities of the liver, and infections. The risk factors here is the mothers blood ground which suggests the cause is fetal-maternal blood group incompatibility.
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This question is part of the following fields:
- Child Health
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Question 24
Incorrect
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A 3-year-old girl presents with pallor and marked gland enlargement. She has been unwell for the past three weeks. She had a full term normal delivery with no neonatal problems. Her immunisations are up to date. There is no family or social history of note. On examination, her temperature is 37.6°C, and she looks pale and unwell. She has a few petechiae on the neck and palate, with moderate generalised lymphadenopathy and a 3 cm spleen. Which is the most likely diagnosis?
Your Answer:
Correct Answer: Acute leukaemia
Explanation:Non-Hodgkin Lymphoma: The history is of enlarged reticuloendothelial system with abnormalities in all 3 cell lines of the bone marrow (pallor, fever and petechiae). The most likely diagnosis is therefore acute (lymphoblastic) leukaemia. Lymphadenopathy may be prominent: mediastinal nodes are characteristic of T-cell leukaemia. In lymphoma the marrow involvement tends to be much less.
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This question is part of the following fields:
- Child Health
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Question 25
Incorrect
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A 2-year-old child, who is not very active, presented with bruises on the back as well as on the chest. X-ray showed a radiolucent area around the ribs indicating callus formation. Which of the following is the most important investigation in this case?
Your Answer:
Correct Answer: Skeletal survey
Explanation:Because the initial chest X-ray returned an anomaly, a skeletal survey is the best option. Also known as a bone survey, the skeletal survey is a series of X-rays that will help analyse the structure of all the bones in the body. Because the child is not very active yet presents with bruising, the child protection register should also be checked but only after a skeletal survey has been conducted.
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This question is part of the following fields:
- Child Health
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Question 26
Incorrect
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A 4 year old boy presented in the sixth day of fever, with erythema of the palms and soles and maculopapular rash. His eyes and tongue were red. Which of the following is the most probable diagnosis?
Your Answer:
Correct Answer: Kawasaki Disease
Explanation:Kawasaki disease is an acute febrile illness of early childhood characterized by vasculitis of the medium-sized arteries. Diagnostic criteria include fever of at least 5 days duration along with 4 or 5 of the principal clinical features – extremity changes, polymorphous rash, oropharyngeal changes, conjunctival injection and unilateral nonpurulent cervical lymphadenopathy.
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This question is part of the following fields:
- Child Health
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Question 27
Incorrect
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A 2-year-old baby sustained a wound to her hand whilst playing in the garden. She is unvaccinated as the parents are concerned regarding side effects. There is no contraindication to vaccinations. What is the most appropriate action?
Your Answer:
Correct Answer: Give complete DPT vaccine course
Explanation:A complete course of DPT should be given.
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This question is part of the following fields:
- Child Health
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Question 28
Incorrect
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An 8-year-old girl presented to the outpatient clinic with fever, pain and discharge from her left ear. Which of the following antibiotics should be used first?
Your Answer:
Correct Answer: Amoxicillin
Explanation:Amoxicillin has high efficacy against haemophilus influenza and streptococcus pneumonia, the most common organisms of otitis media. It is an oral drug with high bioavailability.
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This question is part of the following fields:
- Child Health
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Question 29
Incorrect
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Question 30
Incorrect
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A 9 year old boy was admitted with gastroenteritis. The boy's symptoms started two days ago with profound diarrhoea and emesis. Blood exams show the following: Sodium=148mmol/l, Potassium=2.2mmol/l, Urea=20mmol/l, Glucose=4.3mmol/l. What would be the best management?
Your Answer:
Correct Answer: V normal saline and potassium supplement
Explanation:The boy needs re-hydration and hydro-electrolytic re-balancing due to fluid losses from the gastroenteritis and subsequent dehydration.
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This question is part of the following fields:
- Child Health
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SESSION STATS - PERFORMANCE PER SPECIALTY
