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Question 1
Incorrect
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A 4-year-old boyâs mother is worried about his foreskin not retracting. Ballooning of the foreskin occurs during urination, but the penis appears normal. What is the MOST PROBABLE diagnosis?
Your Answer: Pathological phimosis
Correct Answer: Physiological phimosis
Explanation:Common Male Genital Conditions
Phimosis is a condition where the foreskin cannot be retracted over the glans penis. Physiological phimosis is normal in newborns and usually resolves by 10 years of age. Treatment for pathological phimosis may include topical medication or circumcision if recurrent infections occur. Balanoposthitis is inflammation of the glans and foreskin, often caused by infection or inflammation. Hypospadias is a congenital condition where the urethral opening is on the underside of the penis, and the foreskin may be underdeveloped. Posterior urethral valves are membranes in the posterior urethra that can cause obstruction and frequent infections in boys.
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This question is part of the following fields:
- Children And Young People
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Question 2
Correct
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The mother of a 6-year-old girl contacts you for a prescription. During the night, the child had complained of an itchy bottom, and upon inspection, the parents found a few live tiny white worms near the anus. What advice should you give regarding household contacts?
Advice: It is important to treat all household contacts, including parents and siblings, as they may also be infected with the same type of worm. They should also practice good hygiene, such as washing hands regularly and keeping fingernails short, to prevent the spread of infection. Additionally, it may be helpful to wash all bedding, towels, and clothing in hot water to eliminate any remaining eggs or larvae.Your Answer: Treat all household contacts with oral mebendazole
Explanation:If a patient is diagnosed with threadworms, also known as pinworms, it is recommended that all household contacts receive treatment, even if they do not exhibit any symptoms. Mebendazole should be taken by all family members on the same day, except for pregnant or breastfeeding women and children under 2 years old. Strict hygiene measures are advised for these exceptions to disrupt the life cycle of the worms. The adhesive tape test is preferred over a stool sample for lab testing confirmation, but in this case, it is not necessary as all household contacts should be treated. Permethrin is a topical insecticide used for treating scabies.
Threadworms: A Common Infestation Among Children in the UK
Infestation with threadworms, also known as pinworms, is a prevalent condition among children in the UK. The infestation occurs when individuals swallow eggs present in their environment. Although around 90% of cases are asymptomatic, some possible features include perianal itching, especially at night, and vulval symptoms in girls.
Diagnosis can be made by applying Sellotape to the perianal area and sending it to the laboratory for microscopy to see the eggs. However, most patients are treated empirically, and this approach is supported in the CKS guidelines.
The recommended management for threadworm infestation is a combination of anthelmintic with hygiene measures for all members of the household. Mebendazole is used as a first-line treatment for children over six months old, with a single dose given unless the infestation persists. By following these guidelines, individuals can effectively manage and prevent the spread of threadworms.
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This question is part of the following fields:
- Children And Young People
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Question 3
Correct
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A 4-year-old boy from a traveller community family is brought to the surgery by his mother.
She informs you that he began with what appeared to be a severe catarrhal cold, but now experiences intense paroxysms of coughing, causing him to turn completely red in the face and struggle to catch his breath. Upon examination, he has no fever.
What feature on history, examination, or investigation, although not conclusive, is consistent with the presence of whooping cough?Your Answer: Lack of pyrexia
Explanation:Whooping Cough: Symptoms and Risk Factors
The incubation period for whooping cough, also known as pertussis, typically lasts seven to 10 days but can extend up to 21 days. Patients with this condition often experience a paroxysmal cough with an inspiratory whoop, and lymphocytosis is commonly observed. While extensive consolidation is uncommon, pockets of lower respiratory tract infection may occur due to atelectasis. Notably, a lack of fever is a strong indication of whooping cough.
Children from travelling families may be at a higher risk of contracting whooping cough if they have missed the standard vaccination schedule. It is important to be aware of the symptoms and risk factors associated with this condition to ensure prompt diagnosis and treatment.
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This question is part of the following fields:
- Children And Young People
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Question 4
Incorrect
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At what age would a child typically develop visual acuity comparable to that of a grown-up?
Your Answer: 3 months
Correct Answer: 2 years
Explanation:Vision Testing for Children
A newborn’s visual acuity is not fully developed and only reaches about 6/200. However, it improves to 6/60 by the age of 3 months and reaches adult levels at around 2 years old. When assessing a child’s vision, there are several tests that may be performed. At birth, a red reflex test is typically done. At 6 weeks, the child is asked to fix and follow an object to 90 degrees, such as a red ball 90cm away. By 3 months, the child should be able to fix and follow an object to 180 degrees without any squinting. At 12 months, the child should be able to pick up small objects, such as ‘hundreds and thousands,’ with a pincer grip. For children over 3 years old, letter matching tests are commonly used, while Snellen charts are used for those over 4 years old. Additionally, Ishihara plates may be used to test for color vision. These tests are important in identifying any potential vision problems in children and ensuring they receive appropriate treatment.
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This question is part of the following fields:
- Children And Young People
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Question 5
Correct
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A 7-year-old girl still wets the bed most nights. She is dry by day. Her development has been normal and she is otherwise well. She has never had a urinary infection. There are no behavioural problems or family issues.
What is the most appropriate management option?Your Answer: Enuresis alarm
Explanation:Treatment Options for Enuresis: From Simple Measures to Medications
Enuresis, or bedwetting, is a common problem among children. While most children outgrow it, some may need treatment. The first step is to try simple measures such as restricting fluid intake and encouraging regular toilet use. If bedwetting persists, an enuresis alarm may be considered as first-line treatment. Desmopressin, a medication that reduces urine production, can be used for rapid control or in combination with an alarm. However, it should be used second line after an alarm has been tried. Desmopressin with an anticholinergic medication like oxybutynin is another option, but specialist assessment is recommended. Imipramine, a tricyclic antidepressant, may be considered as a last resort after all other treatments have failed and with caution due to potential side effects. Overall, treatment options for enuresis should be tailored to the individual child and their specific needs.
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This question is part of the following fields:
- Children And Young People
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Question 6
Correct
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A couple bring their 20-month-old baby girl to the clinic. They are concerned that she is not making the required progress with respect to speech development.
What could you tell the parents about speech and language expectations in this child?Your Answer: Around 20-30 words vocabulary would be expected by this age
Explanation:Speech Delay in Children: Possible Causes and Exclusions
Speech delay is a common issue that affects 3-10% of all children, with boys being 3-4 times more likely to experience it than girls. One possible cause of speech delay in older children is elective mutism, which can be assessed through proper diagnosis. However, before progressing to other investigations, it is important to exclude deafness as a possible cause. Other factors that should be excluded include social and environmental deprivation, disorders of metabolism, and degenerative nervous diseases, which are rare possibilities. By identifying and addressing the underlying cause of speech delay, children can receive the necessary support and intervention to improve their communication skills.
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This question is part of the following fields:
- Children And Young People
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Question 7
Incorrect
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A 2-year-old boy is brought to an urgent GP appointment with an acute limp. He is coryzal but apyrexial. There is no history of trauma. He is able to weight bear.
What is the appropriate course of action for management?Your Answer: Urgent hip ultrasound scan
Correct Answer: Urgent specialist assessment
Explanation:Urgent specialist assessment is needed for a child < 3 years with an acute limp, as septic arthritis is more common than transient synovitis in this age group. Routine paediatric referral, urgent x-ray, and urgent hip ultrasound scan are not appropriate. Causes of Limping in Children Vary by Age When a child is limping, the cause can vary depending on their age. For younger children, transient synovitis is a common cause. This condition has an acute onset and is often accompanied by viral infections, but the child is usually well or has a mild fever. It is more common in boys aged 2-12 years. On the other hand, septic arthritis/osteomyelitis is a more serious condition that causes a high fever and an unwell child. Juvenile idiopathic arthritis can also cause a limp, which may be painless. Trauma is usually the cause of a limp in children, and the history of the injury can often diagnose the issue. Development dysplasia of the hip is usually detected in neonates and is six times more common in girls. Perthes disease is more common in children aged 4-8 years and is caused by avascular necrosis of the femoral head. Finally, slipped upper femoral epiphysis is a condition that occurs in children aged 10-15 years and is caused by the displacement of the femoral head epiphysis postero-inferiorly. Understanding the potential causes of a limp in children can help parents and healthcare providers identify and treat the issue promptly.
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This question is part of the following fields:
- Children And Young People
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Question 8
Correct
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A 12-week-old baby is brought to the clinic with persistent regurgitation that causes significant distress. The infant is exclusively breastfed and appears otherwise healthy. The baby was born a week before the due date through a normal vaginal delivery. The mother experienced significant blood loss during delivery and required overnight observation. She was found to be slightly anemic and was given ferrous sulfate supplementation. What initial treatment would you suggest for this baby?
Your Answer: Alginate therapy
Explanation:When breastfed infants display symptoms of gastro-oesophageal reflux, it is important for a qualified individual to conduct a breastfeeding assessment. Simply observing the infant without providing any treatment is not appropriate, as the reported distress of the infant must be taken into consideration. While a proton pump inhibitor is a viable treatment option, an alginate is preferred due to its lower risk of side effects, provided it is effective. Alginates can be administered to breastfed infants by mixing them with cooled boiled water or expressed breast milk.
Gastro-oesophageal reflux is a common cause of vomiting in infants, with around 40% of babies experiencing some degree of regurgitation. However, certain risk factors such as preterm delivery and neurological disorders can increase the likelihood of developing this condition. Symptoms typically appear before 8 weeks of age and include vomiting or regurgitation, milky vomits after feeds, and excessive crying during feeding. Diagnosis is usually made based on clinical observation.
Management of gastro-oesophageal reflux in infants involves advising parents on proper feeding positions, ensuring the infant is not overfed, and considering a trial of thickened formula or alginate therapy. However, proton pump inhibitors (PPIs) are not recommended as a first-line treatment for isolated symptoms of regurgitation. PPIs may be considered if the infant experiences unexplained feeding difficulties, distressed behavior, or faltering growth. Metoclopramide, a prokinetic agent, should only be used with specialist advice.
Complications of gastro-oesophageal reflux can include distress, failure to thrive, aspiration, frequent otitis media, and dental erosion in older children. If medical treatment is ineffective and severe complications arise, fundoplication may be considered. It is important for healthcare professionals to be aware of the risk factors, symptoms, and management options for gastro-oesophageal reflux in infants.
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This question is part of the following fields:
- Children And Young People
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Question 9
Correct
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A 6-month-old infant is presented by their caregiver with concerns about bruising on their legs. The infant is healthy and has received all recommended vaccinations. The caregiver is unsure how the bruising occurred and is worried about a possible bleeding disorder.
What would be the most suitable next step to take?Your Answer: Refer the patient for same day paediatric assessment and discuss with the paediatric consultant on-call
Explanation:Any bruising observed in a non-mobile infant should be immediately referred for paediatric assessment on the same day. The urgency of the situation is the main concern.
Delaying the assessment until later in the week, waiting for blood test results, or consulting with the safeguarding lead is not appropriate. It is also not necessary to contact emergency services at this point, unless the parents refuse to take the child for assessment.
The appropriate action is to refer the infant for same-day paediatric assessment and inform the on-call consultant. If the child doesn’t attend the hospital on the same day, the paediatric team should escalate the situation.
Recognizing Child Abuse: Signs and Symptoms
Child abuse is a serious issue that can have long-lasting effects on a child’s physical and emotional well-being. It is important to recognize the signs and symptoms of child abuse in order to protect vulnerable children. One way that abuse may come to light is through a child’s own disclosure. However, there are other factors that may indicate abuse, such as inconsistencies in a child’s story or repeated visits to emergency departments. Children who appear frightened or withdrawn may also be experiencing abuse, exhibiting a state of frozen watchfulness.
Physical signs of abuse can also be indicative of maltreatment. Bruising, fractures (especially in the metaphyseal area or posterior ribs), and burns or scalds are all possible signs of abuse. Additionally, a child who is failing to thrive or who has contracted a sexually transmitted infection may be experiencing abuse. It is important to be aware of these signs and to report any concerns to the appropriate authorities. By recognizing and addressing child abuse, we can help protect vulnerable children and promote their safety and well-being.
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This question is part of the following fields:
- Children And Young People
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Question 10
Incorrect
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Lila is a 4-year-old girl who presents with a high fever, sore throat and sandpaper-like rash on her torso. You suspect scarlet fever. Her father inquires about the duration of time she should stay away from preschool.
Your Answer: Keep out of nursery until 5 days after starting antibiotics
Correct Answer: Keep out of nursery until 24 hours after starting antibiotics
Explanation:It is recommended that children diagnosed with scarlet fever should not attend nursery or school until they have been on antibiotics for at least 24 hours.
Scarlet fever is a condition caused by erythrogenic toxins produced by Group A haemolytic streptococci, usually Streptococcus pyogenes. It is more common in children aged 2-6 years, with the highest incidence at 4 years. The disease is spread through respiratory droplets or direct contact with nose and throat discharges. The incubation period is 2-4 days, and symptoms include fever, malaise, headache, sore throat, ‘strawberry’ tongue, and a rash that appears first on the torso and spares the palms and soles. Scarlet fever is usually a mild illness, but it may be complicated by otitis media, rheumatic fever, acute glomerulonephritis, or rare invasive complications.
To diagnose scarlet fever, a throat swab is usually taken, but antibiotic treatment should be started immediately, rather than waiting for the results. Management involves oral penicillin V for ten days, while patients with a penicillin allergy should be given azithromycin. Children can return to school 24 hours after starting antibiotics, and scarlet fever is a notifiable disease. Desquamation occurs later in the course of the illness, particularly around the fingers and toes. The rash is often described as having a rough ‘sandpaper’ texture, and children often have a flushed appearance with circumoral pallor. Invasive complications such as bacteraemia, meningitis, and necrotizing fasciitis are rare but may present acutely with life-threatening illness.
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This question is part of the following fields:
- Children And Young People
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Question 11
Correct
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A mother seeks advice on routine vaccination for her 4-month-old baby who was born in Spain and has already received their 2-month vaccinations. These included DTaP/IPV/Hib/Hep B, meningococcal group B, and the oral rotavirus vaccine. What vaccinations will this infant require for their 4-month vaccination according to the current UK routine immunization schedule?
Your Answer: DTaP/IPV/Hib/Hep B + rotavirus + pneumococcal conjugate vaccine (PCV)
Explanation: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 specific intervals. At 12-13 months, the Hib/Men C, MMR, PCV, and Men B vaccines are given. 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 is also 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, while students going to university or college for the first time should contact their GP to have the vaccine before the start of the academic year.
The Men C vaccine used to be given at 3 months but has now been discontinued as there are almost no cases of Men C disease in babies or young children in the UK. 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:
- Children And Young People
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Question 12
Correct
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A 5-year-old boy is brought to the emergency room by his mother. He was playing on the monkey bars at the playground and fell off, landing on his right arm. He started crying and complained that his right elbow hurt. He is now reluctant to move the elbow and holds it slightly flexed and pronated with the forearm held against the abdomen. There is no tenderness, swelling, bruising or deformity at the elbow.
Which is the MOST LIKELY diagnosis?Your Answer: Radial head subluxation
Explanation:Common Elbow Injuries in Children and Adults
Radial head subluxation is a frequent injury in children under the age of 6 years. The rounded end of the radial head is still made of cartilage and can easily slip out of the encircling annular ligament when the arm is pulled. There is usually no history of trauma, but there may be a history of axial traction by a pull on the hand or wrist. Tenderness at the head of the radius may be present. Imaging is only necessary when a fracture is suspected. Manipulation can be done in the GP surgery by immobilizing the elbow with one hand and with the other hand applying axial compression while supinating the forearm and flexing the elbow. Alternatively, it can be done while pronating the forearm. A click indicates success.
Supracondylar fracture of the humerus is most commonly seen in children and usually results from a fall on to an outstretched arm. The patient usually has elbow swelling and pain.
Lateral epicondylitis (tennis elbow) is a chronic condition that peaks between 40 and 50 years of age. It is thought to be an overload tendon injury.
Radial neck fracture occurs due to trauma such as a fall onto the outstretched arm. The median age is 9â10 years. There is pain, swelling, and tenderness over the lateral side of the elbow.
In cases of suspected non-accidental injury, the explanation should be consistent with the injury, and in the absence of other features, non-accidental injury is unlikely.
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This question is part of the following fields:
- Children And Young People
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Question 13
Incorrect
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A 7-week-old boy is presented to your clinic by his mother in the afternoon. The mother reports that her baby has been experiencing effortless and painless regurgitation of his feeds for the past four weeks. The baby is being formula-fed and is currently taking bottles on demand every two hours. Apart from this, the baby is healthy and growing normally. There is no significant medical history, and the baby was born at full term without any complications. What is the appropriate course of action?
Your Answer: Mix feeds with an alginate (e.g. Gaviscon)
Correct Answer: Observation
Explanation:Gastro-oesophageal reflux is a common cause of vomiting in infants, with around 40% of babies experiencing some degree of regurgitation. However, certain risk factors such as preterm delivery and neurological disorders can increase the likelihood of developing this condition. Symptoms typically appear before 8 weeks of age and include vomiting or regurgitation, milky vomits after feeds, and excessive crying during feeding. Diagnosis is usually made based on clinical observation.
Management of gastro-oesophageal reflux in infants involves advising parents on proper feeding positions, ensuring the infant is not overfed, and considering a trial of thickened formula or alginate therapy. However, proton pump inhibitors (PPIs) are not recommended as a first-line treatment for isolated symptoms of regurgitation. PPIs may be considered if the infant experiences unexplained feeding difficulties, distressed behavior, or faltering growth. Metoclopramide, a prokinetic agent, should only be used with specialist advice.
Complications of gastro-oesophageal reflux can include distress, failure to thrive, aspiration, frequent otitis media, and dental erosion in older children. If medical treatment is ineffective and severe complications arise, fundoplication may be considered. It is important for healthcare professionals to be aware of the risk factors, symptoms, and management options for gastro-oesophageal reflux in infants.
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This question is part of the following fields:
- Children And Young People
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Question 14
Correct
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A 9-year-old boy comes to see you with his father; they have returned from a holiday to Egypt and the father is very concerned as his son is lethargic, tired and has most recently become jaundiced, with dark urine. He is nauseated all the time and hardly able to eat.
On examination he is pyrexial 38.2°C, with jaundice and evidence of scratch marks on his skin.
Investigations show:
Haemoglobin 118 g/L (135 - 180)
WCC 8.2 Ă109/L (4 - 10)
Platelets 190 Ă109/L (150 - 400)
Sodium 140 mmol/L (134 - 143)
Potassium 4.7 mmol/L (3.5 - 5.0)
Creatinine 105 ”mol/L (60 - 120)
Bili 142 (<26)
ALT 680 (<36)
Which one of the following is true of his condition?Your Answer: You can reassure her mother that she will almost certainly make a full recovery
Explanation:Hepatitis A in North Africa
This child is suffering from hepatitis A, a common condition in North Africa where most people are exposed to it and develop immunity as children. However, children from the United Kingdom are not immune and may become infected while on holiday through the faeco-oral route.
Fortunately, supportive care is all that is needed, including bed rest, proper nutrition, fluid intake, and pain relief. Only a small percentage of patients progress to fulminant hepatic failure.
To prevent infection, it is recommended to get vaccinated for hepatitis A before traveling to areas where exposure is likely.
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This question is part of the following fields:
- Children And Young People
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Question 15
Incorrect
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At what age would a typical toddler develop the capability to squat down and retrieve a toy?
Your Answer: 2 œ years
Correct Answer: 18 months
Explanation:Gross Motor Developmental Milestones
Gross motor developmental milestones refer to the physical abilities that a child acquires as they grow and develop. These milestones are important indicators of a child’s overall development and can help parents and healthcare professionals identify any potential delays or concerns. The table below summarizes the major gross motor developmental milestones from 3 months to 4 years of age.
At 3 months, a baby should have little or no head lag when pulled to sit and should have good head control when lying on their abdomen. By 6 months, they should be able to pull themselves to a sitting position and roll from front to back. At 9 months, they should be able to crawl and pull themselves to a standing position. By 12 months, they should be able to cruise and walk with one hand held. At 18 months, they should be able to walk unsupported and squat to pick up a toy. By 2 years, they should be able to run and walk up and down stairs holding onto a rail. At 3 years, they should be able to ride a tricycle using pedals and walk up stairs without holding onto a rail. Finally, at 4 years, they should be able to hop on one leg.
It is important to note that while the majority of children crawl on all fours before walking, some children may bottom-shuffle, which is a normal variant that runs in families. By monitoring a child’s gross motor developmental milestones, parents and healthcare professionals can ensure that they are meeting their developmental goals and identify any potential concerns early on.
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This question is part of the following fields:
- Children And Young People
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Question 16
Correct
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A 5-year-old girl is seen in the Paediatric Admissions Unit. She has been experiencing a fever for the past week. During the examination, it is observed that she has red, painful lips and conjunctival injection. Additionally, her hands are swollen and red. After conducting blood tests, the following results were obtained:
Hb 13.1 g/dl
WBC 12.7 *109/l
Platelets 520 *109/l
CRP 96 mg/L
What is the probable diagnosis?Your Answer: Kawasaki disease
Explanation:Understanding Kawasaki Disease
Kawasaki disease is a rare type of vasculitis that primarily affects children. It is important to identify this disease early on as it can lead to serious complications such as coronary artery aneurysms. The disease is characterized by a high-grade fever that lasts for more than five days, which is resistant to antipyretics. Other features include conjunctival injection, bright red, cracked lips, strawberry tongue, cervical lymphadenopathy, and red palms and soles that later peel.
Diagnosis of Kawasaki disease is based on clinical presentation as there is no specific diagnostic test available. Management of the disease involves high-dose aspirin, which is one of the few indications for aspirin use in children. Intravenous immunoglobulin is also used as a treatment option. Echocardiogram is the initial screening test for coronary artery aneurysms instead of angiography.
Complications of Kawasaki disease include coronary artery aneurysm, which can be life-threatening. Early recognition and treatment of Kawasaki disease can prevent serious complications and improve outcomes for affected children.
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This question is part of the following fields:
- Children And Young People
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Question 17
Incorrect
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A father contacts the clinic regarding his 3-year-old daughter who was recently diagnosed with strep throat and prescribed antibiotics. He neglected to inquire about the duration of time she should stay home from preschool. What guidance should be provided?
Your Answer: 24 hours after commencing antibiotics
Correct Answer: 48 hours after commencing antibiotics
Explanation:After starting antibiotics, children with whooping cough can go back to school or nursery within 48 hours, typically with a macrolide.
A vaccination programme for pregnant women was introduced in 2012 to combat an outbreak of whooping cough that resulted in the death of 14 newborn children. The vaccine is over 90% effective in preventing newborns from developing whooping cough. The programme was extended in 2014 due to uncertainty about future outbreaks. Pregnant women between 16-32 weeks are offered the vaccine.
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This question is part of the following fields:
- Children And Young People
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Question 18
Correct
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A 7-year-old boy comes to the clinic complaining of an extremely tender right testicle that started four hours ago. There was no history of trauma or concurrent medical illness.
During the examination, the right testicle was found to be retracted and lying horizontally, but it was too painful to palpate fully. The left hemiscrotum appeared normal.
What is the probable diagnosis?Your Answer: Torsion
Explanation:Torsion: A Serious Condition with Limited Treatment Window
A short history of severe pain without any other symptoms should be considered as torsion. It is crucial to note that even if other symptoms are present, torsion should not be overlooked as there is only a limited time frame for treatment. A horizontal-lying testis is a typical indication of torsion, although it may not always be visible. Early diagnosis and treatment are crucial in managing torsion and preventing any long-term damage.
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This question is part of the following fields:
- Children And Young People
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Question 19
Correct
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A mother brings her 4-year-old child for a routine check-up and mentions her 6-year-old son. She expresses concern about meningitis B due to a friend's experience with the disease. When is the meningitis B vaccine typically administered?
Your Answer: 2 months + 4 months + 12-13 months
Explanation:Meningitis B Vaccine Now Part of Routine NHS Immunisation
Children in the UK have been receiving immunisation against meningococcus serotypes A and C for many years. However, this led to meningococcal B becoming the most common cause of bacterial meningitis in the country. To address this, a vaccine against meningococcal B called Bexsero was developed and introduced to the UK market.
Initially, the Joint Committee on Vaccination and Immunisation (JCVI) rejected the use of Bexsero after conducting a cost-benefit analysis. However, this decision was eventually reversed, and meningitis B has now been added to the routine NHS immunisation. Children will receive three doses of the vaccine at 2 months, 4 months, and 12-13 months.
Moreover, Bexsero will also be available on the NHS for patients at high risk of meningococcal disease, such as those with asplenia, splenic dysfunction, or complement disorder. With the inclusion of meningitis B vaccine in the routine NHS immunisation, the UK hopes to reduce the incidence of bacterial meningitis and protect more children and high-risk patients from the disease.
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This question is part of the following fields:
- Children And Young People
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Question 20
Incorrect
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A father brings his 2-year-old son to your GP clinic. The child has been experiencing symptoms of a cold for the past 2 days. Last night, he developed a barking cough and a slight fever of 37.8Âș.
During the examination, you notice mild stridor when the child moves around, but there are no visible recessions. The chest sounds clear, and there is good air entry on both sides. The temperature remains at 37.8Âș, but all other vital signs are normal.
What is the most appropriate course of action for management?Your Answer: Give nebulised adrenaline
Correct Answer: Give a stat dose of dexamethasone 150 micrograms/kg PO
Explanation:For a child with croup, a single dose of oral dexamethasone (0.15 mg/kg) should be taken immediately regardless of the severity of the illness. Croup typically begins with cold-like symptoms and progresses to a barking cough with a seal-like sound. The severity of croup can be determined by the presence of symptoms such as stridor, recessions, and distress. In this case, the child has mild croup and hospital admission is not necessary. Nebulized adrenaline is only recommended for children with severe symptoms, while a salbutamol inhaler is not effective for croup. Antibiotics are not useful for treating croup as it is a viral illness. Steroids, such as dexamethasone, have been shown to alleviate symptoms and reduce the need for hospitalization.
Croup is a respiratory infection that affects young children, typically those between 6 months and 3 years old. It is most common in the autumn and is caused by parainfluenza viruses. The main symptom is stridor, which is caused by swelling and secretions in the larynx. Other symptoms include a barking cough, fever, and cold-like symptoms. The severity of croup can be graded based on the child’s symptoms, with mild cases having occasional coughing and no audible stridor at rest, and severe cases having frequent coughing, prominent stridor, and significant distress or lethargy. Children with moderate or severe croup should be admitted to the hospital, especially if they are under 6 months old or have other airway abnormalities. Diagnosis is usually made based on clinical symptoms, but a chest x-ray can show subglottic narrowing. Treatment typically involves a single dose of oral dexamethasone or prednisolone, and emergency treatment may include high-flow oxygen or nebulized adrenaline.
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This question is part of the following fields:
- Children And Young People
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Question 21
Incorrect
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A 2-month-old baby is here for their initial vaccinations. What immunisations are recommended at this point?
Your Answer: '6-1 vaccine' (diphtheria, tetanus, whooping cough, polio, Hib and hepatitis B) + PCV + rotavirus + Men B
Correct Answer: '6-1 vaccine' (diphtheria, tetanus, whooping cough, polio, Hib and hepatitis B) + rotavirus + Men B
Explanation:The vaccine regimen includes immunization against diphtheria, tetanus, pertussis, polio, Haemophilus influenza type b, and hepatitis B, as well as vaccination against pneumococcus, rotavirus, and meningococcus B.
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 specific intervals. At 12-13 months, the Hib/Men C, MMR, PCV, and Men B vaccines are given. 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 is also 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, while students going to university or college for the first time should contact their GP to have the vaccine before the start of the academic year.
The Men C vaccine used to be given at 3 months but has now been discontinued as there are almost no cases of Men C disease in babies or young children in the UK. 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:
- Children And Young People
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Question 22
Correct
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A 4-week-old girl is referred to you by the health visitor after her mother noticed that she âlooked yellowâ. On examination, she is jaundiced, with dark urine and pale stools. Examination is otherwise normal. The mother had an uneventful pregnancy and birth, and the baby has had vitamin K.
What is the most likely diagnosis?Your Answer: Biliary atresia
Explanation:Neonatal Jaundice: Differential Diagnosis
Biliary atresia is a congenital condition that causes obstructive jaundice due to the obliteration of the extrahepatic biliary system. It presents soon after birth with persistent jaundice, pale stools, and dark urine. Physiological jaundice, which appears after 2-3 days of age, is a different condition that doesn’t cause changes in stool and urine color. Gallstones and Rhesus incompatibility can also present with obstructive jaundice, but they are less likely. Vitamin K deficiency is not a likely cause of neonatal jaundice if the child has received vitamin K soon after birth. Any term infant who is still jaundiced after 14 days (or preterm infants after 21 days) should be investigated for the underlying cause of their jaundice.
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This question is part of the following fields:
- Children And Young People
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Question 23
Incorrect
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What is the most common cause of hypertension in adolescents?
Your Answer: Renal vascular disease
Correct Answer: Renal parenchymal disease
Explanation:Hypertension, or high blood pressure, can also affect children. To measure blood pressure in children, it is important to use a cuff size that is approximately 2/3 the length of their upper arm. The 4th Korotkoff sound is used to measure diastolic blood pressure until adolescence, when the 5th Korotkoff sound can be used. Results should be compared to a graph of normal values for their age.
In younger children, secondary hypertension is the most common cause, with renal parenchymal disease accounting for up to 80% of cases. Other causes of hypertension in children include renal vascular disease, coarctation of the aorta, phaeochromocytoma, congenital adrenal hyperplasia, and essential or primary hypertension, which becomes more common as children get older. It is important to identify the underlying cause of hypertension in children in order to provide appropriate treatment and prevent complications.
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This question is part of the following fields:
- Children And Young People
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Question 24
Incorrect
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A concerned mother brings her 2-year-old daughter to see you as she has not had a wet diaper for the past 12 hours. Her mother suspects a lump in her tummy. Additionally, she has been refusing to walk for the past 36 hours and has been crying excessively. What type of cancer is most likely to present with these symptoms?
Your Answer:
Correct Answer: Nephroblastoma
Explanation:Recognizing Symptoms of Neuroblastoma in Children
Neuroblastoma is a rare but serious condition that primarily affects children under the age of 5. It can be difficult to detect in primary care due to its rarity and vague symptoms. The most common symptom is a lump in the abdomen, which may cause swelling or pain. However, children with neuroblastoma may also experience general symptoms of metastatic disease, such as malaise, bone pain, and respiratory issues. Other concerning symptoms include proptosis, unexplained back pain, leg weakness, and urinary retention. These symptoms may indicate that the tumour is pressing on the spinal cord or adjacent to the adrenal glands. Excessive catecholamine release can also cause tachycardia, flushing, sweating, weight loss, and watery diarrhoea. If a child presents with symptoms that could be explained by neuroblastoma, an abdominal examination and urgent abdominal ultrasound should be performed, along with a chest x-ray and full blood count. Any identified mass should prompt an urgent referral. Knowing the age at peak incidence can also aid in diagnosis.
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This question is part of the following fields:
- Children And Young People
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Question 25
Incorrect
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Which one of the following statements regarding developmental dysplasia of the hip is true?
Your Answer:
Correct Answer: 20% of cases are bilateral
Explanation:Developmental dysplasia of the hip (DDH) is a condition that affects 1-3% of newborns and is more common in females, firstborn children, and those with a positive family history or breech presentation. It used to be called congenital dislocation of the hip (CDH). DDH is more often found in the left hip and can be screened for using ultrasound in infants with certain risk factors or through clinical examination using the Barlow and Ortolani tests. Other factors to consider include leg length symmetry, knee level when hips and knees are flexed, and restricted hip abduction in flexion. Ultrasound is typically used to confirm the diagnosis, but x-rays may be necessary for infants over 4.5 months old. Management options include the Pavlik harness for younger children and surgery for older ones. Most unstable hips will stabilize on their own within 3-6 weeks.
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This question is part of the following fields:
- Children And Young People
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Question 26
Incorrect
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A 7-month-old infant comes in with a one day history of fever (39°C), and a generalised rash, which started on the legs and is now present on limbs and trunk virtually equally. The rash is purplish, non-palpable, and non-blanching. What is the most probable diagnosis?
Your Answer:
Correct Answer: Meningococcal septicaemia
Explanation:Meningococcal Septicaemia and Other Skin Conditions
Meningococcal septicaemia is a serious condition that can cause a non-blanching purpuric eruption all over the body. This symptom is a key indicator of the disease and should be taken seriously. Other skin conditions, such as giant urticaria, measles rash, and haemophilia, do not typically present with this type of rash.
Giant urticaria is characterised by recurrent attacks of oedema that appear suddenly in various areas of the body. The measles rash, on the other hand, appears as a macular eruption on the face and neck that spreads over three days. Haemophilia is not associated with any generalised rash.
HSP, another skin condition, may present in a subacute manner and is not typically associated with a high fever in an acutely unwell child. It may occur following an upper respiratory tract infection.
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This question is part of the following fields:
- Children And Young People
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Question 27
Incorrect
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At what ages is the immunisation given as part of the routine UK schedule, specifically at 8 and 12 weeks?
Your Answer:
Correct Answer: Rotavirus
Explanation:Routine Childhood Immunisation Schedule
The routine childhood immunisation schedule is a crucial aspect of healthcare for young children. It protects them from a range of diseases that can cause serious harm or even death. The schedule includes vaccinations for diphtheria, tetanus, pertussis, polio, Hib, hepatitis B, pneumococcal disease, meningococcal group B, and rotavirus.
At 8 weeks, infants receive vaccinations for diphtheria, tetanus, pertussis, polio, Hib, hepatitis B, pneumococcal disease, meningococcal group B, and oral rotavirus. At 12 weeks, they receive vaccinations for diphtheria, tetanus, pertussis, polio, Hib, and oral rotavirus. At 16 weeks, they receive vaccinations for diphtheria, tetanus, pertussis, polio, Hib, hepatitis B, pneumococcal disease, and meningococcal group B.
It is important to note that the hepatitis B immunisation was added to the routine schedule in 2017, but not hepatitis A. Additionally, pneumococcal immunisation is given at 8 and 16 weeks, but not at 12 weeks, while meningococcal B immunisation is given at 8 and 16 weeks, but not at 12 weeks. Understanding the routine childhood immunisation schedule is crucial for healthcare professionals and parents alike to ensure the health and safety of young children.
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This question is part of the following fields:
- Children And Young People
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Question 28
Incorrect
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Which one of the following statements regarding Chickenpox in adults is incorrect?
Your Answer:
Correct Answer: Children are infectious once rash begins until all lesions have scabbed over
Explanation:Chickenpox is a viral infection caused by the varicella zoster virus. It is highly contagious and can be spread through respiratory droplets. The virus can also reactivate later in life and cause shingles. Chickenpox is most infectious from four days before the rash appears until five days after. The incubation period is typically 10-21 days. Symptoms include fever and an itchy rash that starts on the head and trunk before spreading. The rash goes through stages of macular, papular, and vesicular. Management is supportive, with measures such as keeping cool and using calamine lotion. Immunocompromised patients and newborns with peripartum exposure should receive varicella zoster immunoglobulin. Complications can include secondary bacterial infection of the lesions, pneumonia, encephalitis, and rare complications such as disseminated haemorrhagic Chickenpox.
One common complication of Chickenpox is secondary bacterial infection of the lesions, which can be increased by the use of NSAIDs. This can manifest as a single infected lesion or small area of cellulitis. In rare cases, invasive group A streptococcal soft tissue infections may occur, resulting in necrotizing fasciitis. Other rare complications of Chickenpox include pneumonia, encephalitis (which may involve the cerebellum), disseminated haemorrhagic Chickenpox, and very rarely, arthritis, nephritis, and pancreatitis. It is important to note that school exclusion may be necessary, as Chickenpox is highly infectious and can be caught from someone with shingles. It is advised to avoid contact with others until all lesions have crusted over.
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This question is part of the following fields:
- Children And Young People
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Question 29
Incorrect
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A 4-year-old child has been started on montelukast due to recurrent episodes of viral-induced wheezing that have resulted in hospitalization. What is a typical side effect of this medication that should be cautioned to the parents?
Your Answer:
Correct Answer: Nightmares
Explanation:Nightmares are a frequent and distressing side effect of montelukast. It is recommended that children take the medication in the morning instead of at night if they experience this issue. Montelukast is not associated with exacerbating coughs (which are usually caused by ramipril), blurred vision (which can be caused by Olanzapine), ringing in the ears (which is often caused by furosemide), or increased appetite (which is often a side effect of antidepressants like sertraline).
Preschool Wheeze in Children: Classification and Management
Wheeze is a common occurrence in Preschool children, with around 25% experiencing it before they reach 18 months old. Viral-induced wheeze is now one of the most frequently diagnosed conditions in paediatric wards. However, there is still ongoing debate about how to classify wheeze in this age group and the most appropriate management strategies.
The European Respiratory Society Task Force has proposed a classification system for Preschool wheeze, dividing children into two groups: episodic viral wheeze and multiple trigger wheeze. Episodic viral wheeze occurs only during a viral upper respiratory tract infection and is symptom-free in between episodes. On the other hand, multiple trigger wheeze can be triggered by various factors, such as exercise, allergens, and cigarette smoke. Episodic viral wheeze is not associated with an increased risk of asthma in later life, while a proportion of children with multiple trigger wheeze may develop asthma.
For parents who smoke, it is strongly recommended that they quit smoking. The management of episodic viral wheeze is symptomatic, with first-line treatment involving short-acting beta 2 agonists or anticholinergic via a spacer. If symptoms persist, the next step is intermittent leukotriene receptor antagonist or inhaled corticosteroids, or both. Oral prednisolone is no longer considered necessary for children who do not require hospital treatment. For multiple trigger wheeze, a trial of inhaled corticosteroids or a leukotriene receptor antagonist is typically recommended for 4-8 weeks.
Overall, the classification and management of Preschool wheeze in children is an ongoing area of research and debate, with the aim of providing the most effective and appropriate care for these young patients.
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This question is part of the following fields:
- Children And Young People
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Question 30
Incorrect
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You are asked to see a 3-day-old newborn baby who was born by normal vaginal delivery without any complications. The parents report that the baby has suddenly become ill and deteriorated over the last few hours. The child is drowsy and lethargic, has a bulging fontanelle, and a high fever. You suspect meningitis and call for immediate transfer to the hospital.
What is the most probable causative agent for this condition?Your Answer:
Correct Answer: Group B Streptococcus
Explanation:Newborn Meningitis: Signs, Causes, and Consequences
Sepsis in newborns can cause nonspecific signs of unwellness, such as apnoeic episodes, drowsiness, lethargy, and irritability. However, meningitis in newborns may present differently, with a bulging fontanelle being a late and sometimes absent finding. The most common cause of meningitis in newborns is group B streptococcus (GBS), which is often transmitted vertically during labor and delivery. In some cases, infection may be delayed for up to one month.
Meningitis as a whole has significant morbidity and mortality rates, with a mortality rate of 5-15% in infants. Even those who survive may experience learning difficulties, speech problems, visual impairment, and neural deafness. Recently, NICE has issued guidance on the prehospital care of patients with a clinical diagnosis of meningitis. It is crucial to recognize the signs of meningitis in newborns and seek prompt medical attention to prevent severe consequences.
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This question is part of the following fields:
- Children And Young People
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Question 31
Incorrect
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A 6-year-old child is brought to see you by his parents. They have noticed that he has developed a skin rash and bruising over last 24-36 hours.
The parents report that he has previously been a well child with no serious past medical problems or hospital admissions. The only time they have sought medical attention in the past has been for the occasional upper respiratory tract infection but these have been infrequent.
He last had a viral upper respiratory tract infection about 7-10 days ago. The parents managed this at home without the need for medical assessment as the symptoms were not severe.
On examination he appears well in himself with no temperature, and is interacting and playful. However there is marked superficial bruising and purpura over his trunk and legs. You also note four blood blisters on his tongue. There is no lymphadenopathy or hepatosplenomegaly and the remainder of the clinical examination is unremarkable with normal urine on dipstick testing.
What is the most likely diagnosis?Your Answer:
Correct Answer: Immune-mediated thrombocytopenic purpura
Explanation:Immune-Mediated Thrombocytopenic Purpura in Children
This condition is the most common cause of low platelets in children and occurs due to immune-mediated platelet destruction. It typically affects children between 2 and 10 years of age, with onset occurring one to two weeks after a viral infection. Children with this condition develop purpura, bruising, nosebleeds, and mucosal bleeding. While intracranial hemorrhage is a rare complication, it is serious. However, in the vast majority of cases, ITP is an acute and self-limiting condition.
While acute lymphoblastic leukemia (ALL) can also present with abnormal bruising, the history and clinical features of this child are more suggestive of ITP. Other features of ALL include malaise, recurrent infections, pallor, hepatosplenomegaly, and lymphadenopathy, which are not present in this case.
Haemolytic-uraemic syndrome is a triad of acute renal failure, thrombocytopenia, and microangiopathic haemolytic anaemia. Patients are typically very unwell. Henoch-Schönlein purpura (HSP) typically presents with a palpable purpura that affects the buttocks and extensor surfaces, along with arthralgia, abdominal pain, and renal problems. Meningococcal septicaemia can also cause purpura, but affected patients are seriously unwell.
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This question is part of the following fields:
- Children And Young People
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Question 32
Incorrect
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A 7-year-old girl has recently been seen by the dermatologists.
She had some scalp scrapings and hair samples sent to the laboratory for analysis following a clinical diagnosis of tinea capitis. The laboratory results confirmed the diagnosis of tinea capitis and the dermatologists faxed through a letter asking you to prescribe griseofulvin suspension at a dose of 12 mg/kg once daily.
The child weighs 20 kg. Griseofulvin suspension is dispensed at a concentration of 125 mg/5 ml.
What is the correct dosage of griseofulvin in millilitres to prescribe?Your Answer:
Correct Answer: 9 ml
Explanation:Calculation of Griseofulvin Dosage
When calculating the dosage of Griseofulvin for a patient, it is important to consider their weight and the recommended dose per kilogram. For example, if a patient weighs 15 kg and the recommended dose is 15 mg/kg OD, then the total dosage would be 225 mg.
Griseofulvin is available in a concentration of 125 mg in 5 ml, which means there is 25 mg in 1 ml. To determine the correct dosage, divide the total dosage (225 mg) by the concentration (25 mg/ml), which equals 9 ml. Therefore, the correct dosage for this patient would be 9 ml OD. It is important to carefully calculate and administer the correct dosage to ensure the patient receives the appropriate treatment.
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This question is part of the following fields:
- Children And Young People
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Question 33
Incorrect
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For which children is it necessary to defer their polio vaccination and refer them to a child specialist for additional guidance?
Your Answer:
Correct Answer: A child with uncontrolled epilepsy
Explanation:Polio Vaccination and Neurological Conditions
The Department of Health’s ‘Green Book’ provides guidelines for polio vaccination and neurological conditions. According to the book, stable pre-existing neurological conditions such as spina bifida and congenital brain abnormalities do not prevent polio vaccination. However, if a child has an unstable or deteriorating neurological condition, vaccination should be deferred, and the child should be referred to a specialist for further assessment and advice. This includes children with uncontrolled epilepsy.
It is important to note that a family history of seizures or epilepsy doesn’t prevent immunization. However, if there is a personal or family history of febrile seizures, there is an increased risk of these occurring after any fever, including post-immunization. In such cases, immunization should proceed as recommended, with advice on the prevention and management of fever beforehand.
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This question is part of the following fields:
- Children And Young People
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Question 34
Incorrect
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The parents of a 6-month-old baby have brought their child to see you due to ongoing problems with reflux.
The baby has been seen in paediatric outpatients and was started on ranitidine. You can see from the clinic letters that this was started at an initial dose of 1 mg/kg three times a day but to achieve symptom control it has been titrated to 3 mg/kg TDS. The higher dose seems to be controlling symptoms well.
The paediatricians have asked you to continue to prescribe the ranitidine at a dose of 3 mg/kg until they review the child again in four weeks time.
You weigh the child today and the current weight is 6 kg. Ranitidine oral solution is dispensed at a concentration of 75 mg/5 ml.
What is the correct dosage in millilitres to prescribe?Your Answer:
Correct Answer: 1 ml TDS
Explanation:Calculation of Ranitidine Dose for a 5 kg Child
When administering medication to a child, it is important to calculate the correct dosage based on their weight. In this case, the child weighs 5 kg and the prescribed dose of ranitidine is 3 mg/kg TDS. To calculate the correct dose, we multiply the child’s weight by the prescribed dose: 5 x 3 = 15 mg TDS.
The oral solution of ranitidine is available in a concentration of 75 mg/5 ml. This means that there is 15 mg of ranitidine in 1 ml of the solution. Therefore, the correct dose for the child is 1 ml TDS.
It is important to ensure that the correct dosage is administered to avoid any potential adverse effects or ineffective treatment. By following the appropriate calculations and using the correct concentration of medication, healthcare professionals can ensure safe and effective treatment for their patients.
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This question is part of the following fields:
- Children And Young People
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Question 35
Incorrect
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Sophie is a 2-year-old girl who is brought in by her father. She has had a fever overnight, along with a sore throat and cough. Her father is worried that she seems more tired than usual today. During the examination, you note the following:
Temperature 38.5 degrees
Heart rate 160 bpm
Respiratory rate 40 / min
Oxygen saturation 95%
The lungs are clear, but there is inflammation and redness in the throat, and there are swollen lymph nodes in the neck.
According to the NICE traffic light system for assessing fever in children, which of the following is considered 'amber'?Your Answer:
Correct Answer: Heart rate 155 bpm
Explanation:The NICE Feverish illness in children guidelines were introduced in 2007 and updated in 2013 to provide a ‘traffic light’ system for assessing the risk of febrile illness in children under 5 years old. The guidelines recommend recording the child’s temperature, heart rate, respiratory rate, and capillary refill time, as well as looking for signs of dehydration. Measuring temperature should be done with an electronic thermometer in the axilla for children under 4 weeks or with an electronic/chemical dot thermometer in the axilla or an infra-red tympanic thermometer. The risk stratification table categorizes children as green (low risk), amber (intermediate risk), or red (high risk) based on their symptoms. Management recommendations vary depending on the risk level, with green children managed at home, amber children provided with a safety net or referred to a specialist, and red children urgently referred to a specialist. The guidelines also advise against prescribing oral antibiotics without an apparent source of fever and note that a chest x-ray is not necessary if a child with suspected pneumonia is not being referred to the hospital.
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This question is part of the following fields:
- Children And Young People
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Question 36
Incorrect
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You assess an 8-year-old boy who was released from hospital 3 days ago after undergoing a tonsillectomy. His mother reports that he is experiencing a 'sore throat' despite taking both paracetamol and ibuprofen simultaneously. They were informed to anticipate some discomfort for approximately 5-7 days but are seeking your assistance in prescribing something to alleviate the pain. Physical examination reveals no abnormalities.
What is the best recommendation for pain relief?Your Answer:
Correct Answer: Advice that he should persevere with paracetamol + ibuprofen
Explanation:Reye’s syndrome is a risk associated with the use of aspirin in children, therefore it should not be administered to them.
To avoid the risk of morphine toxicity and respiratory depression, the MHRA recommends that codeine should not be given to children under the age of 12.
Codeine, a commonly used pain medication, can have different effects on patients due to genetic variations in the CY62D6 component of the P450 enzyme system. Some patients may be more sensitive to the effects of codeine, which can lead to serious adverse events. A recent review found that paediatric patients, particularly those from southern European countries, the Middle East, and Africa, have a higher incidence of rapid codeine metabolism. This has led to reports of morphine toxicity in children, especially those with a history of obstructive sleep apnoea. As a result, the MHRA now advises that codeine should only be used in children over 12 years of age for pain that is not controlled by other medications. Additionally, breastfeeding mothers should avoid using codeine due to the potential effects of morphine toxicity on their babies.
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This question is part of the following fields:
- Children And Young People
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Question 37
Incorrect
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A mother brings her 20-month-old son for review following a recent admission after a febrile convulsion. Which one of the following statements regarding febrile convulsions is not correct?
Your Answer:
Correct Answer: Giving antipyretics promptly can reduce the chance of further seizures
Explanation:There is no proof that administering antipyretics to a child with a fever can prevent febrile convulsions.
Febrile convulsions are seizures that occur in otherwise healthy children when they have a fever. They are most common in children between the ages of 6 months and 5 years, affecting around 3% of children. Febrile convulsions usually occur at the onset of a viral infection when the child’s temperature rises rapidly. The seizures are typically brief, lasting less than 5 minutes, and are usually tonic-clonic in nature.
There are three types of febrile convulsions: simple, complex, and febrile status epilepticus. Simple febrile convulsions last less than 15 minutes and are generalised seizures. Complex febrile convulsions last between 15 and 30 minutes and may be focal seizures. Febrile status epilepticus lasts for more than 30 minutes. Children who have had their first seizure or any features of a complex seizure should be admitted to paediatrics.
Following a seizure, parents should be advised to call an ambulance if the seizure lasts longer than 5 minutes. Regular antipyretics have not been shown to reduce the chance of a febrile seizure occurring. If recurrent febrile convulsions occur, benzodiazepine rescue medication may be considered, but this should only be started on the advice of a specialist, such as a paediatrician. Rectal diazepam or buccal midazolam may be used.
The overall risk of further febrile convulsions is 1 in 3, but this varies depending on risk factors for further seizure. These risk factors include age of onset under 18 months, fever below 39ÂșC, shorter duration of fever before the seizure, and a family history of febrile convulsions. Children with no risk factors have a 2.5% risk of developing epilepsy, while those with all three risk factors have a much higher risk of developing epilepsy, up to 50%.
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This question is part of the following fields:
- Children And Young People
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Question 38
Incorrect
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During a localised outbreak of measles your practice is inundated with requests for MMR vaccine from worried parents of young children.
In which of the following age groups is MMR vaccine contraindicated?Your Answer:
Correct Answer: Pregnant women
Explanation:Who Should Not Receive the MMR Vaccine?
There are only a few circumstances where the MMR vaccine cannot be given. Firstly, pregnant women should not receive the vaccine. Secondly, those with a confirmed anaphylactic reaction to gelatin or neomycin should not receive the vaccine. Thirdly, those who are immunocompromised should not receive the vaccine. Lastly, those who have had a confirmed anaphylactic reaction to a previous dose of measles, mumps or rubella-containing vaccine should not receive the vaccine.
Breastfeeding is not a contraindication to MMR immunisation, and MMR can be given to breastfeeding mothers without any risk to the baby. While two MMR vaccinations are needed for 99% protection, there is no limit to the number of MMR vaccinations an individual can receive. The risk of adverse reactions becomes less with increasing doses of MMR. Additionally, there is no upper age limit to receiving the MMR vaccine, and a 1-year-old child could theoretically receive the vaccine.
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This question is part of the following fields:
- Children And Young People
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Question 39
Incorrect
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You see a 6-month-old baby girl who has been crying and pulling her legs up as if she is in pain. She has had some loose stools and has vomited twice today.
Her mother says that the last stool looked rather red as if there was blood in it. She looks pale and distressed.
What is the likely diagnosis?Your Answer:
Correct Answer: Intussusception
Explanation:Intussusception: A Common Cause of Intestinal Obstruction in Children
Intussusception is a common cause of intestinal obstruction in children aged 5 months to 3 years, accounting for up to 25% of abdominal emergencies in children up to age 5. It occurs when one segment of the bowel invaginates into another just distal to it, leading to obstruction. This condition is more common in boys than girls, with a ratio of approximately 3:2, and two-thirds of patients are under 1-year-old, with the peak age being between 5-10 months.
The clinical features of intussusception include sudden onset of paroxysms of colicky abdominal pain, which may be more insidious in older children. The pain occurs about every 10-20 minutes and is often accompanied by crying. Patients may appear well between paroxysms initially, but early vomiting can rapidly become bile-stained. Neurological symptoms such as lethargy, hypotonia, or sudden alterations of consciousness can also occur.
Other features of intussusception include a palpable ‘sausage-shaped’ mass, often in the right upper quadrant, and absence of bowel in the right lower quadrant (Dance’s sign). Patients may also experience dehydration, pallor, shock, irritability, sweating, and later mucoid and bloody ‘red currant stools’. Late pyrexia may also occur.
In summary, intussusception is a common cause of intestinal obstruction in children, with a range of clinical features that can help diagnose the condition. Early recognition and treatment are essential to prevent complications and improve outcomes.
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This question is part of the following fields:
- Children And Young People
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Question 40
Incorrect
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You are taking the family history of an adult whom you suspect may have a cancer.
Which of the following conditions would alert you to an increased risk of cancer?Your Answer:
Correct Answer: Neurofibromatosis
Explanation:Syndromes and their Association with Cancer
There are certain syndromes that have been linked to an increased risk of developing certain types of cancer. Down’s syndrome, for example, has been associated with leukaemia, while neurofibromatosis, which is inherited in an autosomal dominant fashion, has been linked to CNS tumours. Other rare syndromes have also been linked to certain cancers.
It is important for primary healthcare professionals to be aware of these associations and to be vigilant for any unexplained symptoms in children or young people with these syndromes. Early detection and treatment can greatly improve outcomes for these patients. Therefore, it is crucial for healthcare professionals to stay informed and up-to-date on the latest research and recommendations regarding these syndromes and their potential links to cancer.
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This question is part of the following fields:
- Children And Young People
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