MISCELLANEOUS FACTS FROM PASSMED Flashcards
Which one of the following is least likely to cause snoring in children?
Hypertrophic nasal turbinates
Tonsillitis
Obesity
Kallman’s syndrome
Down’s syndrome
Kallman’s syndrome - a cause of delayed puberty secondary to hypogonadotrophic hypogonadism. It is not associated with snoring
What are some of the causes of snoring in children?
Obesity
Nasal problems: polyps, deviated septum, hypertrophic
Nasal turbinates
Recurrent tonsillitis
Down’s syndrome
Hypothyroidism
What is the first sign of puberty in girls?
Development of pubic hair
Menstrual bleeding
Development of axillary hair
Breast development
Height spurt
Breast development
Which one of the following statements regarding the MMR vaccine is incorrect?
Malaise, fever and rash may occur after around one week
Allergy to neomycin is a contraindication
The second dose is given at 3-4 years
MMR is a live attenuated vaccine
Children who received another live vaccine 2 weeks ago can safely have MMR
Children who received another live vaccine 2 weeks ago can safely have MMR
Must leave a gap of more than 4 weeks
Which one of the following statements regarding retinoblastoma is true?
The most common presenting symptom is strabismus
70% of cases are hereditary
All cases require enucleation
The average age at diagnosis is 3 months
More than 90% of children survive to adulthood
More than 90% of children survive to adulthood
Most common diagnosis is through loss of red reflex
10% are hereditary
Alternatives to enucleation include external beam radiation therapy, chemotherapy and photocoagulation.
The average age of diagnosis is 18 months.
A 2-year-old child with a history of atopic eczema is brought to the local GP surgery. Her eczema is usually well controlled with emollients but her parents are concerned as the facial eczema has got significantly worse overnight. She now has painful clustered blisters on both cheeks, around her mouth on her neck. Her temperature is 37.9ºC. What is the most appropriate management?
Advise paracetamol + emollients and reassure
Admit to hospital
Add hydrocortisone 1%
Oral flucloxacillin
Topical fusidic acid
Admit to hospital - Eczema herpeticum is a serious condition that requires IV antivirals
Which one of the following examination findings is abnormal?
Respiratory rate of 40 / min in a 2-year-old
Heart rate of 140 bpm in a 6-month-old
Respiratory rate of 24 / min in a 10-year-old
Heart rate of 120 bpm in a 18-month-old
Heart rate of 110 bpm in a 7-year-old
Respiratory rate of 40 / min in a 2-year-old
What are the normal ranges for heart rate and resp rate in an infant (under 1 year old)?
HR – 110-160
RR – 30-40
What are the normal ranges for heart rate and resp rate in a child aged 1-2 years old?
HR – 100-150
RR – 25-35
What are the normal ranges for heart rate and resp rate in a child aged 2-5 years old?
HR – 90-140
RR – 25-30
What are the normal ranges for heart rate and resp rate in a child aged 5-12 years old?
HR – 80-120
RR – 20-25
What are the normal ranges for heart rate and resp rate in a child who is older than 12 years old?
HR – 60-100
RR – 15-20
What is the most common presenting feature of Wilms tumour?
Recurrent urinary tract infections
Abdominal mass
Fever
Loin pain
Haematuria
Abdominal mass
Which one of the following is least recognised as a side-effect of carbamazepine?
Headache
Hirsutism
Diplopia
Ataxia
Transient erythematous rash
Hirsutism is associated with phenytoin
Side effects of carbamazepine:
- P450 enzyme inducer
- dizziness and ataxia
- drowsiness
- headache
- visual disturbances (especially diplopia)
- Steven-Johnson syndrome
- leucopenia and agranulocytosis
- syndrome of inappropriate ADH secretion
You are in a genetics clinic and explaining to a mother and father the reasoning why their son has Prader-Willi syndrome. What is the term we use to describe the mode of inheritance for Prader-Willi syndrome?
Autosomal recessive
Autosomal dominant
Imprinting
Pleiotropy
Variable expressivity
Imprinting - Prader-Willi is an example of imprinting. For this disease to occur, the patient does not receive the gene from their father. The mother’s gene may be normal, but that does not prevent the phenotype occurring. The phenotype consists of learning difficulties, hypotonia, obesity and the urge to eat.
- Prader-Willi syndrome if gene deleted from father
- Angelman syndrome if gene deleted from mother
You see a 6 week-old baby boy for his routine baby check and note a small, soft, umbilical hernia on examination. What should you do?
Advise parents to tape a coin over the area
Refer for surgery
Refer for ultrasound
Watch and wait
Arrange emergency admission
Watch and wait
Small umbilical hernias are common in babies and tend to resolve by 12 months of age. Parents should be reassured no treatment is usually required but to be aware of the signs of obstruction or strangulation such as vomiting, pain and being unable to push the hernia in - this is rare in infants. Advise the parents to present the child at around 2 years of age if the hernia is still present to arrange referral to a surgeon. Attempts to treat the hernia by strapping or taping things over the area are not helpful and can irritate the skin.
An 8-year-old child is brought into the emergency department after have 5 episodes of bloody diarrhoea. Her parents say that the diarrhoea begun 3 days ago after a barbecue at a friends house but did not turn bloody till today. On examination the child is pyrexial at 38 degrees with diffuse abdominal pain. Blood test are taken which show a thrombocytopenia, raised urea, creatinine and lactate dehydrogenase.
Which of the following organisms has most likely caused this infection?
Escherichia coli
Campylobacter jejuni
Listeria monocytogenes
Norovirus
Giardia lamblia
Escherichia coli
The child is not just showing signs of food poisoning but also early signs of haemolytic uraemic syndrome.
You deliver a baby on the maternity ward. At 2 minutes, the baby’s heart rate is 110bpm, the baby is crying loudly with stimulation and moving all four limbs. The baby is pink but hands and feet are slightly blue and feel cold to the touch. What is the APGAR score?
5
7
8
9
10
In this case, the baby scores a 9 as the only point he/she misses is the fact his extremities are blue and cold to the touch. This is not unusual in babies
A 5-year-old girl is brought in to see her GP by her mother complaining of increased frequency of passing urine and dysuria. This has never happened before and she is otherwise well. The GP asks for a urine sample to be given before starting antibiotics. Pending culture results, he decides to prescribe a 3-day course of antibiotics. Which antibiotic would be most appropriate in this case?
Trimethoprim
Amoxicillin
Cefalexin
Nitrofurantoin
Clarithromycin
Trimethoprim
Nitrofurantoin is not licensed for a 3-day course. Amoxicillin resistance is common so it should ideally only be used if the culture and sensitivities show that the organism is sensitive. Cephalosporins should be avoided if more narrow-spectrum antibiotics would work due to the increased risk of MRSA, Clostridium difficile and resistant UTIs.
Which one of the following statements regarding childhood squints is correct?
Amblyopia is a sign of a paralytic squint
Divergent squints are more common than convergent squints
The corneal light reflection test is a suitable screening test
Management of the majority of childhood squints should be done in primary care
A child with a non-paralytic squint would have a degree of double vision
The corneal light reflection test is a suitable screening test
A 7-year-old boy is diagnosed with Attention Deficit Hyperactivity Disorder. What is the most appropriate dietary advice to give to his parents?
Eat a normal balanced diet + avoid artificial colourings
Eat a normal balanced diet + avoid all sugar containing products
Eat a normal balanced diet
Eat a normal balanced diet + take a fatty acid supplement unless having three portion of oily fish per week
Eat a normal balanced diet + take a multivitamin tablet
Eat a normal balanced diet
Unless a food diary has shown a link between diet and behaviour there is no basis for recommending the avoidance of artificial colourings or the use of fatty acid supplements
A 4-year-old boy is brought to the GP by his mother who states that she has noted a ‘barking’ cough a few times every day for the last two days. There has been no change to his appetite and his behaviour has not changed. The GP does not find any abnormalities on examination. Given the likely diagnosis of mild croup, what would be the first-line treatment?
Nebulised adrenaline
Oral benzylpenicillin
Oral dexamethasone
Oral prednisolone
Oral ibuprofen
Oral dexamethasone
CKS recommend giving a single dose of oral dexamethasone (0.15mg/kg) to all children regardless of severity
A 10-month-old boy is brought to surgery. Around 4 days ago he developed a fever after being irritable the previous day. The fever settled after around 3 days but following this he developed a rash, which prompted his mother to bring him to surgery. He is taking around 75% of his normal feeds, is producing wet nappies and has had two episodes of loose stools. On examination he is alert, temperature is 37.0ºC, chest is clear, ears/throat unremarkable. There are a number of blanching, rose pink macules present on his trunk. What is the most likely diagnosis?
Rubella
Chickenpox
Roseola infantum
Pityriasis rosea
Measles
Roseola infantum
Fever followed later by rash
A 3-year-old child is brought to surgery as her mother has noticed that she is ‘cross-eyed’. The corneal light reflection test confirms this. What is the most appropriate management?
Advise that referral to secondary care should be delayed until 5 years of age, when surgery may be contemplated
Refer to ophthalmology
Refer to paediatric physiotherapy for eye movement exercises
Reassure mother that the majority of squints improve with age
Advise the mother to restrict the amount of television she watches
Refer children with a squint immediately to ophthalmology