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  • Question 1 - You see a 3-year-old girl who presents with fever, irritability and offensive smelling...

    Correct

    • You see a 3-year-old girl who presents with fever, irritability and offensive smelling urine. A urine dipstick shows leucocytes+, nitrites -.

      What would be the next most appropriate management step?

      Your Answer: Send for MC&S and start antibiotic treatment

      Explanation:

      NICE Guidelines for UTI in Children

      According to the National Institute for Health and Care Excellence (NICE), children between 3 months to 3 years old with suspected urinary tract infection (UTI) can start antibiotic treatment if their urine sample shows either leucocyte or nitrite positive, or both. However, it is still recommended to send off the sample for culture to confirm the diagnosis and ensure appropriate treatment. These guidelines aim to provide a standardized approach in managing UTI in children and prevent complications associated with untreated infections.

    • This question is part of the following fields:

      • Children And Young People
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  • Question 2 - A 10-week-old child is about to receive vaccination with pertussis. You are assessing...

    Correct

    • A 10-week-old child is about to receive vaccination with pertussis. You are assessing his suitability for vaccination.

      In which of the following situations should the vaccine be postponed?

      Your Answer: He is currently suffering from an upper respiratory tract infection and fever

      Explanation:

      Understanding Contraindications and Postponements for Vaccines

      This question requires careful reading of the introduction to determine the appropriate answer. The focus is on situations where the vaccine may need to be postponed rather than being completely contraindicated. While a history of fever is not a contraindication, if the patient is acutely unwell with a fever, it would be appropriate to delay the vaccine to avoid confusing the diagnosis of any acute illness. Allergy to egg protein, forceps delivery, and family history of epilepsy are not contraindications, while convulsions within seven days of the first vaccine are. This question tests your understanding and practical application of the guidance rather than memorization. Remember to read carefully and consider the specific circumstances before administering any vaccine.

    • This question is part of the following fields:

      • Children And Young People
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  • Question 3 - A 4-year-old girl is brought to an evening surgery after swallowing a battery...

    Correct

    • A 4-year-old girl is brought to an evening surgery after swallowing a battery from a watch. On examination, she is well, with no drooling, respiratory symptoms or abdominal tenderness.
      What is the most appropriate management option?

      Your Answer: Arrange immediate admission for investigation and possible endoscopy

      Explanation:

      The Dangers of Swallowing Button Batteries: Why Immediate Action is Necessary

      Button batteries are small, but they can cause serious harm if swallowed. These batteries contain metals and concentrated solutions of caustic electrolytes, which can damage the oesophageal wall if left stuck for even just two hours. Therefore, it is essential to arrange immediate admission for investigation and possible endoscopy if a child has swallowed a button battery.

      Prescribing laxatives and taking no further action is not appropriate for a high-risk foreign body like a button battery. Similarly, asking the mother to collect all stools and return in 48 hours if the battery doesn’t pass is not recommended. Instead, it may be appropriate to observe asymptomatic children for the passage of the battery in the stool, but only if certain conditions are met.

      Reassuring the mother that no action is necessary is also not appropriate, as symptoms may still develop even if the child is asymptomatic. Referring for an abdominal X-ray on the next day is also not recommended, as urgent chest and abdominal X-rays will be carried out in the hospital.

      In conclusion, immediate action is necessary when a child swallows a button battery. Delaying treatment can lead to serious harm, and it is important to seek medical attention as soon as possible.

    • This question is part of the following fields:

      • Children And Young People
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  • Question 4 - A parent brings her 5-year-old son to the pediatrician's office. She informs you...

    Correct

    • A parent brings her 5-year-old son to the pediatrician's office. She informs you that her son has head lice and the school nurse has recommended keeping him at home until the treatment is finished to prevent the spread of head lice to other children. The parent asks for your advice on what to do next.

      Your Answer: No school exclusions apply

      Explanation:

      There is no need to exclude children with head lice from school, so the answer to the question is no. The mother should be comforted that her daughter can still attend school, and there is no reason for the patient to stay home. Therefore, the other answer options for this question are incorrect.

      The Health Protection Agency has provided guidance on when children should be excluded from school due to infectious conditions. Some conditions, such as conjunctivitis, fifth disease, roseola, infectious mononucleosis, head lice, threadworms, and hand, foot and mouth, do not require exclusion. Scarlet fever requires exclusion for 24 hours after commencing antibiotics, while whooping cough requires exclusion for 2 days after commencing antibiotics or 21 days from onset of symptoms if no antibiotics are taken. Measles requires exclusion for 4 days from onset of rash, rubella for 5 days from onset of rash, and Chickenpox until all lesions are crusted over. Mumps requires exclusion for 5 days from onset of swollen glands, while diarrhoea and vomiting require exclusion until symptoms have settled for 48 hours. Impetigo requires exclusion until lesions are crusted and healed, or for 48 hours after commencing antibiotic treatment, and scabies requires exclusion until treated. influenza requires exclusion until the child has recovered for 48 hours.

      Regarding Chickenpox, Public Health England recommends that children should be excluded until all lesions are crusted over, while Clinical Knowledge Summaries suggest that infectivity continues until all lesions are dry and have crusted over, usually about 5 days after the onset of the rash. It is important to follow official guidance and consult with healthcare professionals if unsure about exclusion periods for infectious conditions.

    • This question is part of the following fields:

      • Children And Young People
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  • Question 5 - A 10-year-old boy has had lower abdominal and left-sided testicular pain for the...

    Incorrect

    • A 10-year-old boy has had lower abdominal and left-sided testicular pain for the past 4 hours. He was at school playing sport when it began. The scrotal skin overlying his left testicle is erythematous and swollen, and lifting the testicle worsens his pain. The child has had similar episodes of pain affecting the left testicle over the past few weeks, but these episodes have been brief.
      What is the most likely diagnosis?

      Your Answer: Epididymo-orchitis

      Correct Answer: Testicular torsion

      Explanation:

      Common Scrotal Conditions in Children

      Testicular torsion, epididymo-orchitis, hydrocele, testicular tumour, and varicocele are common scrotal conditions in children. Testicular torsion is a common condition that occurs between the ages of 7 and 12 years. It presents with an acutely swollen scrotum with a painful testicle. Lifting the testis up over the symphysis increases pain, and the testis is usually retracted upwards with an absent cremasteric reflex. Immediate reduction is necessary to increase the chances of testicular salvage. Epididymo-orchitis presents with pain, swelling, and inflammation of the epididymis, commonly due to sexually transmitted infections. Hydrocele is painless swelling, and the scrotum transilluminates when a torch is held against it. Testicular tumour produces scrotal enlargement, only infrequently accompanied by pain. Varicocele is usually asymptomatic and presents with infertility investigations. An obvious varicocele is often described as feeling like a bag of worms.

    • This question is part of the following fields:

      • Children And Young People
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  • Question 6 - Which one of the following statements regarding developmental dysplasia of the hip is...

    Incorrect

    • Which one of the following statements regarding developmental dysplasia of the hip is true?

      Your Answer: The Ortolani test attempts to dislocate an articulated femoral head

      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.

    • This question is part of the following fields:

      • Children And Young People
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  • Question 7 - Who is recommended to receive the Human Papillomavirus (HPV) immunisation according to the...

    Incorrect

    • Who is recommended to receive the Human Papillomavirus (HPV) immunisation according to the January 2020 UK immunisation update?

      Your Answer: Boys and girls aged 12 to 13

      Correct Answer: Boys aged 10 to 12

      Explanation:

      Changes to UK Immunisation Schedule in 2020

      In January 2020, the UK immunisation schedule was updated with a few minor changes. It is important to stay up-to-date with these changes as they may be tested in exams. One change to note is that both boys and girls should receive the HPV immunisation at the age of 12 to 13. This is an important step in protecting against certain types of cancer caused by the human papillomavirus. It is recommended that parents and healthcare providers ensure that children receive this immunisation at the appropriate age.

    • This question is part of the following fields:

      • Children And Young People
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  • Question 8 - A father brings his 4-year-old son to see you in the surgery. He...

    Incorrect

    • A father brings his 4-year-old son to see you in the surgery. He has had a fever for 24 hours, vomited once and complains of abdominal discomfort and pain when passing urine. He is drinking plenty of fluids. He has been potty trained for one year, but had several urinary accidents in the past couple of days. There is nothing of note in his past medical history.

      On examination there are no recessions, his chest is clear, abdomen is soft with mild lower abdominal tenderness and no loin tenderness. He has a normal ENT examination. He is well hydrated and has no rash. His urine dipstick is positive for leukocytes and protein, but negative for nitrate and blood. His temperature is 38°C, HR 120, RR 28, and CR <2 sec.

      According to the NICE 'traffic light' system what is the most appropriate management?

      Your Answer: Give trimethoprim, send urine for microscopy and send child home with worsening advice

      Correct Answer: Admit to paediatrics as child is at high risk of serious illness

      Explanation:

      Diagnosis and Management of UTIs in Children

      This child doesn’t exhibit any immediately life-threatening symptoms, but a UTI is the most likely diagnosis based on their clinical history. Early detection and treatment of UTIs can prevent the development of renal scarring and end-stage renal failure. Dipstick tests for leukocyte esterase and nitrite can be used to diagnose UTIs in children aged 2 years and older. However, a urine sample should be sent for microscopy and culture to confirm the diagnosis.

      The following table outlines urine-testing strategies for children aged 3 years and older:

      Leukocyte+ Nitrite+ – Antibiotic treatment should be started, and a urine sample should be sent for culture if the child has a high or intermediate risk of serious illness or a history of previous UTIs.

      Leukocyte- Nitrite+ – Antibiotic treatment should be started if the urine test was carried out on a fresh sample of urine. A urine sample should be sent for culture, and management will depend on the results.

      Leukocyte+ Nitrite- – A urine sample should be sent for microscopy and culture. Antibiotic treatment should not be started unless there is clear clinical evidence of a UTI.

      Leukocyte- Nitrite- – Antibiotics should not be started, and a urine sample should not be sent for culture. Other potential causes of illness should be explored.

    • This question is part of the following fields:

      • Children And Young People
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  • Question 9 - A Health Visitor has requested a review of a 9-month-old girl who is...

    Incorrect

    • A Health Visitor has requested a review of a 9-month-old girl who is not reaching out for objects. The mother reports that the child is able to sit with support and has started to crawl.
      Which is the single most appropriate initial intervention?

      Your Answer: Offer reassurance

      Correct Answer: Refer to Paediatrics

      Explanation:

      Referral and Support for Children with Developmental Delays

      Children who present with delays in their development require a thorough assessment to identify the underlying cause. In cases where delays are observed in one area, such as fine motor development, a full developmental assessment with a Paediatrician is recommended. The Paediatrician can then refer the child to other services, such as Physiotherapy, Audiology, and Speech and Language Therapy, as needed.

      Concerns regarding hearing, speech, and language development should prompt a referral to Audiology. While congenital hearing problems are usually detected via newborn screening tests, it is important to consider hearing loss in children presenting with developmental concerns.

      Offering reassurance is not always sufficient, especially if a child is unable to reach out for objects by six months. In such cases, further assessment is necessary.

      Health Visitors play a crucial role in monitoring children with developmental concerns and offering support to parents. Parents can contact the Health Visiting service directly without a referral from primary care.

      Physiotherapy can be helpful in children presenting with delays in gross motor development. However, for children with concerns regarding fine motor development, a review by a Paediatrician is necessary before considering a referral to Physiotherapy.

    • This question is part of the following fields:

      • Children And Young People
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  • Question 10 - You are reviewing a 16-year-old girl with a diagnosis of mild depression. She...

    Incorrect

    • You are reviewing a 16-year-old girl with a diagnosis of mild depression. She has no past or current history of self harm or suicidal thoughts. She was initially seen six weeks ago and is being reviewed today for the second time over this period.

      You discuss her symptoms and things are unchanged from when she was last seen four weeks ago with persistence of the mild depression. She tells you that she cannot see herself improving and is keen to engage with any help that may be appropriate.

      What is the most appropriate approach in this instance?

      Your Answer: Consider starting fluoxetine

      Correct Answer: Offer psychological therapy in the form of individual non-directive supportive therapy, group cognitive therapy behavioural therapy, or guided self-help

      Explanation:

      NICE Guidance on Depression in Children and Young People

      NICE has released guidance on how to manage depression in children and young people. For those presenting with mild depression, a ‘watchful waiting’ approach should be taken, with a further assessment arranged two weeks later. If the depression persists after up to four weeks of watchful waiting, psychological therapies such as individual non-directive supportive therapy, group cognitive behavioural therapy, or guided self-help can be offered for a limited period of around two to three months. Antidepressant medication should not be used at this stage. If the mild depression remains unresponsive to psychological therapies after two to three months, referral to tier 2-3 CAMHS can be made for further assessment and management. This guidance aims to provide a structured approach to managing depression in children and young people, ensuring that appropriate interventions are offered at the right time.

    • This question is part of the following fields:

      • Children And Young People
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Children And Young People (4/10) 40%
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