THE CHILD HEALTH FORMATIVE

Question 1

In a tonic-clonic seizure, there are two phases Tonic and clonic phase What happens in these phase?

Answer 1

In the tonic phase, the muscles stiffen - the person can lose consciousness and fall to the floor In the clonic phase - the arms and legs begin to jerk and twitch

Question 2

What type of seizure attack is it where the toddler can get angry/ start crying The toddler then holds breath, goes blue then limp and has a rapid recovery? (their is no toni-clonic seizure) Breath holding attack Arryhtmia Epilepsy febrile seizure

Answer 2

This a breath holding attack

Question 3

What is a siezure accompanied by fever in the absence of intracranial infection? Usually occurs between 6 months and 6 years of life

Answer 3

This is a febrile seizure

Question 4

Toddler precipitated by pain stops breathing, goes pale, has a brief seizure and then a rapid recovery What is this?

Answer 4

Reflex anoxic siezure

Question 5

A 13 year old boy who has had 4 generalised tonic-clonic seizures over the past 3 months. He is otherwise well, with normal development. There are no obvious precipitating factors for the seizures, but they are more likely to occur if he is tired. What is diagnosis?

Answer 5

Epilepsy

Question 6

A 10 year old boy who has experienced 3 generalised tonic-clonic seizures over the past 6 months. Each episode has occurred whilst he has been whilst playing football. He is otherwise well. What is this?

Answer 6

This is arrythmia

Question 7

A 2 year old girl who has lost consciousness after hurting herself on 4 occasions. A typical episode will start with crying, she will then go blue and then briefly lose consciousness. She is back to normal immediately after. What is this? Breath holding attack Febrile seizure Reflex anoxic attack

Answer 7

Breath holding attack

Question 8

What proportion of cerebral palsy is believed to be due to hypoxic-ischaemic injury during delivery?

Answer 8

only about 10%

Question 9

A profoundly disabled 7 year old boy who can not walk and is unable to feed himself. Both arms have fixed contractures and he requires regular baclofen to relax his muscles. What form of cerebral palsy is this? (how many limbs are involved)

Answer 9

Quadriplegic - all four limbs are involved

Question 10

A 5 year old boy with weakness in both legs, requiring the use of a wheelchair. Both arms are normal. What form of cerebral palsy is this?

Answer 10

This is paraplegia

Question 11

Can paraplegia affect the upper limbs?

Answer 11

Paraplegia only affects the lower half of the body and limbs

Question 12

A 10 year old girl with increased tone in her right arm and right leg, who walks with a limp. What form of cerebral palsy?

Answer 12

This is hemiplegia - affects only one side of the body

Question 13

A 12 year old girl who attends mainstream school who walks unaided but has an intoing gait affecting both right and left. She has normal use of her arms but has increased tone. What form of cerebral palsy is this?

Answer 13

This is diplegia - affects all four limbs but the legs are affected worse

Question 14

Which form of cerebral palsy are hemiplegia, quadraplegia and diplegia all suptypes of? Spastic (tense contracted muscles - most common type of cerebral palsy) Ataxic (poor balance) Dyskinetic (invluntary, uncontrolled motions of the limbs)

Answer 14

Spastic cerebral palsy

Question 15

Passive immunity is protection provided from the transfer of antibodies from immune individuals What are the two common forms of passive immunity?

Answer 15

Transplacental transfer from mother to foetus Artificial Human IgG

Question 16

What are the two common forms of active immunity?

Answer 16

Artificial immunisation Natural infection causing immunisation

Question 17

Which of the following are representative of active immunity? 1. Cell mediated response to BCG vaccine 2. IV Immunoglobulin for an immunocompromised child exposed to chicken pox 3. Transplacental IgG against VZV 4. Acquisition of anti-RSV antibodies following a viral upper respiratory tract infection 5. IV ceftriaxone given to a child with suspected meningococcal sepsis 6. Seasonal flu vaccine

Answer 17

1. True 2. False - artificial human IgG - passive 3. False - transplacental IgG - passive 4. True - active natural immunisation 5. False - Ceftriaxone is a treatment 6. True

Question 18

The Department of Health have published recommended amounts of physical activity for children. These are based on exercise intensity and duration. A 7 year old girl is recommended to do vigorous activity for how many day(s) a week?

Answer 18

For 3 days at least per week

Question 19

A 3 year old child is recommended to be physically active for how many hour(s) per day, spread throughout the day?

Answer 19

3 hours per day - 180 minute guidleine (under 5 capable of walking)

Question 20

A 12 year old boy is recommended to have how many ≥ hour(s) of moderate to vigorous intensity physical activity per day?

Answer 20

At least one hour

Question 21

How much moderate intensity or high intensity exercise should an adult get per week?

Answer 21

At least five 30minute moderate intensity exercise per wekk or At least two 75 minutes of vigorous intensity exercise

Question 22

For each of the conditions below, choose the most appropriate test that our genetics labs may use when trying to reach a genetic diagnosis. (choose between Array CGH or next generation sequencing) DiGeorge syndrome Sickle cell disease Turner’s syndrome Down’s syndrome Prader Willi syndrome

Answer 22

DiGeorge syndrome - 22q11 microdeltion - Array CGH Sickle cell - next generation sequencing (point mutation) Turner’s syndrome - 45 X - Array CGH Down’s sydrome - trisomy 21 - Array CGH Prader Willi Syndrome - microdeltion on chromosme 15 - Array CGH

Question 23

What is Array CGH used to detect? (what kind of mutation)

Answer 23

Deletions or insertion in chromosomes Cannot detect mutations where there is the same number of genes as there should be

Question 24

State the median age at which each of the the following social, emotional and behavioural milestones are achieved. Holds spoon and uses it to get food to mouth Symbolic play Continent of urine during day Parallel play - interacts with others and starting to take turns

Answer 24

Holds spoon and uses it to get food to mouth - 18 months Symbolic play eg feeding teddy - 2 years Continent of urine during day - 3 years Parallel play - interacts with others and understands sharing - 4 years

Question 25

At what age is the milestone of drinking from a cup/ waving bye bye achieved?

Answer 25

This is achieved at 12 months of age

Question 26

Healthy Start Vitamins (contain vit A, C & D) are provided to young children of low-income families. This is most likely to reduce the prevalence of which one of the following deficiency diseases: a. Beri-beri b. Pellagra Incorrect c. Iron deficiency anaemia d. Rickets e. Goitre

Answer 26

Rickets

Question 27

Deficiency of what vitamin results in beri-beri disease? There are two main types in adults: wet beriberi, and dry beriberi.[1] Wet beriberi affects the cardiovascular system resulting in a fast heart rate, shortness of breath, and leg swelling.[1] Dry beriberi affects the nervous system resulting in numbness of the hands and feet, confusion, trouble moving the legs, and pain

Answer 27

Vitamin B1 deficiency - thiamine

Question 28

What are the four Ds of vitamin B3 deficiency (niacin deficiency)? What is the word for the 4Ds?

Answer 28

Diarrhoea Dermatitis - photosensitive Dementia Death Pellagra

Question 29

Which of the following statements about child development are true? a. Assessment of vision and fine motor development are closely related b. The Moro reflex is an example of a Primitive reflex c. Gross motor development at 4-months can be assessed by “pulling to sit”

Answer 29

a. Assessment of vision and fine motor development are closely related b. The Moro reflex is an example of a Primitive reflex c. Gross motor development at 4-months can be assessed by “pulling to sit” Moro reflex - child thinks its falling and it reaches out then cries

Question 30

Which of the following statements about child development are true? d. At 9-months of age an infant will localise sound consistently, babble for self-amusement and initiate sounds e. An infant of 3 months tends to hold their hands in the midline and demonstrate “hand regard” f. At 12 months of age normal social development would include feeding with a spoon and mimicking adults

Answer 30

d. At 9-months of age an infant will localise sound consistently, babble for self-amusement and initiate sounds e. An infant of 3 months tends to hold their hands in the midline and demonstrate “hand regard”

Question 31

At what age (in years) would a boy be considered to have delayed puberty if he has no signs of secondary sexual development a. 15 b. 7 c. 14 d. 4 e. 9

Answer 31

c. 14

Question 32

How long should children remain on breastmilk after birth?

Answer 32

Should remain on breast milk for 6 months

Question 33

It is recommended that infants are weaned onto family foods at approximately … months of age 4, 5, 6, or 12 months of age?

Answer 33

Recommended they are weaned onto famly foods at 6 months of age

Question 34

Skimmed milk should not be given before … years Semi skimmed milk should not be given before … years 2,4,5,6,12?

Answer 34

* Skimmed milk should not be given before 5 years * Semi skimmed milk should not be given before 2 years After the age of 2, children can gradually move to semi-skimmed milk as a drink, as long as they’re eating a varied and balanced diet and growing well. Do not give skimmed or 1% fat milk as a drink to children under 5 years old. It does not contain enough calories and other important nutrients for young children.

Question 35

Some infants require solids earlier than recommended, but they should not be introduced until … months of age, at the earliest 2,4,5,6,12?

Answer 35

4 months at earliest

Question 36

Full fat unmodified cows’ milk can be introduced as a drink from … months 4,5,6,12?

Answer 36

12 months

Question 37

Give an example of an X-linked recessive condition? Give an example of an Autosomal recessive condition?

Answer 37

X-linked recessive - Duchenne Muscular dystrophy Autosomal recessive - Sickle cell anaemia

Question 38

What is the autistic triad?

Answer 38

Problems with social interaction, communication and flexibilty of thought

Question 39

What type of developmental pattern is seen in autism?

Answer 39

Developmental deviation

Question 40

What is developmental regression seen in? (name one mainly affecting boys and one mainly affecting girls)

Answer 40

Seen in Hunter’s syndrome (It is one of the mucopolysaccharidoses. These metabolic conditions should be considered when a child loses previously attained developmental milestones.) - mainly affects males Seen in Rett syndrome - mainly affects girls

Question 41

What is hunter’s syndrome? (inheritance and brief description)

Answer 41

It is an X-linked recessive lysosomal storage disorder which is seen where childs reach certain milestones before regressing to previous milestones - mainly affects males

Question 42

What is the mutation in Rett’s syndrome and why does it mainly affect females?

Answer 42

Rett’s syndrome occurs due to a mutation in the MECP2 gene - can be sporadic or x-linked dominant * Inheritance follows an X-linked dominant pattern and is seen almost exclusively in females, as most males die in utero or shortly after birth

Question 43

Give 2 examples of developmental delay disorders?

Answer 43

Cerebral palsy and down’s syndrome

Question 44

Choose which type of mutation has affected the wild type sequence: the cat sat on the mat. A - The car sat on the mat B - The cat spa to nth ema t C - The cat cat sat on the mat D - The cas ato nt hem at E - The cat on the mat F - The cat

Answer 44

A - missense mutation B - insertion (out of frame) C - insertion (in frame) - triplet expansion D - Deletion out of frame E - Deletion in frame F - nonsense (stop) mutation

Question 45

According to the World Health Organization, six solutions to the most preventable causes of under-5 deaths include: What are the six solutions?

Answer 45

1. immediate and exclusive breastfeeding 2. skilled attendants for the antenatal, birth and post-natal care 3. Access to nutrition and micronutrients 4. Family knowledge of danger signs in a child’s health 5. Water sanitisation and hygiene 5. Immunisations

Question 46

* A 5 year old boy who struggles to walk up the stairs. His calves appear enlarged. Development is otherwise normal. * A 6 year old girl who hates loud noises and gets very upset in a busy classroom. Struggles to form friends & gets upset if her daily routine is disturbed. * A 3 year old boy, global developmental delay, generalised, hypotonia,flat occiput&brushfield spot Which investigations should be performed to diagnose?

Answer 46

Creatine kinase Validated questionairre - person is supected of having autism Karyotype

Question 47

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Answer 47

• Case 1 - Not contraindicated
• Case 2 - Not contraindicated
• Case 3 - Not contraindicated
• Case 4 - Not contraindicated
• Case 5 - Contraindicated as MMR is a live attenuated vaccination (avoid in pregnant and immunocompromised) Do not give live vaccines to immunocompromised Do not give vaccines if previous anaphylactic reaction