Passmed extras

Question 1

Snoring in children
Causes

Answer 1

• obesity
• nasal problems: polyps, deviated septum, hypertrophic nasal turbinates
• recurrent tonsillitis
• Down’s syndrome
• hypothyroidism

Question 2

Acute lymphoblastic leukaemia (ALL) definition including demographic

Answer 2

Acute lymphoblastic leukaemia (ALL) is the most common malignancy affecting children and accounts for 80% of childhood leukaemias. The peak incidence is at around 2-5 years of age and boys are affected slightly more commonly than girls

Question 3

Acute lymphoblastic leukaemia (ALL) three main features

Answer 3

Features may be divided into those predictable by bone marrow failure:
* anaemia: lethargy and pallor
* neutropaenia: frequent or severe infections
* thrombocytopenia: easy bruising, petechiae

Question 4

Acute lymphoblastic leukaemia (ALL) other features

Answer 4

• bone pain (secondary to bone marrow infiltration)
• splenomegaly
• hepatomegaly
• fever is present in up to 50% of new cases (representing infection or constitutional symptom)
• testicular swelling

Question 5

Acute lymphoblastic leukaemia (ALL) types

Answer 5

• common ALL (75%), CD10 present, pre-B phenotype
• T-cell ALL (20%)
• B-cell ALL (5%)

Question 6

Acute lymphoblastic leukaemia (ALL) poor prognostic factors

Answer 6

Poor prognostic factors
* age < 2 years or > 10 years
* WBC > 20 * 109/l at diagnosis
* T or B cell surface markers
* non-Caucasian
* male sex

Question 7

The following table gives a basic outline of child health surveillance in the UK

Answer 7

Question 8

the triad of the shaken baby syndrome

Answer 8

Retinal haemorrhages, subdural haematoma and encephalopathy is the triad of the shaken baby syndrome

Question 9

Precocious puberty definition

Answer 9

‘development of secondary sexual characteristics before 8 years in females and 9 years in males’
more common in females

Question 10

2 precocious puberty classifications

Answer 10

1.Gonadotrophin dependent (‘central’, ‘true’)
due to premature activation of the hypothalamic-pituitary-gonadal axis
- FSH & LH raised

2. Gonadotrophin independent (‘pseudo’, ‘false’)
   due to excess sex hormones
   - FSH & LH low

Question 11

precocious puberty presentation in males

Answer 11

Males - uncommon and usually has an organic cause

Testes
* bilateral enlargement = gonadotrophin release from intracranial lesion
* unilateral enlargement = gonadal tumour
* small testes = adrenal cause (tumour or adrenal hyperplasia)

Question 12

precocious puberty presentation in females causes

Answer 12

Females - usually idiopathic or familial and follows normal sequence of puberty

Organic causes
are rare, associated with rapid onset, neurological symptoms and signs and dissonance
e.g. McCune Albright syndrome

Question 13

first line therapy for treatment of threadworm

Answer 13

Mebendazole is first line therapy for treatment of threadworm

Question 14

What is the first sign of puberty in girls?

Answer 14

Breast development

Question 15

one of biggest risk factors of Meconium aspiration

Answer 15

It is more common in post-term deliveries, with rates of up to 44% reported in babies born after 42 weeks

Question 16

reflex anoxic seizures definition and features

Answer 16

Question 17

difference between epileptic seizures and reflex anoxic seizures

Answer 17

Reflex anoxic seizures have a rapid recovery unlike epileptic seizures

Question 18

congenital diaphragmatic hernia exam finding

Answer 18

Evidence of bowel sounds in a respiratory exam of a neonate in respiratory distress should make you consider a diaphragmatic hernia

Question 19

poor prognostic factor for congenital diaphragmatic hernia

Answer 19

The presence of the liver in the thoracic cavity is a poor prognostic factor for CDH

Question 20

The most common fractures associated with child abuse are:

Answer 20

• Radial
• Humeral
• Femoral

Question 21

Common fractures in paediatrics not associated with NAI are:

Answer 21

• Distal radial
• Elbow
• Clavicular
• Tibial