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Paeds Flashcards

1
Q

A 2y/o has episodes of falling to the ground whilst tightening and stiffening his hands, accompanied by screaming and sweating. During the episodes the child is inconsolable but between episodes the child is well with normal development. What is the most likely diagnosis?

a. Hyperactivity
b. Reflex anoxic seizure
c. Temper tantrum
d. Tonic-clonic seizure
e. Vasovagal syncope

A

c. Temper tantrum

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2
Q

5 y/o boy brought to GP with vague abdo pain. He has been having several loose bowel motions per day with occasional soiling of his underwear. His parents recall him passing a hard blood-streaked stool 5 days ago. Which is the most appropriate investigation?

a. Colonoscopy with biopsies
b. No investigations at this stage
c. Stool microscopy, culture, and sensitivity
d. Tissue transglutaminase antibody titres
e. Urgent abdominal x-ray

A

b. No investigations at this stage

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3
Q

5 y/o presents with widespread non-blanching erythematous rash over her body, after 1 week of cough and coryzal symptoms. Teperature is 37.2, pulse 95bpm, BP 90/60, RR 22, and O2 sats are 98% on room air. Urinanalysis yields no abnormalities, but FBC shows elevated WCC and a platelet count of 7 x 10^9. What is the most likely diagnosis?

a. Acute lymphoblastic leukaemia
b. Henoch-Schonlein purpura
c. Haemophilia
d. Von Willebrand disease
e. Immune thrombocytopenic purpura

A

e. Immune thrombocytopenic purpura

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4
Q

9 m/o boy is brought to A&E with vomiting and lethargy. He has a purpuric rash and bulging anterior fontanelle. His temperature is 40, HR 160, RR 55, capillary refill is 3 seconds and O2 sats are 100% on supplemental oxygen. He has no neck stiffness and Kernig’s sign is negative. What is the most likely cause?

a. Group B Streptococcal disease
b. Henoch-Schonlein purpura
c. Measles
d. Meningococcal disease
e. Viral meningitis

A

d. Meningococcal disease

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5
Q

7 y/o girl in GP practice with a 6 month history of central abdominal pain. Height and weight is growing steadily along the 50th centile. She has no other symptoms but recently has been reluctant to attend school. Abdomen SNT, temperature 36.9, HR 91, BP 98/60, RR 20, and O2 sats are 98% on room air. What is the most likely diagnosis?

a. Coeliac disease
b. Functional abdominal pain
c. Inflammatory bowel disease
d. Irritable bowel syndrome
e. Mesenteric adenitis

A

b. Functional abdominal pain

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6
Q

Boy born at 40 weeks with male phenotype, but neither testicle can be palpated on examination. What is the most likely diagnosis?

a. Androgen insensitivity syndrome
b. Excess in utero oestrogen exposure
c. Klinefelter’s syndrome
d. Physiological delay in descent
e. Retractile testes

A

d. Physiological delay in descent

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7
Q

6 m/o seen in A&E is distressed and blue around the mouth. Temperature 36.5, HR 170, RR 35, O2 sats 83% on room air. He has a loud ejection systolic murmur at the upper left sternal edge. He has dropped from the 50th to the 3rd centile for weight. What is the most likely cause of the murmur?

a. Atrial septal defect
b. Innocent murmur
c. Tetralogy of Fallot
d. Transposition of the Great Vessels
e. Ventricular septal defect

A

c. Tetralogy of Fallot

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8
Q

22 m/o child had cough and coryza for 2 days, and is now struggling with breathing. She has subcostal and intercostal recessions and widespread wheeze. Her temperature is 37.3, HR 125, RR 45, O2 sats 98% on room air. What is the most appropriate next step in her management?

a. 0.5L/min supplemental oxygen
b. 2 puffs beclomethasone inhaler
c. 10 puffs salbutamol inhaler
d. Intravenous aminophylline
e. Oral prednisolone

A

c. 10 puffs salbutamol inhaler

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9
Q

3 month old boy has 2 days of fever and crying accompanied by reduced feeding and fewer wet nappies. Temperature 38.0, HR 170, RR 38, O2 sats 97% on room air. He has reduced movement in his right leg, chest is clear, urinanalysis is normal and anterior fontanelle is slightly sunken. What is the most likely diagnosis?

a. Developmental dysplasia of the hip
b. Non-accidental injury
c. Osteomyelitis
d. Reactive arthritis
e. Sickle cell crisis

A

c. Osteomyelitis

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10
Q

3 m/o boy presents in acute respiratory failure and is diagnosed with Pneumocystis pneumonia. His parents are first cousins from Pakistan. What is the most likely underlying cause?

a. Agammaglobulinaemia
b. Chronic granulomatous disease
c. Cystic fibrosis
d. HIV infection
e. Severe combined immunodeficiency

A

e. Severe combined immunodeficiency

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11
Q

2 y/o girl with loud barking cough and stridor is finding it increasingly difficult to breathe. Temperature 38.3, HR 190bpm, RR 53, O2 sats 92% on room air. Which is the most appropriate immediate treatment?

a. Intravenous salbutamol
b. Intubation and ventilation
c. Nebulised adrenaline
d. Nebulised salbutamol
e. Oral dexamethasone

A

c. Nebulised adrenaline

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12
Q

A 19 month old girl has been able to sit unsupported for 1 month. She can speak 11 words and feed herself. She was born at 30 weeks. Which is the best description of her current development?

a. Fine motor delay
b. Gross developmental delay
c. Gross motor delay
d. Mild developmental delay
e. Normal development

A

c. Gross motor delay

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13
Q

A 3 y/o boy has pruritis ani which is worse at night. He has no abdominal pain and bowel movements are normal. He is growing well and his development is normal. What si the most appropriate course of action?

a. Chlorpheniramine solution
b. Hydrocortisone
c. Macrogol sachet
d. Mebendazole solution
e. Miconazole cream

A

d. Mebendazole solution

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14
Q

6 y/o boy’s parents have noticed long-standing hearing difficulties and take him to GP. Teachers have commented on poor school performance and behaviour. Speech is normal and there is no otalgia. The ear canals are narrow with non-occluding wax. Which is the most appropriate next step in his management?

a. Aural olive oil drops
b. Grommet insertion
c. Pure tone audiometry
d. Referral for hearing aids
e. Review in 3 months

A

Pure tone audiometry

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15
Q

3 y/o boy with an URTI has temperature of 38.5, HR 125, BP 95/60, RR 18, O2 sats 92%. Oxygen is given, then while being examined the boy develops jerky motions of his limbs which have now lasted 5 minutes continuously and he is not responding to his mother’s voice. His lips are cyanosed and he has irregular gasping respirations. There is no skin rash and his capillary blood glucose is normal at 4.5. What is the most appropriate immediate management option?

a. Buccal midazolam
b. Intramuscular benzylpenicillin
c. Intravenous glucose
d. Oral paracetamol
e. Subcutaneous adrenaline

A

a. Buccal midazolam

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16
Q

14 y/o girl seen in GP for short stature. The mid-parental height is on the 50th centile. She has no secondary sexual characteristics. She is not taking any medications and is otherwise well, and her progress at school is satisfactory. Which is the most likely diagnosis?

a. Constitutional delay
b. Familial short stature
c. Hypothyroidism
d. Pituitary tumour
e. Turner’s syndrome

A

e. Turner’s syndrome

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17
Q 
3 week old baby referred for prolonged jaundice, dark wet nappies, and pale stools. There are no developmental concerns and he is currently breastfed. Birth weight was 3.45kg and he currently weighs 3.2kg, Temperature is 37.1, HR 140, RR 45, O2 sats 98% on room air. Investigations:
Hb 110 (normal)
WCC 6 (normal)
Platelets 430 (slightly high)
Bilirubin 175 (high)
Conjugated bilirubin 100 (high)
ALP 160 (normal)
ALT 35 (normal)
Albumin 25 (lower end of normal)
Sodium 137 (normal
Potassium 4 (normal)
What is the most appropriate next step in management?
a.	Feeding advice
b.	Inpatient ultrasound
c.	I.V. antibiotics
d.	Outpatient ultrasound
e.	Phototherapy
A

b. Inpatient ultrasound

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18
Q

5 y/o boy with 2 days of fever, runny nose, cough, and sore throat. He developed a rash over the past 24 hours, temperature 39.2, HR 105, RR 30, capillary refill <2 seconds and O2 sats are 98% on room air. There is cervical lymphadenopathy, a red tongue, cracked lips, and a fine erythematous macular rash all over his body. Which is the most effective treatment?

a. Aciclovir
b. Aspirin
c. Co-amoxiclav
d. Paracetamol
e. Phenoxymethylpenicillin

A

e. Phenoxymethylpenicillin

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19
Q

18 m/o presents to GP with 1 day history of left ear pain. There is no discharge and mum reports normal number of wet nappies for that day. There is a bulging erythematous left tympanic membrane with no perforation. Temperature 38, HR 135, RR 33, O2 sats 98 on room air. What is the most appropriate management?

a. Offer simple analgesia and an immediate prescription of amoxicillin
b. Offer simple analgesia and ciprofloxacin ear drops
c. Offer simple analgesia and delayed prescription of amoxicillin
d. Offer simple analgesia and gentamicin ear drops
e. Offer simple analgesia and reassurance

A

e. Offer simple analgesia and reassurance

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20
Q

A 5 year old boy seen in GP with a rash across buttocks (see below) on a background of 4 days of cough, coryza, and mild fever, but he is otherwise generally well. Temperature 37.4, HR 105, capillary refill <1s, RR 25, O2 sats 99% on room air.
(https://dermnetnz.org/assets/Uploads/vascular/s/hsp5__WatermarkedWyJXYXRlcm1hcmtlZCJd.jpg)
What is the most likely diagnosis?

a. Discoid eczema
b. Henoch-Schonlein purpura
c. Idiopathic thrombocytopenic purpura
d. Menigiococcal septicaemia
e. Viral exanthem

A

b. Henoch-Schonlein purpura

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21
Q

A 2 y/o in GP has worsening painful rash behind the knee for 5 days. He has eczema managed with E45 cream. Temperature 37.2, HR 130, RR 30, O2 sats 98%. What is the most appropriate management?

a. Immediate referral to Paediatric A&E
b. Give oral Aciclovir for 1 week
c. Give oral Flucloxacillin for 1 week
d. Give topical dermovate
e. Give topical fusidic acid

A

a. Immediate referral to Paediatric A&E

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22
Q

A 3 y/o boy in GP has left-sided neck lump on a background of 6 days of coryza, cough, and mild fever, but no systemic symptoms. Temperature 37.0, HR 105, capillary refill <1s, RR 26, O2 sats 99% on room air. ENT exam is normal and chest is clear. He has a single enlarged lymph node in the left posterior chain. What is the most appropriate next step in management?

a. Arrange urgent ENT referral
b. Arrange USS
c. Arrange urgent FBC
d. Prescribe Amoxicillin 250mg TDS for 7 days
e. Reassurance and watchful waiting

A

e. Reassurance and watchful waiting

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23
Q

11 y/o girl in GP with nausea, vomiting, headaches, and loss of appetite. School say she is starting to lag behind in class and has attended the school nurse regularly with playground falls. She is a healthy weight and has no focal neurology. What is the most appropriate next step?

a. Immediately discuss with on call paediatrician
b. Reassure and review in 4 weeks
c. Refer for a non-urgent MRI brain scan
d. Refer to neurologist under 2 week wait
e. Routine bloods

A

a. Immediately discuss with on call paediatrician

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24
Q

An 8 y/o boy is forgetful and fidgety, and teachers report he has always been disruptive in class, has had difficulty concentrating, and finds it hard to make friends. His symptoms occur every day of the week. Which is the most likely diagnosis?

a. ADHD
b. Anxiety
c. Autistic spectrum disorder
d. Bullying
e. Oppositional defiant disorder

A

a. ADHD

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25
Q

6 y/o boy in GP with 3 week history of intermittent limp and occasional complaints of pain in left hip. Mother reports no trauma or other symptoms. What is the most likely diagnosis?

a. Osteomyelitis
b. Perthes disease
c. Rickets
d. Septic arthritis
e. Soft tissue injury

A

b. Perthes disease

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26
Q

9 m/o boy with fever of 38.5 brought to GP by mother but sent away with paracetamol. Re-presents 4 days later when child develops facial rash (see below) but is otherwise well. What is the most likely diagnosis?

(https: //www.babycenter.com/ims/2013/04/slapped-cheek_wide.jpg.pagespeed.ce.hUmR0kqAjj.jpg)
a. Eczema herpeticum
b. Erysipelas
c. Impetigo
d. Non-accidental injury
e. Parvovirus B19

A

e. Parvovirus B19

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27
Q

2 y/o boy in GP with 3 days of fever, coryza, poor appetite and a 24 hour history of rash (see below). Temperature 38.5, HR 110, capillary refill <2s, and O2 sats 99% on room air. What is the most likely diagnosis?

(https: //i0.wp.com/keepkidshealthy.com/wp-content/uploads/2018/08/hand-foot-mouth-disease.jpg?resize=840%2C637&ssl=1)
a. Chickenpox
b. Hand foot and mouth disease
c. Herpes simplex
d. Impetigo
e. Molluscum contagiosum

A

b. Hand foot and mouth disease

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28
Q

7 y/o boy in GP with bedwetting for 2 months having previously been dry at night since age 4. Abdo exam is normal. What is the most appropriate initial investigation?

a. Abdominal USS
b. Abdominal x-ray
c. Finger prick glucose test
d. Renal function
e. Urine dipstick

A

e. Urine dipstick

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29
Q

16 hour old baby is jaundiced, has yellow stools, is sleepy, and is not feeding. The mother was positive for Group B Streptococcus in her previous pregnancy. What is the most likely diagnosis?

A

Group B Streptococcus Sepsis

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30
Q

A baby is born with 45XO karyotype. What is the most likely cardiac abnormality associated with this syndrome?

A

Bicuspid aortic valve

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31
Q

Child has difficulty breathing, lip swelling, a rash, and wheeze. What is the definitive first-line treatment in this scenario (give drug and route of administration)?

A

Intramuscular adrenaline

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32
Q

15 y/o boy has worsening severe headaches for 1 month and has been vomiting in the morning. There is no history of trauma and he is afebrile. What definitive investigation should now be requested?

A

Brain MRI

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33
Q

5 y/o boy has a systolic murmur which is soft and audible at the left sternal edge. The boy is asymptomatic. What is the most likely diagnosis?

A

Innocent murmur

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34
Q

Child has weight loss, diarrhoea, and positive Endomysial and tissue Transglutaminase antibody tests. What is the most likely diagnosis?

A

Coeliac disease

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35
Q

Child has symptoms of perennial rhinitis (blocked nose, nasal voice, running eyes). What is the most likely causative allergen in this scenario?

A

Dust mites

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36
Q

2 y/o girl has a fever of 39.7 and a painful, swollen right eye with preserved eye movements (see picture below).
https://images.ctfassets.net/uszvm6pv23md/1RChVVs8sGHzBE6Iv8fUSJ/7dd1a62b55627e5e9bb8594234d28e6d/periorbital_cellulitis.jpg
What is the most appropriate first-line treatment?

A

Oral co-amoxiclav

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37
Q

6 y/o girl has cloudy urine but no dysuria or frequency. Her parents say her urine looks like beer. She has had a recent upper respiratory tract infection. What is the most likely diagnosis?

A

IgA nephropathy or post- streptococcal glomerulonephritis (depends on time frame of recent)

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38
Q

7 year old boy with juvenile idiopathic arthritis has been on treatment for 1 year. He has experienced weight gain, dark striae on his abdomen and thighs, and a round plethoric face. Which medication is likely to be responsible?

A

Prednisolone

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39
Q

A ‘clunk’ is felt when examining the hips of a 48 hour old baby at the routine check. Which investigation should now be requested?

A

USS of the hip

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40
Q

A child who was late to start walking, but who had otherwise normal development, has bowed legs. What is the most likely cause?

A

Rickets

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41
Q

15 y/o girl weighs 100kg. She has striae and darker skin in her armpits and neck. She has been feeling tired and has had episodes of vulval thrush, but is otherwise well. A blood test shows a fasting blood glucose of 7.6mmol/L (3-6 normal range). What pharmacological treatment should be considered?

A

Metformin

42
Q

Mother with SLE has a baby who is born with a slow heartbeat. What is the most likely diagnosis?

A

Congenital heart block

43
Q

2 y/o boy has suddenly started crying and intermittently pulling his legs up. He has vomited several times, and the last vomitus was green. He has not opened his bowels for several hours. He is resuscitated appropriately. What is the definitive management for this condition?

A

Rectal air insufflation

44
Q

13 y/o girl seen in GP with fever, sore throat, and cervical lymphadenopathy. Her temperature is 37.9 and she has white exudates on enlarged tonsils. She is prescribed Amoxicillin 500mg TDS, then 7 days later re-presents with a widespread rash (see picture below).
https://post.healthline.com/wp-content/uploads/2019/04/Amoxicillin-induced-rash-in-mononucleosis-1296x728-gallery_slide3-1-1296x728.jpg
What is the most likely causative organism?

A

Epstein-Barr virus

45
Q

4 month old in GP has non-bilious vomiting after feeds and persistent crying, but a normal amount of wet and soiled nappies. She is meeting her developmental milestones and growing well along the 25th centile. What is the most likely diagnosis?

A

Gastro-oesophageal reflux

46
Q

2 month old boy attends GP with fever, rash, and coryza. He is taking 70% of his normal feeds and is producing a normal number of wet nappies. There is a non-blanching petechial rash on his left arm. Temperature 38.9, HR 148, RR 43, and O2 sats 98% on room air. What is the most appropriate pharmacological management to give in the GP surgery?

A

Intramuscular benzylpenicillin

47
Q

2 week old boy in GP has bilateral red eyes with purulent discharge since birth. What is the most likely causative organism?

A

Neisseria gonorrhoeae

48
Q

15 y/o has non-productive cough and wheeze for 2 months that is worst at night. Two courses of antibiotics have not helped it. Temperature 37.0, HR 80, BP 105/70, RR 20, O2 sats 99% on room air. What is the most appropriate first-line management?

A

Salbutamol inhaler

49
Q 
A 13 year old girl in the Paediatric Emergency Department has drowsiness, weight loss and tiredness over the last 10 days. Her capillary blood gas results on arrival shows:
pH 7.01 (7.35 - 7.45)
PCO2 2.9 kPa (4.6 - 6.4)
HCO3 9 mmol/L (22 - 30)
Glucose 24 mmol/L (3.0 - 6.0)
Blood ketones 6 mmol/L

Following an initial ABC assessment, bloods were taken. Her latest observations are: temperature 37C, pulse rate 118 bpm, BP 105/74 mmHg, capillary refill time 3 seconds, respiratory rate 27 breaths per minute, oxygen saturation 96% breathing air.

Rank the following subsequent management steps in order of priority with (1) being performed first and (5) being performed last

a. SC insulin
b. Repeat blood gas
c. Administer a fluid bolus
d. IV insulin
e. Calculate IV fluid requirement

A

c. Administer a fluid bolus
e. Calculate IV fluid requirement
d. IV insulin
b. Repeat blood gas
a. SC insulin

50
Q

A 5 year old boy in General Practice has 3 days of cough and coryza. His mother noticed a fever and a rash this morning. His temperature is 39C, pulse rate 150 bpm, respiratory rate 35 breaths per minute, and oxygen saturation 99% breathing air. His rash is found to be non-blanching. Which medication should be prescribed in this scenario?

a. IM Benzylpenicillin
b. IM Hydrocortisone
c. PO Co-Amoxiclav
d. PO Paracetamol
e. PO Penicillin V

A

a. IM Benzylpenicillin

51
Q

A 9 year old girl is in Paediatric Outpatients following parental concerns about her weight. During the consultation the girl reveals she is being bullied at school. Her weight is 49kg, and height is 1.37m (given growth chart with this plotted). Her thyroid function test results are as follows. TSH 3.5mU/L (0.7-4.1), free T4 16 pmol/L (12-22). Which is the most appropriate next step in her weight management?

a. Prescribe metformin
b. Prescribe orlistat
c. Refer to a paediatric dietician
d. Refer to Child and Adolescent Mental Health Services (CAMHS)
e. Refer to endocrinology

A

c. Refer to a paediatric dietician

52
Q

A 3 week old girl has had loose stools since day 2 of life and there are now streaks of blood in the stool. The baby examies well with normal observations, normal findings on abdominal examination, but there is dry skin on the scalp and face. Which is the most likely diagnosis?

a. Coeliac disease
b. Cow’s milk protein allergy
c. Gastroenteritis
d. Intussusception
e. Lactose intolerance

A

e. Lactose intolerance

53
Q

A 3 year old girl with eczema has a 2 day history of a new rash on her arms (see image).
https://dermnetnz.org/assets/Uploads/viral/eczema-herpticum17__WatermarkedWyJXYXRlcm1hcmtlZCJd.jpg
Which is the most appropriate treatment for this rash?

a. IV aciclovir
b. IV flucloxacillin
c. Topical clobetasone
d. Topical emollient
e. Topical fucidin

A

a. IV aciclovir

54
Q

An 11 year old girl has had intermittent central abdominal pain for 6 months. Her symptoms improved over the summer holidays but returned in the autumn. She also had headaches, which settled with no treatment. She opens her bowels daily with type 4 stool, and no bleeding. There is no history of fevers, vomiting or urinary frequency. Her height and weight have remained on the 75th centile. Which is the most likely diagnosis?

a. Coeliac disease
b. Constipation
c. Crohn’s disease
d. Functional abdominal pain
e. Urinary tract infection

A

d. Functional abdominal pain

55
Q

A 15 year old boy has 3 weeks of cough, weight loss, night sweats and fever. He moved to the UK from India 3 years ago. His chest x-ray is show in the image (can’t find exact image but showed some left upper zone shadowing I think). Which investigation is regarded as the gold standard for diagnosis for his underlying condition?

a. Blood culture
b. Gastric washings
c. Mantoux
d. QuantiFERON / IGRA
e. Sputum culture

A

d. QuantiFERON / IGRA

56
Q

The parents of a 7 year old boy are concerned about intermittent pains in his leg, which have worsened over the last few days. He has now developed a limp. His temperature is 36.5C, heart rate 80 beats per minute, respiratory rate 20 breaths per minute. Which is the most likely diagnosis?

a. Henoch Schönlein Purpura
b. Osgood Schlatter’s
c. Perthes disease
d. Reactive arthritis
e. SUFE

A

c. Perthes disease

57
Q

A 3 year old girl in the paediatric Emergency Department has conjunctival pallor, lethargy and dark urine. Last week she finished a course of nitrofurantoin for a urinary tract infection. Her blood results are as follows: Hb 70 g/L (110-140), WBC 3.2 x 10^9/L (5.0 - 12.0), platelets 520 x 10^9/L (150 - 400), albumin 37 g/L (30 - 50), bilirubin 75 umol/L (<21), ALT 18 IU/L (0 - 29), ALP 130 IU/L (60 - 425). Which is the most likely underlying diagnosis?

a. Beta Thalassaemia
b. G6PD deficiency
c. Hereditary spherocytosis
d. Iron deficiency anaemia
e. Sickle cell disease

A

b. G6PD deficiency

58
Q

A 7 year old boy has a history of recurrent chest infections, persistent sinusitis and has been prescribed multiple courses of antibiotics. He has bibasal crepitations and a right-sided apex beat. Which is the most likely underlying diagnosis?

a. Agammaglobulinaemia
b. Cystic fibrosis
c. HIV
d. Primary ciliary dyskinesia
e. Tracheo-oesophageal fistula

A

d. Primary ciliary dyskinesia

59
Q

A 3 day old baby girl is not feeding well. Her temperature is 36.7C, heart rate 180 bpm, respiratory rate 66 breaths per minute. There is a systolic murmur and femoral pulses are not palpable. Which is the most likely diagnosis?

a. Atrial septal defect
b. Coarctation of the aorta
c. Patent ductus arteriosus
d. Patent foramen ovale
e. Ventricular septal defect

A

b. Coarctation of the aorta

60
Q

A 5 year old boy in the paediatric Emergency department recently had a sore throat and now has a rash across her lower legs. She is afebrile but has abdominal pain and joint pains in both legs. Her full blood count result is as follows: Hb 110 g/L (115 - 140), WCC 10.3 x 10^9/L (3.8 - 10), neutrophils 6 x 10^9/L (150 - 400). Which is the most likely diagnosis?

a. Acute lymphoblastic leukaemia
b. Henoch Schonlein Purpura
c. Idiopathic thrombocytopenic purpura
d. Juvenile idiopathic arthritis
e. Meningococcal septicaemia

A

b. Henoch Schonlein Purpura

61
Q

A 15 year old girl in outpatients has no sign of breast development. Her growth is plotted in the chart below (growth chart showed short stature for age). She has widely spaced nipples and wide carrying angle of her arms. Which is the most likely diagnosis?

a. Familial short stature
b. Hypothyroidism
c. Kallmann’s syndrome
d. Noonan’s syndrome
e. Turner’s syndrome

A

e. Turner’s syndrome

62
Q 
A 15 year old boy presents to the Emergency Department with nausea, diarrhoea and abdominal pain, jaundice, lethargy and generalised joint pains. The diarrhoea is watery, pale in colour and does not contain blood. He returned from Thailand last week.
Investigations:
Hb 150 g/L (130 -175)
WBC 12.5 x 10^9/L (3.8 - 10.0)
Platelets 380 x 10^9/L (150 - 400)
Albumin 48 g/L (30 - 50)
ALT 650 IU (0-37)
ALP 280 IU (60 - 425)
Bilirubin 110 umol/L (<21)
Gamma-GT 94 IU/L (9 - 40)
Which is the most likely diagnosis?
a.	Hepatitis A infection
b.	Hepatitis B infection
c.	Infectious mononucleosis
d.	Shigella enteritis
e.	Typhoid fever
A

a. Hepatitis A infection

63
Q

An 8 year old boy in the Emergency Department has been unable to open his left eye for 1 day. Prior to this he had a cold one week ago. When examining the left eye, it is difficult to open, and he reports pain on all eye movements. The conjunctiva is injected. Which is the most appropriate next step in management?

a. Blood pressure
b. Blood tests
c. CT head
d. Lumbar puncture
e. Refer to specialist

A

c. CT head

64
Q

A 4 year old boy has recently emigrated to the UK with a chronic persistent cough, frequent chest infections and loose stools. He has low weight, a wet cough and nasal polyps. His uncle had a similar condition, and died at age 28. Which investigation is discriminatory in this scenario?

a. Chest x-ray
b. Mantoux test
c. Pernasal swab
d. Sputum culture
e. Sweat test

A

e. Sweat test

65
Q

A 5 year old girl has 5 days of fever, red lips, red eyes and cervical lymphadenopathy. She has had a course of amoxicillin for a sore throat. Which is the definitive treatment in this scenario?

a. IV aciclovir
b. IV ceftriaxone
c. IV clindamycin
d. IV IG
e. IV remdesivir

A

d. IV IG

66
Q

A 7 year old girl has breast buds but no pubic hair. Her height is on the 98th centile and her weight is on the 75th centile. She is otherwise fit and well. There is no significant family history. Investigations show: bone age of 10 years, FSH 3.2 IU/L (<1), LH 3.4 IU/L (<1). Which is the most likely diagnosis?

a. Adrenarche
b. Central precocious puberty
c. Congenital adrenal hyperplasia
d. Normal variant
e. Thelarche

A

b. Central precocious puberty

67
Q

A 4 year old boy is in the Emergency Department has 1 week of tiredness. His mother reports that he has generalised swelling, mostly around the eyes and lower legs. His abdomen also seems bigger than normal. Which is the most appropriate first line investigation in this scenario?

a. 24 hour urine collection
b. Abdominal ultrasound
c. Abdominal x-ray
d. Blood tests
e. Urine dipstick

A

e. Urine dipstick

68
Q

A 2 year old boy has daily loose stools for 2 weeks, containing visibly undigested food matter, such as peas and carrots. He is growing along the 50th centile. Which is the most likely diagnosis?

a. Constipation with overflow
b. Food poisoning
c. Gastroenteritis
d. Inflammatory bowel disease
e. Toddler diarrhoea

A

e. Toddler diarrhoea

69
Q

A 4 year old boy has abdominal pain for 2 weeks and noticed some blood in his urine. He has a palpable abdominal mass on the left side, extending below the umbilicus. Which is the most likely diagnosis?

a. Constipation
b. EBV
c. Horseshoe kidney
d. Neuroblastoma
e. Wilms tumour

A

e. Wilms tumour

70
Q

A 3 year old boy attends the Emergency Department after an episode of sudden onset jerky movements of both arms and legs for 5 minutes, which stopped before the ambulance arrived. His current observations are: temperature 38.5C, pulse 130 bpm, blood pressure 100/90 mmHg, respiratory rate 25 breaths per minute, oxygen saturation 98% breathing air. He has had a coryzal illness for 24 hours and is otherwise fit and well. He is alert, with a blood glucose of 4.5 mmol/L (3.0 - 6.0) and neurological examination is normal. Which is the most appropriate next step in management?

a. Order a CT brain and observe
b. Prescribe buccal midazolam and discharge
c. Prescribe IV ceftriaxone and admit
d. Prescribe oral antipyretics and observe
e. Prescribe oral co-amoxiclav and discharge

A

d. Prescribe oral antipyretics and observe

71
Q

A term infant born to a diabetic mother is 4 hours old on the postnatal ward and is noted to be jittery. The capillary blood gas result is as follows: pH 7.37 (7.35 - 7.45), PCO2 5.5 kPa (4.6 - 6.4), PO2 4.9 kPa (8 - 12), glucose 2.4 mmol/L (3 - 6), lactate 2.0 mmol/L (1 - 2). Which is the most appropriate treatment for the baby in this scenario?

a. Buccal midazolam
b. Feed the baby
c. IV dextrose
d. IV lorazepam
e. Oxygen

A

b. Feed the baby

72
Q

A 2 year old boy has acute onset of cough and drooling, with inspiratory upper airway noises. His vaccinations are up to date. His examination is otherwise normal. His temperature is 36.8C, pulse 120 bpm, blood pressure 100/60 mmHg, respiratory rate 26 breaths per minute and oxygen saturation 98% breathing air. Which is the most likely diagnosis?

a. Anaphylaxis
b. Croup
c. Epiglottitis
d. Inhaled foreign body
e. Laryngomalacia

A

d. Inhaled foreign body

73
Q

A 14 year old girl attends Paediatric Outpatients with ongoing headaches. These are associated with nausea and vomiting and she is missing school. They are occurring once per month and at any time of day. The headaches eventually settle after lying down in a dark room. She has tried NSAIDs, which do not help. Neurological examination is normal. Which is the most appropriate treatment?

a. Aspirin once daily
b. Metoclopramide when required
c. Nasal sumatriptan when required
d. Pizotifen when required
e. Propanolol once daily

A

c. Nasal sumatriptan when required

74
Q

A 12 year old girl in GP complains of ongoing headaches for the last 4 months. The headaches are severe and throbbing in nature and often associated with nausea and vomiting. The headaches are worse in the morning. His father has noticed he is more tired than usual and has been more irritable. His weight is 62 kg. Which is the most likely diagnosis?

a. Benign intracranial hypertension
b. Insomnia
c. Low mood
d. Migraine
e. Tension headaches

A

d. Migraine

75
Q

A 5 year old boy in General Practice has bright red blood when opening his bowels for 1 week. He opens his bowels every 3 days. He has no past medical history and is thriving. He has a well-balanced diet and has good fluid intake. There are no safeguarding concerns. Abdominal examination is unremarkable. Rectal inspection reveals a fissure. Which is the most appropriate management?

a. Dietary advice
b. Osmotic laxative
c. Phosphate enema
d. Stimulant laxative
e. Toilet training

A

a. Dietary advice

76
Q

A 7 year old boy in General Practice has a sore throat, fever and pain on swallowing for 1 day. His temperature is 38.5C, pulse rate 110 bpm, respiratory rate 24 breaths per minute, and oxygen saturation 99% breathing air. He has bilateral tonsillar enlargement with exudate and bilateral cervical lymphadenopathy. He is talking in full sentences without using accessory muscles. Which is the most appropriate management?

a. Admit to hospital
b. Continue supportive measures
c. Prescribe amoxicillin
d. Prescribe phenoxymethylpenicillin
e. Review in 48 hours

A

d. Prescribe phenoxymethylpenicillin

77
Q

A 14 year old has a 2 day history of worsening abdominal pain, reduced appetite and constipation. His temperature is 38.1C. He is tender in his right lower quadrant. Which is the most appropriate action?

a. Admit to hospital for assessment
b. Encourage oral fluids
c. Prescribe analgesia and follow up next week
d. Prescribe movicol
e. Refer to paediatric 2 week wait

A

a. Admit to hospital for assessment

78
Q

A 6 week old baby is seen for his routine baby check in General Practice with his mother. She has no concerns. A soft systolic murmur is heard on examination. It varies with posture and does not radiate. The child appears well. Which is the most likely diagnosis?

a. Coarctation of the aorta
b. Innocent murmur
c. Patent ductus arteriosus
d. Pulmonary stenosis
e. Ventricular septal defect

A

b. Innocent murmur

79
Q 
A 7 year old boy in General Practice has ongoing night time bed-wetting. He is dry during the day but has never been dry at night. His mother has tried managing his fluid intake, regular toileting and a star chart for 6 months with no success. He has no past medical history and takes no regular medication. He is doing well at school and at home. Abdominal examination is unremarkable.
Urinalysis:
Glucose - negative
Protein - negative
Ketone - negative
Blood - negative
Nitrites - negative
Leukocytes - negative
Which is the most suitable management option?
a.	Continue star chart
b.	Desmopressin
c.	Enuresis alarm
d.	Imipramine
e.	Oxybutynin
A

c. Enuresis alarm

80
Q

The father of a 3 year old is concerned about her weight. She is always hungry and has put on a lot of weight this year due to overeating. The child is short in stature, has almond-shaped eyes and a narrow forehead. Which is the most likely diagnosis?

a. Edward’s syndrome
b. Fragile X syndrome
c. Pierre-Robin syndrome
d. Prader-Willi syndrome
e. William’s syndrome

A

d. Prader-Willi syndrome

81
Q

A 2 year old in General Practice has a cough. He has reached all of his developmental milestones at the right time so far. Which motor skill would this child have most recently acquired?

a. Crawling
b. Draw a circle
c. Draw a square
d. Transfers objects from one hand to the other
e. Turning one page in a book

A

e. Turning one page in a book

82
Q

An 8 month old baby is seen in clinic with widespread rash localised to his flexures, cheek and neck. There is a strong family history of atopy. What is the most appropriate first line treatment?

A

Emollients & 1% hydrocortisone

83
Q

A 5 month old baby who is unvaccinated is in the Paediatric Emergency Department following apnoeic episodes with coughing at home. What is the most likely causative organism?

A

Bordetella pertussis

84
Q

A 9 month old boy in the Paediatric Emergency Department has left cheek bruising. He had multiple bruises on both thighs and buttocks. Full blood count and clotting screens were unremarkable. What is the most likely cause for his presentation?

A

Non-accidental injury

85
Q

A 4 year old boy in paediatric outpatients is unsettled with abdominal pain. He is scratching his bottom, worse at night, He has small white threads seen in his stool. What is the most appropriate treatment for this condition?

A

Mebendazole for the whole household

86
Q

A 6 year old girl with known sickle cell disease is in the Emergency Department with lethargy and shortness of breath. This is in the context of a recent febrile illness with a rash that has now resolved. Her blood results show: Hb 45 g/L (115 - 140), WBC 2.8 x 10^9/L (3.8 - 10), platelets 55 x 10^9/L (150 - 400). What pathogen is likely to have caused this presentation?

A

Parvovirus B19

87
Q

A 3 year old non-verbal girl is seen in outpatients. She is noted to have ritualistic behaviours, poor eye contact and a lack of pretend play. She has significant sensory issues. What is the most likely diagnosis?

A

Autism spectrum disorder

88
Q

A 2 year old boy in the Paediatric Emergency Department has a barking cough and difficulty breathing. He has inspiratory stridor on crying and mild intercostal and subcostal recessions. He is alert and playing. There is no drooling. His temperature is 38.2C, pulse rate 130 bpm, respiratory rate 34 breaths per minute, oxygen saturation 98% breathing air. What is the most appropriate first line treatment?

A

Dexamethasone

89
Q

A 6 month old boy presents with abdominal distension, bilious vomiting, excessive crying and drawing her legs up to his chest. He has recently been weaned off breastfeeding. He has blood in his stools. What is the most likely diagnosis?

A

Intussception

90
Q

A 12 year old girl develops discolouration of her urine and tears after starting medication for persistent chronic cough and fever. What medication commonly used for this condition is causing her symptoms?

A

Rifampicin

91
Q

A 6 week old girl in the Paediatric Emergency Department has jaundice which has been present since 1 week of age. She has pale stools and dark urine. She has dropped two centiles for weight. What is the most likely diagnosis?

A

Biliary atresia

92
Q

A 6 year old girl in clinic has asthma, and is currently on treatment with salbutamol and Clenil inhalers. What device is most suitable for delivering these medications?

A

Spacer

93
Q

A small for gestational age baby is born following an unremarkable pregnancy. He has low set ears, micrognathia, microcephaly, rocker bottom feet, overlapping digits, cleft lip and palate. What is the most likely diagnosis following chromosomal analysis?

A

Trisomy 18

94
Q

A previously well 4 year old boy is in the Paediatric Emergency Department with his mother. She saw him swallow a 20p coin while playing outside 30 minutes ago. She reports no coughing, choking or difficulty in breathing since. What is the investigation of choice in this scenario?

A

No investigation, X-ray could be done

95
Q

A 3 year old boy has 3 days of fever and a sore throat. He has red tonsils with exudate and a coarse, sandpaper rash on his abdomen. His temperature is 38.5C, pulse rate 125 bpm, respiratory rate 26 breaths per minute, oxygen saturation 98% breathing air. What is the most likely diagnosis?

A

Scarlet fever

96
Q

A 13 year old girl in General Practice has 3 weeks of left knee pain. The pain feels worse after running. She is very active and does a lot of sport. There is tenderness at the left tibial tuberosity. She is systemically well. What is the most likely diagnosis?

A

Osgood-Schlatter disease

97
Q

The mother of a 3 year old boy in General Practice has noticed that her son’s foreskin is ballooning on urination. The foreskin is non-retractile. There is no redness or discomfort. What is the most likely diagnosis?

A

Phimosis

98
Q

A 5 month old girl in General Practice has a worsening nappy rash for the last 2 weeks despite regular nappy changes, barrier cream and nappy-free time. She is feeding normally and otherwise well. Her temperature is 36.8C, and pulse rate 128 bpm. The rash is depicted in the image provided.
https://dermnetnz.org/assets/Uploads/dermatitis/napkin-thrush-s__ProtectWyJQcm90ZWN0Il0_FocusFillWzI5NCwyMjIsIngiLDFd.jpg
What is the most appropriate management option in this scenario?

A

1% hydrocortisone

99
Q

A 6 year old boy in General Practice has a new petechial rash on his legs and a bruise on his left knee, after knocking it on a table. He had a cold last week but fully recovered and was back to his normal self after a few days. There are no safeguarding concerns. He is well on examination and vital signs are normal. Investigations: Hb 123 g/L (115 - 140), WCC 6.2 x 10^9/L (3.8 - 10.0), platelets 15 x 10^9/L (150 - 400), normal blood film and normal coagulation screen. What is the most likely diagnosis

A

ITP

100
Q

A 5 month old boy in General Practice is found to have developmental delay and recurrent spasms. An EEG has shown hypsarrhythmia. What is the most likely diagnosis?

A

West syndrome

! Specialties past paper Qs (4 decks)

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