Paeds EMQs Flashcards
At which of these ages is the following action (screening, examination, health promotion activity) taken in the child health surveillance and promotion programme in the United Kingdom? Each answer can be used once, more than once, or not at all.
Guthrie test (biochemical screening test)
Newborn 5-6 days 12 days 8 weeks 3 months 4 months 8 months 12 months 13 months 2-3 years 4-5 years (pre-school) 5 years (school entry)
5-6 days
At which of these ages is the following action (screening, examination, health promotion activity) taken in the child health surveillance and promotion programme in the United Kingdom? Each answer can be used once, more than once, or not at all.
First routine immunisation with 5 in 1 immunisation - DTaP/IPV, Hib, PCV (diphtheria, tetanus, pertussis, polio, Haemophilus influenza, pneumococcal)
Newborn 5-6 days 12 days 8 weeks 3 months 4 months 8 months 12 months 13 months 2-3 years 4-5 years (pre-school) 5 years (school entry)
8 weeks
At which of these ages is the following action (screening, examination, health promotion activity) taken in the child health surveillance and promotion programme in the United Kingdom? Each answer can be used once, more than once, or not at all.
Hearing test using evoked otoacoustic emission or auditory brainstem response audiometry
Newborn 5-6 days 12 days 8 weeks 3 months 4 months 8 months 12 months 13 months 2-3 years 4-5 years (pre-school) 5 years (school entry)
Newborn
At which of these ages is the following action (screening, examination, health promotion activity) taken in the child health surveillance and promotion programme in the United Kingdom? Each answer can be used once, more than once, or not at all.
Advice on reducing the risk of sudden infant death syndrome by ‘Back to sleep’, avoiding overheating and avoiding parental smoking
Newborn 5-6 days 12 days 8 weeks 3 months 4 months 8 months 12 months 13 months 2-3 years 4-5 years (pre-school) 5 years (school entry)
Newborn
Steven has just had his first birthday party. During his party he commando-crawled with great speed, although he cannot walk. He managed to pick off all the Smarties (round chocolate sweets) from his birthday cake. He can say two words with meaning. After his birthday party, he impressed his guests by waving goodbye.
Which area of Steven’s development is delayed?
Gross motor Fine motor and vision Speech and hearing Social, emotional and behavioural development None of the above
None of the above
He has therefore achieved normal milestones for a 12-month-old.
At which of these ages is the following action (screening, examination, health promotion activity) taken in the child health surveillance and promotion programme in the United Kingdom? Each answer can be used once, more than once, or not at all.
First MMR (measles/mumps/rubella) immunisation
Newborn 5-6 days 12 days 8 weeks 3 months 4 months 8 months 12 months 13 months 2-3 years 4-5 years (pre-school) 5 years (school entry)
13 months
At what age will children achieve the milestones described in the scenarios (median age)? Each age can be used once, more than once, or not at all.
Herbert can transfer objects from one hand to the other whilst sitting without support and with a straight back.
6 weeks 6 months 8 months 10 months 12 months 18 months 2 yrs 3 yrs 4 yrs 5yrs
8 months
Jonathan is 4 years old and lives in a small village in southern England. He attends a paediatric outpatient clinic with his grandmother who is his legal guardian. She is concerned that he only seems to like to play with his toy train and insists on watching the same DVD every night before he goes to bed. He attends nursery where he plays with the toys but not with other children. His behaviour can be very difficult to manage at times. He does not say any words whereas the grandmother’s children were speaking in sentences at his age. On examination you notice he does not make eye contact with you and pushes his toy train back and forth on the floor. The rest of his examination is normal.
What is the most likely diagnosis?
ADHD Autistic spectrum disorder Developmental coordination disorder (dyspraxia) Asperger syndrome Expressive language disorder
Autistic Spectrum Disorder
Autism is a triad of impaired social interaction, speech and language disorder and ritualistic and repetitive behaviour.
At which of these ages is the following action (screening, examination, health promotion activity) taken in the child health surveillance and promotion programme in the United Kingdom? Each answer can be used once, more than once, or not at all.
An orthoptist assessment for visual impairment
Newborn 5-6 days 12 days 8 weeks 3 months 4 months 8 months 12 months 13 months 2-3 years 4-5 years (pre-school) 5 years (school entry)
4-5 years (pre-school)
At what age does autistic spectrum disorder usually become evident?
0-12 months 12-24 months 2-4yrs 4-8yrs >8yrs
2-4yrs
Autistic spectrum disorder usually presents at this age because this is when language and social skills rapidly develop.
At what age will children achieve the milestones described in the scenarios (median age)? Each age can be used once, more than once, or not at all.
Rosette can build a three-cube tower and can point to her nose.
6 weeks 6 months 8 months 10 months 12 months 18 months 2 yrs 3 yrs 4 yrs 5yrs
12 months
At what age would you expect the clinical features of cerebral palsy to become evident?
0-12 months 12-24 months 2-4 years 4-8yrs >8yrs
0-12 months
Cerebral palsy most often presents during this time when acquisition of motor skills occurs most rapidly.
Fortunate is an 8-month-old black African girl who was born at term. She is seen in the paediatric outpatient department. She can roll over. She does not crawl. She can say ‘dada’, but says it to everyone not just her father. She reaches out and grasps objects with her left hand but not with her right, and puts objects in her mouth. She smiles, but is not able to wave bye-bye.
Select the option that concerns you most about Fortunate’s development.
Unable to crawl Left hand preference Unable to use sounds discriminately to parents Unable to wave bye-bye None of the above
Left hand preference
Fortunate has developed a preference for using her left hand at 8 months. Development of a hand preference before 1 year of age is abnormal, and she needs to be assessed for hemiplegic cerebral palsy affecting her right side.
Gloria is a 19-month-old white British girl whose health visitor is concerned because she is still only babbling and says no distinct words. She is able to walk, scribbles with crayons and feeds herself with a spoon.
What is the most appropriate first action?
Hearing test
Assessment by a team specialising in autistic spectrum disorders
Reassure the health visitor
Refer to ENT surgeon
Refer to a paediatrician for a full developmental assessment
Hearing test
Speech delay can be due to hearing impairment, and this should be assessed first prior to referring her to a specialist.
Which of these investigations would you choose to confirm the diagnosis of developmental delay in the children described in the following scenarios? Each investigation can be used once, more than once, or not at all.
Clarissa, a cheerful 20-month-old white British girl, is referred to the child development clinic by her health visitor because she is not yet walking. She was born at term with no complications. She learnt to sit without support at 10 months, and is able to crawl, although she drags her right leg behind her. Her mother says that she has always been left-handed. Examination revealed reduced power and reflexes but increased tone in the right arm.
Chromosome karyotype DNA FISH analysis TFTs Maternal amino acids for raised phenylalanine Creatine kinase Blood lactate Congenital infection screen Cranial US CT or MRI of the brain Electroencephalography (EEG)
CT or MRI of the brain
Which of these investigations would you choose to confirm the diagnosis of developmental delay in the children described in the following scenarios? Each investigation can be used once, more than once, or not at all.
Darren is a 3-year-old boy who has difficulty climbing stairs. He always needs to hold on to the railings or to have a supporting hand. He walked unsupported at 14 months. His development is otherwise normal. On examination the power in his legs is reduced, he is somewhat hypotonic but the reflexes are normal.
Chromosome karyotype DNA FISH analysis TFTs Maternal amino acids for raised phenylalanine Creatine kinase Blood lactate Congenital infection screen Cranial US CT or MRI of the brain Electroencephalography (EEG)
Creatine kinase
Which of these investigations would you choose to confirm the diagnosis of developmental delay in the children described in the following scenarios? Each investigation can be used once, more than once, or not at all.
Dorcus is a 9-month-old Ugandan infant who attends clinic because of unusual movements. She has developed episodes of suddenly throwing her head and arms forward. These occur in repetitive bursts. She was able to sit and babble but has stopped doing so.
Chromosome karyotype DNA FISH analysis TFTs Maternal amino acids for raised phenylalanine Creatine kinase Blood lactate Congenital infection screen Cranial US CT or MRI of the brain Electroencephalography (EEG)
Electroencephalography (EEG)
Which of these investigations would you choose to confirm the diagnosis of developmental delay in the children described in the following scenarios? Each investigation can be used once, more than once, or not at all.
Batar is a 1-week-old baby born at term who is seen in the ophthalmology clinic because of cataracts. He has a head circumference of 32cm (normal range) and weight of 2.3kg, mild jaundice, pallor and moderate hepatosplenomegaly. His mother thinks that he does not hear well. His mother had a mild flu-like illness during pregnancy.
Chromosome karyotype DNA FISH analysis TFTs Maternal amino acids for raised phenylalanine Creatine kinase Blood lactate Congenital infection screen Cranial US CT or MRI of the brain Electroencephalography (EEG)
Congenital infection screen
Which of these investigations would you choose to confirm the diagnosis of developmental delay in the children described in the following scenarios? Each investigation can be used once, more than once, or not at all.
Geoffrey is a 10-month-old Afro-Caribbean baby referred to the child development clinic. His mother raised concerns because he is slower in his development than her four other children. He can sit, but only if he is propped up with cushions. He is not crawling or pulling to stand. On examination he is hypotonic, with some dysmorphic features, including upslanting palpebral fissures, there is a skin fold of the upper eyelid covering the inner corner of the eye and a flat occiput. He has no other medical problems except some vitiligo. He was born at term by normal vaginal delivery. He has been slow to feed.
Chromosome karyotype DNA FISH analysis TFTs Maternal amino acids for raised phenylalanine Creatine kinase Blood lactate Congenital infection screen Cranial US CT or MRI of the brain Electroencephalography (EEG)
Chromosome karyotype
Considering these types of cerebral palsy, choose the type of movement disorder to fit the scenarios below. Each type of cerebral palsy can be used once, more than once, or not at all.
Ronaldo is a 6-year-old boy. He attends the outpatient department as his teacher has had some concerns. He has recently started school and has been noted to be unsteady on his feet. He has to walk and run with his legs quite wide apart to stop himself from falling over. His teacher also reports that he finds it difficult to grip a pen and to write because of unsteadiness.
Spastic hemiplegia Spastic diplegia Spastic quadriplegia Dyskinetic Hypotonic ataxic
Hypotonic ataxic
Considering these types of cerebral palsy, choose the type of movement disorder to fit the scenarios below. Each type of cerebral palsy can be used once, more than once, or not at all.
Hassan is 3 years old and was born at 26 weeks gestation weighing 700g. He sat at 10 months, and has just started to walk. He can scribble and build a tower of 3 blocks. When you examine him, he is walking on tiptoes, and his legs ‘scissor’ when you lift him up. He is able to feed himself.
Spastic hemiplegia Spastic diplegia Spastic quadriplegia Dyskinetic Hypotonic ataxic
Spastic diplegia
Considering these types of cerebral palsy, choose the type of movement disorder to fit the scenarios below. Each type of cerebral palsy can be used once, more than once, or not at all.
Moses is a 5-year-old boy who failed to attain his developmental milestones from shortly after birth. Currently, he cannot roll or talk, but he can smile. His mother complains it is difficult to dress him as both his arms and legs are stiff. On examination, his left and right upper and lower limbs are stiff and hyper-reflexic. He has a primitive grasp reflex in both hands.
Spastic hemiplegia Spastic diplegia Spastic quadriplegia Dyskinetic Hypotonic ataxic
Spastic quadriplegia
Considering these types of cerebral palsy, choose the type of movement disorder to fit the scenarios below. Each type of cerebral palsy can be used once, more than once, or not at all.
Gerald is a 4-year-old boy who was born in Tanzania, and had severe jaundice as a neonate that could not be treated because of lack of medical services. He now has abnormal movements of all his limbs where he adopts and maintains unusual postures, and when he is startled by a loud noise the arm on one side straightens and the opposite arm bends. When he is asleep he is hypotonic.
Spastic hemiplegia Spastic diplegia Spastic quadriplegia Dyskinetic Hypotonic ataxic
Spastic quadriplegia
Considering these types of cerebral palsy, choose the type of movement disorder to fit the scenarios below. Each type of cerebral palsy can be used once, more than once, or not at all.
Alan is a 3-year-old boy who developed a preference for using his left hand at 7 months of age. He learnt to sit at 9 months and walked at 20 months. When he runs, he holds his right arm flexed and limps with his right foot. On examination, his right upper and lower limbs are stiff, with increased reflexes.
Spastic hemiplegia Spastic diplegia Spastic quadriplegia Dyskinetic Hypotonic ataxic
Spastic hemiplegia
Which of the following health professionals involved in the care of a disabled child would most help the children described below?
Frankie is a 6-month-old infant from the UK. She has always struggled to gain weight and never took her bottles of milk. When she was fed she would often have choking episodes which led to episodes of pneumonia. She subsequently needed to have a naso-gastric (NG) tube and gastrostomy so she could be fed. Her mother wants to start trying to feed her some solid food.
Dietician Social worker Psychologist Paediatrician Speech and language therapist Occupational therapist Physio Specialist health visitor
Speech and language therapist
Which of the following health professionals involved in the care of a disabled child would most help the children described below?
Cathy is 15 years old and was in a road traffic accident. She spent a week in intensive care and needed an operation on her spine. She is currently not able to walk and has been shown how to use a wheelchair. Her parents are desperate to get her back home. They live in a town house where her bedroom is on the first floor, and therefore her father would need to carry her up the stairs.
Dietician Social worker Psychologist Paediatrician Speech and language therapist Occupational therapist Physio Specialist health visitor
Occupational therapist
Which of the following health professionals involved in the care of a disabled child would most help the children described below?
Jake is a 20-month-old boy who burnt himself on a radiator whilst playing unsupervised. He attended the Accident and Emergency department where analgesia was given and dressings applied. He was seen by a paediatrician who performed a more detailed examination looking for signs of child abuse. There were no concerns and the child was discharged home to be seen later in the burns clinic.
Dietician Social worker Psychologist Paediatrician Speech and language therapist Occupational therapist Physio Specialist health visitor
Specialist health visitor
Which of the following health professionals involved in the care of a disabled child would most help the children described below?
Sian is 2 years old. She is being followed-up for failure to thrive (growth faltering). All her investigations have come back normal but she is still not gaining adequate weight. She drinks a lot of dilute squash but her mother complains she won’t eat any of the food she gives her.
Dietician Social worker Psychologist Paediatrician Speech and language therapist Occupational therapist Physio Specialist health visitor
Dietician
Which of the following health professionals involved in the care of a disabled child would most help the children described below?
Thomas is a 9-year-old boy who has suspected Asperger syndrome. He has problems interacting with his siblings and classmates. His academic performance at school is poor. He has a very strict daily routine and becomes very upset if this is broken. He sleeps poorly at night.
Dietician Social worker Psychologist Paediatrician Speech and language therapist Occupational therapist Physio Specialist health visitor
Psychologist
Which of the following health professionals involved in the care of a disabled child would most help the children described below?
Bilal is a 6-year-old boy who has recently been diagnosed with Duchenne muscular dystrophy. This presented with weakness and easy fatiguability when walking. He finds it difficult to co-ordinate his movements. He is currently in mainstream school and needs to be able to move around the classroom.
Dietician Social worker Psychologist Paediatrician Speech and language therapist Occupational therapist Physio Specialist health visitor
Physio
