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Question 1

What does onion peel/skin on x ray suggest and what does it show?

Answer 1

Ewings sarcoma
Multilayer periosteal reaction
The layers are thought to be the result of periods of variable growth 2 and indicate a pathological process of intermediate aggressiveness

Question 2

Aggressive chemo side effects

Answer 2

Neutropenia - immunosupressed
Fertility long term problems
Nausea
Extremely tired

Question 3

Features of Edwards syndrome

Answer 3

micrognathia, low-set ears, rocker bottom feet and overlapping of fingers
Trisomy 18

Question 4

Edwards syndrome signs in utero

Answer 4

Cardiac malformations
Choroid plexus cysts
Neural tube defects
Abnormal hand and feet position: clenched hands, rocker bottom feet and clubbed feet
Exomphalos
Growth restriction
Single umbilical artery
Polyhydramnios
Small placenta

Question 5

What differentiates PTSD from acute stress disorder

Answer 5

PTSD - Only can be diagnosed from 4 weeks (esp if dissociation continues)
ASD -intrusive thoughts e.g. flashbacks, nightmares
dissociation e.g. ‘being in a daze’, time slowing
negative mood
avoidance
arousal e.g. hypervigilance, sleep disturbance

Question 6

What does normal paCO2 suggest in asthma attack and what is the range

Answer 6

Life threatening
4.8-6kpa

Question 7

Management for asthma attack

Answer 7

A-E
administering oxygen,
neb salbutamol -> ipatropium bromide
Oral prednisolone
closely monitoring the child’s clinical status and PaCO2 levels.

Question 8

Red flags in children

Answer 8

Moderate or severe chest wall recession
Does not wake if roused
Reduced skin turgor
Mottled or blue appearance
Grunting
Silent chest in asthma

Question 9

Amber flags in children

Answer 9

Nasal flaring
Lung crackles on auscultation
Not responding normally to social cues
Reduced nappy wetting
Dry mucous membranes
Pallor reported by parent or carer

Question 10

Osteosarcoma on x ray

Answer 10

Sunburst outwards from long bone