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  • Question 1 - The parents of a 7-year-old boy seek your consultation regarding their son's lifelong...

    Correct

    • The parents of a 7-year-old boy seek your consultation regarding their son's lifelong bed wetting problem. They are worried that the issue is not improving despite his age. The boy has never had any daytime accidents and has regular bowel movements. He was potty-trained at the age of 3 and has no relevant family history except for hay fever. Physical examination shows no abnormalities, and urinalysis is normal. The parents are particularly concerned as their son is going on a camping trip with his friend's parents in 2 weeks, and they do not want him to wet the bed. What is the most appropriate management plan?

      Your Answer: Give general advice on enuresis, reassure the parents that he is almost certain to grow out of the problem and prescribe desmopressin to be taken during the camping trip to prevent bedwetting

      Explanation:

      Managing Primary Enuresis in Children: Advice and Treatment Options

      Primary enuresis, or bedwetting, is a common condition affecting 15-20% of children. It is characterized by nocturnal enuresis without daytime symptoms and is thought to be caused by bladder dysfunction. However, parents can be reassured that most children will grow out of the problem by the age of 15, with only 1% continuing to have symptoms into adulthood.

      The first-line treatment for primary enuresis without daytime symptoms is an enuresis alarm combined with a reward system. Fluid should not be restricted, and the child should be involved in the management plan. However, if short-term control is required, a prescription of desmopressin can be given to children over 5 years of age.

      It is important to refer children to a pediatric urologist if they have primary enuresis with daytime symptoms or if two complete courses of either an enuresis alarm or desmopressin have failed to resolve the child’s symptoms.

      Overall, while there may be little that can be done to cure the problem prior to a camping trip, there are still treatment options available to manage primary enuresis in children.

    • This question is part of the following fields:

      • Paediatrics
      32.3
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  • Question 2 - What is the most suitable method to confirm a diagnosis of pertussis in...

    Incorrect

    • What is the most suitable method to confirm a diagnosis of pertussis in children?

      Your Answer: Throat swab

      Correct Answer: Per nasal swab

      Explanation:

      Whooping Cough: Causes, Symptoms, Diagnosis, and Management

      Whooping cough, also known as pertussis, is a contagious disease caused by the bacterium Bordetella pertussis. It is commonly found in children, with around 1,000 cases reported annually in the UK. The disease is characterized by a persistent cough that can last up to 100 days, hence the name cough of 100 days.

      Infants are particularly vulnerable to whooping cough, which is why routine immunization is recommended at 2, 3, 4 months, and 3-5 years. However, neither infection nor immunization provides lifelong protection, and adolescents and adults may still develop the disease.

      Whooping cough has three phases: the catarrhal phase, the paroxysmal phase, and the convalescent phase. The catarrhal phase lasts around 1-2 weeks and presents symptoms similar to a viral upper respiratory tract infection. The paroxysmal phase is characterized by a severe cough that worsens at night and after feeding, and may be accompanied by vomiting and central cyanosis. The convalescent phase is when the cough subsides over weeks to months.

      To diagnose whooping cough, a person must have an acute cough that has lasted for 14 days or more without another apparent cause, and have one or more of the following features: paroxysmal cough, inspiratory whoop, post-tussive vomiting, or undiagnosed apnoeic attacks in young infants. A nasal swab culture for Bordetella pertussis is used to confirm the diagnosis, although PCR and serology are increasingly used.

      Infants under 6 months with suspected pertussis should be admitted, and in the UK, pertussis is a notifiable disease. An oral macrolide, such as clarithromycin, azithromycin, or erythromycin, is indicated if the onset of the cough is within the previous 21 days to eradicate the organism and reduce the spread. Household contacts should be offered antibiotic prophylaxis, although antibiotic therapy has not been shown to alter the course of the illness. School exclusion is recommended for 48 hours after commencing antibiotics or 21 days from onset of symptoms if no antibiotics are given.

      Complications of whooping cough include subconjunctival haemorrhage, pneumonia, bronchiectasis, and

    • This question is part of the following fields:

      • Paediatrics
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  • Question 3 - A 7-year-old boy is presented to the Emergency department with a sudden onset...

    Correct

    • A 7-year-old boy is presented to the Emergency department with a sudden onset of limping. He denies any history of injury, but experiences pain in his right hip with any movement. Additionally, his temperature is 37.5°C. What investigation would have the greatest impact on your management plan in the next few hours?

      Your Answer: Full blood count (FBC) and C reactive protein (CRP)

      Explanation:

      Assessing Orthopaedic Infection Risk in Limping Children

      In order to assess the risk of orthopaedic infection in a limping child, it is important to consider the most likely diagnoses, which include septic arthritis, osteomyelitis, and trauma. If the child is apyrexial, the risk of septic arthritis is low, but it is still important to measure inflammatory markers and white cell count before considering further testing. If these markers are elevated, blood cultures should be taken and an ultrasound scan performed to look for an effusion that could be aspirated. If the markers are normal, the diagnosis is likely to be transient synovitis of the hip.

      In older apyrexial children, bilateral AP hip x-rays may be performed to investigate for slipped upper femoral epiphysis, although this is rare in children under 8 years old. By carefully assessing the child’s symptoms and conducting appropriate tests, healthcare professionals can accurately diagnose and treat orthopaedic infections in limping children.

    • This question is part of the following fields:

      • Paediatrics
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  • Question 4 - A 5-year-old girl is brought to the emergency department with difficulty breathing. Since...

    Correct

    • A 5-year-old girl is brought to the emergency department with difficulty breathing. Since yesterday, she has developed a fever (38.5ºC) and become progressively short of breath. On examination, she appears unwell with stridor and drooling. Her past medical history is otherwise unremarkable.
      What is the most probable causative organism for this presentation?

      Your Answer: Haemophilus influenzae B

      Explanation:

      Acute epiglottitis is a rare but serious infection caused by Haemophilus influenzae B (HiB) bacteria. It is characterized by a sudden onset of fever, stridor, and drooling due to inflammation of the epiglottis. It is important to keep the affected child calm and seek specialist input from anaesthetics and paediatrics. In the UK, the current vaccination against HiB has made epiglottitis uncommon. Bordetella pertussis, Streptococcus pneumoniae, and Parainfluenza virus are incorrect answers as they do not produce the same presentation as acute epiglottitis.

      Acute epiglottitis is a rare but serious infection caused by Haemophilus influenzae type B. It is important to recognize and treat it promptly as it can lead to airway obstruction. Although it was once considered a disease of childhood, it is now more common in adults in the UK due to the immunization program. The incidence of epiglottitis has decreased since the introduction of the Hib vaccine. Symptoms include a rapid onset, high temperature, stridor, drooling of saliva, and a tripod position where the patient leans forward and extends their neck to breathe easier. Diagnosis is made by direct visualization, but x-rays may be done to rule out a foreign body.

      Immediate senior involvement is necessary, including those who can provide emergency airway support such as anaesthetics or ENT. Endotracheal intubation may be necessary to protect the airway. It is important not to examine the throat if epiglottitis is suspected due to the risk of acute airway obstruction. The diagnosis is made by direct visualization, but only senior staff who are able to intubate if necessary should perform this. Treatment includes oxygen and intravenous antibiotics.

    • This question is part of the following fields:

      • Paediatrics
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  • Question 5 - A 6-week-old baby girl is brought to her pediatrician's office by her mother...

    Correct

    • A 6-week-old baby girl is brought to her pediatrician's office by her mother who is worried about her poor feeding over the past 24 hours. The mother has noticed that the baby feels warm but has not observed any signs of cough or cold. The baby is scheduled to receive her vaccinations next week. She has had a wet and dirty diaper today and her urine has a strong odor.

      During the examination, the baby has a fever of 38.9ºC and is fussy, but her chest and abdomen appear normal.

      What is the most appropriate course of action for this infant?

      Your Answer: Admit same day to the paediatrics ward for assessment

      Explanation:

      If a child under 3 months old is suspected to have a UTI, it is important to refer them to specialist paediatrics services. In the case of a baby with a persistent fever and no clear source of infection, a urine sample should be collected to check for a UTI. It is important to note that a raised temperature alone is considered a red sign according to NICE guidance for assessing fever in children, and the child should be referred for urgent paediatric assessment. It would be inappropriate to reassure the mother that this is just a virus and can be managed at home, and using paracetamol to manage the fever would not be acceptable in this case. While antibiotics may treat the infection, waiting a week for a review could be dangerous for an unwell child who may deteriorate rapidly. Referring the child for a routine review with paediatrics would also not be appropriate, as urgent attention is required. While a health visitor may be helpful for feeding issues, the short history of poor feeding and fever suggests that the baby is struggling to feed due to illness, and this would not address the current presentation.

      Urinary tract infections (UTI) are more common in boys until 3 months of age, after which the incidence is substantially higher in girls. Presentation in childhood depends on age, with infants showing poor feeding, vomiting, and irritability, younger children showing abdominal pain, fever, and dysuria, and older children showing dysuria, frequency, and haematuria. NICE guidelines recommend checking urine samples in children with symptoms or signs suggestive of a UTI, unexplained fever of 38°C or higher, or an alternative site of infection but who remain unwell. Urine collection should be done through clean catch or urine collection pads, and invasive methods should only be used if non-invasive methods are not possible. Management includes referral to a paediatrician for infants less than 3 months old, admission to hospital for children aged more than 3 months old with an upper UTI, and oral antibiotics for 3-10 days for children aged more than 3 months old with a lower UTI. Antibiotic prophylaxis is not given after the first UTI but should be considered with recurrent UTIs.

    • This question is part of the following fields:

      • Paediatrics
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  • Question 6 - A 3-year-old girl is brought to her pediatrician due to frequent respiratory infections...

    Correct

    • A 3-year-old girl is brought to her pediatrician due to frequent respiratory infections that have resulted in hospitalization. Her parents have also noticed a decrease in her weight from the 50th to the 25th percentile on the growth chart. She was born at term with a normal birth weight. During the physical examination, the pediatrician observes the presence of nasal polyps. What is the probable underlying condition?

      Your Answer: Cystic fibrosis

      Explanation:

      Consideration of cystic fibrosis is warranted when a child experiences recurrent serious respiratory tract infections and weight loss, particularly if nasal polyps are present. While bronchiolitis may lead to hospitalisations and potential weight loss due to poor feeding, it is not associated with nasal polyps. Bronchopulmonary dysplasia typically affects premature infants with low birth weights and is not linked to nasal polyps. Neglect is not a factor in this scenario, and the presence of nasal polyps suggests an underlying medical condition.

      Cystic Fibrosis: Symptoms and Characteristics

      Cystic fibrosis is a genetic disorder that affects various organs in the body, particularly the lungs and digestive system. The symptoms of cystic fibrosis can vary from person to person, but there are some common features that are often present. In the neonatal period, around 20% of infants with cystic fibrosis may experience meconium ileus, which is a blockage in the intestine caused by thick, sticky mucous. Prolonged jaundice may also occur, but less commonly. Recurrent chest infections are a common symptom, affecting around 40% of patients. Malabsorption is another common feature, with around 30% of patients experiencing steatorrhoea (excessive fat in the stool) and failure to thrive. Liver disease may also occur in around 10% of patients.

      It is important to note that while many patients are diagnosed with cystic fibrosis during newborn screening or early childhood, around 5% of patients are not diagnosed until after the age of 18. Other features of cystic fibrosis may include short stature, diabetes mellitus, delayed puberty, rectal prolapse (due to bulky stools), nasal polyps, male infertility, and female subfertility. Overall, the symptoms and characteristics of cystic fibrosis can vary widely, but early diagnosis and treatment can help manage the condition and improve quality of life.

    • This question is part of the following fields:

      • Paediatrics
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  • Question 7 - A 12-year-old boy comes to see his GP complaining of hip and knee...

    Correct

    • A 12-year-old boy comes to see his GP complaining of hip and knee pain on one side. He reports that the pain started 2 weeks ago after he was tackled while playing football. His limp has become more pronounced recently. During the examination, the doctor notes a reduced ability to internally rotate the leg when flexed. The boy has no fever and his vital signs are stable. What is the probable diagnosis?

      Your Answer: Slipped capital femoral epiphysis

      Explanation:

      Slipped capital femoral epiphysis is often associated with a loss of internal rotation of the leg in flexion. Acute transient synovitis is an incorrect answer as it typically resolves within 1-2 weeks and is often preceded by an upper respiratory infection. Developmental dysplasia of the hip is typically diagnosed in younger children and can be detected using the Barlow and Ortolani tests. While Perthes’ disease is a possibility, the loss of internal rotation of the leg in flexion makes slipped capital femoral epiphysis a more likely diagnosis. Septic arthritis would present with a fever and may result in difficulty bearing weight.

      Slipped Capital Femoral Epiphysis: A Rare Hip Condition in Children

      Slipped capital femoral epiphysis, also known as slipped upper femoral epiphysis, is a rare hip condition that primarily affects children between the ages of 10 and 15. It is more commonly seen in obese boys. This condition is characterized by the displacement of the femoral head epiphysis postero-inferiorly, which may present acutely following trauma or with chronic, persistent symptoms.

      The most common symptoms of slipped capital femoral epiphysis include hip, groin, medial thigh, or knee pain and loss of internal rotation of the leg in flexion. In some cases, a bilateral slip may occur. Diagnostic imaging, such as AP and lateral (typically frog-leg) views, can confirm the diagnosis.

      The management of slipped capital femoral epiphysis typically involves internal fixation, which involves placing a single cannulated screw in the center of the epiphysis. However, if left untreated, this condition can lead to complications such as osteoarthritis, avascular necrosis of the femoral head, chondrolysis, and leg length discrepancy.

      In summary, slipped capital femoral epiphysis is a rare hip condition that primarily affects children, especially obese boys. It is characterized by the displacement of the femoral head epiphysis postero-inferiorly and can present with various symptoms. Early diagnosis and management are crucial to prevent complications.

    • This question is part of the following fields:

      • Paediatrics
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  • Question 8 - You assist in the delivery of a newborn in the neonatal unit. At...

    Incorrect

    • You assist in the delivery of a newborn in the neonatal unit. At 5 minutes, the baby's heart rate is 120 bpm, the baby is crying vigorously with active movement in all extremities. The baby is coughing and sneezing. The body is pink but the hands and feet are slightly blue and cool to the touch. Determine the APGAR score.

      Your Answer: 7

      Correct Answer: 9

      Explanation:

      The Apgar score is a tool used to evaluate the health of a newborn baby. It is recommended by NICE to be assessed at 1 and 5 minutes after birth, and again at 10 minutes if the initial score is low. The score is based on five factors: pulse, respiratory effort, color, muscle tone, and reflex irritability. A score of 0-3 is considered very low, 4-6 is moderate low, and 7-10 indicates that the baby is in good health. The score helps healthcare professionals quickly identify any potential issues and provide appropriate care.

    • This question is part of the following fields:

      • Paediatrics
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  • Question 9 - A 6-month-old female infant is found to have a clicky left hip during...

    Incorrect

    • A 6-month-old female infant is found to have a clicky left hip during a routine check-up. What is the most suitable test to conduct?

      Your Answer: Ultrasound

      Correct Answer: X-ray

      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 bilateral in 20% of cases. Screening for DDH is recommended for infants with certain risk factors, and all infants are screened using the Barlow and Ortolani tests at the newborn and six-week baby check. Clinical examination includes testing for leg length symmetry, restricted hip abduction, and knee level when hips and knees are flexed. Ultrasound is used to confirm the diagnosis if clinically suspected, but x-ray is the first line investigation for infants over 4.5 months. Management includes the use of a Pavlik harness for children under 4-5 months and surgery for older children with unstable hips.

    • This question is part of the following fields:

      • Paediatrics
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  • Question 10 - As an FY2 doctor in the Paediatric Emergency Department, you encounter an 8-month-old...

    Correct

    • As an FY2 doctor in the Paediatric Emergency Department, you encounter an 8-month-old girl who has been brought in after experiencing rectal bleeding. According to her parents, she has been suffering from abdominal pain since this morning, drawing her legs up into the fetal position, and has had little appetite, which is unusual for her. She vomited three times and then passed bloody stools, which were described as jelly-like red and slimy. The child has been weaned for the past 2 months and only given baby food. Upon examination, you notice right lower abdominal tenderness, dehydrated mucous membranes, and a vague mass in her right lower abdomen. What is the most probable diagnosis?

      Your Answer: Intussusception

      Explanation:

      Common Causes of Gastrointestinal Issues in Toddlers

      Gastrointestinal issues in toddlers can be caused by a variety of factors. Here are some common causes and their symptoms:

      1. Intussusception: This condition is characterized by slimy or jelly-like red stools, abdominal pain, and a palpable mass or fullness. It is most common in toddlers aged around 9-12 months old and is diagnosed with an ultrasound scan. Treatment usually involves an air enema, but surgery may be required in complicated cases.

      2. Campylobacter-related gastroenteritis: This bacterial infection is rare in toddlers and is even more unlikely if the child only consumes baby food.

      3. Colon cancer: Colorectal cancer is almost unheard of in this age group.

      4. Hirschsprung’s disease: This congenital condition causes bowel obstruction, with the child vomiting and not passing stools. It usually occurs in very young neonates and is diagnosed with a rectal biopsy. Treatment involves surgically removing the affected part of the bowel.

      5. Pyloric stenosis: This condition causes forceful projectile vomiting immediately after feeds and usually occurs within the first 4 weeks of birth. It is diagnosed with ultrasound imaging and is treated surgically with a pyloromyotomy.

      It is important to seek medical attention if your toddler is experiencing any gastrointestinal symptoms.

    • This question is part of the following fields:

      • Paediatrics
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  • Question 11 - The pediatrician is asked to review a 4 hour old term baby by...

    Correct

    • The pediatrician is asked to review a 4 hour old term baby by the nurse. The mother had no antenatal concerns and was not on any medication during pregnancy. The baby has not yet latched to the breast and appears lethargic. A heel prick blood sugar test was done and the result was as follows:
      Glucose 2.5 mmol/L (4.0-5.9)

      Upon examination, the baby was easily rousable and had a good suck. He had normal tone and cardiovascular examination was unremarkable. However, he had not passed urine or opened his bowels yet.

      What should be the first step in the pediatrician's management plan for this baby?

      Your Answer: Ask the breastfeeding support team to come and support mum and baby with attempting a further feed now

      Explanation:

      It is common for newborns to experience transient hypoglycemia in the first few hours after birth. If a mother wishes to breastfeed, she should be provided with support and guidance on proper latching techniques and encouraged to engage in skin-to-skin contact with her baby. If the baby is having difficulty feeding, the mother can be taught how to hand express and provide colostrum through alternative methods. Blood glucose levels should be monitored before and after each feeding, without more than three hours between feeds. If the baby is asymptomatic, buccal glucose can be administered in conjunction with a feeding plan. However, if the baby has not yet had a feed and is mildly hypoglycemic, action should be taken and blood sugar levels should be checked again prior to the next feeding. It is important to provide mothers with information and support to encourage breastfeeding, rather than immediately suggesting formula feeding for a well, asymptomatic term baby. These guidelines are based on the BAPM Framework for Practice’s Identification and Management of Neonatal Hypoglycemia in the Full Term Infant (2017).

      Neonatal Hypoglycaemia: Causes, Symptoms, and Management

      Neonatal hypoglycaemia is a common condition in newborn babies, especially in the first 24 hours of life. While there is no agreed definition, a blood glucose level of less than 2.6 mmol/L is often used as a guideline. Transient hypoglycaemia is normal and usually resolves on its own, but persistent or severe hypoglycaemia may be caused by various factors such as preterm birth, maternal diabetes mellitus, IUGR, hypothermia, neonatal sepsis, inborn errors of metabolism, nesidioblastosis, or Beckwith-Wiedemann syndrome.

      Symptoms of neonatal hypoglycaemia can be autonomic, such as jitteriness, irritability, tachypnoea, and pallor, or neuroglycopenic, such as poor feeding/sucking, weak cry, drowsiness, hypotonia, and seizures. Other features may include apnoea and hypothermia. Management of neonatal hypoglycaemia depends on the severity of the condition and whether the newborn is symptomatic or not. Asymptomatic babies can be encouraged to feed normally and have their blood glucose monitored, while symptomatic or severely hypoglycaemic babies may need to be admitted to the neonatal unit and receive intravenous infusion of 10% dextrose.

    • This question is part of the following fields:

      • Paediatrics
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  • Question 12 - A 28-year-old primiparous woman delivers her first child via caesarean section at 38...

    Incorrect

    • A 28-year-old primiparous woman delivers her first child via caesarean section at 38 weeks. Both the mother and baby are in good health after delivery, and there are no complications during the postoperative period. As part of the routine post-birth checks, a sample of umbilical cord blood is collected and analysed, revealing a glucose level of 2.4 mmol/L. What is the appropriate course of action?

      Your Answer: No action necessary

      Correct Answer: Encourage early feeding and monitor blood glucose

      Explanation:

      For neonatal hypoglycaemia, the correct course of action is to encourage early feeding and monitor blood glucose. Asymptomatic hypoglycaemia is common in newborns and not a cause for concern. Therefore, encouraging early feeding, either through bottle or breast, and monitoring blood glucose until it normalizes is sufficient. Admitting the baby to the neonatal unit for further monitoring is unnecessary at this point, as observations are normal and the baby is doing well. Monitoring blood glucose alone is not enough, as feeding is necessary for the glucose levels to normalize. No action is not an option, as it is important to take steps to resolve the hypoglycaemic episode, even if it is mild and asymptomatic.

      Neonatal Hypoglycaemia: Causes, Symptoms, and Management

      Neonatal hypoglycaemia is a common condition in newborn babies, especially in the first 24 hours of life. While there is no agreed definition, a blood glucose level of less than 2.6 mmol/L is often used as a guideline. Transient hypoglycaemia is normal and usually resolves on its own, but persistent or severe hypoglycaemia may be caused by various factors such as preterm birth, maternal diabetes mellitus, IUGR, hypothermia, neonatal sepsis, inborn errors of metabolism, nesidioblastosis, or Beckwith-Wiedemann syndrome.

      Symptoms of neonatal hypoglycaemia can be autonomic, such as jitteriness, irritability, tachypnoea, and pallor, or neuroglycopenic, such as poor feeding/sucking, weak cry, drowsiness, hypotonia, and seizures. Other features may include apnoea and hypothermia. Management of neonatal hypoglycaemia depends on the severity of the condition and whether the newborn is symptomatic or not. Asymptomatic babies can be encouraged to feed normally and have their blood glucose monitored, while symptomatic or severely hypoglycaemic babies may need to be admitted to the neonatal unit and receive intravenous infusion of 10% dextrose.

    • This question is part of the following fields:

      • Paediatrics
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  • Question 13 - A 14-year-old high school student comes to your office with symptoms of depression....

    Correct

    • A 14-year-old high school student comes to your office with symptoms of depression. During the consultation, she reveals that she has been bullied for having sex with an 18-year-old boy in the same school. The sexual encounter was consensual and occurred only once, without the influence of drugs or alcohol.

      What is the best immediate step to take?

      Your Answer: You should disclose that this girl has been sexually active to the relevant authority

      Explanation:

      When it comes to sexual issues involving young people, the topics of consent and confidentiality can be challenging. However, in this particular case, there is no ambiguity. Legally, individuals under the age of 13 are incapable of giving consent for sexual activity. Therefore, it is typically necessary to disclose this information. If there is a decision to withhold this information, it should be discussed with a designated doctor for child protection and documented appropriately. This is an uncommon occurrence. As the patient is under 13, she is unable to provide consent for sexual activity. While it may be necessary to discuss the situation with the patient’s mother, this is not the most urgent responsibility. The primary duty is to report the incident to the appropriate authority, and it cannot be left in the hands of the patient.

      Guidelines for Obtaining Consent in Children

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

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

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

    • This question is part of the following fields:

      • Paediatrics
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  • Question 14 - A 3-day-old neonate was discovered to be cyanosed with a PaO2 of 2...

    Correct

    • A 3-day-old neonate was discovered to be cyanosed with a PaO2 of 2 kPa on umbilical artery blood sampling. Upon auscultation of the chest, a murmur with a loud S2 was detected, and a chest X-ray revealed a narrow upper mediastinum with an ‘egg-on-side’ appearance of the cardiac shadow. To save the infant's life, a balloon atrial septostomy was performed. What is the probable diagnosis?

      Your Answer: Transposition of the great arteries (TGA)

      Explanation:

      Transposition of the great arteries (TGA) is a congenital heart condition where the aorta and pulmonary arteries are switched, resulting in central cyanosis and a loud single S2 on cardiac auscultation. Diagnosis is made with echocardiography and management involves keeping the ductus arteriosus patent with intravenous prostaglandin E1, followed by balloon atrial septostomy and reparative surgery. Patent ductus arteriosus is the failure of closure of the fetal connection between the descending aorta and pulmonary artery, which can be treated with intravenous indomethacin, cardiac catheterisation, or ligation. Hypoplastic left heart syndrome is a rare condition where the left side of the heart and aorta are underdeveloped, requiring a patent ductus arteriosus for survival. Interruption of the aortic arch is a very rare defect requiring prostaglandin E1 and surgical anastomosis. Tetralogy of Fallot is the most common cyanotic congenital heart disease, characterized by four heart lesions and symptoms such as progressive cyanosis, difficulty feeding, and Tet spells. Diagnosis is made with echocardiography and surgical correction is usually done in the first 2 years of life.

    • This question is part of the following fields:

      • Paediatrics
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  • Question 15 - Which diagnostic test is most effective in identifying the initial stages of Perthes'...

    Incorrect

    • Which diagnostic test is most effective in identifying the initial stages of Perthes' disease?

      Your Answer: Plain x ray

      Correct Answer: MRI

      Explanation:

      Legg-Calvé-Perthes’ Disease: Diagnosis and Imaging

      Legg-Calvé-Perthes’ disease is a condition where the femoral head undergoes osteonecrosis, or bone death, without any known cause. The diagnosis of this disease can be established through plain x-rays of the hip, which are highly useful. However, in the early stages, MRI and contrast MRI can provide more detailed information about the extent of necrosis, revascularization, and healing. On the other hand, a nuclear scan can provide less detail and expose the child to radiation. Nevertheless, a technetium 99 bone scan can be helpful in identifying the extent of avascular changes before they become evident on plain radiographs.

      In summary, Legg-Calvé-Perthes’ disease is a condition that can be diagnosed through plain x-rays of the hip. However, MRI and contrast MRI can provide more detailed information in the early stages, while a technetium 99 bone scan can help identify the extent of avascular changes before they become evident on plain radiographs. It is important to consider the risks and benefits of each imaging modality when diagnosing and monitoring this disease.

    • This question is part of the following fields:

      • Paediatrics
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  • Question 16 - A 6-year-old boy fell off his bike and now has an angled left...

    Incorrect

    • A 6-year-old boy fell off his bike and now has an angled left elbow. His left hand feels cold and there are no detectable brachial, radial, or ulnar pulses. An X-ray of the elbow reveals a displaced humeral supracondylar fracture on the left side (Milch Type 1/Gartland II). What is the most suitable initial course of action?

      Your Answer: Backslab plaster and review in fracture clinic

      Correct Answer: Closed reduction and percutaneous pinning of the fracture

      Explanation:

      Complications and Management of Supracondylar Fractures

      Supracondylar fractures can lead to various complications, including vascular and nerve injuries, compartment syndrome, and malunion. Arterial injury is a common complication, occurring in 5% of fractures, and can result from the brachial artery becoming kinked or lacerated. It is important to carefully check and record the distal circulation in the patient’s notes.

      Initial management of supracondylar fractures involves providing analgesia and performing an emergency reduction of the fracture to restore the brachial artery’s unkinking and distal blood flow. Displaced fractures are typically treated with percutaneous pinning. However, if blood flow is not restored, a vascular surgeon should perform a surgical exploration of the brachial artery.

      Lacerations of the artery can be repaired either primarily with sutures or with a vein graft. It is crucial to address complications promptly to prevent further damage and ensure proper healing. By the potential complications and appropriate management strategies, healthcare professionals can provide optimal care for patients with supracondylar fractures.

    • This question is part of the following fields:

      • Paediatrics
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  • Question 17 - A mother brings her 8-week-old baby to the GP clinic for their routine...

    Incorrect

    • A mother brings her 8-week-old baby to the GP clinic for their routine 7-week check-up. The baby appears happy and responsive during the assessment. During the examination, you observe weak femoral pulses on both sides. The rest of the examination is normal.

      What is the most suitable course of action to take?

      Your Answer: Advise the mother to take the child to the emergency department immediately

      Correct Answer: Same day discussion with paediatrics

      Explanation:

      If a baby’s femoral pulses are absent or weak during their 6-8 week check, it is important to discuss this immediately with paediatrics. Any signs of a critical or major congenital heart abnormality should also be seen urgently by a specialist. Advising the mother that these findings are normal would be inappropriate, as they are abnormal. While safety netting is important, the child should still be seen urgently by the appropriate specialist. Taking the child to the emergency department is not the best option, as they may not be equipped to deal with this issue and will likely refer to the paediatrics team themselves. Referring routinely to paediatrics or making an appointment in 2 weeks would waste valuable time in a potentially unwell child who needs urgent referral.

      Congenital heart disease can be categorized into two types: acyanotic and cyanotic. Acyanotic heart diseases are more common and include ventricular septal defects (VSD), atrial septal defect (ASD), patent ductus arteriosus (PDA), coarctation of the aorta, and aortic valve stenosis. VSD is the most common acyanotic heart disease, accounting for 30% of cases. ASDs are less common than VSDs, but they are more frequently diagnosed in adult patients as they tend to present later. On the other hand, cyanotic heart diseases are less common and include tetralogy of Fallot, transposition of the great arteries (TGA), and tricuspid atresia. Fallot’s is more common than TGA, but TGA is the more common lesion at birth as patients with Fallot’s generally present at around 1-2 months. The presence of cyanosis in pulmonary valve stenosis depends on the severity and any other coexistent defects.

    • This question is part of the following fields:

      • Paediatrics
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  • Question 18 - A 3-day-old baby has not passed meconium yet. Your consultant suspects Hirschsprung's disease...

    Incorrect

    • A 3-day-old baby has not passed meconium yet. Your consultant suspects Hirschsprung's disease and asks for your initial management plan. What would be the best initial treatment for this child until a definite diagnosis is made and more specific treatment can be given?

      Your Answer: Anorectal Pull through

      Correct Answer: Bowel Irrigation

      Explanation:

      The first step in managing Hirschsprung’s disease is to perform rectal washouts or bowel irrigation. While waiting for a full thickness rectal biopsy to confirm the diagnosis, this treatment can help the baby pass meconium. Once the diagnosis is confirmed, the definitive management is an anorectal pull through procedure. It is important to note that anorectal pull through is not the initial treatment but rather the final solution. Lactulose is not appropriate for constipation in children with Hirschsprung’s disease. Rectal biopsy is only used for diagnostic purposes.

      Understanding Hirschsprung’s Disease

      Hirschsprung’s disease is a rare condition that affects 1 in 5,000 births. It is caused by a developmental failure of the parasympathetic Auerbach and Meissner plexuses, resulting in an aganglionic segment of bowel. This leads to uncoordinated peristalsis and functional obstruction, which can present as constipation and abdominal distension in older children or failure to pass meconium in the neonatal period.

      Hirschsprung’s disease is three times more common in males and is associated with Down’s syndrome. Diagnosis is made through a rectal biopsy, which is considered the gold standard. Treatment involves initial rectal washouts or bowel irrigation, followed by surgery to remove the affected segment of the colon.

      In summary, Hirschsprung’s disease is a rare condition that can cause significant gastrointestinal symptoms. It is important to consider this condition as a differential diagnosis in childhood constipation, especially in male patients or those with Down’s syndrome. Early diagnosis and treatment can improve outcomes and prevent complications.

    • This question is part of the following fields:

      • Paediatrics
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  • Question 19 - A 9-month-old girl is brought to your clinic by her parents, reporting an...

    Correct

    • A 9-month-old girl is brought to your clinic by her parents, reporting an atypical sequence of movements observed in their daughter. They managed to record a video of the episode, and upon reviewing it, you observe mild bilateral flexion of her neck and legs, succeeded by extension of her arms. She repeats this pattern approximately 40 times before ceasing.
      What is the probable diagnosis for this scenario?

      Your Answer: Infantile spasms

      Explanation:

      Understanding Infantile Spasms

      Infantile spasms, also known as West syndrome, is a form of epilepsy that typically occurs in infants between 4 to 8 months old, with a higher incidence in male infants. This condition is often associated with a serious underlying condition and has a poor prognosis. The characteristic feature of infantile spasms is the salaam attacks, which involve the flexion of the head, trunk, and arms followed by the extension of the arms. These attacks last only 1-2 seconds but can be repeated up to 50 times.

      Infants with infantile spasms may also experience progressive mental handicap. To diagnose this condition, an EEG is typically performed, which shows hypsarrhythmia in two-thirds of infants. Additionally, a CT scan may be used to identify any diffuse or localized brain disease, which is present in 70% of cases, such as tuberous sclerosis.

      Unfortunately, infantile spasms carry a poor prognosis. However, there are treatment options available. Vigabatrin is now considered the first-line therapy, and ACTH is also used.

    • This question is part of the following fields:

      • Paediatrics
      8
      Seconds
  • Question 20 - A family planning clinic is consulted by a couple who are hoping to...

    Incorrect

    • A family planning clinic is consulted by a couple who are hoping to have another child. They previously lost their first child to Tay Sachs disease. Upon genetic testing, it is discovered that both parents are carriers of the condition. What is the likelihood that their next child will also be a carrier?

      Your Answer: 25%

      Correct Answer: 50%

      Explanation:

      There are two possible scenarios for inheriting the TSD gene. In the first scenario, known as CC, both parents pass on the TSD gene to their child. In the second scenario, known as Cc, only one parent passes on the TSD gene while the other does not. Regardless of which scenario occurs, the patient will be a carrier and heterozygous. The likelihood of either scenario occurring is 25%.

      Understanding Autosomal Recessive Inheritance

      Autosomal recessive inheritance is a genetic pattern where a disorder is only expressed when an individual inherits two copies of a mutated gene, one from each parent. This means that only homozygotes, individuals with two copies of the mutated gene, are affected. Both males and females are equally likely to be affected, and the disorder may not manifest in every generation, as it can skip a generation.

      When two heterozygote parents, carriers of the mutated gene, have children, there is a 25% chance of having an affected (homozygote) child, a 50% chance of having a carrier (heterozygote) child, and a 25% chance of having an unaffected child. On the other hand, if one parent is homozygote for the gene and the other is unaffected, all the children will be carriers.

      Autosomal recessive disorders are often metabolic in nature and can be life-threatening compared to autosomal dominant conditions. Understanding the inheritance pattern of autosomal recessive disorders is crucial in genetic counseling and family planning.

    • This question is part of the following fields:

      • Paediatrics
      10.4
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SESSION STATS - PERFORMANCE PER SPECIALTY

Paediatrics (11/20) 55%
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