paeds ls

Question 1

normal gestation

Answer 1

37-42 weeks

Question 2

Key diagnostic feature of ALL

Answer 2

The key diagnostic feature of ALL is the presence of greater than 20% blast cells in the bone marrow.

Question 3

A 2-week-old neonate, born at 34 weeks, in the neonatal unit starts to vomit green fluid and develop bloody stools.
On examination, there are no bowel sounds heard. A capillary blood gas shows a metabolic acidosis.
An abdominal x-ray is performed, which shows dilated bowel loops with gas within the bowel wall.
Which of the following is the most likely diagnosis?

Answer 3

This baby is preterm and has presented with signs of necrotising enterocolitis (NEC)(bilious vomiting, bloody stools, absent bowel sounds, systemic compromise with metabolic acidosis). NEC is a common gastrointestinal condition in preterm neonates. The main investigation in NEC is a supine abdominal x-ray which shows dilated asymmetrical bowel loops, bowel wall oedema with ‘thumbprinting’ and pneumatosis intestinalis (gas within the bowel wall).

Question 4

Roseola infantum

Answer 4

Herpes 7

Question 5

Hand foot and mouth disease

Answer 5

Enterovirus 71

Question 6

pneumatosis intestinalis

Answer 6

NEC

Question 7

Hodgkin’s lymphoma cells

Answer 7

Reed Sternberg cells
These are giant B cells seen in patients with Hodgkin’s lymphoma. They are typically multinucleated and contain inclusions

Question 8

Poor prognostic factor in ALL

Answer 8

Testicular involvement as suggests Extra medullary involvement

Question 9

A 35y year old primiparous woman has gone into spontaneous labour at 41 + 1. The labour is prolonged and the baby has an APGAR score of 4 on delivery. You start the clock and dry the baby immediately. You notice that the baby has greenish-tinged skin and has intercostal recession. There is a poor cry.
What is the most likely diagnosis?

Answer 9

Meconium aspiration syndrome

Question 10

A 21-day old baby presents with jaundice. He was full-term, normal birth weight and appeared well until recently. Blood results show a conjugated hyperbilirubinaemia.
What is the most likely diagnosis?

Answer 10

This neonate is jaundiced with a conjugated hyperbilirubinaemia. Cystic fibrosis (CF) may also cause these two in conjunction but would likely represent with weight loss or failure to thrive and/or other ciliary disorder symptoms. Biliary atresia is therefore the correct answer. Incidence is approximately 1 in 10 000 and may be associated with other congenital malformations such as intestinal atresia and imperforate anus. It is surgically treated with the Kasai procedure. Many will also go on to require a liver transplant

Question 11

Breast milk jaundice

Answer 11

Unconjugated billirubin raised

Question 12

At what age can a baby breastfeed

Answer 12

34 weeks

Question 13

Why do hydrocoeles that persist require surgical intervention

Answer 13

Hydroceles that do not resolve by 1–2 years require surgical correction due to the increased risk of developing an indirect inguinal hernia. This is because of the failure of the processus vaginalis to close.