Passmedicine

Question 1

What is precocious puberty

Answer 1

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

more common in females

Question 2

What type of transmission does haemophilia have

Answer 2

X linked transmission

Can only be passed on from carrier mothers to males to be affected

Females could be carriers

Question 3

What are common signs of child abuse

Answer 3

story inconsistent with injuries
repeated attendances at A&E departments
delayed presentation
child with a frightened, withdrawn appearance - ‘frozen watchfulness’

Possible physical presentations of child abuse include:
bruising
fractures: particularly metaphyseal, posterior rib fractures or multiple fractures at different stages of healing
torn frenulum: e.g. from forcing a bottle into a child’s mouth
burns or scalds
failure to thrive
sexually transmitted infections e.g. Chlamydia, Gonorrhoea, Trichomonas

Question 4

What is the treatment for threadworm

Answer 4

CKS recommend a combination of anthelmintic with hygiene measures for all members of the household

mebendazole is used first-line for children > 6 months old. A single dose is given unless infestation persists

Question 5

what are undescended testes associated with

Answer 5

infertility
torsion
testicular cancer
psychological

Question 6

what is the management for undescended testes

Answer 6

Unilateral undescended testis
NICE CKS now recommend referral should be considered from around 3 months of age, with the baby ideally seeing a urological surgeon before 6 months of age
Orchidopexy: Surgical practices vary although the majority of procedures are performed at around 1 year of age
Bilateral undescended testes
Should be reviewed by a senior paediatrician within 24hours as the child may need urgent endocrine or genetic investigation

Question 7

what are some associations with hypospadias

Answer 7

Hypospadias most commonly occurs as an isolated disorder. However, associated conditions include cryptorchidism (present in 10%) and inguinal hernia.

Question 8

what is the treatment for hypospadias

Answer 8

once hypospadias has been identified, infants should be referred to specialist services
corrective surgery is typically performed when the child is around 12 months of age
it is essential that the child is not circumcised prior to the surgery as the foreskin may be used in the corrective procedure
in boys with very distal disease, no treatment may be needed.