FOP recalls Flashcards by Kayan Cheung

Boy with cystic fibrosis - what is the chance his sister is a carrier of CF?

A) 1/4
B) 2/3
C) 1/2
D) No chance

B) 2/3

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What is the inheritance pattern of the following: short girl, learning difficulties, webbed neck.

a) Karyotype XO
b) X linked recessive
c) X linked dominant
d) Autosomal dominant

a) karyotype XO

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What is the inheritance pattern of the following: 21 month boy pulls to stand on furniture, cannot walk, normal tone, history of cousin with disability

a) Karyotype XO
b) X linked recessive
c) X linked dominant
d) Autosomal dominant

b) X linked recessive

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Baby was under CPP and came with smooth philtrum and learning difficulties with thin upper lip. Diagnosis?

a) Fetal alcohol syndrome
b) Prader Willi syndrome
c) Phenytoin syndrome

a) Fetal alcohol syndrome

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What is the chance of a patient with sickle cell disease at risk of having another affected child with SCD?

1/4

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What is the chance of a father with haemophilia A having an affected boy?

Population risk

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What is the risk of having a carrier sibling for a family with affected cystic fibrosis child?

2/3

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What is the karyotype of a tall boy with undeveloped secondary sexual characteristics with mild learning difficulty?

47 XXY (Kleinefelter syndrome)

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Girl whose height is on 0.2% centile and weight is on 25% centile with mild learning disability. What is the next genetic investigation?

Karyotyping

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18 yo female student pregnant at 8 weeks with cystic fibrosis. Husband is not affected with no FHx of CF. She wants to continue pregnancy and wants to know if the baby will be affected. What is your advice?

a) Wait for neonatal screening
b) Screen father for most common mutation of CF
c) Amniocentesis
d) Chorionic villous sampling
e) DNA after delivery

b) Screen father for most common mutation of CF

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11 yo with Down’s syndrome playing football has a short stature without previous follow up. What is the next best investigation?

a) Cervical XR
b) TFT
c) blood film
d) Coeliac screening

b) TFT

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Boy with CF, what is the chance of carrier for his sibling?

2/3

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What is the inheritance pattern of a boy with delay in walking, hypotonia and uncle using wheelchair? Examination otherwise normal.

X linked recessive (likely Becker’s muscular dystrophy)

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What is the inheritance pattern of a short girl whose height is on 0.4th centile (mid parental height 25th centile) with no obvious feature?

XO - Turner’s syndrome

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What is the risk of having an affected baby for a well parent to have a son with sickle cell disease?

1/4

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What is the genetic cause for Prader Willi syndrome?

Imprinting

loss of function of specific genes on the paternal copy of chromosome 15

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What is the mode of inheritance for myotonic dystrophy?

Autosomal dominant

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What is the inheritance pattern of rickets in a child whose mother has genu valgum?

X-linked dominant (X -linked dominant hypophosphataemic rickets)

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What is the best investigation to do for a girl with short stature and learning disability?

Karyotyping

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Boy with gynaecomastia, small testicles and tall stature. Diagnosis?

Kleinefelter syndrome - 47 XXY

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Girl with tachycardia narrow complex HR > 300. What drug would you give?

a) Propranolol
b) Digoxin
c) Adenosine
d) Amiodarone

c) Adenosine

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12-days old baby girl with 2 days deterioration and lethargy poor feeding
lymphedema in (hands or feet) weak femoral pulsations murmur 2/6
with normal heart sounds. CRT = 3, on 100% O2 but no oxygen saturation
can be recorded. What drug to give?

a) Prostaglandin infusion
b) IV Abx
c) IV Aciclovir
d) Dopamine

a) Prostaglandin infusion

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Girl with clinical feature and recent diagnosis of rheumatic fever, what investigation to rule out/in diagnosis?

a) ASOT
b) echo
c) blood culture
d) throat swab

a) ASOT

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Infection treated with antibiotics with joint pain. Heart murmur. What is the diagnosis?

Mitral stenosis
Mitral valve prolapse
AS
PS

Mitral valve prolapse

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12 yo girl previously healthy, history of hurting L shoulder and had nose piercing; developed skin infection which responded to topical antibiotic treatment. Now presents with fever + murmur at the apex. What is the next best investigation? a) Blood culture b) echo c) U&Es

a) blood culture

Child with small VSD needs elective tonsillectomy. ENT doctor asks if the patient needs prophylactic antibiotics?

Does not need prophylactic antibiotics

6 week old baby girl, non-dysmorphic, presents with lethargy, poor feeding during examination, lymphoedema on lower limbs and systolic murmur. Diagnosis?

Coarctation of aorta

3 month old with mild dysmorphic features. SpO2 95% with loud systolic murmur all over pericardium. Not cyanosed with FTT. a) VSD b) TGA c) ASD d) PDA e) TOF

A) VSD

Neonate with heart failure. What is the sure sign of heart failure? a) hepatomegaly b) cyanosis c) weak peripheral pulses d) pedal oedema

a) hepatomegaly

7 yo child has infrequent SVT attacks. Mother is worried if he has attack outside. What to do? a) Immerse face in ice water b) inflate a new balloon c) occular pressure d) propranolol

b) inflate a new balloon

6 month old with ejection systolic murmur in left upper sternal edge. Diagnosis?

Pulmonary stenosis with normal heart sound

34 weeker 10 days old with long systolic murmur BP 70/30 mmHg R arm and L lef no difference. What is the diagnosis?

PDA - wide pulse pressure

Patient with loud systolic murmur at left lower sternal edge - diagnosis?

VSD

Patient had illness after which he had basal crepitations. HR 140, RR 40, liver 2 cm. What's the diagnosis?

Viral myocarditis

Boy collapsed after swimming, slowly recovered his consciousness. Has cousin with epilepsy. What to do? a) EEG b) ECG c) Exercise ECG

b) ECG

12 yo with T21 + VSD, developed fever, had spleen 4 cm. Urine +++ blood. What's the diagnosis? a) ALL b) infective endocarditis

b) infective endocarditis

Neonate with pounding pulse murmur - continuous. What is the diagnosis?

PDA

Ejection systolic murmur in 3 month old well infant in L intercostal space. Diagnosis?

Pulmonary stenosis

Patient with collapse after swimming + FHx of uncle in follow up with cardiology. What is the diagnosis?

Long QT syndrome

9 month old baby with BW 3.7 kg presents with failure to thrive and weight < 0.4th centile. Has basal crepitations and presents with distress. What is the likely cardiac cause?

VSD

Baby with cyanosis and no murmur when he pulls his leg up. Diagnosis?

Tetralogy of Fallot

Ejection click 2nd intercostal space to the right radiates to the neck. Diagnosis?

Aortic stenosis

Child with viral injection + 1/6 mid-systolic murmur - diagnosis?

Innocent murmur

2 yo admitted to hospital 4 times in last 6 months with diagnosis of croup. On one occasion required I&V. Born at 26 weeks gestation and was oxygen dependent until 4 months of age. What is the next best investigation?

Bronchoscopy

9 yo girl with 10 day history of fever and cough. Responded initially to PO amoxicillin but now looks ill and has stony dullness on right lower chest. What is the next best Ix?

US chest

8 yo boy taking 750 mcg/day inhaled fluticasone propionate. Poor controlled cough and last week has become very lethargic after short-lived episode of vomiting. Other children in his class has had similar illness but less severely affected. Has finger clubbing and height on 25th centile. What is the next best Ix?

Short SynACTHen test

Child with recurrent attacks of barking cough and mild grade fever. Diagnosis?

Laryngotracheobronchitis

Febrile child with muffled sounds, weak crying and torticollis and otitis media. Best next step?

Urgent referral to ENT

Infant with poor feeding, lethargy, cough and intercostal and subcostal recession with oliguria (1 x wet nappy per day). O/E: wheeze + crackles SpO2 96%. Mum wanted to go home within 2 days because Christmas. What is the first step in management?

NGT feeding

Adolescent girl presents to ED with tachypnoea, SOB and paraesthesia in hands, SpO2 99%. What to do initially? a) Rebreathe bag b) Benzodiazepines c) O2 d) IV calcium

a) Rebreathe bag

Patient with brain tumour, headache, controlled on slow release morphine BD and PRN morphine but developed dysphagia. What do add?

Hyoscine patch

Patient with neuroblastoma, pain controlled with slow release morphine BD and PRN morphine. BNO for 3/7 with soiling. What to give next?

Movicol

Patient with metastatic osteosarcoma on slow release morphine BD and PRN morphine, on reviewing him by palliative care team, they found he received > 8 doses per day PRN morphine and pain is still not controlled. What to give next?

S/C Morphine

Breast T1. Pubic hair T3. Diagnosis? A) Premature adrenarche B) Premature thelarche

A) premature adrenarche

18 mo unwell with 24 hour history of vomiting and 1 x bloody stool. Bloods show mildly raised WCC and CRP 20. CBG shows metabolic acidosis. What is the diagnosis? a) E Coli enteritis b) dysentery c) intussusception

c) intussusception

MOA of baclofen?

GABA - B agonist

Neuroblastoma - what would you find on urine dip? Dopamine ACh Phylalanine Tyrosine

Dopamine

What is the genetics of alpha thalassemia trait?

Deletion of 2 alpha genes - Silent carrier = deletion of 1 alpha gene - Alpha thalassaemia trait = deletion of 2 alpha genes - HbH = deletion of 3 genes - Deletion of 4 genes = incompatible with life - leads to hydrops All forms of Hb requires alpha chains

Medication that interacts with melatonin?

Montelukast

11 month old Caucasian baby, exclusively breastfeeding; mother wants to introduce solid food at 12 months. Pale. No other neonatal problem. Diagnosis?

IDA

10 year old Caucasian boy. O/E: he is pale, jaundiced, palpable spleen 2 cm below costal margin. Hb 97, plt 140, normal WCC, retics 11%. History of travelling to Greece. Required phototherapy in neonatal period for 2 days. Diagnosis?

Hereditary spherocytosis

2 year old Indian girl presenting with history of URTI. O/E: Small solitary cervical lymph node, pallor "microcytic hypochromic" retics and ferritin normal. Diagnosis?

Thalassemia minor

Female entering secondary school presented with increasing morning headache and vomiting and ataxia. Diagnosis?

Brain stem glioma

Female entering secondary school presented with headache associated with abdominal pain and vomiting. Diagnosis?

Migraine

Female entering secondary school presented with diffuse banding headache with no vomiting. Diagnosis?

Tension headache

11 year old girl presented with menarche, started with breast and pubic hair 2 years ago. Height on 91st centile. Diagnosis? Normal puberty Premature adrenarche Idiopathic central precocious puberty CAH Kleinefelter

Normal puberty

6 year old came with scanty, slightly pigmented pubic hair and acne. Diagnosis?

Premature adrenarche

8 year old girl with menarche, breast and pubic hair, Turner stages B3 P3. Diagnosis?

Idiopathic central precocious puberty

14 yo girl with DiB, pins and needles in hands. O/E: chest clear, SpO2 97%, RR 45, HR 120, no history of note. Diagnosis?

Hyperventilation

18 mo baby boy from Syria, malnourished, came with cough for 2 months and night sweats, came with his grandfather and CXR was normal. Diagnosis?

2 year FTT, weight on 0.4th centile, came with respiratory distress, O/E: b/l basal crepitations and crackles. Diagnosis?

?CF (other option was VSD)

4 year old presenting with abdominal pain and distension. Found to be anaemic (microcytic hypochromic). Investigation?

IgA Anti-TTG

2.5 yo baby presented with history of PICA, sister also has PICA; they live in an old house with renovation. Hb 97, MCV + MCH in normal ranges, normal ferritin. What is the next investigation?

Lead level

Baby came in with bloody diarrhoea after GE, low Hb, high WCC, urea normal upper limit and high creatinine. Next investigation?

Peripheral blood film

12 year old boy with clumsiness and difficulty jumping in gym class. There is now difficulty walking and climbing stairs. What is the diagnosis? Becker's dystrophy Duchenne dystrophy Polymyositis

Becker's muscular dystrophy

2 year old female, quiet and withdrawn and reluctant to bear weight. Bruises and petechiae on calf muscle. O/E: thin and crying when moving her left leg. There is no organomegaly. ITP Septic arthritis HSP Leukaemia NAI

NAI

11 yo Muslim girl from Pakistan. Fasting in Ramadan. Wants to be included with her family activity. Developed fainting at school during fasting and banging her head. On arrival to hospital, BM 3.5 mmol/dl, weight on 2nd centile. Parents are 1st degree cousins, she has 2 other well siblings. What will you advise the family? A) She must stop fasting B) Her low blood sugar needs more investigations C) Speak to social and safeguarding as this is against best interest of child D) Fasting can cause fainting and if she developed further episodes, parents should reconsider the decision of her fasting E) Refer to dietitian to investigate her low body weight

?A or D

24 mo girl took first step independently at 23 months. She was born at 30 weeks. What is the cause? DDH DMD NAI Spastic diplegia

DDH

2 yo child choking at restaurant while eating biscuit, mother shouts for help, you found the baby drowsy with weak cough. What do you do first?

a) Give 5 back blows and then 5 consecutive abdominal thrusts b) Give 5 back blows and then 5 consecutive chest thrusts c) 5 rescue breaths d) Encourage cough e) Manual removal

3 yo girl, mother separated, noticed there is blood in underwear on 2 occasions after she visited her father on the weekend. Mother said the baby had constipation and scratching. Playing with her bicycle for long time. What do you do as a trainee doctor? A) Discuss with experienced paediatrician for help B) Inform social services C) Interview her personally D) Detailed genital examination E) Arrange investigation for tapeworm

?A or C

Baby presented with history of GE and URTI, after that he developed tachypnoea. HR 190 with gallop rhythm. CRT 4 seconds and weak, peripheral pulses and hepatomegaly. What is the 1st causative organism? Adenovirus Influenza RSV Salmonella Group A Strep

Adenovirus - common cause of myocarditis and arrhythmia

4 yo presented with severe abdominal pain and fever, mother noticed blood in her stool. O/E: child looks well, family works in dairy products. What is the causative organism? A) E Coli 0157 B) Rotavirus C) Campylobacter jejuni D) Norovirus E) Giardia

A - E Coli 0157

3 yo girl with soreness down below. Grandma thinks her external genitalia doesn't look like her other cousins. Mother didn't notice any abnormalities before. O.E: there is labial fusion near urethral opening. What will you do? Topical emollient Surgical referral Topical antifungal Topical estrogen Karyotyping

Topical oestrogen

15 yo boy not going to school, excessive sleeping since 8 pm, not coming out of room for breakfast until midday and not playing video games either. He was diagnosed with ASD at age of 9 years as he is keen with maths. What is the diagnosis? Depression Onset of puberty Hypothyroidism Drug induced

Depression

15 yo came with fever, fatiguability and joint pain. O/E: she was pale, heart murmur 1/6. BP 145/95 mmHg, maculopapular rash. Ix: anaemia and thrombocytosis, WCC 19 (neut 2.5%, lymph 3.7%), urine dip RCC +++, protein +++, and cast. No macroscopic haematuria. Diagnosis? SLE Haemolytic anaemia Systemic JIA IgA Nephropathy Reactive arthritis

SLE

14 yo with tiredness. FBC shows low MCV, low MCHC, low Hb. Diagnosis?

IDA

Picture shows newborn with bilateral cataracts. Cause? Infant of diabetic mother CMV Retinoblastoma Galactosaemia

CMV

3 wk baby boy with fever, non-bilious vomiting. Urine culture shows coliform bacteria. Received N/S bolus, full maintenance and IV Abx. He improved and is well perfused but still febrile. Next day has decreased UOP. Na 128, K 5.3, Urea 7, creatinine 150. What will you do? a) Add/change to gentamicin b) Strict fluid intake c) Urgent US for kidney and bladder d) Give furosemide e) Give albumin 4.5%

C - Urgent US KUB

What is the cause for macrocephaly? A) Congenital rubella B) Maternal PKU C) Foetal alcohol syndrome D) Neurofibromatosis 1 E) T21

D - NF1

Infant has paronychia in toes, took topical Abx but did not improve, then developed fever, macular rash with peeling and crusting around nose and eye, no mucosal membrane affected. Sterile culture. What is the diagnosis? a) SSSS b) SJS c) TEN d) Epidermolysis bullosa e) HSV

A) SSSS

What is the side effect of IV salbutamol? Lactic acidosis Metabolic alkalosis Hyperkalaemia Hypoglycaemia

Lactic acidosis - through mechanism of beta agonist causing glycogenolysis therefore not enough pyruvate metabolism and causing build up of lactic acid Salbutamol also causes hypokalaemia and hyperglycaemia

14 yo boy weight 68 kg, OGTT as per insurance, found to have fasting BM 6.5 and post-prandial was 8.9. What is your diagnosis? T2DM Impaired glucose tolerance MODY Normal glucose homeostasis T1DM

Impaired glucose tolerance Normal: fasting < 6.1, post-prandial < 7.8 Impaired glucose tolerance: fasting 6.1 - 6.9, post prandial 7.8 - 11.0 Diabetes: fasting 7 or higher; post prandial 11.1 or higher

7 month old baby brought for developmental assessment. Father was left-handed. What requires further investigation? Left hand preference Can't recognise strangers

L hand preference

6 hour baby boy on postnatal ward, during NIPE midwife checks oxygen saturation and it was 73%, diagnosis? VSD TGA PDA ASD CoA of Aorta

TGA

Mother asking what the benefits of breastfeeding to baby is. What is the most researched? Decreased incidence of obesity Decreased risk of breast cancer to mother Increased intelligence Reduced risk of infection Decreased risk of eczema

Reduced risk of infection

Child with TSH 180 and no uptake on isotope scan. What is the diagnosis? Dyshormonogenesis Sublingual thyroid Thyroid aplasia

Thyroid aplasia

You're doing a NIPE on postnatal ward. Mother wants to do circumcision for her baby due to religious causes; she wants a referral ASAP. She is married but separated from father who is refusing. What is the most accurate thing to tell her? A) Father must consent with her B) GP must refer the child for surgery C) Must postpone until the baby is competent D) Surgery should be delayed after nappy is off for fear of infection E) D/w social services

A - father must consent with her

5 month old presented with continuous crying and diarrhoea after feeding, there is eczema. He is on regular full term formula. What to give?

Trial of extensively hydrolysed formula

Baby on CPP, comes in with bruises and epistaxis, purpuric rash on trunk and back. He had viral illness 3 weeks before. What is the diagnosis?

ITP

Where is the site of BCG vaccination?

Intradermal left arm at site of deltoid (not right as WHO advises left)

9 yo child with T21, weight on 9th centile, height on 0.4th centile on Down's growth chart. No regular F/U before. He is well and playing football. Normal examination apart from features of T21. What is the best investigation for short stature? A) TFT B) IGF-1 C) Cortisol D) Coeliac disease E) RBC

A- TFT

2 yo girl has 6 perianal warts. Mother treated with warts in pregnancy. What to tell mother? A) HPV not needed B) Chlamydia must be screened C) It will spontaneously resolve D) Most likely due to sexual abuse

Baby with small phallus and bilateral impalpable gonads, no dysmorphic features, feeding after 12 hours, parents are not relatives, no FHx of chronic disease. Diagnosis? A) CAH B) Kleinefelter C) Prader Willi D) Hypospadias E) Beckwith-Wiedemann syndrome

A) CAH - most common deficiency in 21-hydroxylase causing: - Decreased aldosterone - Decreased cortisol - High testosterone

Which is the highest risk factor of neonatal infection? A) Preterm before 37 weeks spontaneous delivery B) Intrapartum fever of more than 38.5 degrees C) Suspected infection in multiple pregnancy D) Maternal colonisation of GBS + bacteria in current pregnancy E) GBS infection in previous pregnancy

C - Suspected infection in multiple pregnancy

Teenager girl was gymnastics champion, previous was good achiever in gymnastics before and participated in school. Now c/o myalgia, arthralgia and fatigue. History of viral infection 4 months ago, she missed some school days. Family are worried about her condition and need her to win before next competition. Management? A) Graded exercise, CBT, Home tuition B) Graded exercise, CBT, Adjustable school timetable C) Graded exercise, CBT, Stimulant medication D) Family therapy, CBT, Home tuition E) CBT, Multivitamin, adjustable school timetable

B) Graded exercise, CBT, Adjustable school timetable

15 yo girl presents with vomiting, severe abdominal pain 8/10 with tenderness in RLQ, no guarding, had irregular cycle, last period was 6 weeks ago and today she bled. BP 80/50 mmHg. No fever. What will you do? A) Pregnancy test B) Urinalysis C) US Abdo/pelvis D) FBC

B) Urinalysis

Female diagnosed as seasonal sinusitis and has exam in 3 days. What is your advice? A) PO steroids for 48 hours B) PO Cetirizine starting this evening for 3 days C) Topical beclomethasone/nasal spray D) Xylometazoline nasal spray PRN during the exam E) PO Chlorphernamine for 3 days

B) PO cetirizine starting this evening for 3 days

4 month old came to paediatric clinic with squint, the squint was apparent on examination, mother also had a squint when she was a child. What should you do? A) Refer to ophthalmology B) Review at 6 months C) Do MRI/CT

A) refer to ophthalmology

18 month baby fever for 4 days, given amoxicillin yesterday. Fever subsided and baby became well but developed maculopapular rash on trunk and back today. What is the diagnosis? A) Roseola infantum B) Measles C) Rubella D) Drug reaction

A - Roseola infantum caused by HHV 6 (most commonly) or HHV 7. Typically high fever for 3-5 days and maculopapular rash appears after fever subsides

12 yo boy with polyuria, polydipsia, BM 34 and blood ketone 4. What to do at time of diagnosis? A) Blood gas B) Islet cell antibodies C) Anti GAD antibodies D) C peptide E) Urine ketones

A - blood gas

6 yo girl with short stature, weight on 9th centile, height on 2nd centile with mild learning difficulties, mid parental height on 50th centile. What investigation to do? A) Karyotyping B) TFT C) IgA TTG D) IGF-1

A) Karyotyping

6 month old Somalian infant crying at night. O/E: Baby is well apart from umbilical hernia which is easily reducible (1cm length and 0.5 cm defect). What advised should you give regarding umbilical hernia? A) Wait for natural closure B) Come back to ED if vomiting C) Refer for surgery 4) Reduce by coin

A) Wait for natural closure Most umbilical hernias in infants resolve spontaneously; surgery considered if hernia persists beyond 4-5 years old; especially if hernia smaller than 1.5 cm.

15 yo girl came to you after she took 16 tablets of paracetamol at (24hr, 12hr and 2 hr) before she came, she had skin rash when treated for previous paracetamol toxicity. What will you do? A) Infuse NAC immediately over 60 minutes B) Measure level of paracetamol and give NAC over 4 hours C) Take paracetamol level after 4 hours D) Take level and wait for result E) Do not give NAC due to previous sensitivity

A) Infuse NAC immediately over 60 minutes NAC management plan: - Loading dose 150 mg/kg over 1 hour - 50 mg/kg over next 4 hours - 100 mg/kg over next 16 hours - Start immediately if timing of the OD is unclear

Patient with ALL on maintenance chemo and has no history of chickenpox before with seronegative immunity. Brother develops vesicular rash today. Family asking for advice over the phone, what to do? A) Prescribe aciclovir now B) VZIG and aciclovir when rash appears C) Give vaccine and VZIG together D) Reassure family rash will be self limiting and nothing to be done

A - Prescribe aciclovir now (Out of all the options A seems best as in immunocompromised patients, on exposure you should give VZIG; only if they develop symptoms would you give aciclovir. However, you wouldn't give the vaccine to immunocompromised as it is a live vaccine so only option is A)

3 day old newborn discharged 6 hours after birth who came in with bilious vomiting twice at home. O/E: normal examination. What to do now? A) Admit and investigate B) No need for investigation C) Tell midwife to follow up D) Urgent paediatric outpatient appointment E) Ask mother to take sample of vomits and bring it with her

A - admit and investigate

7 year old boy on 200 mcg fluticasone and salbutamol but not well controlled. What will you add next? A) LTRA B) LABA C) Increase steroid use D) Continue on same dose

A) LTRA

2 yo girl is pale and appears lifeless and floppy after minor injury, the child is subdued for some time after the attack. Diagnosis? A) Reflex anoxic seizure B) Long QT Syndrome C) Epilepsy D) Anxiety attack

A) Reflex anoxic seizure

7 yo child complaining of 3 month period of cough and wheeze. Received multiple antibiotics with little response. He can't keep up with his friends in the playground. He has eczema when he was an infant and his mum has hay fever. What is the investigation that will lead to a definitive diagnosis? A) Spirometry B) Immunological study C) Skin prick test D) CXR E) Viral serology

A) Spirometry

28 week patient presenting with a loud murmur. Difficult to wean from ventilation. What is the management? A) Spironolactone B) Furosemide C) Ibupfoen D) Prostaglandin

C) Ibuprofen

11 yo boy came in after playing football with severe L scrotal pain. What is the diagnosis? A) Haematocoele B) Testicular torsion C) Torsion of appendix testis D) Epididymo-orchitis E) Torsion of hyatid cyst of Morgagni

B) Testicular torsion

6 yo boy came with limping and internal rotation with restricted movement (abduction). What is the diagnosis? A) Perthe's disease B) SUFE C) Reactive arthritis D) Septic arthritis

A) Perthe's disease

3 yo baby came with fever and inability to bear weight O/E: knee was hot, tender. What is the investigation to confirm the diagnosis?

Joint aspirate

Which indicates NAI from the following: A) Bruises in ear in 4 month old baby B) Bruises in the back in 5 month old baby C) Bruises in forehead in 3 yo baby D) Quadriplegic CP with thigh bruises in 12 year old E) Shin bruises in 2 year old

A) Bruises in ear on 4 month old baby

2 year old baby in foster care, came toxic with high fever 39, intercostal and subcostal recessions, soft stridor and drooling what to do? A) Nebulised normal saline B) IM Adrenaline C) IV Cefotaxime D) Urgent ENT referral E) XR neck

D) Urgent ENT referral

School age child on school trip to camping in mountains and canoeing. Trip needed to be cut short due to floods and rain. He presents with malaise, joint pain, intermittent fever, rigor and night sweats for 2 weeks. O/E: Jaundice, HSM, conjunctival injection, macular rash in trunk. History of travel to Malta 1 year ago. Diagnosis? A) Leptospirosis B) Typhoid fever C) Lyme disease D) Hepatitis A E) Malaria

?A) Leptospirosis i.e. Weil's disease - zoonotic infection spread through infected animal's urine.

Female with morbid obesity BMI 99.6 centile, no family history of DM or cardiac disease. What is the management? A) Dietary management B) Give Orlistat C) Refer for local weight management programme D) Check lipid profile E) Screen for DM

C) Refer for local weight management programme

Child playing on bicycle, hit by a car and car didn't stop. Presents with bruises in elbow and knees. He was conscious and well, observed for 6 hours and discharged home. What is the most potential complication that can occur? A) Extradural haemorrhage B) SAH C) IVH D) Nec fas

A) Extradural haemorrhage

6 week newborn, presented with progressive vomiting. What investigation is most indicative of pyloric stenosis? A) Hypokalaemia B) Hypochloraemia C) Hypernatraemia D) High urea E) Metabolic acidosis

B) Hypochloraemia

2 year old child had loose stool since infancy. What finding indicates further investigation? A) Recurrent chest infections B) Weight and heigh on 2nd centile C) Faecal incontinence D) Eczema

A) Recurrent chest infections

Known case of T1DM, admitted for control of her blood control. At 12:05pm she gets pale, sweating and shaking. BM 3.5. What do you give next? A) IV dextrose B) PO Glucose 15 g C) Adjust time of lunch D) Orange juice and toast E) IM glucagon

B) PO glucose 15g

2 yo case of febrile convulsion, midazolam given by paramedic, IV lorazepam prepared to be given, child is still seizing, no signs of focal infection. What is the next step in management? A) Check glucose B) LP C) Check serum calcium D) BC E) CT Head

A) Check glucose

Boy developed meningococcal meningitis. His sister is 14 yo on OCP. What is the prophylaxis for meningitis? A) Single dose of ciprofloxacin B) Ceftriaxone C) Rifampicin

A) Single dose of PO ciprofloxacin

7 year old with polyuria, polydipsia and weight loss. What investigation will you do? A) C peptide B) Islet cell antibodies C) Blood glucose D) HbA1c

C) Blood glucose

2 year old child coming for elective inguinal hernia repair after premedication, the child developed convulsion. PMHx irrelevant apart from history of afebrile convulsion at 9 months of age. What is the possible diagnosis? A) MCAAD B) Idiopathic epilepsy C) Febrile convulsion D) B6 deficiency

A) MCAAD

2 week old newborn referred by midwife because of jaundice. Bili 215, conj. 92, GGT "little high". What is the diagnosis? A) Neonatal hepatitis B) Breastmilk jaundice C) Physiological jaundice D) Biliary atresia E) Haemolytic disease of the newborn

D) Biliary atresia

6 yo boy presents with joint pain in ankle and knee with abdominal pain, purpuric rash in LL. No macroscopic haematuria, urine dipstick showed proteinuria +, RCC +. What is the diagnosis? A) HSP B) Meningococcal septicaemia C) IgA nephropathy.

A) HSP

14 yo girl has fatiguability, fever of 2 weeks, night sweats, history of piercing. O/E: Diastolic murmur, splenomegaly and finger clubbing. Urinalysis shows microhaematuria. Diagnosis?

Infective endocarditis

12 yo girl had day and night symptoms. Night symptoms improved with pelvic floor exercises but she still had dripping of urine with laughing and coughing. What will you give?

Oxybutynin

18 month fully immunised, toxic appearance, temperature 40 degrees, came with pupuric rash on LL. CRT 4 sec. Anterior fontanelle flat. What is the diagnosis? A) Meningococcal septicaemia B) HSP C) ITP D) NAI

A) Meningococcal septicaemia

4 week old diagnosed as unstable hip, referred for ortho surgery. Mother asked about management? A) Abduction splint B) Adduction splint C) Open reduction D) Acetabuloplasty E) Close reduction

A) Abduction splint

Child presented with generalised body swelling more prominent in LL, he had a history of skin infection. What investigation will you do? A) Serum albumin B) Urinalysis C) U&Es D) Complement assay

B) Urinalysis

Mother has known SLE, had history of recurrent miscarriage. What is the most serious complication that could affect the baby? A) Complete heart block B) 1st degree heart block C) Carditis D) Thrombocytopenia

A) Complete heart block

9 yo argued with her mother after stepfather came home, she went to bed and when she stood up she went pale and fell to the ground. Twitching of her hands, she rapidly recovered. She remembered she was dizzy before. There is a positive history of epilepsy. Diagnosis? A) Complex partial B) Syncope C) Pseudoseizure D) Vertigo E) Reflex anoxic

Syncope

Teenage girl, mother thinks she is inducing vomiting but girl is denying. What is the evidence to support mother? A) Multiple cuts in wrist B) Erosion of teeth enamel

B) Erosion of teeth enamel

Child with history of fever after 5 days, urinalysis shows microscopic haematuria, proteinuria ++. What is the most likely diagnosis? A) IgA nephropathy B) Glomerulonephritis C) Renal failure

A) IgA Nephropathy - Berger's disease (occurs days after fever whereas PSGN occurs weeks after)

7 yo boy c/o headache. O/E: Pubic hair, testis 3 ml, penis stage 3, high BP, facial acne, adult odour. What is the diagnosis? A) CAH B) Adrenal tumour C) Premature adrenarche D) Idiopathic central precocious puberty

B) Adrenal tumour

Nurse gave double dose of gentamicin when she was preparing it in a side room. She was was interrupted by a phone call. High trough level. What will you do? A) Don't inform parents unless harm has occurred B) Inform parents and tell them investigations are going on C) Inform parent and tell them who is responsible D) Don't tell parent at all E) Inform medical governance team

B) Inform parents and tell them investigations are going on

2 month old with inconsolable crying 2-3 hours after vaccination. What to do? A) Continue as same schedule as planned B) Provide the next vaccination under hospital care C) Delay next vaccination

A) Continue as planned

Child with URTI (OM), torticollis, stridor. Diagnosis? A) Mastoiditis B) Retropharyngeal abscess C) Steromastoid tumour D) Cervical lymphadenopathy

Retropharyngeal abscess

Baby developed bleeding after circumcision, you are on the ward and found baby to be tachycardic, CRT prolonged. What will you do? A) Call surgical team B) Give 0.9% NS bolus C) Give factor 8 D) FFP E) HAS

B) Bolus

18 month attended with 3 days of respiratory symptoms, cough and mild decrease in feeding with normal SpO2 98%. Mother was anxious. What do you do?

Reassurance

9 month old baby came with fever, coryzal symptoms, noisy breathing, harsh cough and intermittent stridor. Management?

PO dexamethasone (not pred as dex has longer half life)

6 hr old baby delivered at home, presented with hypotonia and 6 x green vomits. Diagnosis?

Duodenal atresia (assuming hypotonia secondary to T21?)

4 week old baby presented with vomiting which hits the other wall of the caravan where they live and keen to feed after vomiting. Diagnosis?

Pyloric stenosis

3-8 wk baby with a history of diarrhoea and vomiting, wheezy chest and weight loss. PMHx eczema and skin rash. Diagnosis?

Cow's milk protein allergy

What is the chance of a healthy mother and father who have a sickle cell child to have another affected sibling?

1/4

What is the chance of a father with haemophilia disease to have an affected boy?

Population risk

What is the chance of a healthy appearing sibling of a CF child to be a carrier?

2/3

Baby boy looks frightened, goes pale with repetitive swallowing for 15-30 seconds after which he is tired. Diagnosis? A) Complex partial seizure B) Vasovagal syncope C) Pseudo seizure D) Daydreaming

A) Complex partial seizure

Girl in assembly loses consciousness, suddenly goes pale with twitches in hands and jerky movements after that she regains consciousness and becomes confused for seconds. Diagnosis? A) Complex partial seizure B) Vasovagal syncope C) Pseudo seizure D) Daydreaming

B) Vasovagal syncope

Child noticed at school by teacher he is beginning to develop learning difficulty. Mother didn't notice any problem at home. Diagnosis? A) Complex partial seizure B) Vasovagal syncope C) Pseudo seizure D) Daydreaming

D) Daydreaming

4 yo with URTI 2 days ago now complaining of limitation of abduction at hip joint and can't weight bear. Diagnosis? A) Perthes B) SUFE C) Transient synovitis D) Reactive arthritis E) Discitis

C) Transient synovitis

4 yo with history of limping for 5 months. O/E: limitation to external and internal rotation and limited flexion and pain referred to knee. Diagnosis? A) Perthes B) SUFE C) Transient synovitis D) Reactive arthritis E) Discitis

A) Perthe's disease

12 yo presenting with local tenderness on lumbar spine and pain in the leg. Normal examination in all joints. Diagnosis? A) Perthes B) SUFE C) Transient synovitis D) Spinal tumour E) Discitis

E) Discitis

5 yo Bangladeshi boy recently arrived to UK with history of tiredness and intermittent fever for 3 weeks with pallor. O/E: Liver 3 cm, spleen 2cm, bilateral cervical lymphadenopathy 0.5 x 1cm. Diagnosis? A) ALL B) EBV C) Reactive lymphadenitis D) Mycobacterium TB E) NHL

A) ALL

3 yo Asian presented with lump for 1 month on right side of neck. Asymptomatic, afebrile. Vaccinated with BCG. O/E: Lymph node 2 x 1 cm in anterior triangle of neck for last few weeks and discoloration over swelling, non-tender. Vitals stable with normal XR. Treated with amoxicillin for 10 days without response. Diagnosis? A) ALL B) EBV C) Reactive lymphadenitis D) Mycobacterium TB E) Atypical mycobacterium TB

E) Atypical mycobacterium TB

6 yo given treatment for tonsilitis 1 month ago with small mobile lymph nodes and non-tender 0.2-0.5cm. Diagnosis? A) ALL B) EBV C) Reactive lymphadenitis D) Mycobacterium TB E) Atypical mycobacterium TB

C) Reactive lymphadenitis

Concerning migraines in children, which of the following is the most accurate statement? a) Visual aura is common b) FHx is needed in diagnosis c) It is rarely diagnosed before 5 years of age d) Must be excluded if unilateral

c) It is rarely diagnosed before 5 years of age

Boy presented with polyuria and polydipsia. Weight and height at 5th centile, urine osmolality 200. What is the diagnosis? a) DM b) RTA c) Nephrogenic diabetic insipidus d) Central diabetic insipidus e) Habitual drinking

C - Nephrogenic DI (I'm assuming the urine fails to concentrate despite desmopressin)

15 yo girl with regular period at first then becomes irregular. There is brown pigmentation in the neck and axilla. There is also excessive facial hair and striae. She is overweight. Diagnosis? A) PCOS B) Cushing's C) NF1 D) CAH E) BWS

A) PCOS

3 yo boy started to walk at 18 months; after URTI, he is reluctant to walk, he doesn't know his colours and can't do 3 step commands and has stopped walking. O/E: Severe lordosis, waddling gait and symmetrical muscle weakness. What is the investigation you will do? A) ESR B) Dystrophin gene C) TFT D) CK E) Microarray

D) CK (they have put either CK or TFT)

T1DM presenting with DKA, BM 32, Ketone 3, father has T2DM and grandfather was receiving oral hypoglycaemia treatment. What advice will you tell the family? A) He will need lifelong insulin B) No further investigations C) Low carbohydrate diet

A) He will need lifelong insulin

14 mo boy admitted due to URTI, you are called urgently to attend because the child is having tonic clonic seizure. When you arrive, the child has been seizing for 2 mins, BM 7.6, senior nurse applies O2 mask. What will you do next? A) Obtain IV access B) Observation C) Buccal midazolam D) IV lorazepam

B) Observation

Baby received methadone with noisy breathing, SPO2 96% and HR 100, RR 18. What do you do now? A) Secure airway B) Naloxone C) Intubation

A) Secure airway

Baby presents with 7 day history of fever, cracked lips, red eyes, and cervical LN. Received 2 days of antibiotics and then a rash appears. High ESR, Platelet 250, normal WCC and Hb. What investigation would you do to guide further management? A) CXR B) Echo C) ASOT D) ECG

B) Echo

5 week old breastfed baby comes in with coryzal symptoms, midwife noticed he is jaundiced, total bili 120, direct 90 with liver 1 cm below costal margin. Diagnosis? A) Biliary atresia B) Galactosaemia C) Hepatitis A D) Breastmilk jaundice E) Spherocytosis

A) Biliary atresia

3 week old Chinese baby of hepatitis B surface antigen positive mother, mother refused to give vaccine at birth and baby is well and thriving and breastfeeding. Found to be jaundiced with mustard stool colour and baby is well. Weight on 50th centile. Diagnosis? A) Neonatal hepatitis B) Breastmilk jaundice C) Biliary atresia D) Hepatitis B virus

B) Breastmilk jaundice

4 yo baby presents with intermittent abdominal pain in last 4 weeks, vomiting 4-6 times in last 48 hours and last 24 hours was greenish. Diagnosis? A) Malrotation B) Intussuscpetion C) Duodenal atresia D) Viral GE E) Lymphadenitis

A) Malrotation

14 yo T21 c/o abdominal distension and low centile weight and height on Down's chart. He lives with grandparents and mother abandoned him. TFT normal last year. Diagnosis? A) Coeliac disease B) Psychological deprivation C) Hypothyroidism D) ALL

A) Coeliac disease

18 month child with vomiting, tachycardia, pale, bloody diarrhoea and lethargic. Urea 39 (upper limit of normal), Hb 12, WCC 14, Plt 140, CRP 20, pH 7.2, HCO3 11. Diagnosis? A) Bacillary dysentery B) Diverticulitis C) Intussusception D) E. coli E) Mesenteric lymphadenitis

C) Intussusception

14 yo with DKA. O/E: HR 120, CRT 2 sec and severe dehydration. What is the maintenance fluid regime in DKA? A) Normal saline B) NS + 5% Dex C) NS + 10% dex D) 0.45% Saline + 5% dex E) 500 ml 0.9% Nacl + KCL

E) 500 ml 0.9% Nacl + KCL

1 yo child with recent onset of right convergent squint. O/E: HC 91st centile, weight and height on 5th centile. He can cruise around furniture and say 2 words. What is the most common paediatric ophthalmological cause? A) Right rectus muscle injury B) Congenital cataracts C) Optic glioma D) Errors of refraction

D) Errors of refraction

Known diabetic child on basal bolus regime. After a football class, he fell down and became drowsy, chatty. Nurse measured his BM 2.5. What is the best action to do? A) Call ambulance B) IM glucagon C) 200 ml sugary fluid D) IV Glucose

C) 200 ml sugary fluid

Full term neonate admitted onto NICU 3.7 kg after 4 hours he developed hypoglycaemia and received maintenance 150 ml/kg/d 10% dex and withdrawn gradually onto full feeds with close follow up of BM then before d/c he developed hypoglycaemia. What to do next? A) Stop feeding and start IVF B) Ix for hypoglycaemia C) Continue formula feeding D) Do CT E) Give IV hydrocortisone

B) Ix for hypoglycaemia

10 yo known case of DM presented with persistent vomiting and ketones was +++ in blood. BM 2.3. What to do next? A) 10% dex 2 ml/kg B) 10% dex 10 ml/kg C) 5% dex 10 ml/kg

A) 10% dex 2 ml/kg Hypoglycaemia in children is BM < 4.0

8 week old baby with breastmilk jaundice and meningitis, what do you give? A) Ceftriaxone B) Cefotaxime C) Gentamicin D) Clindamycin

B) Cefotaxime N.B. Can't give ceftriaxone to babies due to risk of hyperbilirubinaemia and biliary sludge

Patient diagnosed with measles after 10 days developed tonic clonic seizure and received lorazepam and seizure stopped. Patient is drowsy and unresponsive and fundoscopy is normal. No focal abnormality. What should you do next? A) CT and MRI B) Give measles Immunoglobulins C) Immediate LP D) EEG

A) CT and MRI ?suggestive of acute demyelinating encephalitis (occurs within 2 weeks of rash appearing). N.B. sub-acute sclerosing pan-encephalitis occurs 5-10 years after measles infection.

Teenager is about to do GCSEs has come in the afternoon before the exam and developed dysuria, fever 38 degrees and headache. Urine dipstick positive for nitrite and negative for others. What will your next action be? A) Give broad spectrum Abx and go to exam next day B) Give trimethoprim and send culture C) Admit and defer exam D) Manifestation due to anxiousness about exam

A) Give broad spectrum Abx and go to exam next day

10 yo girl with fever and no focus and non-specific symptoms. Urinalysis WCC 50. All cultures negative. Leukocyte esterase negative and nitrite negative. Diagnosis? A) Non-specific viral infection B) Bacterial vaginitis C) UTI

B) Bacterial vaginitis

3 yo girl with 1 day history of fever 38 degrees, went to GP and diagnosed her as URTI. What is the best advice to the mother? a) Wrap and put to bed b) Fever will usually subside in 3 days c) Come tomorrow to assess to give Abx d) Return back if fever not subsided in 3 days and give antibiotics e)e Return back if the girl starts to pull her ear to give Abx

b) Fever will usually subside in 3 days

15 yo initially was active recently became irritable and less feeding and sleepy and keeps herself in her room. Not keen to go out with her friends. Claimed she is fussy and overactive. Doesn't like to eat at home and said she doesn't like the home meals on examination. Quiet and no eye contact. Diagnosis? a) eating disorder b) depression c) hypothyroidism

b) depression

What is the fine motor milestone of 3 year old? a) draws a circle b) bridge of 12 cups c) draws square d) using scissors e) cut paper into 2 equal pieces

a) draws a circle

What is the most important at 6 months to refer for surgery? a) inguinal hernia b) phimosis c) epigastric hernia d) umbilical hernia e) hydrocoele

a) inguinal hernia

6 month old baby missed hearing screening at birth. What to do now? a) Evoked brain stem response b) Tympanometry c) Distraction test d) Visual reinforcement audiometry e) Pure tone audiometry

a) Evoked brainstem response

2 yo child not saying any words. He goes to nursery and the teacher at the nursery reported that he is not interacting with other children. He passed his neonatal hearing screening test and his neuro exam is normal. Management? a) audiological assessment b) refer to SALT c) Refer to developmental assessment for ASD d) Refer to education psychiatrist

a) audiological assessment

3 yo on salbutamol inhaler PRN and flexotide inhaler 100 micro BD. Has daily night symptoms daily in last 3 weeks. What next step to add?

a) LTRA

Child with periorbital oedema then becomes painful with ecchymosis and painful eye movements. What to give?

IV ceftriaxone

3 day old in NICU. Nurse forgot to give vitamin K and parents were outside. What to do? a) Tell parents and apologise for them b) Tell parents and call the consultant c) Tell parents to go to administrative office d) Don't tell the parents and document on file

b) Tell parents and call the consultant

Vegetarian girl with history of URTI 3 weeks ago. Presents with tiredness and lethargy and Hb 6, WCC 5, plt 60, low MCV. What is the diagnosis?

Aplastic anaemia

You are a junior doctor and parents came with their 4 month old boy as the baby can't move the upper limb on the right side as they said the baby has fallen from the sofa. XR shows spiral fracture of humerus. What do you do next? a) Skeletal survey b) Inform the registrar c) Discuss with parents suspicion of NAI d) Call Ortho reg

b) Inform the registrar

Asthmatic 4 year old child on salbutamol. What is best to be given with? a) metered dose inhaler b) dried powder c) metered dose inhaler with wide volume spacer d) ultrasonic nebuliser

c) MDI with wide volume spacer

Which of the following if present alone will be indication of CT brain? a) B/l bruises around the eye b) Amnesia > 5 mins c) Fall > 3 m d) Vomiting > 3 x e) LOC > 5 mins

a) B/l bruises around the eye - signs of basal skull fracture The other options need to be present with another risk factor to warrant a CTH within 1 hour.

1 yo had viral infection and mother complained of difficulty of feeding and breathlessness. HR 190, RR 45, liver 3 cm below costal margin and b/l crepitation and normal air entry. Diagnosis? A) Pneumonia B) Viral myocarditis C) CF D) Bronchiolitis

B) Viral myocarditis

8 yo with history of father initally healthy then deveoped stroke at 35 years and her uncle died prematurely at 37 years. Mother was worried about the girl and asks for your advice. a) Lipid profile now and through puberty b) Lipid profile and discharge if normal c) Wait until girl becomes competent d) Reassure and discharge

a) Lipid profile now and through puberty

12 yo girl referred from school for obesity, weight and height at 98 centile and BMI at 91st centile. Tanner B3, P3. What further management? a) Diet and lifestyle management b) Weight management c) Lipid profile d) Reassurance e) Refer to dietitian

b) Weight management

Child collapsed whilst playing rugby; he regained his consciousness immediately and after that was referred into hospital. On arrival, was fully conscious with normal examination. Which investigation will you perform? a) EEG b) ECG c) Echo

b) ECG

Child presents with sudden pain associated with testicular swelling, tenderness, nausea and absent cremasteric reflex. Diagnosis?

Testicular torsion

Baby with history of ventouse extraction and obstructed labour with abnormal shaped skull and posing of R frontal and L posterior occipital region. Diagnosis? a) Plagiocephaly b) Cephalohaematoma c) Craniosyntosis d) Rickets

a) plagiocephaly = when a baby develops a flat spot on one side of the head

Patient with CF and develops staphylococcal infection with sudden breathlessness and decreased entry on the right side. Shifting of trachea to L side. Diagnosis? a) PTX b) Empyema c) Lung collapse

a) PTX (pneumothorax)

Baby with eczema on face and parents applying hydrocortisone cream due to severe eczema and they increased the potency from emollients to hydrocortisone to clobetazone during acute exacerbation. Mum is worred of using potent corticosteroid on face and causing skin atrophy. What will you management be? a) Tacrolimus 0.3% b) Increase frequency of steroids c) Use of memetasone

a) Tacrolimus 0.3%

10 year old boy with plantar warts engaging in competitive swimming. Nurse calls you for advice. a) Apply waterproof plaster b) Don't allow swimming c) Refer to derm

a) Apply waterproof plaster

Asian girl with facial rash and haematuria and joint pain. Urine dip shows protein 3+ and RBC 2+. What investigation will lead to diagnosis?

Anti dsDNA (SLE)

8 yo boy with gross haematuria after 2 days fo URTI. He said that he has had previous attacks with previous illnesses and he was ashamed to tell the parents there is flank pain. Urine dip shows haematuria with no RCC cast. What is your diagnosis? a) IgA nephropathy b) Nephrolithiasis c) PSGN d) E coli

b) Nephrolithiasis (presumably secondary to dehydration during acute illnesses?)

Patient presents with previous history of anaphylaxis to penicillin. Now presents with tonsillitis. What do you give? a) Clarithromycin b) Amoxicillin c) Co-amoxiclav d) Clindamycin

a) Clarithromycin

10 year boy came with cough and fever 38.8 diagnosed with respiratory tract infection not responded to antibiotics and developed painful nodular lesion on chin. What is the diagnosis? a) atypical mycobacterium b) mycoplasma pneumonia c) Rheumatic fever

b) mycoplasma pneumonia (unsure why it's b and not a)

9 month old baby presents with drowsiness. GCS 6. Mother said that he rolled over the sofa while his 3 year old brother was watching him. What will you do next?

CT head Any one of the following risk factors is an indication for performing a CT brain within one hour: - suspicion of non-accidental injury - Glasgow Coma Scale (GCS) < 14 on initial assessment - Glasgow Coma Scale (GCS) < 15 after two hours following the injury - suspected open or depressed skull fracture or tense fontanelle - signs of basal skull fracture - post-traumatic seizure without a history of epilepsy - focal neurological deficit - bruise, swelling or lacerations > 5 cm on the head in children under one year of age.

2 yo child 12 kg what will be the dose of adrenaline if presented with anaphylaxis in hospital?

150 mcg IM 1:1000

8 week old baby, formula feeding, mother reported that he vomits half his feeding. O/E he was well hydrated, alert. Soft abdomen, weight on 50th centile. What is your advice? a) advice about positioning before and after feeding b) change to soya formula c) use of sodium alginate d) add thickener e) change to follow on formula

a) advice about positioning before and after feeding

11 yo JIA on SC methotrexate weekly developed small eruption of classic chicken pox eruption. What is the next best step in management? a) Hospital admission of IV aciclovir b) PO aciclovir for 5 days and then come for F/U c) Reassure d) VZIG e) Oseltamivir PO for 5 days

a) IV aciclovir

12 week baby not following his mother. What is the best action to do? a) Refer to ophthalmologist b) Reassure c) Refer to orthoptis d) Specialised paediatrician

a) Refer to ophthal

Breastfed baby developed manifestation of eczema and blood streaks in stool. Management? 1.Advice the mother to exclude dairy products from her meals 2.Extensive hydrolyzed formula 3.Lactose formula 4.Soya formula

1.Advice the mother to exclude dairy products from her meals

Child diagnosed with life limiting condition. Feeding by NGT, he is under the care of multidisciplinary team. The parents in the meeting the parent asked if it is suitable to transfer him to hospice what would be the appropriate action? 1.Refer to holistic care 2.Advice to make advanced care plan 3.It is not appropriate to do as this time as he under multidisciplinary team. 4.Only after assessment of his condition.

1.Refer to holistic care

6 year asymptomatic, C/O pain in lower leg, vitamin D level is 17. Mx? 1.Reassurance 2.Calcium 3.High dose of vitamin D 6000 IU for 4 weeks 4.Advice of daily vit D supplm. & increase dietary calcium

4.Advice of daily vit D supplm. & increase dietary calcium

8 year girl came with greenish discharge on her pants. Her mother refused to be examined. Mother work as sex worker. Recently the child has changed to be aggressive behavior at school. She had several times wetting at school , become withdrawal from her family and like to stay alone in her room. What is the diagnosis? 1.Non consensual contact with adult 2.Non consensual contact with child. 3.Consensual sex

1.Non consensual contact with adult

A girl admitted to the hospital because of severe weight loss, she known to have anorexia nervosa. For dealing her management. What is the least concerning to her case? 1.Bradycardia 2.Frequent cutting of her forearm 3.Like image to be low BMI 4.Hypophosphatemia 5.Hypothermia

5.Hypothermia

A girl was delivered at 27 weeks , she had prolonged ventilation during neonatal period , now she cruise around furniture, also she has tip toe walking. What is the diagnosis? 1.Spastic diplegia 2.Duchene M.D 3.DDH

1.Spastic diplegia

Toddler asked to buy something from supermarket but his mother refused, then the child started to have excessive crying and become cyanosis then seizing. What is the diagnosis? 1.Pseudo seizure 2.Vasovagal syncope. 3.Anoxic reflex 4.Complex partial

3.Anoxic reflex

A boy came from Bangladesh to UK one year back presented with history of HSM & jaundice , no symptoms in his country. What investigation you will do? 1.Hb. Electrophoresis 2.CBC with blood film 3.Abd U.S

2.CBC with blood film

Neonate birth weight was 3.4kg currently3.7 kg, has frequent vomiting, his feeding is 120 ml every 6hours. What is your diagnosis?

Overfeeding

pregnant women delivered deaf baby. Which is the most common cause of neonatal deafness? 1. Toxoplasmosis 2. CMV 3. HSV

2. CMV

Child after diagnosis of brain stem death, confirmed by 2 seniors, many trials to convince the parents that ventilation must be stop. Family refused. Further discussion failed. Who will take decisions of separation from ventilation? 1.Judge 2.hospital ethicscommittee 3.Local authority 4.Biological parents

1. Judge

Newborn has heavy meconium stain with Hx of PROM at first stage of labour. Mother delivered with prolonged labour for 36 hours, baby cried immediately then become vigorous. What to do next? 1.Observation 2.Admission and start antibiotic 3.ETT suction and ventilation. 4.ETT suction and observation 5.Oropharyngeal suction and AB.

1. Observation

8 year old CP with learning difficulty, increase night time awake and crying with bilateral hip dislocation. Hx of epilepsy, constipation, gastrostomy feeding. Parents gave him regular CPT with no benefit. No home nurse. What to give? 1.Fentanyl patch 2.Ibuprofen 3.Codeine 4.Morphine sulphate 5.Buprenorphine patch

2. Ibuprofen

5 month baby full term sleep with parents in their room. Mother and father are heavy smoker, takes 25 cigarette per day. Which of the following will increase SID in this baby? 1.Bottle feeding 2.Preterm 3.Smoking 4.Being 5 months

The recall answer says it's preterm but in the context of this question, I would've put smoking as the baby in the vignette isn't preterm

14 year girl had sex with her boyfriend 15 year old last time was unprotected sex want OCP, she doesn’t want to inform her mother. What to do? 1.Prescribe emergency OCP 2.Refer to social worker. 3.Advice her to Inform parents before giving OCP . 4.Talk to parent before prescribing OCP

1. Prescribe emergency OCP

3 weeks female delivered premature, what the diagnostic tests for DDH? 1.X- ray of hip 2.US of hip 3.Barlow test & Ortolani test

3.Barlow test & Ortolani test

When to transfer a cystic fibrosis patient to adult service? 1.Aware to take decision 2.Understand his role of shared decision making. 3.He know his medications and illness. 4.Know to Communicate with adult

2.Understand his role of shared decision making.

A child came for assessment of his growth, birth weight was normal , now decrease from 50th to 2nd centile. What will you do? 1.Ask for the previous chart 2.Do Lab investigation 3.Refer to nutrition unit

1.Ask for the previous chart

A child has hit car while riding bicycle, the hit was strong enough to let the boy lean forward and hit by bicycle bar when he arrived to the hospital, he was fully conscious and lucid & talked with doctors and nurses, examination was normal except for bruises on the forehead and upper abdomen. After 10 hours he started vomiting and his heart rate increases, , CRT 2sec he still conscious and no focal neurological signs. What is the cause of his deterioration? 1.Extra Dural hematoma 2.Pancreatic injury 3.Liver injury. 4.Kidney injury

2. Pancreatic injury (liver injury would be more immediate)

Baby with scenario of HF with large VSD on furosemide and spironolactone, during round a 5th year medical student asking why used unlicensed drugs. How do you answer the medical student? 1. The drug is unlicensed 2. Explain to the family the expected side effetc 3. Write all information in the baby's notes. 4. There is no licensed drug used instead of this drug 5. Need to monitor K &electrolytes

?4. There is no licensed drug used instead of this drug

15 days baby on breastfeeding, now become dehydrated. Weight was 3.2 kg at delivery, now become 2.7 kg. Mother said he missed some feeds serum sodium 150. What will you give? 1.100 ml/ kg/ day NGT or cup 2.150 ml/ kg / day NGT or cup 3.10 ml/kg/ day iv 10 % dextrose 4.20 ml / kg / day IV 10 % dextrose

1.100 ml/ kg/ day NGT or cup

2 year old child with bow leg, irritable during crawling. Lab; low Ca=1.9 (N=2.1-2.6), low Phosphate =1 (N=0.8-1.5), low vitamin D=17 (N=23-50), low PTH=6 (N=11-24), high ALP=800. What you will do next? B.Give vitaminD and diatery supplement C.Give 25 hydroxy vitaminD D.Give calcium supplements. E.Give phosphorus supplements

E.Give phosphorus supplements

Child 4-years with intermittent stridor and difficult swallowing lumpy foods What is the diagnosis? a. Vascular ring b. NHL c. Haemangioma d. Laryngomalacia

a. Vascular ring

8 weeks old operated for inguinal hernia when he was 4 weeks old, suffering from stridor, improved partially with steroid, now biphasic stridor. Diagnosis? a. laryngomalacia b. subglottic stenosis c. subglottic haemangioma d. viral croup e. vascular ring

c. subglottic haemangioma

9-year-old child with primary nocturnal enuresis last year he took desmopressin when he went for camp and he was ok on it. Now the child is very distressed about his condition, ask about Mx? a. Course of desmopressin b. Enuresis alarm c. Amitriptyline d. Imipramine

b. Enuresis alarm

day and night enuresis with drippling ask about possible US abnormalities. a. Duplex kidney. b. Horseshoe kidney. c. Rt kidney mass d. Hydronephrosis

a. Duplex kidney.

3-years old child with repeated abdominal pain and vomiting and pallor with fever weight on 0.4 centile, no organomegaly normal abdominal examination with hypertension. What Dx? a. Renal artery stenosis b. Essential HTN c. Wilms tumor d. Dysplastic kidney e. Coarctation

d. Dysplastic kidney

Case of macroscopic haematuria RBCs +3 ,protine +2 on dipstick then after one week dipstick test showed trace rbcs and no protein Ask about which will be abnormal during infection. a. IgA level b. C3,C4 c. Abdominal US d. Cystoscopy e. Cystogram

a. IgA level - this vignette is pointing towards Berger's IgA nephropathy

6-weeks infant boy with unilateral translucent scrotal mass baby was calm, well and has good feeding, what is yours next action? a. Scrotal US b. Refer to surgen c. Reassure and follow up if present in 1 year d. No follow up needed

c. Reassure and follow up if present in 1 year

What warrant you for referral to paediatric surgery? a. Supra umbilical hernia at 1 year b. Undescended testis at 6 weeks c. Umbilical hernia d. Retracted foreskin at 3 y

a. Supra umbilical hernia at 1 year

When to refer to Surgery old at 6 months? a. Inguinal hernia b. Epigastric hernia c. Umblical hernia d. Phymosis

a. Inguinal hernia

15 years old girl has period 2 weeks ago with flank pain with fever, sweaty And irregular cycle with pain score6/10 and distressed. What is the initial investigation? a. kub and xray b. urine analysis c. abd, us d. blood culture

b. urine analysis

Pt with generalized Oedema with protein ++++and –ve nitrate and leucocytes puffy eyes What is the treatment? a. steroid b. Lasix c. Albumin

a. steroid

15 yo self harm, readmitted to hospital, calmed by nurse. Next step by doctor? Contact for urgent assessment Contact for urgent admission

Contact for urgent admission

A girl with recurrent epistaxis is diagnosed with a bleeding disorder. Diagnosis? Haemophilia A Haemophilia B Von Willebrand deficiency Factor 11 Factor 7

Von Willebrand deficiency Superficial bleed not a deep bleed therefore wouldn’t be a factor deficiency as deep bleeds normally due to factor deficiency Haemophilia is X-Linked recessive

5 yo girl had episodes of blackout, she has several attacks. Her mum has same episodes. Her uncle died at teenager age. EEG, Ca level and blood glucose are all normal. Diagnosis? Long QT syndrome Epilepsy Reflex anoxic seizures Breath holding Sinus syndrome

Long QT syndrome

Suggestive of NAI? Tibial metaphyseal fracture 1 yo Spiral # 14 yo Oblique # 5 yo

Tibial metaphyseal fracture 1 yo Corner # = bucket handle fracture is a metaphyseal # that is pathognomic of NI Scapula # Posterior rib #

6 wk old with tachypnoea, palpable femoral pulse, systolic heart murmur, CRT 3 sec. HR 160, liver 3cm below costal margin. SpO2 96%. What should be done? O2 + IV fluid resuscitation O2 + Furosemide O2 + fluid bolus IV prostaglandin infusion

O2 + Furosemide ?Best option of the rest (fluid overload) and not suggestive of congenital cyanotic heart disease

T1DM on insulin, persistent early hyperglycaemia despite of taking 10 units insulin at night and 1:10 insulin:carbohydrate intake. What should you do? Increase long acting insulin Increase short acting dinner

Increase long acting insulin Dawn phenomenon

Child had history of cough coryza 2 days ago. Then he saw blood in urine and developed flank pain. Urinalysis shows plenty RBCs but no casts. Had no FHx. Diagnosis? IgA nephropathy Nephrocalcinosis Alport syndrome

Nephrocalcinosis As this is painful haematuria not painless

Disease need to notify public health? Scarlet fever Measles Acute encephalopathy Mumps

Measles (urgent notification) Scarlet fever and mumps are routine notifications

Hot, tender lymph node, firm, erythematous skin. Temp 39 degrees. What is the next step? Review Commence Abx US FBC + CRP

Commence Abx As per lymphadenitis guidelines

Egg rash, asks about intranasal influenza vaccine. Can have at community level Should have under hospital supervision Refer for allergy assessment

Can have at community level

Sudden pain on knee joint, he lies hip flexed and externally rotated. What investigation to diagnose? Aspiration knee Aspiration hip Blood culture US of hip/knee XR

Aspiration knee Likely septic arthritis as hip is compensating for the knee

12 week immunisation schedule?

6 in 1; Men B; rotavirus

Epilepsy well controlled on carbamazepine, prescribed erythromycin for cough and fever. Develops drowsiness and unsteadiness. Why?

Due to carbamazepine toxicity (macrolide-carbamazepine interaction) - erythromycin is a drug inhibitor

Pregnant mother develops chickenpox in last 5 days of pregnancy. Fully vaccinated. What to do for baby? Observe and give varicella IVIg if rash develops Give IVIg Give IV aciclovir if rash develops

Give IVIg If VZV 7 days before or after delivery Give IV aciclovir if rash develops This is also correct but b is more correct than c in this scenario

4 yo boy with 4 week history of abdo pain, 6-8 episodes of vomiting in last 24 hours. Today had bilious vomiting. Diagnosis?

Malrotation

Boy with head nodding and flexion of limbs, EEG showed chaotic appearance. Tx?

Vigabatrin - West syndrome

Macropcephaly seen in: a) NF1 b) Rubella

NF1

If mother suffers from Rubella, what will be found in baby? Rash Sensorineural deafness

Sensorineural deafness Typical of rubella and CMV

Diabetic child comes with very high blood sugar. Next most important investigation?

Blood gas

Child weight 14, BNF format prescription for trimethoprim for UTI at 4 mg/kg/dose BD x 3 days

Trimethoprim 50 mg/5 ml 60 mg BD

School canoeing trip develops rash, HSM, conjunctivitis. Diagnosis?

Leptospirosis

Hirchsprung disease, what Ix to confirm diagnosis? Anal manometry Rectal biopsy

Rectal biopsy

5 yo short stature, constipation, weight gain. Diagnosis?

Autoimmune hypothyroidism

3 day history of fever, cough, breathlessness. Able to take feed. O/E Basal crackles in lower lobe. What treatment? PO Cipro PO amoxicillin PO clarithromycin IV ceftriaxone

PO amoxicillin

Girl with ear piercing, had murmur. Next investigation? Echo Blood culture

Blood culture

Boy with severe flare of eczema + fever 38.9 + erythematous skin rash. Next step? Admit for Abx Ask mother compliance of tropical ointment Increase dose of hydrocortisone

Admit for Abx

2 mo old with E coli, responded to treatment. Investigation? USS in 6 weeks DMSA Us prior to discharge

USS in 6 weeks

10 year old child with CF has sputum culture positive for pseudomonas. Given cipro syrup + colistin nebs. She says she hates the taste of syrup. What to do next?

Try oral tablet of cipro

2 week history of lethargy, limp, spleen 2cm, low Hb, WCC 5, low plt, Diagnosis? ALL Septic arthritis

ALL

Exclusive BF baby, vegan mother. 14 mo baby developed pallor, lethargy, low Hb, MCV low. Which nutrient? Iron Zinc Vit B12

Iron

Lymphoedema of hands, poor peripheral perfusion, pink baby. CoA Bicuspid aortic valve

Bicuspid aortic valve Lymphoedema of hands is associated with Turner’s syndrome which is assoc. With bicuspid aortic valve

12 yo developed joint pain after football match. Grown well compared to other peers. Diagnosis? SUFE Perthes

SUFE

Bleeding after circumcision in shock CRT 4 sec. What to give? Saline IV Vit K

Saline

Vit D level 30 mmol/l. Tx? Treatment dose Prophylactic dose Vit D + Ca

Prophylactic dose If vit D levels < 25 = deficient = treatment dose followed by prophylactic dose If vit D levels 25-50 = insufficient = prophylactic dose + lifestyle advice 50-75 = adequate = lifestyle advice > 75 = optimal

18 month Turkish baby travelled to UK from Turkish village was breastfed until 6m then weaned on mixed food now coming with mild HSM, pallor and Hb 40. Diagnosis?

Thalassaemia major Major has HSM and anaemia, common in Asian and Mediterranean ethnicity. Minor does not have HSM.

Malaysian baby with cough and runny nose, received herbal treatment coming with jaundice dark urine. Hb 60. Diagnosis?

G6PD Jaundice often occurs after use of certain drugs or fava beans -> anaemia, dark urine, abdominal pain

Child from northern Europe with a history of phototherapy from day 1 in the neonatal period coming with splenomegaly. Jaundice. Hb 9. Diagnosis

Hereditary spherocytosis Autosomal dominant

What is the treatment for alopecia areata?

Topical steroid

Scaly crusty lesion and used anti-dandruff with no improvement. What is the treatment?

PO Gresoflovin This is a case of scalp ring worm therefore treatment is PO antifungal gresoflovin

Baby flexes his legs and cries and becomes pale. Mother has HTN. Diagnosis? a) Generalised tonic epilepsy b) Hypocalcaemia c) Hypoglycaemia d) Tuberous sclerosis e) Sturge Weber syndrome

Tuberous sclerosis Infantile spasm associated with tuberous sclerosis (history of mother of HTN due to renal involvement, autosomal dominant condition) Treatment: vigabatrin

Asian boy presents with seizure. Mother has a limp and previously fractured her arm. Diagnosis? a) Generalised tonic epilepsy b) Hypocalcaemia c) Hypoglycaemia d) Tuberous sclerosis e) Sturge Weber syndrome

Hypocalcaemia Autosomal dominant or autosomal recessive or X-linked. Seizure likely related to hypocalcaemia secondary to hypophosphataemic rickets

Child with a systolic murmur in the left lower sternal border. Diagnosis?

VSD

Child with ejection systolic murmur in the left upper sternal edge. Diagnosis?

Pulmonary stenosis

Child with a long (continuous) murmur in left upper sternal edge. Diagnosis?

PDA

2 year old patient with koilonychia, no HSM, no LN, is eating wallpaper. Hb 62, low MCV, WCC normal, platelets normal. What investigation?

Ferritin Ferritin will exclude lead poisoning and thalassaemia in which ferritin will be normal Koilonychia is a sign of chronic anaemia

Neonate with absent red reflex, pulmonary stenosis and microcephaly. Diagnosis?

Rubella Cardiac problem + cataract + microcephaly with mental retardation and hearing loss

Child presented with generalised body swelling more prominent in lower limbs. History of resolved rash. What's first line investigation? a) Serum albumin level b) U&Es c) Complement assay d) Urinalysis

d) Urinalysis HSP -> Complicated by nephrotic syndrome. 1st line investigation is to check BP and urine dip for proteinuria and haematuria

Patient had recurrent bronchiolitis in winter; went to a party last week and then developed a cough. Took 2 x antibiotics with little effect. CXR revealed consolidation in right lower lobe. Diagnosis?

Foreign body

18 month girl presents with 3 day history of being unwell. Feverish and off her food. She has a rash which covers her entire body and is variable but more marked when febrile. Her cheeks are red, pale around her mouth, tongue and lips are red and pus noted on tonsils. Fever recorded up to 38.5 degrees. HR 150 RR 40 CRT 2 sec WCC 15, neut 11. Diagnosis? a) Scarlet fever b) Infectious mononucleosis c) Varicella

a) Scarlet fever Sandpaper like rash covering face, trunk and extremities after pharyngitis with circular pallor around the mouth. Tongue becomes white and then desquamation leaving it red (strawberry tongue).

What is premature thelarche?

Premature development of breast tissue

What is premature adrenarche?

Premature appearance of pubic/underarm hair, acne or body odour

Nigerian mother with known sickle cell disease. Father is not a carrier and is not affected. What is the risk for their children? a) 100% will be carrier b) 100% affected c) 50% carrier d) 50% affected

a) 100% will be carrier

3 yo with bilateral leg pain, periorbital oedema and protrusion. BP 140/85. Diagnosis? a) Neuroblastoma b) Orbital cellulitis

a) Neuroblastoma - Kidney tumour causing HTN; metastasis involving bones and eyes

What indicates severe liver damage? a) high bilirubin b) low albumin c) prolonged PT

C) Prolonged PT

What is a side effect of montelukast?

Night terrors Can also cause nightmares and sleep walking

5 month old child with 2nd episode of lower UTI E. Coli responds to trimethoprim within 48 hrs. What is the next investigation? a) USS within 6 weeks b) DMSA c) MCUG

a) USS within 6 weeks Simple UT => USS < 6 weeks Recurrent UTI or Atypical UTI (2 or more upper UTI/1 upper UTI + 1 or more lower UTI/ 3 or more lower UTI) => Acute USS during infection + DMSA + MCUG

Child with recent painful defecation. O/E: well, circumscribed redness around anus with scratch marks. What's the organism?

Group A streptococcus

5 year old girl, developed swollen face and skin rash after eating ice cream, no difficulty in breathing, with history of asthma and eczema. Examination was normal. What is the best treatment? a) PO antihistamine b) IM adrenaline c) PO steroid

a) PO antihistamine

9 year old girl with sparse pubic hair, breast buds. What is the Tanner stage?

B2, PH2

3 year old child presenting with 2 week cough. WCC 32, lymphocytes 28. What is the diagnosis? a) Pertussis b) TB c) Leukaemia

a) Pertussis

Child complains of pain and swelling in one joint for last 6 months, positive ANA. What is the most urgent investigation to do next? a) Slit lamp b) Anti dsDNA

A) Slit lamp Likely JIA therefore need to screen for uveitis

Mother known to have HIV on HAART therapy since 16 weeks of pregnancy. She is planned for elective CS. What is the drug to be given IV intrapartum to decrease risk of transmission to the baby? a) Zidovudine b) Lamivudine c) Interferone d) Nevirapine e) Zidovudine + lamivudine

a) Zidovudine

What is expected of a 2 year old in terms of speech and language? a) understand comparative b) understand negatives c) understand adjectives d) understand 2 step commands e) 50+ words

e) 50+ words

Which of the following explanations best describes the action of Macrogol laxatives? a) Fermentable carbohydrate with osmotic effect b) Detergent-like action to soften stool c) Non absorbed large molecule with osmotic effect d) Gut promotility agent e) Gut smooth muscle stimulation

c) Non absorbed large molecule with osmotic effect Docusate = Detergent-like action to soften stool

Which of the following regimes would be expected to produce the most improvement in the first 4 hours after treatment starts during an acute asthma attack in a 7 year old boy? A.Prednisolone oral 30mg + salbutamol via nebuliser 5mg, then “stretch” to assess for discharge B.Salbutamol nebuliser 5mg hourly, then prednisolone 30mg orally after first dose of salbutamol C.Prednisolone orally 30mg plus salbutamol nebuliser 5mg prn at nurses’ discretion D.Prednisolone orally 30mg plus salbutamol nebuliser 5mg 3 doses 30 minutes apart then prn E.Prednisolone orally 30mg plus salbutamol via volumatic 1000micrograms hourly

D.Prednisolone orally 30mg plus salbutamol nebuliser 5mg 3 doses 30 minutes apart then prn

Dysfunction of which cranial nerve would lead to the following abnormalities? i. Complete ptosis and downward lateral gaze of affected eye ii. Diplopia and inability to abduct the affected eye iii. Hoarse, breathy speech quality

i. CN III ii. CN VI iii. CN X

Parents attend antenatal clinic. The father has glucose-6-phosophate dehydrogenase deficiency and the mother is not a carrier for the condition. Ultrasound scan suggest they are having a baby boy. What is the most likely chances of their son inheriting the condition? A.0% B.25% C.50% D.75% E.100%

A.0% Glucose 6 phosphate dehydrogenase deficiency is a X linked recessive condition and as such, father’s cannot pass condition onto son

Which of the following is the best diagnostic test for Beta Thalassaemia major? A.Decreased osmotic fragility test B.Ferritin Level C.Haemoglobin Electrophoresis D.Full Blood count to check for microcytic hypochromic anaemia E.Target cells on peripheral blood smear

C.Haemoglobin Electrophoresis Decreased osmotic fragility test and target cells on peripheral blood smear. Increased osmotic fragility test for hereditary spherocytosis

15 year old boy is brought to A&E by his older sister. She is concerned that he is agitated and not his usual self over the last couple of days. She’s also noticed that he’s talking to himself a lot and hasn’t been sleeping. There is no past medical history of note. General physical examination is normal apart from HR 110bpm; appears irritable and restless. What is the most likely cause? A.Alcohol B.Amphetamines C.Cannabis D.Diazepam E.Opiates

B.Amphetamines

A 14 year old boy complains of pain over his left knee. He is a cross country runner. On examination, he has a lump below the knee which is tender on movement. What is the most likely diagnosis?

Osgood-Schlatter Disease Common apophysitis is caused by traction forces at the insertion of the patellar tendon on the tibial tubercle. Typically presents with the complaint of pain and swelling over tibial tubercle, tender to palpate.

An 11 year old boy presents with a right sided limp. On examination his weight and height are both on the 91st percentile. His right foot is externally rotated and his hip movements restricted. What is the most likely diagnosis?

SUFE Slipped upper femoral epiphysis (SUFE) tends to occur in 10–15-year-old, often with body weight above the 90th centile. Boys are affected slightly more often than girls and nearly a quarter of patients have bilateral disease. There may or may not be a history of minimal trauma. Clinical features consistent with this diagnosis

A 14 year old boy returns from holiday where he had “food poisoning” with a self-limiting vomiting and diarrhoeal illness. He is now complaining of a sore left hip and knee, dysuria and a sore eye. On examination he is afebrile his knee has a small effusion. What is the most likely diagnosis?

Reactive arthritis This presentation is most consistent with reactive arthritis. Typically, reactive arthritis occurs around 7–10 days after the acute illness and spontaneously remits within 2–3 weeks of onset; gastrointestinal infections may cause a reactive arthritis. The arthritis is typically oligoarticular, with a predilection for lower extremities.

A 15 year old boy of African-Caribbean origin is brought to the emergency department complaining of pain in his right groin after playing football. He has a tender right hip with reduced range of movement. He is noted to be clinically anaemic and mildly jaundiced. A pelvic x-ray shows sclerosis of the right femoral head. What is the most likely diagnosis?

Sickle cell disease The presentation is consistent with sickle cell disease with a history alluding to avascular necrosis of the femoral head in the context of haemolysis. Avascular necrosis (AVN) occurs at a higher rate among children with sickle cell anaemia than in the general population and is a source of both acute and chronic pain. Most commonly, the femoral head is affected. Painful episodes often affect the long bones in older children.

A 15 year old boy of African-Caribbean origin is brought to the emergency department with a petechial rash which appeared overnight. He looks well, but has widespread petechiae all over his body with a few large ecchymotic lesions on his lower legs. He had a febrile illness associated with sore throat 2 weeks previously, but has made a complete recovery without treatment. What's the most likely diagnosis?

ITP Classical presentation: most children presenting between the age of 2 and 6 years with the acute onset of purpura and a history of a recent febrile illness. ITP rather than HSP in view of petechiae over all body rather than just on lower limbs and buttocks. ITP presents with bruising and petechial rash. Mucosal bleeding can occur. Child is otherwise clinically well apart from signs of bleeding.

A 15 year old boy of African-Caribbean origin is brought to the emergency department with pain in his legs for 3 weeks. His parents say that he has just developed bruising on his trunk and limbs. He looks unwell with a temperature of 38.8°C. He is noted to be clinically anaemic and has bruises on his back, thighs and abdomen, and petechiae on the palate. What is the most likely diagnosis?

ALL History of unwell child with anaemia, bruising fever and painful legs indicative of ALL.

A 7 week old girl was born at 32 weeks' gestation. She was ventilated for 5 days after developing an infection at 4 days of age. She has been well since, apart from 2 strawberry naevi on her forehead and neck. She presents with a 2 week history of increasing biphasic stridor most marked on inspiration. What is the most likely diagnosis?

Subglottic haemangioma

A 1 month old boy has intermittent stridor which has been present since 2 weeks of age. It increases during feeding and crying but is absent during sleep. What is the most likely diagnosis?

Laryngotracheomalacia He has persistent stridor which in view of his age, is most likely to be due to a congenital abnormality. Laryngotracheomalacia accounts for at least 90% of cases and the history of symptoms worsening with agitation and feeding is typical.

A 3 year old girl presents with a short history of respiratory distress and stridor associated with cough and a blocked nose. She has been well in the past apart from an episode of fever and rash at the age of 11 months, following which her parents declined MMR immunisation because they believed she had egg allergy. What is the most likely diagnosis?

Viral croup Croup is by far the commonest reason for acute upper airways obstruction in children is viral laryngo-tracheobronchitis, or croup, which accounts for at least 98% of cases of stridor caused by infection. Typically, the child has a prodromal coryzal illness and develops a barking cough, a hoarse voice and stridor.

A 6 month old boy presents with a severe exacerbation of eczema. His skin is markedly inflamed all over. He has been breast-fed from birth. He developed mild facial eczema at the age of 4 months and up to now has been treated with emollients. His mother has a sore on her lip. His temperature is 37.8°C. Which is the most appropriate treatment or course of action?

IV aciclovir History of maternal cold sore points to diagnosis of eczema herpeticum which can be a severe and possibly life threatening infection. The most important treatment is aciclovir and in view of his age and temperature he should be admitted for intravenous treatment.

A 6 month old boy has been breast-fed from birth. His skin became dry and itchy at the age of 4 months and he has become distressed and is sleeping poorly. The skin is very dry and excoriated. His temperature is 37°C. His mother is unwilling to use steroids under any circumstances. Which is the most appropriate treatment or course of action? a) Demonstration and education in the use of emollients b) Tacrolimus ointment

a) Demonstration and education in the use of emollients All children with eczema should be prescribed unperfumed emollients to use every day for moisturising, washing and bathing. This should be suited to the child's needs and preferences, and may include a combination of products or one product for all purposes. Leave-on emollients should be prescribed in large quantities (250–500 g weekly) and easily available to use at nursery, pre-school or school. They are the most appropriate treatment to be prescribed at this stage. | These are licensed as second/third line treatments in those over 2 years

A 6 month old boy presents with a severe exacerbation of eczema. His skin is markedly inflamed all over. Some of the lesions have yellow crusting. He has been breast-fed from birth. He developed mild facial eczema at the age of 4 months and up to now has been treated with emollients. He is feeding poorly and has a temperature of 39°C. Which is the most appropriate treatment or course of action?

IV Abx

A 13 year old boy is concerned that he is not developing any changes of puberty like his friends at school. He attends with his father and on examination has normal pre-pubertal external genitalia. What will be the first sign of puberty?

Enlargement of the testes Development of 4 ml testicular volumes, followed shortly thereafter

A 4 week old boy was first noticed to have a swollen scrotum 2 days ago during his bath. He is afebrile, does not appear to be in any discomfort and general examination is normal. There is a non-tender soft swelling in the left side of the scrotum. Both testes are palpable. What is the most likely diagnosis?

Hydrocoele

A 5 year old boy who was slow to talk and is having speech therapy is not responding very well. He was born at term weighing 3.2 kg and his motor milestones are normal. At school entry he is reluctant to talk to other children. He becomes restless during group activities and has temper tantrums when other children want to share toys with him. He can read and has an aptitude for number work. What is the most likely diagnosis?

Autism Spectrum Disorder

A 10 week old breast-fed baby girl who has mild eczema presents with streaks of fresh red blood in her stools. She is feeding well, has a soft abdomen and her weight is on the 50th percentile. She received vitamin K at birth and her full blood count and clotting studies are normal. Stool samples are negative on microbiology. What would be the most appropriate management?

Advise mother to remove dairy products from her diet

A 2 year old boy is not yet walking unaided. He has “bottom-shuffled” from the age of 10 months. His cognitive development is normal and he is well. His 5 year old brother crawled at 9 months and walked at 12 months of age. What is the most important investigation to arrange?

Creatine Kinase

A 4 year old girl is seen with a cough. She is found to have a widespread systolic murmur best heard at the upper left sternal border associated with a thrill. What is the most likely diagnosis?

Pulmonary stenosis

A 12 month old girl is given her first spoon of scrambled egg. Within 5 minutes her face is red with a bumpy rash and she has swelling of her eyes and lips. She vomits. Her symptoms subside over the next hour and she returns to normal without any treatment. She is an otherwise healthy girl with no medical concerns. What is the best advice to give to the parents regarding MMR immunisation?

She can have her MMR vaccine next month as normal in the community

An 8 year old boy’s teacher reports that he is not progressing well in school. He seems inattentive in class and can fall asleep in the middle of lessons. His parents report that he has disturbed nights and has episodes where he appears to choke. His past health is good apart from recurrent otitis media. What is the most likely diagnosis?

Obstructive sleep apnoea

An 8 year old boy who cannot ride a bicycle is upset at being excluded from the school football team. He is articulate but his handwriting is often illegible. His muscle power is normal but his reflexes are slightly exaggerated. What is the most likely diagnosis? a) BMD b) Congenital myopathy c) Developmental coordination disorder (dyspraxia) d) Spastic diplegia e) Friedreich's ataxia

Development coordination disorder (dyspraxia) Developmental coordination disorder (DCD) is associated with difficulties in motor planning and execution. The prevalence is around 5-6% of school-age children and is more common in boys than in girls. Its diagnosis is made on clinical history and examination providing evidence that a child’s motor performance is significantly impaired relative to chronological age, and that it impacts upon daily functioning

You are seeing a boy in the primary care practice when his 10 month old sister suddenly starts to cough and gag whilst eating grapes. After a short time she becomes quiet and is cyanosed but conscious. You shout for help. What is the most appropriate initial action in managing this child?

Give 5 back blows

Recent studies have shown a decrease in the incidence of Sudden Infant Death Syndrome (SIDS). Which one of the following modifiable risk factors contributes most to this decrease? a) Overheating b) Maternal smoking c) Co-sleeping d) Formula feeding e) Prone sleep position

e) Prone sleep position

A previously healthy 18 month old girl presents with a 1 day history of sore mouth, drooling and refusal to drink. Her temperature is 39°C. She is irritable and has ulcers on her lips and tongue with vesicles on the anterior chest wall. The cervical glands are enlarged and tender. What is the most likely diagnosis? a) Aphthous ulceration b) HSV infection c) Measles d) Scarlet fever e) SJS

b) HSV infection Herpes gingivostomatitis is the commonest childhood HSV infection there is malaise, fever and small vesicles which may affect the all areas of the mouth, lips and peri-orally. Lesions are painful resulting in poor fluid intake. Complications include spread of HSV infection to other areas by autoinoculation

A 10 year old boy is brought to the emergency department, having developed abdominal pain during a weekend access visit with his father. He is found to have appendicitis and needs immediate surgery. The boy claims that his mother would not want him to have an operation. The parents are married but separated although not divorced. His mother has gone away for the weekend and cannot get to the hospital. Who is the best person to give consent?

The father

A 9 year old girl who is the youngest of 7 children attends a school for moderate learning difficulties. Her teacher has described blank episodes several times a day over the past 3 months. Each lasts 1 or 2 minutes, but she appears to respond when spoken to. Her mother has not noticed any such episodes at home. What is the most likely diagnosis?

Daydreaming

A 22 month old girl is referred to the emergency department by her GP because she is reluctant to weight bear. She is reported to have been well recently. She is quiet and withdrawn, but cries when her left leg is examined. She has an area of petechiae and bruising on her left calf. Systemic examination reveals a thin child with no organomegaly. What is the most likely diagnosis?

NAI

A girl presents at 60 hours of age with lethargy, poor perfusion and jaundice. She is breast-fed. Parents are Caucasian. Maternal blood group is A RhD positive and the baby's blood group is O RhD positive. Direct anti-globulin is negative. Clinical examination reveals jaundice and a liver edge just palpable below the costal margin. Investigations: Serum bilirubin 444 µmol/l (<300 µmol/l ) Conjugated bilirubin 17 µmol/l (<35 µmol/l) What is the most likely cause? a) ABO incompatibility b) Dehydration c) Galactosaemia d) G6PD e) Septicaemia

Septicaemia This is a Caucasian girl making G6PD less likely. Galactosaemia would have significant hepatosplenomegaly, absent vomiting and higher conj bili.

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