Questions

Question 1

See learning guide for practice SAQs

Answer 1

x

Question 2

Child presents to you with the following skills, how old are they:

• Can roll from back to belly
• Can sit upunaided
• Scooting on bum
• Is grasping toys with the whole hand
• Making simple sounds
• Responding to mums voice
• Enjoys rhythmic music

Answer 2

Probably 6 months

Maybe a little older as sitting without a hand and enjoying music are a few months beyond 6

Most of these skills develop around 6 except responding to mums voice which they should be able to do about 4months

Question 3

little boy presents with the following skills, how old is he?

• running
• picking things up with finger and thumb
• points when simply requested
• takes off his top
• Can say “Ball, mum!”
• Smiles when praised

Answer 3

Around 2yrs

using simple words together is a 2 yr skill as well as being praised, taking off clothes and pointing when requested

Running is common by 2 and grasping with thumb and forefinger comes around 18months

Question 4

A wee Girl presents with the following skill, how old is she?

• Says “Mama” & comes when called
• Imitates mum
• Drinks from her cup alone
• focusses on you from across the ward
• Mum says she takes some steps at home while holding her hand

Answer 4

1yr

using single words and responding to very simple requests like “come here” are 1 yr skills

Being able to drink from a glass shows 1 yr fine motor skills & self care

Imitating people is a 1 yr social skill

Being able to focus on distant objects comes about 9months to a year

First steps occur on avg by 12 months`

Question 5

Another wee Girl presents with the following skills, how old is she?

• She can see shapes at 6m
• she seems to understand most of what you say
• She can walk on tiptoes and heels but falls over walking backwards
• “Mostly” toilet trained
• She plays with another child (but only when prompted)
• Brings things when mum asks

Answer 5

probably just under 3 yrs

seeing 6m clearly and understand most simple language is normal at 3yrs

toilet training should be good by 3yrs

Playing with other kids starts around 18months but often they don’t do it independently until 3yrs

Walking backwards develops around 3yrs, shes trying but not got it yet

following simple instructions is normal by 3

Question 6

Case 1)
A 6yr old boy called Marvin comes in to see you
Mum says he’s suffered for 12 months from abdo pain and passes 1 stool/week with occasional blood

On exam you notice small soft masses in LLQ.
What else would you want to know about his history?

Answer 6

1) Is it always 1 stool/week
2) Consistency & size of stool
3) Any pain defecating
4) How often/much blood

5) Toilet training
6) Soiling
7) Withholding

8) Diet
9) Appetite
10) Fluid intake
11) Activity
12) School routine

Question 7

Case1)

What else would you want to examine on Marvin?

Answer 7

Inspect lower spine (Spinal damage)
Inspect Anus (Perianal disease)
Lower Limb Neurology (spinal problems)
Measurments and centiles (growth)

Don’t do DREs on kids

Question 8

Case 1)

Based on the initial presentation (1stool/wk, abdo pain and occasional blood) what do you think Marvin has?

Answer 8

Chronic Constipation

Question 9

Case 1)

How would you manage Marvin’s constipation? (Clue theres atleast 4 non-medical ways)

Answer 9

1) Increase fruit, veg & fibre
2) decrease milk and sweets
3) Increase fluid intake
4) Improve toilet comfort and reward it

5) Laxatives (Lactulose, Senna or Movicol)

Question 10

Case 2)
8wk old Eryk is brought to the GP by his dad for a routine exam.
You notice he has a murmur.
What else would you want to ask the dad?

Answer 10

1) Breathless & Colour Changes
2) Poor feeding & weight change
3) Sweating

Question 11

Case 2)

What else would you look for on baby Eryk?

Answer 11

1) Tachycardia/Tachypnoea
2) Hepatomegaly
3) Peripheral Pulses
4) Measurments & Centiles

Question 12

Case 2)

Assuming you find something on Eryk’s exam/history to suggest this is not a simple innocent murmur, how would you manage it?

Answer 12

1) Refer to paediatrics

2) Sats, 4 limp BP, Echo, EXG and/or CXR

Question 13

Case 2)

What features of baby Eryk’s murmur would suggest it’s innocent?

Answer 13

1) Systolic
2) Soft (Grade 1 or 2)
3) Vibratory
4) Very localised (oft to L SB)
5) It varies with activity, position or respiration

Bonus point if Eryk’s otherwise asymptomatic

Question 14

Case 3)
12hr old baby Lucca is noted to be blue in the face, tongue and limbs.
Her peripheral pulses are present along with a loud systolic murmur

DDx?

Answer 14

Heart disease causing cyanosis in a baby is not a big list:

1) Transposition of Great Arteries!
2) Tetralogy of Fallot
3) Pulmonary Atresia
4) Truncus Arteriosus
5) TAPVD

Question 15

Case 3)

An angiogram confirms little Lucca has Transposition of her Great Arteries. How do you manage her?

Answer 15

Prostaglandin Infusion to reopen/maintain her DA

Then do a Switch procedure

Question 16

Case 4)

Mum brings in 3 month old Baby Dalmar because he’s been vomiting, unsettled and always seems hungry/upset after feeds

Weighs = 11lbs
Takes = 7oz 6x/day

First off how much does he weight in kilos, what his feed volume per feed and per kilo per day?

Answer 16

Roughly 11lbs x 500g = 5.5Kg
Actually 11lbs x 450g = 5Kg

Roughly 7oz x 30ml = 210ml per feed
Actually 7oz x 28ml = ~200ml per feed

200 x 6 / 5 = ~240ml/Kg/day

Note these calculations are not examinable and you’re not expected to know what a normal/target intake it

Question 17

Case 4)

What advice should you give Dalmar’s Mum?

Answer 17

240ml is a lot

Advice reducing to about 120-140 mils (4/5oz) per feed
I.e. ~155ml/Kg/Day (5ish oz /Kg/day)

Note these calculations are not examinable and you’re not expected to know what a normal/target intake it