more

Question 1

A four year old boy presents with a bumpy, red rash over his buttocks and pain in his knees. This had occurred around two weeks after an upper respiratory tract infection.
What is the most likely diagnosis?

Answer 1

HSP - HSP consists of a typical symmetrical, palpable, maculopapular rash over the buttocks and extensor surfaces of the arms and legs, arthralgia, abdominal pain, oedema and glomerulonephritis

Question 2

what causes mesenteric adenines

Answer 2

Yersinia enterocolitica
This patient has mesenteric adenitis. This is a diagnosis of exclusion. Yersinia enterocolitica is the most likely to cause mesenteric adenitis. Mesenteric adenitis is a self-limiting condition.

Question 3

impetigo treatment for bullous and non bullous

Answer 3

Fluclox, or clarithro if pen allergy when bullous

non bullous = topical fusidic acid and hydrogen peroxide 1%

Question 4

whooping cough treatment

Answer 4

azithromycin for 5 days

Question 5

praeder willi chromosome

Answer 5

15

Question 6

sickle cell puts you at risk of

Answer 6

salmonella osteomyelitis

Question 7

branchial cyst content

Answer 7

cholesterol crystals

Question 8

management of swallowed small lego

Answer 8

Most small, non-sharp, ingested foreign objects, such as a LEGO brick, will pass through the gastrointestinal tract uneventfully. The object is already below the diaphragm on the X-ray, indicating it has passed the oesophagus and stomach. Since the child is asymptomatic, no intervention is needed. Parents should be advised to monitor for symptoms such as abdominal pain, vomiting, or failure to pass the object within a few days, and to return if these occur. Although there are no clear unified NICE guidelines on ingested foreign bodies, this is a helpful summary.

Question 9

exotropia Mx

Answer 9

refer to opthamology to rule out space occupying lesion (amblyopia is treated with patch)

Question 10

A baby born post-term is delivered and immediately in respiratory distress with low APGAR scores. The mother has no past medical history but was taking medication for pre-eclampsia during the pregnancy. A portable chest x-ray is taken.
What is the x-ray most likely to show?

Answer 10

Bilateral patchy infiltrates
Respiratory distress in a post-term baby with a history of maternal pre-eclampsia raises suspicion for meconium aspiration syndrome (MAS). In MAS, meconium-stained amniotic fluid is aspirated, leading to chemical pneumonitis, airway obstruction, and alveolar collapse. A chest X-ray typically shows bilateral patchy infiltrates, with areas of atelectasis and hyperinflation.

Question 11

what is bacterial tracheitis

Answer 11

epiglottitis

Question 12

epiglottitis causes

Answer 12

haem infl, staph aureus if vaccinated

Question 13

A 3-day-old female neonate presents to the Emergency Department with significant abdominal distension and bilious vomiting. The mother informs you that she has not yet passed meconium.
On examination, the baby appears lethargic and dehydrated. A fever of 38.1 °C is noted.
What is the definitive management for her underlying condition?

Answer 13

Bowel surgery
The presentation above suggests a diagnosis of Hirschsprung’s disease. This patient has some of the red-flag features of constipation: bilious vomiting and not passing meconium within 48 h of birth. Two of the most common causes of failing to pass meconium are cystic fibrosis or Hirschsprung’s disease.
Hirschsprung’s disease is a congenital condition in which the myenteric plexus which forms the enteric nervous system has not developed properly. This leads to segments of aganglionic bowel where there are no parasympathetic nerve cells and thus those areas cannot undergo peristalsis, subsequently causing obsrtuction. Definitive management requires surgical removal of the aganglionic bowel segment.

Question 14

chance of a second febrile seizure

Answer 14

30-40%

Question 15

A 15 year old girl has developed a rash on her face and hands. The rash is non-pruritic. She reports feeling weak and lethargic over the last two weeks. She has felt feverish but has not checked her temperature. She is otherwise well. Which serological marker will be presently raised

Answer 15

Erythrocyte sedimentation rate (ESR)
The rash is a malar rash with eyelid involvement, characteristic of juvenile dermatomyositis (JDM). ~50% of patients with JDM are positive for auto-antibodies but they are myositis specific ones. Even with the the antibody profile, ESR is still most likely to be raised in an untreated patient

Question 16

measles Ix

Answer 16

If after 3 days then Measles-specific immunoglobulin M (IgM) and IgG serology, if rash 48 hours prior then PCR for measles mRNA

Question 17

A 2-year old boy presents with abdominal pain, bilious vomiting and rectal bleeding. On examination his abdomen appears distended and is tender to palpation worst in the midline and right iliac fossa. An abdominal ultrasound shows a small fluid filled pouch off the distal small intestine.
What is the most likely diagnosis?

Answer 17

meckels diverticulum, often presents in toddlers

Question 18

crying before collapse

Answer 18

Breath-holding spells, characterised by crying, collapse, cyanosis, and rapid recovery, are self-limiting events with no increased risk of epilepsy or behavioural problems.

often following trauma

Question 19

oligoarticular JIA with 4 or less joints involved

Answer 19

intra articular methyl prednisolone acetate injections

Answer 20

Anti-tissue transglutaminase (tTG) IgA antibody

This is a classical presentation of coeliac disease. The rash is known as dermatitis herpetiformis. Coeliac is associated with other autoimmune conditions such as type 1 diabetes mellitus and autoimmune thyroid disease.

Total IgA should also be performed incase they are IgA deficient and would have a false negative of the above

Question 21

children GCS

Answer 21