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Question 1
Incorrect
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As an FY2 doctor in the Paediatric Emergency Department, you encounter an 8-month-old girl who has been brought in after experiencing rectal bleeding. According to her parents, she has been suffering from abdominal pain since this morning, drawing her legs up into the fetal position, and has had little appetite, which is unusual for her. She vomited three times and then passed bloody stools, which were described as jelly-like red and slimy. The child has been weaned for the past 2 months and only given baby food. Upon examination, you notice right lower abdominal tenderness, dehydrated mucous membranes, and a vague mass in her right lower abdomen. What is the most probable diagnosis?
Your Answer: Campylobacter related gastroenteritis
Correct Answer: Intussusception
Explanation:Common Causes of Gastrointestinal Issues in Toddlers
Gastrointestinal issues in toddlers can be caused by a variety of factors. Here are some common causes and their symptoms:
1. Intussusception: This condition is characterized by slimy or jelly-like red stools, abdominal pain, and a palpable mass or fullness. It is most common in toddlers aged around 9-12 months old and is diagnosed with an ultrasound scan. Treatment usually involves an air enema, but surgery may be required in complicated cases.
2. Campylobacter-related gastroenteritis: This bacterial infection is rare in toddlers and is even more unlikely if the child only consumes baby food.
3. Colon cancer: Colorectal cancer is almost unheard of in this age group.
4. Hirschsprung’s disease: This congenital condition causes bowel obstruction, with the child vomiting and not passing stools. It usually occurs in very young neonates and is diagnosed with a rectal biopsy. Treatment involves surgically removing the affected part of the bowel.
5. Pyloric stenosis: This condition causes forceful projectile vomiting immediately after feeds and usually occurs within the first 4 weeks of birth. It is diagnosed with ultrasound imaging and is treated surgically with a pyloromyotomy.
It is important to seek medical attention if your toddler is experiencing any gastrointestinal symptoms.
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This question is part of the following fields:
- Paediatrics
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Question 2
Incorrect
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A 24-hour old baby is evaluated in the neonatal intensive care unit due to tremors in his limbs, as observed by his nurse. He is also experiencing poor feeding, increased irritability, and excessive drowsiness. The baby was delivered via emergency caesarean section at 34 weeks due to reduced foetal movements and foetal bradycardia. The mother had an otherwise healthy pregnancy, but was taking lamotrigine for epilepsy. During the examination, the baby appeared larger than expected for his prematurity and exhibited visible arm tremors. Based on these symptoms, which aspect of the baby's medical history is most likely responsible for his condition?
Your Answer:
Correct Answer: Prematurity
Explanation:Prematurity is a significant risk factor for neonatal hypoglycaemia, which is characterized by autonomic symptoms such as irritability and jitteriness, as well as neuroglycopenic symptoms like drowsiness and poor feeding. This is because preterm infants have not yet developed the same glycogen reserve as term infants. Admission to the neonatal intensive care unit, delivery via emergency caesarean section, formula feeding, and maternal lamotrigine use are not independent risk factors for neonatal hypoglycaemia. While caesarean section may result in transient hypoglycaemia, it is not typically symptomatic due to the lack of catecholamine release present during vaginal delivery. Terbutaline use, on the other hand, may increase the risk of hypoglycaemia.
Neonatal Hypoglycaemia: Causes, Symptoms, and Management
Neonatal hypoglycaemia is a common condition in newborn babies, especially in the first 24 hours of life. While there is no agreed definition, a blood glucose level of less than 2.6 mmol/L is often used as a guideline. Transient hypoglycaemia is normal and usually resolves on its own, but persistent or severe hypoglycaemia may be caused by various factors such as preterm birth, maternal diabetes mellitus, IUGR, hypothermia, neonatal sepsis, inborn errors of metabolism, nesidioblastosis, or Beckwith-Wiedemann syndrome.
Symptoms of neonatal hypoglycaemia can be autonomic, such as jitteriness, irritability, tachypnoea, and pallor, or neuroglycopenic, such as poor feeding/sucking, weak cry, drowsiness, hypotonia, and seizures. Other features may include apnoea and hypothermia. Management of neonatal hypoglycaemia depends on the severity of the condition and whether the newborn is symptomatic or not. Asymptomatic babies can be encouraged to feed normally and have their blood glucose monitored, while symptomatic or severely hypoglycaemic babies may need to be admitted to the neonatal unit and receive intravenous infusion of 10% dextrose.
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This question is part of the following fields:
- Paediatrics
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Question 3
Incorrect
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You are requested to assess a preterm neonate in the neonatal unit. During the examination of the palate, you observe a white nodule on the roof of the mouth. The baby is alert and active, and there is no interference with feeding. What is the probable diagnosis?
Your Answer:
Correct Answer: Epstein's pearl
Explanation:Epstein’s pearls, which are located in the middle of the posterior hard palate, can be mistaken for neonatal teeth. However, unlike neonatal teeth, Epstein’s pearls do not need any treatment. Bohn’s nodules, on the other hand, are situated on the inner labial aspect of the maxillary alveolar ridges. Dermoid cysts, which may contain teeth, are not commonly found in the oral cavity. Oral candida infection can manifest as white patches on the interior of the mouth.
Understanding Epstein’s Pearl
Epstein’s pearl is a type of cyst that is present in the mouth from birth. It is commonly found on the hard palate, but can also be seen on the gums, which may be mistaken for a tooth eruption. The good news is that no treatment is usually required as these cysts tend to disappear on their own within a few weeks.
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This question is part of the following fields:
- Paediatrics
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Question 4
Incorrect
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A teenager attends the GP with his mother who is concerned about his height. The GP charts the teenager's height on a growth chart and finds him to be in the 5th percentile. At birth, he was in the 50th percentile. However, the teenager's developmental milestones are normal, and he appears to be content with himself. What is the most appropriate next step in managing this teenager?
Your Answer:
Correct Answer: Make a referral to the the paediatric outpatients clinic
Explanation:A paediatrician should review children who fall below the 0.4th centile for height. Referral is the appropriate course of action as it is not an urgent matter. While waiting for the review, it is advisable to conduct thyroid function tests and insulin-like growth factor tests on the child.
Understanding Growth and Factors Affecting It
Growth is a significant aspect that distinguishes children from adults. It occurs in three stages: infancy, childhood, and puberty. Several factors affect fetal growth, including environmental, placental, hormonal, and genetic factors. Maternal nutrition and uterine capacity are the most crucial environmental factors that affect fetal growth.
During infancy, nutrition and insulin are the primary drivers of growth. Insulin plays a significant role in fetal growth, as high levels of insulin in a mother with poorly controlled diabetes can result in hypoglycemia and macrosomia in the baby. In childhood, growth hormone and thyroxine drive growth, while in puberty, growth hormone and sex steroids are the primary drivers. Genetic factors are the most important determinant of final adult height.
It is essential to monitor growth regularly to ensure that children are growing at a healthy rate. Infants aged 0-1 years should have at least five weight recordings, while children aged 1-2 years should have at least three weight recordings. Children older than two years should have annual weight recordings. Children below the 2nd centile for height should be reviewed by their GP, while those below the 0.4th centile for height should be reviewed by a paediatrician. Understanding growth and the factors that affect it is crucial for ensuring healthy development in children.
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This question is part of the following fields:
- Paediatrics
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Question 5
Incorrect
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A 23-year-old woman with a history of bipolar disorder gives birth to a baby girl at home. She received no prenatal care, but when she found out she was pregnant, she started taking prenatal vitamins that she got from the pharmacist. Her only medication is valproic acid. It is 2 days since the birth, and the mother has brought her baby to the Emergency Department because she has become impossible to arouse. On examination, the baby is estimated to have been born at 35 weeks’ gestation. The baby is afebrile, with stable vital signs. A head ultrasound through the fontanelle shows an intracerebral haemorrhage in the germinal matrix. There are no calcifications. Retinal examination does not show petechial haemorrhages. A full skeletal survey is negative.
What is the most likely pathophysiologic mechanism underlying this baby’s haemorrhage?Your Answer:
Correct Answer: Vitamin K deficiency
Explanation:Causes of Periventricular Hemorrhage in Neonates
Periventricular hemorrhage is a common condition in neonates that can lead to neurological damage. There are several possible causes of this condition, including vitamin K deficiency, folate deficiency from valproic acid treatment, congenital cytomegalovirus, congenital toxoplasmosis, and congenital herpes simplex virus.
Vitamin K deficiency is a natural occurrence in neonates as they do not have established gut bacteria that produce this vitamin. Vitamin K is essential for the production of clotting factors and anticoagulant proteins. Therefore, neonates born in hospitals are usually injected with vitamin K to prevent periventricular hemorrhage.
Folate deficiency from valproic acid treatment is a common cause of neural tube defects but does not lead to periventricular hemorrhage. Prenatal vitamins usually contain folate, which can prevent this deficiency.
Congenital cytomegalovirus and congenital toxoplasmosis can cause periventricular hemorrhage, but they are also accompanied by other congenital abnormalities, such as intracerebral calcifications.
Congenital herpes simplex virus can cause periventricular hemorrhage and neurological damage, but it also causes a diffuse vesicular rash and other symptoms.
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This question is part of the following fields:
- Paediatrics
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Question 6
Incorrect
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You are evaluating the growth of a 6-week-old infant. Her length is at the 35th percentile, weight at the 42nd percentile, and head circumference at the 4th percentile. What is the probable reason for her microcephaly?
Your Answer:
Correct Answer: Foetal alcohol syndrome
Explanation:Microcephaly is often linked to foetal alcohol syndrome, which also presents with other physical characteristics such as a smooth philtrum, hypoplastic upper lip, and epicanthic folds. Conditions like Thalassaemia, Turner’s syndrome, and cerebral palsy do not typically impact head size, while Achondroplasia is associated with macrocephaly and frontal bossing, not microcephaly. Recognizing the distinct physical features of congenital conditions is crucial for both exams and accurate diagnosis.
Understanding Fetal Alcohol Syndrome
Fetal alcohol syndrome is a condition that occurs when a pregnant woman consumes alcohol, which can lead to various physical and mental abnormalities in the developing fetus. At birth, the baby may exhibit symptoms of alcohol withdrawal, such as irritability, hypotonia, and tremors.
The features of fetal alcohol syndrome include a short palpebral fissure, a thin vermillion border or hypoplastic upper lip, a smooth or absent philtrum, learning difficulties, microcephaly, growth retardation, epicanthic folds, and cardiac malformations. These physical characteristics can vary in severity and may affect the child’s overall health and development.
It is important for pregnant women to avoid alcohol consumption to prevent fetal alcohol syndrome and other potential complications. Early diagnosis and intervention can also help improve outcomes for children with fetal alcohol syndrome. By understanding the risks and consequences of alcohol use during pregnancy, we can work towards promoting healthier pregnancies and better outcomes for children.
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This question is part of the following fields:
- Paediatrics
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Question 7
Incorrect
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A 4-month old baby presents with a murmur and cyanosis. What is the most probable diagnosis?
Your Answer:
Correct 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.
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This question is part of the following fields:
- Paediatrics
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Question 8
Incorrect
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A 3-year-old girl presents to the emergency department with a 2 day history of intermittent vomiting. She has been generally unwell and has had episodes of inconsolable crying. Her parents have become concerned following a dirty nappy that contained both stool and blood. They have brought this nappy with them and on inspection there appears to be formed stool with streaks of jelly like blood.
On examination, the girl is quiet and pale. Her capillary refill time is 2-3 seconds peripherally. She has very mild increased work of breathing with normal heart sounds on auscultation. Her abdomen is tender on palpation with guarding centrally. You are unable to palpate any obvious masses.
Her observations are as follows-
Blood pressure 92/55 mmHg
Heart rate 140 bpm
Respiratory rate 30/min
Saturations 96% in air
After stabilizing the child, which investigation would be the most helpful in confirming a diagnosis for ongoing management?Your Answer:
Correct Answer: Abdominal ultrasound scan
Explanation:When investigating intussusception, ultrasound is the preferred method due to its high specificity and sensitivity rates, as well as its lack of ionising radiation. The classic target or bull’s eye sign can be seen on an abdominal ultrasound scan. CT scans are not necessary for diagnosis and should be avoided due to their use of ionising radiation. Abdominal X-rays may show certain features of intussusception, but cannot definitively diagnose the condition. Barium enemas were previously the preferred method for diagnosis and treatment, but are now considered risky due to the potential for bowel perforation. Instead, abdominal ultrasound is preferred for diagnosis before reduction by air insufflation. A chest X-ray can rule out perforation, but cannot diagnose intussusception.
Understanding Intussusception
Intussusception is a medical condition that occurs when one part of the bowel folds into the lumen of the adjacent bowel, usually around the ileo-caecal region. This condition is most common in infants between 6-18 months old, with boys being affected twice as often as girls. The symptoms of intussusception include severe, crampy abdominal pain that comes and goes, inconsolable crying, vomiting, and blood stained stool, which is a late sign. During a paroxysm, the infant will typically draw their knees up and turn pale, and a sausage-shaped mass may be felt in the right upper quadrant.
To diagnose intussusception, ultrasound is now the preferred method of investigation, as it can show a target-like mass. Treatment for intussusception involves reducing the bowel by air insufflation under radiological control, which is now widely used as a first-line treatment instead of the traditional barium enema. If this method fails, or the child shows signs of peritonitis, surgery is performed.
In summary, intussusception is a medical condition that affects infants and involves the folding of one part of the bowel into the lumen of the adjacent bowel. It is characterized by severe abdominal pain, vomiting, and blood stained stool, among other symptoms. Ultrasound is the preferred method of diagnosis, and treatment involves reducing the bowel by air insufflation or surgery if necessary.
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This question is part of the following fields:
- Paediatrics
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Question 9
Incorrect
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Which of the following is least commonly associated with constipation in toddlers?
Your Answer:
Correct Answer: Addison's disease
Explanation:Understanding and Managing Constipation in Children
Constipation is a common problem in children, with the frequency of bowel movements decreasing as they age. The National Institute for Health and Care Excellence (NICE) has provided guidelines for the diagnosis and management of constipation in children. A diagnosis of constipation is suggested by two or more symptoms, including infrequent bowel movements, hard stools, and associated distress or pain. Most cases of constipation in children are idiopathic, but other causes such as dehydration, low-fiber diet, and medication use should be considered and excluded.
If a diagnosis of constipation is made, NICE recommends assessing for faecal impaction before starting treatment. Treatment for faecal impaction involves using polyethylene glycol 3350 + electrolytes (Movicol Paediatric Plain) as the first-line treatment, with the addition of a stimulant laxative if necessary. Maintenance therapy involves a similar regime, with adjustments to the starting dose and the addition of other laxatives if necessary.
It is important to note that dietary interventions alone are not recommended as first-line treatment, although ensuring adequate fluid and fiber intake is important. Regular toileting and non-punitive behavioral interventions should also be considered. For infants, extra water, gentle abdominal massage, and bicycling the legs can be helpful for constipation. If these measures are not effective, lactulose can be added.
In summary, constipation in children can be managed effectively with a combination of medication, dietary adjustments, and behavioral interventions. It is important to follow NICE guidelines and consider the individual needs of each child.
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This question is part of the following fields:
- Paediatrics
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Question 10
Incorrect
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A baby boy is born after 29 weeks gestation. On day three, a routine examination reveals a continuous mechanical murmur and bounding femoral pulses. Echocardiography confirms a haemodynamically significant, isolated patent ductus arteriosus (PDA). What should be the next step in managing this condition?
Your Answer:
Correct Answer: Medical management - cyclooxygenase inhibitor infusion
Explanation:Management of Patent Ductus Arteriosus
The ductus arteriosus is a fetal blood vessel that directs deoxygenated blood from the right ventricle directly into the descending aorta. After birth, the ductus should close within the first few days due to decreased prostaglandin levels and increased oxygen concentrations. Premature and low birth weight babies are at a higher risk of the ductus remaining open, which can lead to complications such as reduced blood supply to tissues, pressure overload of the pulmonary circulation, and volume overload of the systemic circulation.
The decision to intervene and close a patent ductus arteriosus (PDA) is based on the individual case and the severity of the condition. Medical management is usually the first step and involves administering a cyclooxygenase inhibitor to block prostaglandin synthesis and promote closure of the ductus. Conservative management may be an option for PDAs of little consequence, but even small PDAs pose long-term risks and may require intervention. Cardiac catheterisation is not appropriate in isolated PDA cases, and surgical management is reserved for those who fail medical management. Prostaglandin infusions may be used to keep the ductus patent in certain cardiac malformations that require a shunt for survival.
Overall, the management of PDA is crucial in preventing complications and ensuring proper blood flow. The decision to intervene should be made on a case-by-case basis, with medical management being the usual first step.
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This question is part of the following fields:
- Paediatrics
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Question 11
Incorrect
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As an F1 in the emergency department, you receive a 15-year-old girl who has been brought in from her high school due to complaints of abdominal pain and nausea. Upon examination, you discover that she is septic and can only provide a brief medical history before becoming drowsy. The surgical team suspects that she may have a perforated appendicitis and requires immediate surgery. Unfortunately, the patient's parents cannot be reached with the contact numbers provided by the school, and the patient is not in a state to provide consent for the operation. What would be the most appropriate course of action in this situation?
Your Answer:
Correct Answer: Take the patient to surgery immediately
Explanation:According to GMC, it is permissible to administer emergency treatment to a child or young person without their consent in order to save their life or prevent their health from seriously deteriorating. This means that obtaining consent from their parents, seeking permission from others, or obtaining a court order is not required.
Understanding Consent in Children
The issue of consent in children can be complex and confusing. However, there are some general guidelines to follow. If a patient is under 16 years old, they may be able to consent to treatment if they are deemed competent. This is determined by the Fraser guidelines, which were previously known as Gillick competence. However, even if a child is competent, they cannot refuse treatment that is deemed to be in their best interest.
For patients between the ages of 16 and 18, it is generally assumed that they are competent to give consent to treatment. Patients who are 18 years or older can consent to or refuse treatment.
When it comes to providing contraceptives to patients under 16 years old, the Fraser Guidelines outline specific requirements that must be met. These include ensuring that the young person understands the advice given by the healthcare professional, cannot be persuaded to inform their parents, is likely to engage in sexual activity with or without treatment, and will suffer physical or mental health consequences without treatment. Ultimately, the young person’s best interests must be taken into account when deciding whether to provide contraceptive advice or treatment, with or without parental consent.
In summary, understanding consent in children requires careful consideration of age, competence, and best interests. The Fraser Guidelines provide a useful framework for healthcare professionals to follow when providing treatment and advice to young patients.
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This question is part of the following fields:
- Paediatrics
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Question 12
Incorrect
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You are participating in a morbidity and mortality meeting following the death of a patient on the 30th day after birth. The classification of the patient's death is being debated. What is the appropriate classification for this case?
Your Answer:
Correct Answer: Neonatal death
Explanation:Neonatal death is the term used to describe the death of a baby within the first 28 days of life. This classification is important for public health interventions and is a common topic in exams. Miscarriage, on the other hand, is defined as the death of a fetus before 24 weeks of gestation in the UK, or before 28 weeks globally. Puerperal death refers to the death of a mother within the first 6 weeks after giving birth. Perinatal death is a broader term that includes stillbirths and deaths within the first week of life, often resulting from obstetric events. Early neonatal death refers to death within the first week of life, while late neonatal death refers to death after 7 days but before 28 days of life.
Perinatal Death Rates and Related Metrics
Perinatal mortality rate is a measure of stillbirths and early neonatal deaths within seven days per 1,000 births after 24 weeks of gestation. In the UK, this rate is around 6 per 1,000 births. This figure is usually broken down into 4 per 1,000 stillbirths and 2 per 1,000 early neonatal deaths.
Maternal mortality rate, on the other hand, is calculated by dividing the number of deaths during pregnancy, labor, and six weeks after delivery by the total number of maternities and multiplying the result by 1000. Meanwhile, the stillbirth rate is determined by dividing the number of babies born dead after 24 weeks by the total number of births (live and stillborn) and multiplying the result by 1000. Lastly, the neonatal death rate is computed by dividing the number of babies who died between 0-28 days by the total number of live births and multiplying the result by 1000.
These metrics are important in assessing the quality of perinatal care and identifying areas for improvement. By monitoring these rates, healthcare providers can work towards reducing perinatal deaths and improving maternal and neonatal outcomes.
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This question is part of the following fields:
- Paediatrics
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Question 13
Incorrect
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You are requested to assess a 35-year-old man who has presented to the emergency department complaining of shortness of breath, fever, and unusual breathing sounds for the past twelve hours. He reports having a sore throat for the past few days, which has rapidly worsened. He has no significant medical history.
Upon examination, his vital signs are as follows: respiratory rate 30/min, pulse 120 bpm, oxygen saturation 96%, temperature 39.0ºC, blood pressure 110/60 mmHg. From the end of the bed, you can observe that he is visibly struggling to breathe, has a hoarse voice, and is drooling into a container. You can hear a high-pitched wheeze during inspiration.
What would be the most appropriate course of action at this point?Your Answer:
Correct Answer: Call the on-call anaesthetist to assess the patient for intubation
Explanation:In cases of acute epiglottitis, protecting the airway is crucial and may require endotracheal intubation. Symptoms such as high fever, sore throat, dyspnoea, change in voice, and inspiratory stridor indicate a potential airway emergency. While other treatments may be necessary, securing the airway should be the top priority, following the ABCDE management steps. IV dexamethasone can help reduce laryngeal oedema, but an anaesthetic assessment should be arranged before administering any medication. Nebulised salbutamol is ineffective in treating laryngeal narrowing caused by epiglottitis. X-rays of the neck may be used, but they can take time to organise and delay urgent airway management. Attempting to visualise the larynx without appropriate senior support and intubation capabilities is dangerous in cases of acute epiglottitis. Flexible nasendoscopy should only be performed with the presence of trained personnel who can secure the airway if necessary.
Acute epiglottitis is a rare but serious infection caused by Haemophilus influenzae type B. It is important to recognize and treat it promptly as it can lead to airway obstruction. Although it was once considered a disease of childhood, it is now more common in adults in the UK due to the immunization program. The incidence of epiglottitis has decreased since the introduction of the Hib vaccine. Symptoms include a rapid onset, high temperature, stridor, drooling of saliva, and a tripod position where the patient leans forward and extends their neck to breathe easier. Diagnosis is made by direct visualization, but x-rays may be done to rule out a foreign body.
Immediate senior involvement is necessary, including those who can provide emergency airway support such as anaesthetics or ENT. Endotracheal intubation may be necessary to protect the airway. It is important not to examine the throat if epiglottitis is suspected due to the risk of acute airway obstruction. The diagnosis is made by direct visualization, but only senior staff who are able to intubate if necessary should perform this. Treatment includes oxygen and intravenous antibiotics.
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This question is part of the following fields:
- Paediatrics
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Question 14
Incorrect
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A 5-year-old girl presents with a 3-day history of passing loose stools and non-bilious vomiting. She has passed 6 loose stools and vomited 3 times over the last 72 hours. No visible mucous or blood seen in the stool, and urine output has not changed according to her mother. She is able to tolerate oral fluid and liquid food.
She has not travelled abroad recently and there are no sick contacts. Her vaccination schedule is up-to-date and there are no concerns regarding her growth and development.
On examination, she appears well and is alert and responsive. She has warm extremities and capillary refill time is <2 seconds. Her vital signs are normal. Peripheral pulses are strong and regular. There is normal skin turgor and there are no sunken eyes.
What is the appropriate management for this patient?Your Answer:
Correct Answer: Introduce oral rehydration solution (ORS)
Explanation:It is not recommended to give antidiarrhoeal medications to children under 5 years old who have diarrhoea and vomiting caused by gastroenteritis. This is because these medications do not provide any benefits and can cause side effects such as ileus, drowsiness, and nausea. It is also important to discourage the consumption of fruit juices and carbonated drinks, especially for those who are at risk of dehydration. Antibiotics are not routinely recommended for children with gastroenteritis as they do not effectively treat symptoms or prevent complications. The patient in question does not require antibiotic treatment. IV fluid therapy is not necessary as the patient is not clinically dehydrated and can be rehydrated with oral rehydration solution (ORS) and increased daily fluid intake. However, IV fluid therapy may be necessary if the patient shows signs of clinical dehydration or if they persistently vomit the ORS solution.
Understanding Diarrhoea in Children
Diarrhoea is a common condition in children that can be caused by various factors. One of the most common causes is gastroenteritis, which is often accompanied by fever and vomiting for the first two days. The main risk associated with this condition is severe dehydration, which can be life-threatening if left untreated. The most common cause of gastroenteritis is rotavirus, and the diarrhoea may last up to a week. The treatment for this condition is rehydration.
Chronic diarrhoea is another type of diarrhoea that can affect infants and toddlers. In the developed world, the most common cause of chronic diarrhoea in infants is cow’s’ milk intolerance. Toddler diarrhoea, on the other hand, is characterized by stools that vary in consistency and often contain undigested food. Other causes of chronic diarrhoea in children include coeliac disease and post-gastroenteritis lactose intolerance.
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This question is part of the following fields:
- Paediatrics
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Question 15
Incorrect
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A 4-year-old patient is brought to the GP by their mother due to a high fever and sore throat. Upon examination, the child appears comfortable but feverish, with a rash on both arms that is more pronounced in the cubital fossas. The lesions are rough and erythematosus in texture, and the throat and tongue are both red in color. The child has no prior medical history. What is the appropriate course of action for this case?
Your Answer:
Correct Answer: Prescribe oral penicillin V for 10 days
Explanation:The recommended treatment for scarlet fever in patients who do not require hospitalization and have no penicillin allergy is a 10-day course of oral penicillin V. This condition is characterized by symptoms such as fever, sore throat, strawberry tongue, and a rash that is more prominent in the cubital fossas. Scarlet fever is caused by erythrogenic toxins produced by Group A haemolytic streptococci, and if left untreated, it can lead to complications such as otitis media and rheumatic fever. Administering varicella-zoster immunoglobulin is not appropriate for this condition. Prescribing analgesia and asking the patient to return in 5 days for review is also not recommended, as antibiotics should be given as soon as possible to prevent complications. Oral azithromycin for 5 days is not the first-line treatment for scarlet fever, and co-amoxiclav is not indicated for this condition.
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.
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This question is part of the following fields:
- Paediatrics
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Question 16
Incorrect
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A 7-year-old girl presents with a 3-day history of an itchy rash, initially on her abdomen and now spreading across the rest of her torso and limbs. She is usually healthy and is not taking any other medications, and the rest of her family is also healthy. There is a widespread vesicular rash with some papules and crusting, as well as newer papules. Her temperature is 37.6 °C and her other vital signs are normal.
What is the next appropriate step in managing this patient?Your Answer:
Correct Answer: Paracetamol
Explanation:Management of Chickenpox in Children: Treatment Options and Complications
Chickenpox (varicella-zoster) is a common childhood infection that spreads through the respiratory route, causing a vesicular rash. The child may experience a low-grade fever, which can be managed with paracetamol for symptomatic relief. However, parents should also be advised on hydration and red flag symptoms for potential complications. While chlorphenamine and calamine lotion can provide supportive therapy, evidence for their effectiveness is limited.
In rare cases, chickenpox can lead to complications such as encephalitis, pneumonitis, disseminated intravascular coagulation, or bacterial superinfection with staphylococcal aureus. If bacterial superinfection occurs, hospital admission and treatment with antibiotics, possibly in conjunction with acyclovir, may be necessary.
Zoster immunoglobulin is not recommended for children with uncomplicated chickenpox who do not have a history of immunosuppression. Similarly, oral acyclovir is not recommended for otherwise healthy children under the age of 12.
It is important for healthcare providers to be aware of the potential complications of chickenpox and to provide appropriate management to ensure the best possible outcomes for affected children.
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This question is part of the following fields:
- Paediatrics
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Question 17
Incorrect
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A 9-year-old girl presents to the Emergency department with a three day history of limping. She has been experiencing illness recently. Upon examination, she has no fever and shows discomfort when moving her hip. What is the probable diagnosis?
Your Answer:
Correct Answer: Transient synovitis
Explanation:Transient Synovitis in Childhood: the Causes and Diagnosis
Transient synovitis is a prevalent cause of hip pain in children, but it is crucial to rule out other more severe causes before diagnosing it. The exact cause of this condition is still unknown, but it is believed to be associated with viral infections, allergic reactions, or trauma.
Transient synovitis is a self-limiting condition that typically resolves within a few days to weeks. However, it is essential to differentiate it from other conditions that may require urgent medical attention, such as septic arthritis or Legg-Calve-Perthes disease. Therefore, a thorough medical history, physical examination, and imaging studies are necessary to make an accurate diagnosis.
In conclusion, transient synovitis is a common cause of hip pain in childhood, but it is crucial to exclude other more serious conditions before diagnosing it. Parents should seek medical attention if their child experiences hip pain, limping, or difficulty walking to ensure prompt and appropriate treatment.
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This question is part of the following fields:
- Paediatrics
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Question 18
Incorrect
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You are assessing a 9-month-old infant with suspected bronchiolitis. What sign or symptom should raise concern for a possible hospital referral?
Your Answer:
Correct Answer: Feeding 50% of the normal amount
Explanation:Bronchiolitis is a condition where the bronchioles become inflamed, and it is most commonly caused by respiratory syncytial virus (RSV). This virus is responsible for 75-80% of cases, with other causes including mycoplasma and adenoviruses. Bronchiolitis is most prevalent in infants under one year old, with 90% of cases occurring in those aged 1-9 months. The condition is more serious in premature babies, those with congenital heart disease or cystic fibrosis. Symptoms include coryzal symptoms, dry cough, increasing breathlessness, and wheezing. Hospital admission is often necessary due to feeding difficulties associated with increasing dyspnoea.
Immediate referral is recommended if the child has apnoea, looks seriously unwell, has severe respiratory distress, central cyanosis, or persistent oxygen saturation of less than 92% when breathing air. Clinicians should consider referral if the child has a respiratory rate of over 60 breaths/minute, difficulty with breastfeeding or inadequate oral fluid intake, or clinical dehydration. Immunofluorescence of nasopharyngeal secretions may show RSV, and management is largely supportive. Humidified oxygen is given via a head box if oxygen saturations are persistently low, and nasogastric feeding may be necessary if children cannot take enough fluid/feed by mouth. Suction may also be used for excessive upper airway secretions. NICE released guidelines on bronchiolitis in 2015 for more information.
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This question is part of the following fields:
- Paediatrics
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Question 19
Incorrect
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A 10 week old male infant is presented to the GP by his mother with concerns about an undescended testis on the right side since birth. The mother was advised to seek medical attention if the issue persisted after 6 to 8 weeks of age. Upon examination, the GP confirms the presence of a unilateral undescended testis on the right side, with a normal appearing penis. What would be the next step in management?
Your Answer:
Correct Answer: Review at 3 months of age
Explanation:If the testicle remains undescended after 3 months, it is recommended to refer the child to a paediatric surgeon for review before they reach 6 months of age, as per the NICE guidelines for undescended testes.
Undescended Testis: Causes, Complications, and Management
Undescended testis is a condition that affects around 2-3% of male infants born at term, but it is more common in preterm babies. Bilateral undescended testes occur in about 25% of cases. This condition can lead to complications such as infertility, torsion, testicular cancer, and psychological issues.
To manage unilateral undescended testis, NICE CKS recommends considering referral from around 3 months of age, with the baby ideally seeing a urological surgeon before 6 months of age. Orchidopexy, a surgical procedure, is typically performed at around 1 year of age, although surgical practices may vary.
For bilateral undescended testes, it is crucial to have the child reviewed by a senior paediatrician within 24 hours as they may require urgent endocrine or genetic investigation. Proper management of undescended testis is essential to prevent complications and ensure the child’s overall health and well-being.
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This question is part of the following fields:
- Paediatrics
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Question 20
Incorrect
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A 9-month-old baby is presented to the emergency department due to vomiting and diarrhoea that has been going on for 2 days. The vomit and stools are unremarkable, but the father reports that the baby has been lethargic and unsettled for the past 3 days. Additionally, the baby has had 6 episodes of uncontrollable crying where he draws his legs up to his chest for a few minutes at a time. The baby has no fever. During the examination, the baby appears pale and lethargic, and a small mass is palpated in the right upper quadrant. To investigate further, a plain abdominal x-ray is performed, which shows no signs of obstruction, and an ultrasound scan reveals a target sign. What is the most probable diagnosis?
Your Answer:
Correct Answer: Intussusception
Explanation:This question pertains to gastrointestinal disorders in children, specifically focusing on the symptoms of vomiting and diarrhea. While there can be various reasons for these symptoms, the child in this scenario displays indications of Intussusception. One of the classic signs is the child crying intermittently and pulling their legs towards their chest. Additionally, the presence of a small mass in the right upper quadrant and a target sign on ultrasound further support this diagnosis, along with the vomiting, diarrhea, and pain.
The vomit and stool do not show any significant abnormalities, and the absence of a fever suggests that it is not an infectious episode. Pyloric stenosis is unlikely to present in this manner. However, before an abdominal ultrasound x-ray is conducted, it is not possible to rule out a small bowel obstruction. Nevertheless, there are no indications of obstruction on the x-ray.
Understanding Intussusception
Intussusception is a medical condition that occurs when one part of the bowel folds into the lumen of the adjacent bowel, usually around the ileo-caecal region. This condition is most common in infants between 6-18 months old, with boys being affected twice as often as girls. The symptoms of intussusception include severe, crampy abdominal pain that comes and goes, inconsolable crying, vomiting, and blood stained stool, which is a late sign. During a paroxysm, the infant will typically draw their knees up and turn pale, and a sausage-shaped mass may be felt in the right upper quadrant.
To diagnose intussusception, ultrasound is now the preferred method of investigation, as it can show a target-like mass. Treatment for intussusception involves reducing the bowel by air insufflation under radiological control, which is now widely used as a first-line treatment instead of the traditional barium enema. If this method fails, or the child shows signs of peritonitis, surgery is performed.
In summary, intussusception is a medical condition that affects infants and involves the folding of one part of the bowel into the lumen of the adjacent bowel. It is characterized by severe abdominal pain, vomiting, and blood stained stool, among other symptoms. Ultrasound is the preferred method of diagnosis, and treatment involves reducing the bowel by air insufflation or surgery if necessary.
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This question is part of the following fields:
- Paediatrics
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Question 21
Incorrect
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A baby born at 32 weeks’ gestation develops sudden abdominal distension and a purpuric rash. The nurses record the passage of blood and mucous per rectum during the first week of life in the Neonatal Intensive Care Unit.
Which is the most likely diagnosis?Your Answer:
Correct Answer: Necrotising enterocolitis
Explanation:Common Neonatal Gastrointestinal Disorders
Necrotising Enterocolitis: A medical emergency affecting formula-fed preterm infants, characterised by acute inflammation in different parts of the bowel, causing mucosal injury and necrosis, and may lead to perforation. Symptoms include diarrhoea, haematochezia, vomiting, abdominal wall erythema/rash, abdominal distension and pain. Treatment involves bowel rest and intravenous antibiotics, with severe cases requiring a laparotomy to remove necrotic bowel.
Haemorrhagic Disease of the Newborn: Associated with vitamin K deficiency, it can cause intracranial haemorrhage and bleeding in internal organs. Managed by vitamin K supplementation, replacement of blood and factor losses, and specialist care.
Gastroschisis: A congenital abnormality resulting in the herniation of portions of the bowel, liver and stomach outside the abdomen, through a para-umbilical defect in the anterior abdominal wall.
Haemolytic Uraemic Syndrome: Characterised by acute renal failure, haemolytic anaemia and thrombocytopenia, it occurs mainly in young children and is commonly associated with infection. Symptoms include profuse diarrhoea, fever, lethargy, acute renal failure, anuria and seizures.
Hirschsprung’s Disease: Caused by the absence of ganglia in the distal colon, it produces a functional bowel obstruction and presents with delayed passage of meconium or chronic constipation from birth.
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This question is part of the following fields:
- Paediatrics
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Question 22
Incorrect
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A 4-year-old girl is brought to the pediatrician by her mother. The mother is concerned as she has noticed some hair growing in her daughter's armpits, and although she has not shown any distress or had any other noticeable symptoms, the mother is worried that something is wrong as she is too young to begin going through puberty. On examination, the child has axillary hair growth bilaterally, and her breasts are of appropriate size for her age.
Gonadotrophin assays show the following:
FSH 0.2 IU/L Age 6 months - 10 years old: (1 - 3)
LH 0.1 IU/L Age 6 months - 10 years old: (1 - 5)
What is the most likely cause of this child's axillary hair growth?Your Answer:
Correct Answer: Adrenal hyperplasia
Explanation:In cases of gonadotrophin independent precocious puberty (GIPP), both FSH and LH levels are low. This is in contrast to gonadotrophin dependent precocious puberty (GDPP), where FSH and LH levels are high and testes are larger than expected for age. GIPP is caused by increased levels of sex hormones, such as testosterone, which suppress LH and FSH. This can be due to ovarian, testicular, or adrenal causes, such as congenital adrenal hyperplasia. In boys with GIPP, testicular volume is typically normal or small. Adrenal hyperplasia is the only cause of GIPP, as all other causes would result in GDPP and increased levels of FSH and LH.
Understanding Precocious Puberty
Precocious puberty is a condition where secondary sexual characteristics develop earlier than expected, before the age of 8 in females and 9 in males. It is more common in females and can be classified into two types: gonadotrophin dependent and gonadotrophin independent. The former is caused by premature activation of the hypothalamic-pituitary-gonadal axis, resulting in raised levels of FSH and LH. The latter is caused by excess sex hormones, with low levels of FSH and LH. In males, precocious puberty is uncommon and usually has an organic cause, such as gonadotrophin release from an intracranial lesion, gonadal tumour, or adrenal cause. In females, it is usually idiopathic or familial and follows the normal sequence of puberty. Organic causes are rare and associated with rapid onset, neurological symptoms and signs, and dissonance, such as in McCune Albright syndrome. Understanding precocious puberty is important for early detection and management of the condition.
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This question is part of the following fields:
- Paediatrics
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Question 23
Incorrect
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You are asked to help with the resuscitation of a premature neonate who is displaying respiratory distress immediately after birth at 36 +4 weeks. During auscultation of the precordium, you observe the absence of heart sounds on the left side but can hear tinkling sounds. Additionally, the infant is exhibiting cyanosis.
What is the most appropriate initial course of action?Your Answer:
Correct Answer: Intubation and ventilation
Explanation:If you hear bowel sounds during a respiratory exam of a neonate experiencing respiratory distress, it may indicate the presence of a diaphragmatic hernia. This condition occurs when abdominal organs protrude through a hole in the diaphragm, typically on the left side, leading to underdeveloped lungs and breathing difficulties. The sound of bowel in the chest cavity causes the bowel sounds to be audible. The heart sounds may also be louder on the right side due to the displacement of the heart. The initial treatment involves inserting a nasogastric tube to prevent air from entering the gut, but for a cyanotic patient, intubation and ventilation are necessary. Surgical repair of the diaphragm is the definitive treatment. BIPAP and CPAP are not appropriate for this condition, as they are used to keep the airway open in conditions such as COPD or respiratory distress syndrome. Facemask ventilation and nasal cannulae should be avoided as they increase the risk of air entering the gut, and an artificial airway is necessary to ensure adequate oxygenation.
Understanding Congenital Diaphragmatic Hernia
Congenital diaphragmatic hernia (CDH) is a rare condition that affects approximately 1 in 2,000 newborns. It occurs when the diaphragm, a muscle that separates the chest and abdominal cavities, fails to form completely during fetal development. As a result, abdominal organs can move into the chest cavity, which can lead to underdeveloped lungs and high blood pressure in the lungs. This can cause respiratory distress shortly after birth.
The most common type of CDH is a left-sided posterolateral Bochdalek hernia, which accounts for about 85% of cases. This type of hernia occurs when the pleuroperitoneal canal, a structure that connects the chest and abdominal cavities during fetal development, fails to close properly.
Despite advances in medical treatment, only about 50% of newborns with CDH survive. Early diagnosis and prompt treatment are crucial for improving outcomes. Treatment may involve surgery to repair the diaphragm and move the abdominal organs back into their proper position. In some cases, a ventilator or extracorporeal membrane oxygenation (ECMO) may be necessary to support breathing until the lungs can function properly. Ongoing care and monitoring are also important to manage any long-term complications that may arise.
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This question is part of the following fields:
- Paediatrics
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Question 24
Incorrect
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A 2-year-old child is brought in for a routine check-up, with concerns from the parents that the child is smaller than expected for their age. The parents mention that the child has difficulty with eating and mainly consumes milk and soft foods. The child appears healthy upon examination, but is found to be on the 3rd percentile for weight. During a cardiac examination, a systolic murmur is detected in the pulmonary area and a fixed splitting to the second heart sound is heard. All pulses are palpable and within normal range. What is the most likely diagnosis?
Your Answer:
Correct Answer: Atrial septal defect
Explanation:Most children with atrial septal defects (ASDs) do not show any symptoms. However, if these heart defects are not detected before birth, children with severe ASD may experience shortness of breath, fatigue, poor appetite and growth, and increased susceptibility to respiratory infections. During a physical examination, a doctor may detect an ejection systolic murmur and fixed splitting of the second heart sound.
Other congenital heart defects can be identified by the following murmurs:
– Ventricular septal defect: A pansystolic murmur in the lower left sternal border
– Coarctation of the aorta: A crescendo-decrescendo murmur in the upper left sternal border
– Patent ductus arteriosus: A diastolic machinery murmur in the upper left sternal borderCongenital heart disease can be categorized into two types: acyanotic and cyanotic. Acyanotic heart diseases are more common and include ventricular septal defects (VSD), atrial septal defect (ASD), patent ductus arteriosus (PDA), coarctation of the aorta, and aortic valve stenosis. VSD is the most common acyanotic heart disease, accounting for 30% of cases. ASDs are less common than VSDs, but they are more frequently diagnosed in adult patients as they tend to present later. On the other hand, cyanotic heart diseases are less common and include tetralogy of Fallot, transposition of the great arteries (TGA), and tricuspid atresia. Fallot’s is more common than TGA, but TGA is the more common lesion at birth as patients with Fallot’s generally present at around 1-2 months. The presence of cyanosis in pulmonary valve stenosis depends on the severity and any other coexistent defects.
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This question is part of the following fields:
- Paediatrics
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Question 25
Incorrect
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A 3-day-old neonate born at term is presenting with tachypnoea, grunting, and cyanosis. The baby is unable to feed and has an oxygen saturation of 70% on room air. On auscultation, a loud S2 and systolic murmur are heard, which is loudest at the left sternal border. The doctors suspect transposition of the great arteries and have started the baby on intravenous fluids, antibiotics, and scheduled surgery. What additional medication should be given in the meantime?
Your Answer:
Correct Answer: Prostaglandin E1
Explanation:To maintain a patent ductus arteriosus in cyanotic congenital heart diseases, prostaglandin E1 should be administered. It is helpful to recall the 5 T’s for cyanotic CHD, which include Tetralogy of Fallot, Transposition of Great Vessels (TGA), Tricuspid Atresia, Total Anomalous Pulmonary Venous Return, and Truncus Arteriosus. Based on the timing of onset and heart murmur, the patient in this case likely has TGA with a concurrent VSD. TGA typically presents shortly after birth. Prostaglandin E1 is given in ductal dependent cyanotic heart diseases to prevent closure of the patent ductus arteriosus until surgical correction can be performed. This allows for mixing of oxygenated and deoxygenated blood to ensure adequate systemic circulation. Antibiotics should also be administered as prophylaxis for bacterial endocarditis. It is important to note that nonsteroidal anti-inflammatory drugs (NSAIDs) such as indomethacin and ibuprofen will actually close the ductus arteriosus and should not be used in this situation.
Cyanosis, a bluish discoloration of the skin, is a common occurrence in newborns. Peripheral cyanosis, which affects the hands and feet, is often seen in the first 24 hours of life and can be caused by crying or illness. Central cyanosis, on the other hand, is a more serious condition that occurs when the concentration of reduced hemoglobin in the blood exceeds 5g/dl. To differentiate between cardiac and non-cardiac causes of central cyanosis, doctors may use the nitrogen washout test, which involves giving the infant 100% oxygen for ten minutes and then measuring arterial blood gases. A pO2 of less than 15 kPa indicates cyanotic congenital heart disease, which can be caused by conditions such as tetralogy of Fallot, transposition of the great arteries, and tricuspid atresia.
If cyanotic congenital heart disease is suspected, initial management involves supportive care and the use of prostaglandin E1, such as alprostadil, to maintain a patent ductus arteriosus in ductal-dependent congenital heart defects. This can serve as a temporary measure until a definitive diagnosis is made and surgical correction is performed.
Acrocyanosis, a type of peripheral cyanosis, is a benign condition that is often seen in healthy newborns. It is characterized by bluish discoloration around the mouth and extremities, such as the hands and feet, and is caused by vasomotor changes that result in peripheral vasoconstriction and increased tissue oxygen extraction. Unlike other causes of peripheral cyanosis that may indicate significant pathology, such as septic shock, acrocyanosis occurs immediately after birth in healthy infants and typically resolves within 24 to 48 hours.
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This question is part of the following fields:
- Paediatrics
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Question 26
Incorrect
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As a paediatrician, you are reviewing a 1-month-old who was delivered at 39+2 weeks vaginally and without any complications. The parents of the child have a concern that their child might have achondroplasia as the child's father has been diagnosed with this condition. Apart from measuring the child's length, what other physical characteristic should you look for to determine if the child has achondroplasia?
Your Answer:
Correct Answer: Trident hand deformity
Explanation:Identifying physical features of congenital conditions is crucial for exam purposes and diagnosis. One such feature of achondroplasia is trident hands, characterized by short, stubby fingers with a gap between the middle and ring fingers. Other physical features include short limbs (rhizomelia), lumbar lordosis, and midface hypoplasia. Fragile X syndrome is associated with low set ears, while Down’s syndrome is characterized by saddle-gap deformity and a single palmar crease. It is important to note that achondroplasia is characterized by macrocephaly with frontal bossing, not microcephaly.
Understanding Achondroplasia
Achondroplasia is a genetic disorder that is inherited in an autosomal dominant manner. It is caused by a mutation in the fibroblast growth factor receptor 3 (FGFR-3) gene, which leads to abnormal cartilage development. This results in short stature, with affected individuals having short limbs (rhizomelia) and shortened fingers (brachydactyly). They also have a large head with frontal bossing and a narrow foramen magnum, midface hypoplasia with a flattened nasal bridge, ‘trident’ hands, and lumbar lordosis.
In most cases, achondroplasia occurs as a sporadic mutation, with advancing parental age at the time of conception being a risk factor. There is no specific therapy for achondroplasia, but some individuals may benefit from limb lengthening procedures. These procedures involve the application of Ilizarov frames and targeted bone fractures, with a clearly defined need and endpoint being essential for success.
Overall, understanding achondroplasia is important for individuals and families affected by this condition. While there is no cure, there are treatment options available that can improve quality of life for those living with achondroplasia.
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This question is part of the following fields:
- Paediatrics
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Question 27
Incorrect
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A 10-year-old girl is brought to the attention of a psychiatrist by her father with complaints of difficulty concentrating at home and at school. She is reported by the teachers to be easily distracted which is adversely affecting her learning. She also shows repeated outbursts of anger and her father thinks she has 'too much energy'. The psychiatrist diagnoses her with attention-deficit hyperactivity disorder (ADHD) and starts her on methylphenidate (Ritalin).
What parameter must be monitored every 6 months in this patient?Your Answer:
Correct Answer: Weight and height
Explanation:Regular monitoring of weight and height is recommended every 6 months for patients taking methylphenidate, a stimulant medication. This is important as the drug may cause appetite suppression and growth impairment in children. Additionally, blood pressure and pulse should also be monitored regularly.
In March 2018, NICE released new guidelines for identifying and managing Attention Deficit Hyperactivity Disorder (ADHD). This condition can have a significant impact on a child’s life and can continue into adulthood, making accurate diagnosis and treatment crucial. According to DSM-V, ADHD is characterized by persistent features of inattention and/or hyperactivity/impulsivity, with an element of developmental delay. Children up to the age of 16 must exhibit six of these features, while those aged 17 or over must exhibit five. ADHD has a UK prevalence of 2.4%, with a higher incidence in boys than girls, and there may be a genetic component.
NICE recommends a holistic approach to treating ADHD that is not solely reliant on medication. After presentation, a ten-week observation period should be implemented to determine if symptoms change or resolve. If symptoms persist, referral to secondary care is necessary, typically to a paediatrician with a special interest in behavioural disorders or to the local Child and Adolescent Mental Health Service (CAMHS). A tailored plan of action should be developed, taking into account the patient’s needs and wants, as well as how their condition affects their lives.
Drug therapy should be considered a last resort and is only available to those aged 5 years or older. Parents of children with mild/moderate symptoms can benefit from attending education and training programmes. For those who do not respond or have severe symptoms, pharmacotherapy may be considered. Methylphenidate is the first-line treatment for children and should be given on a six-week trial basis. It is a CNS stimulant that primarily acts as a dopamine/norepinephrine reuptake inhibitor. Side effects include abdominal pain, nausea, and dyspepsia. Weight and height should be monitored every six months in children. If there is an inadequate response, lisdexamfetamine should be considered, followed by dexamfetamine if necessary. In adults, methylphenidate or lisdexamfetamine are the first-line options, with switching between drugs if no benefit is seen after a trial of the other. All of these drugs are potentially cardiotoxic, so a baseline ECG should be performed before starting treatment, and referral to a cardiologist should be made if there is any significant past medical history or family history, or any doubt or ambiguity.
As with most psychiatric conditions, a thorough history and clinical examination are essential, particularly given the overlap of ADHD with many other psychiatric and
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This question is part of the following fields:
- Paediatrics
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Question 28
Incorrect
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A 7-year-old girl is diagnosed with Attention Deficit Hyperactivity Disorder and prescribed methylphenidate. What should be monitored during her treatment?
Your Answer:
Correct Answer: Growth
Explanation:In March 2018, NICE released new guidelines for identifying and managing Attention Deficit Hyperactivity Disorder (ADHD). This condition can have a significant impact on a child’s life and can continue into adulthood, making accurate diagnosis and treatment crucial. According to DSM-V, ADHD is characterized by persistent features of inattention and/or hyperactivity/impulsivity, with an element of developmental delay. Children up to the age of 16 must exhibit six of these features, while those aged 17 or over must exhibit five. ADHD has a UK prevalence of 2.4%, with a higher incidence in boys than girls, and there may be a genetic component.
NICE recommends a holistic approach to treating ADHD that is not solely reliant on medication. After presentation, a ten-week observation period should be implemented to determine if symptoms change or resolve. If symptoms persist, referral to secondary care is necessary, typically to a paediatrician with a special interest in behavioural disorders or to the local Child and Adolescent Mental Health Service (CAMHS). A tailored plan of action should be developed, taking into account the patient’s needs and wants, as well as how their condition affects their lives.
Drug therapy should be considered a last resort and is only available to those aged 5 years or older. Parents of children with mild/moderate symptoms can benefit from attending education and training programmes. For those who do not respond or have severe symptoms, pharmacotherapy may be considered. Methylphenidate is the first-line treatment for children and should be given on a six-week trial basis. It is a CNS stimulant that primarily acts as a dopamine/norepinephrine reuptake inhibitor. Side effects include abdominal pain, nausea, and dyspepsia. Weight and height should be monitored every six months in children. If there is an inadequate response, lisdexamfetamine should be considered, followed by dexamfetamine if necessary. In adults, methylphenidate or lisdexamfetamine are the first-line options, with switching between drugs if no benefit is seen after a trial of the other. All of these drugs are potentially cardiotoxic, so a baseline ECG should be performed before starting treatment, and referral to a cardiologist should be made if there is any significant past medical history or family history, or any doubt or ambiguity.
As with most psychiatric conditions, a thorough history and clinical examination are essential, particularly given the overlap of ADHD with many other psychiatric and
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This question is part of the following fields:
- Paediatrics
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Question 29
Incorrect
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You are conducting an 8-month well-baby visit for a boy and his mother. The physical examination is normal, and you proceed to discuss the child's immunizations. The mother expresses concern about recent measles outbreaks and asks when her son should receive the first dose of the MMR vaccine.
When is the MMR vaccine typically administered as part of routine immunizations?Your Answer:
Correct Answer: At 12-13 months of age
Explanation:The MMR vaccine is administered as a standard practice when a child reaches 12-13 months of age, and then again during the preschool booster at 3-4 years old.
The UK immunisation schedule recommends certain vaccines at different ages. At birth, the BCG vaccine is given if the baby is at risk of tuberculosis. At 2, 3, and 4 months, the ‘6-1 vaccine’ (diphtheria, tetanus, whooping cough, polio, Hib and hepatitis B) and oral rotavirus vaccine are given, along with Men B and PCV at certain intervals. At 12-13 months, the Hib/Men C, MMR, and PCV vaccines are given, along with Men B. At 3-4 years, the ‘4-in-1 preschool booster’ (diphtheria, tetanus, whooping cough and polio) and MMR vaccines are given. At 12-13 years, the HPV vaccination is given, and at 13-18 years, the ‘3-in-1 teenage booster’ (tetanus, diphtheria and polio) and Men ACWY vaccines are given. Additionally, the flu vaccine is recommended annually for children aged 2-8 years.
It is important to note that the meningitis ACWY vaccine has replaced meningitis C for 13-18 year-olds due to an increased incidence of meningitis W disease in recent years. The ACWY vaccine will also be offered to new students (up to the age of 25 years) at university. GP practices will automatically send letters inviting 17-and 18-year-olds in school year 13 to have the Men ACWY vaccine. Students going to university or college for the first time as freshers, including overseas and mature students up to the age of 25, should contact their GP to have the Men ACWY vaccine, ideally before the start of the academic year.
It is worth noting that the Men C vaccine used to be given at 3 months but has now been discontinued. This is because the success of the Men C vaccination programme means there are almost no cases of Men C disease in babies or young children in the UK any longer. All children will continue to be offered the Hib/Men C vaccine at one year of age, and the Men ACWY vaccine at 14 years of age to provide protection across all age groups.
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This question is part of the following fields:
- Paediatrics
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Question 30
Incorrect
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A 4-year-old patient presents with recurrent chest infections and green sputum production. Upon examination, a chest x-ray reveals ring shadows and bronchial wall thickening in both lung bases. What is the probable diagnosis?
Your Answer:
Correct Answer: Bronchiectasis
Explanation:Recurrent Chest Infections and Bronchiectasis: A Possible Sign of Cystic Fibrosis
Patients who have a history of recurrent chest infections and x-ray appearances that suggest bronchiectasis may be showing signs of cystic fibrosis. Bronchiectasis is a condition where the airways in the lungs become damaged and widened, leading to a build-up of mucous and bacteria. This can cause recurrent chest infections, which can be difficult to treat. Cystic fibrosis is a genetic condition that affects the production of mucous, leading to thick and sticky secretions that can block the airways and cause infections.
If a patient is showing signs of bronchiectasis, it is important to consider cystic fibrosis as a possible cause. Early diagnosis and treatment of cystic fibrosis can help to manage symptoms and prevent complications. Testing for cystic fibrosis may involve a sweat test, genetic testing, or other diagnostic tests. Treatment may include medications to help clear mucous from the airways, antibiotics to treat infections, and other therapies to manage symptoms.
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This question is part of the following fields:
- Paediatrics
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