PassMed Qs

Question 1

What is the first line for Mycoplasma pneumonia?

Answer 1

Erythromycin - a macrolide

Question 2

What is the heart murmur seen in Turner’s and why?

Answer 2

Ejection systolic

Due to bicuspid aortic valve

Question 3

What drug class is associated with long QT?

Answer 3

Macrolides e.g. clarithromycin

Should either change or have regular ECGs

Question 4

What is the requirement to step up to prescribing an inhaled corticosteroid for asthma?

Answer 4

Symptoms more than 3 times a week, or

night time waking

Question 5

What are acute causes of hydrocephalus?

Answer 5

Meningitis - look out for febrile, poor feeding etc
Traumatic brain injury
Haemorrhage - intraventricular or subarachnoid

Question 6

When are antibiotics indicated for acute otitis media?

Answer 6

Eardrum perforated
<2 years old and bilateral infection
Present for >4 days
<3 months old

Question 7

What is the most common side effect of salbutamol?

Answer 7

Tachycardia

Question 8

How might maternal bipolar disorder be relevant in a presentation of a heart murmur heard in both systole and diastole, and heard best on the left sternal border?

Answer 8

Ebstein’s anomaly

Caused by the use of lithium in pregnancy
Occurs when the posterior leaflets are displaced anteriorly towards the apex, creates tricuspid regurgitation and a pan systolic murmur
Enlargement of the right atrium

Question 9

What are some causes of clubbing in children?

Answer 9

Hereditary clubbing
Cyanotic heart disease
Infective endocarditis
Cystic fibrosis
Tuberculosis
Inflammatory bowel disease
Liver cirrhosis

Question 10

Why do patients with cystic fibrosis take long term prophylactic flucloxacillin?

Answer 10

To prevent staph aureus infection

Pseudomonas is a troublesome coloniser

Question 11

What is the step up from a SABA and ICS in asthma management for children?

Answer 11

Child aged 5-16 years with asthma not controlled by a SABA + paediatric low-dose ICS
add a leukotriene receptor antagonist

Also less than 5 years

Question 12

What is the management of a viral induced wheeze?

Answer 12

first-line is treatment with short acting beta 2 agonists (e.g. salbutamol) or anticholinergic via a spacer

next step is intermittent leukotriene receptor antagonist (montelukast), intermittent inhaled corticosteroids, or both

there is now thought to be little role for oral prednisolone in children who do not require hospital treatment

Question 13

What are the complications of measles?

Answer 13

Otitis media most common
Pneumonia
Encephalitis

Question 14

What are the features of PDA?

Answer 14

left subclavicular thrill
continuous 'machinery' murmur
large volume, bounding, collapsing pulse
wide pulse pressure
heaving apex beat

Question 15

What is the most common cause of RDS in the newborn period, if not premature?

Answer 15

Transient tachypnoea of the newborn (TTN)

Question 16

What are the diagnostic features of Kawasaki disease?

Answer 16

fever >5d with 4 of the following criteria:
A) Conjunctival injection
B) Mucous membrane changes (dry cracked lips, strawberry tongue)
C) Cervical lymphadenopathy
D) Polymorphous rash
E) Red and oedematous palms/soles, peeling of fingers and toes.

Question 17

What is included in APGAR scoring?

Answer 17

pulse, respiratory effort, colour, muscle tone and reflex irritability.

Question 18

How should coronary artery aneurysms be screened for?

Answer 18

With an echocardiogram

Question 19

What is the triad in haemolytic uraemic syndrome?

Answer 19

acute kidney injury
microangiopathic haemolytic anaemia
thrombocytopenia

Question 20

What is the treatment of nocturnal enuresis if an alarm has been ineffective?

Answer 20

Desmopressin for children over 7

Question 21

What is the investigation of choice for reflux nephropathy?

Answer 21

A micturating cystourethrogram

Question 22

When is nocturnal enuresis not considered normal?

Answer 22

Any child over the age of 5

Question 23

Use of anti-epileptics in pregnancy can cause what facial feature?

Answer 23

Orofacial clefts

Question 24

What are the characteristics of an innocent ejection murmur?

Answer 24

soft-blowing murmur in the pulmonary area
or short buzzing murmur in the aortic area

may vary with posture
localised with no radiation
no diastolic component
no thrill
no added sounds (e.g. clicks)
asymptomatic child
no other abnormality

Question 25

Who should doxycycline not be prescribed to?

Answer 25

Children under 12 years

Due to risk of dental hypoplasia and permanent discolouration of teeth

Question 26

What pulses do you check for in PBLS?

Answer 26

Brachial and femoral pulses

Question 27

What are high risk signs/red traffic light signs prompting urgent assessment?

Answer 27

Pale/mottled/blue
No response to social cues
Appears to be ill by health professionals
Does not wake/stay awake
Weak, high pitched or continuous cry

Grunting
Tachypnoea, more than 60 breaths per minute
Moderate/severe chest indrawing

Reduced skin turgor

Age < 3 months with temp > 38
Non-blanching rash, bulging fontanelle
Neck stiffness
Status epilepticus
Focal neurological signs or seizures

Question 28

What is acute chest syndrome in sickle cell disease?

Answer 28

Vaso-occlusive crises of the pulmonary vasculature

Shown with new opacification on chest x-ray

Question 29

What is Gower’s sign?

Answer 29

Child using hands on thighs to stand up

Weakness of the proximal muscles

Question 30

When does the moro reflex typically disappear?

Answer 30

4 months of age

Startle reflex - parachute

Question 31

What is it important to remember in the antibiotic treatment for meningitis?

Answer 31

Give IV amoxicillin in children less than 3 months to cover for listeria

Question 32

What are the main risk factors for SIDS?

Answer 32

prone sleeping
parental smoking
bed sharing
hyperthermia and head covering
prematurity