and infective endocarditis is: a) A positive ASO titre b) A positive blood culture c) A prolonged pyrexia d) An abnomal echocardiogram e) An elevated ESR A 6 year old male who had prolonged bleeding after circumcision in the newborn period now presents with a swollen knee following a fall. Of the ff, the most appropriate investigations are a) APTT and clotting time b) Bleeding time and APTT c) Fibrin degraded product and PT d) Ristocetin cofactor level and PTT e) PT and APTT Erythema marginatum is best described as a) Iris lesions with relatively normal centres and active slightly elevated edges distributed throughout the body b) A slowly expanding erythematous papule that is painful and pruritic with a raised border and central clearing c) Macular lesions with irregular edges that may be exacerbated by warm baths d) Tender violatous subcutaneous plaques that are usually found over the anterior shins but can be found elsewhere e) Yellow white postules frequently noted in the newborn period that resolve spontaneously A 4yr old girl presents with peri-orbital odema and multiple skin lesions on her lower limbs. Her blood pressure is above the 99th percentile. Urinalysis is negative for protein. Of the following, the most appropriate intervention is: a) Review in 1 week and repeat her BP b) Topical antibiotic and review in 1 week c) Give diphenyl hydramine orally and review in 48hrs d) Titrate BP with hydralazine e) High dose oral corticosteroid and review in 48hrs A 12 yr old boy presents with a hx of pyrexia and cough for 4 days. One day prior to admission, he developed a rash characterised by target lesion more marked periorbitally and mucosal erosion. The most likely dx of the boy is: a) Erythema multiforme b) Kawasaki disease c) Rheumatoid disease d) Scarlet fever e) Varicella zooster A 4 year old girl is brought in by her mother. The mother states that her daughter is suffering from nightmares and sores. She has a history of recurrent ear infections. On examination, the child has large tonsils and nasal speech. The most likely dx is: a) Adenoidal hyperplasia b) Sleep apnea c) Asthma d) Nasal polyps e) GERD Conductive hearing loss may be a feature of a) Adrenal hypertrophy b) Congenital rubella syndrome c) Fracture of the base of the skull d) Hypothyroidism e) mucopolysaccharidoses A 13 year old boy presents with a serum blood glucose of 28mmol/L and 3+ ketones in urine. In the initial mgmt of his condition, which of the ff is the most appropriate? a) A fluid bolus of 20ml/kg normal saline b) Potassium 2mmol/kg should be added to IV c) Slow acting insulin can be given subcutaneously d) Administration of bicarbonate in a patient with pH of 7.28 e) A fluid bolus of 20ml/kg of 1/5 normal saline A 10 month old baby presents to the paediatric emergency with a hx of fever, lethargy and poor feeding for 5 days. Examination reveals weight 8kg, oxygen saturation 96% in air, pulse 150/minute, BP 100/60mm Hg, Capillary refill 5sec. The most appropriate mgmt for the patient is to give: a) A bolus of 180ml 5% Dextrose/0.2 saline b) A bolus of 100mls of normal saline c) A bolus of 160mls of normal saline d) A bolus of 180mls Ringers lactate solution e) A bolus of 80mls of albumin A 3 year old boy is admitted with 10% dehydration secondary to diarrhoea and persistent vomiting. Investigations: BUN 23mg/dl Creatinine 0.6mg/dl Cl 101mmol/L K 3.6mmol/l Na 156 mmol/l. The fluid of choice for his rehydration following resuscitation is: a) Normal saline b) Ringers lactate c) 10% Dextrose d) 5% Dextrose/0.2% saline e) 5% Dextrose/0.45% saline A 12 month old child presents with a 3 day history of diarrhoea with a frequency of 10 motions a day. The stools are watery and of a large volume. O/E he seems to be drowsy, his eyes were sunken and he does not seem to be interested in feeding. His weight is 10kg. The most appropriate initial mgmt is to give: a) 800mls of oral rehydration salt solution over the next hour b) 800mls of oral rehydration salt soln over next 4hrs c) 200mls of 0.9% saline IV over the next hour d) 110mls of 0.9% saline IV over the next hour e) 110ml of dextrose 5% in 0.45% saline solution IV over the next hour A 2 year old male infant presents to the ED with a hx of swelling of his legs, vomiting and loss of appetite for a week. Both parents are unemployed and there are 3 older siblings under the age of 6years. Initial investigns show Hb 2.2g/dl, WBC 27 * 109, Film microcytic hypochromic, HIV negative ELISA. The most likely explanation is a) Ancyclostome duodenale b) Ascaris lumbricoides c) Strongyloides stercorulis d) Enterobius vermicularis e) Giardia lamblia A 4yr old presented to the ED with a 3 week hx of puffiness around the eyes and increasing weight. Since 2days ago, he has experienced abdominal pain and occasional loose stools. O/E he has shifting dullness and tenderness. Of the ff the most likely organism causing the abdominal problem is: a) E. coli b) H. influenzae c) Streptococcus faecalis d) Streptococcus pneumoniae e) Staphylococcus aureus Of the ff, the best response related to a 2 yr old is: a) Able to follow 2 step commands b) Able to use sentences routinely c) Able to have a vocabulary of 1 to 3 words only d) Able to name 4 colours e) Able to copy a cross An 8yr old girl comes to the clinic complaining of secondary enuresis (bedwetting) associated with increased uinary frequency and volume over the past week. She has no fever, dysuria or abdominal pain, no noticeable weight loss over the period of her illness and maintains a healthy appetite. She has experienced headaches associated with difficulty seeing the board at school. The most important clinical sign to elicit is a) Papilloedema b) Crackpot sign c) Abnormal deep tendon reflexes d) Caf au lait lesion e) Dehydration A 6month old boy had repeated episodes of vomiting since the age of 1 month. His mother reports that the vomiting is usually large volume sometimes mixed with streaks of blood that he had jaundice during the first few days of life. Anthropometric measurements Weight 7kg (9th centile) Length 67.5cm (on the 50th centile) Head circumference 45cm (just above 50th centile) Of the ff, most likely diagnosis a) Congenital esophageal varices b) Galactosemia c) Gastroesophageal reflux d) Rotavirus gastroenteritis e) UTI An 8 year old girl comes to the clinic with a recent onset of bedwetting associated with increased urinary frequency and volume over the past week. She has no fever, dysuria or abdominal pain, no noticeable weight loss over the period of her illness and maintains a healthy appetite. She has experienced headaches associated with visual difficulties at school. The most likely diagnoses is a) Diabetes mellitus b) Diabetes insipidus c) UTI d) Urethrocoele e) Hypercalcemia An 18 month old child with normal development is able to a) Hop b) Ride a bicycle c) Be dry during the day d) Understand simple commands e) Draw a vertical line The ff are normal developmental features of an 18month old child: a) Follows simple commands b) Says 25 words c) Stacks a tower of 6 cubes d) Stoops and recovers e) Names 2 colours A 7 yr old boy with neurogenic bladder self catheterises 4x a day. He develops fever and a urine sample is sent for Gram staining culture and sensitivity. Of the ff, the most likely organisms isolated is: a) E. coli b) Klebsiella c) Proteus mirabilis d) Pseudomonas sp e) Staphylococcus aureus A 5 yr old presents with a 2 week hx of recurrent left knee pain and a limp. O/E the joint is warm and swollen. Of the ff she is most likely to test positive for a) Anti nuclear antibody b) Anti streptolysin O antibody c) Gonococcal antigen d) Rheumatoid factor e) Smith antigen Of the ff, which is the most appropriate mgmt option for a child who ingested kerosene?
a) Should have gastric lavage
b) Must be given an emetic c) May require oxygen therapy d) Should be given IV fluid for 24hrs e) Should be given charcoal Clinical vignette for next 2 MCQs A 9 month old male presents to ER with suspected kerosene ingestion. He is retching and crying. The kerosene had spilt on his clothes and on the floor. He recently had upper respiratory tract infection associated with a mild fever. On examination he is lethargic and tachypnoeic, RR 60/minute, pulse 130/min and temperature 100deg F. There is no stridor, but mild intercostal and subcostal recession Of the ff, the most likely cause of the childs presentation is: a) Upper airway obstruction b) Lower airway obstruction c) Pneumonitis d) Pneumonia e) Lung collapse Of the following, the most appropriate initial mgmt in this patient is to: a) Take blood for CBC b) Do an urgent chest radiograph c) Give oxygen by face mask d) Give normal saline bolus e) Pass a nasogastric tube A 2 yr old child was found by his mother chewing a paracetamol tablet while holding the empty bottle in his hand. The mother knows that there were 10tablets of 500mg strength in the bottle. She brought the child to the ED within half an hour. He was playful and active. The most appropriate mgnt is to: a) Reassure the mother and send the child home b) Admit the child and institute forced alkaline diuresis c) Administer ipecac to induce vomiting d) Take blood for serum paracetamol levels e) Administer N-acetylcysteine orally A previously healthy 9month old girl presents with moderate respiratory distress. On auscultation there is bilateral generalised crepitations and wheeze. The most likely causative agent is a) Mycoplasma sp. b) Chlamydia sp c) Pneumocystis jirovecii d) Parainfluenza type 1 e) Streptoccus pneumoniae A 3 month old male was seen in ED with a respiratory rate of 64/min, audible wheezing and intercostal and subcostal recession. Mother gives a hx that this has been occuring for 4 days and was getting progressively worse. Her 4 yr old daughter had a similar episode when she was 4 months old requiring hospital admission. Auscultation revealed rhonchi bilaterally, anteriorly and posteriorly. Of the ff, the most likely dx is: a) Acute asthmatic attack b) Bronchiolitis c) Viral pneumonia d) Milk aspiration e) Bacterial pneumonia An 8 yr old presents with multiple generalised petechiae following a recent viral upper respiratory tract infection. The rest of his examination is unremarkable. His CBC shows Hb 12.2 g/dl WBC 8.3 * 109 Platelets 35 * 109 The blood film shows no blasts or abnormal cells but a decreased platelet count. Of the ff, the most appropriate treatment for the child is a) Expectant management b) Commence oral steroids c) Infuse IV gamma globulin d) Perform bone marrow biopsy e) Transfuse with platelets A 7 month old male infant is admitted to the ward with a hx of aspiration after a feed. The chest xray changes are expected to be found in the: a) Left lower lobe b) Left upper lobe c) Right lower lobe d) Right middle lobe e) Right upper lobe A 3yr old boy is dx with croup and discharged to his parents care from ED. The parents should be advised to return if there is a) An increase in loudness of the barking sound b) An increase in the pitch of the stridor c) Increased work of breathing d) Persistence of respiratory symptoms for more than 7days e) Persistence of hoarseness for more than 1 day A 7yr old girl presents with a 4day hx of fever and cough. O/E of her chest, she has decreased breath sounds in the right middle and lower zones, with decreased percussion note and decreased vocal fremitus. No crepitations are heard. The most likely cause is a) Bronchospasm b) Lobar consolidation c) Hemothorax d) Pleural effusion e) Pneumothorax A 12 year old girl presents with a 3day hx of cough and temperature of 37.5deg C. O/E she is not toxic and has crepitation in the bases bilaterally. Of the following, the most appropriate antibiotics for the pt is: a) Ampicillin b) Azithromycin c) Benzyl penicillin d) Ceftriaxone e) Ciprofoxacin A 4 yr old boy presents with a 5day hx of fever and cough. His chest x ray shows opacification obscuring the right heart border. The antibiotic of choice is: a) Amoxicillin b) Cefotaxime c) Cotrimoxazole d) Erythromycin e) Vancomycin Questions that are not in pp 1. Baby had dehydration etc pointing towards some signs dehydration as the child could tolerate fluids and the question was what maintenance fluids you would give and the answers were a) 1000ml hypoosomolar ORS solution b) 1000ml isoosmolar ORS solution c) 800ml hyperosmolar ORS d) 800ml hypoosmolar soln etc. Kerosene ingestion question
Answers included a variation from the one in the
pp as it included an option on doing both bloods for paracetamol levels and administering N acetylcysteine Questions on azithromycin and ampicillin came twice exactly the same question repeated (under resp) The question on slide 38 of initial set platelets were reduced to 5 instead of 35 but no bleeding. Dont know if that makes a difference in the management A scenario with a child with deepening jaundice etc. The picture seemed to point towards intrahepatic challenges as the stools etc were normal. The answers were something like more unconjug bili; more unconj bili but with some conjug etc. Just review the scenarios with pre intra and post hepatic jaundice stuff to see what happens There were 2 questions on CVS congenital d/o 1 was on coarctation of the aorta with the coarc distal to the left subcalvian artery and described options as a) weaker lower limb pulses on the right, b) stronger upper rt limb pulse, c) weaker lower limbs etc. Just revise what happens with coarc distal and proximal to LSA The 2nd question described a baby crying etc and going blue with feeds. It wasnt quite the same as the one in pp but if u review the one in pp you get the gist They brought a question about child who had trauma at home but on admission has no neuro findings etc. The scenario was very similar to the one in pp although they changed a few things and the options are a) Admit for 24hours b) CT scan c) Monitor in A & E for 4hours d) Send home etc A 3 yr old presents with an enlarged cervical lymph node for which he has prescribed antibodies with no response. The Mantoux test was 8mm. The next best line of action is: a) Excision biopsy of node b) INH therapy c) Request ESR d) Order chest X ray e) Give follow up rx A 3yr old boy is dx with croup and discharged to his parents care from ED. The parents should be advised to return if there is a) An increase in loudness of the barking sound b) An increase in the pitch of the stridor c) Increased work of breathing d) Persistence of respiratory symptoms for more than 7days e) Persistence of hoarseness for more than 1 day The agent most likely associated with croup in a child is: a) Bordetella pertussis b) Haemophilus influenza c) Influenza A H1N1 strain d) Parainfluenza virus e) Streptococcus pneumoniae A 6 month old infant was seen in the A &E in moderate respiratory distress with a RR of 60/min, HR 220/min and is febrile. There is a 1 week hx of cold and cough prior to his presentation at the A &E dept. He has received the primary immunisations. The most likely dx is a) Aspiration pneumonitis b) Atypical pneumonia c) Bronchiolitis d) Viral myocarditis e) bronchopneumonia A 5 yr old presents with a 2 week hx of recurrent left knee pain and a limp. O/E the joint is warm and swollen. Of the ff she is most likely to test positive for a) Anti nuclear antibody b) Anti streptolysin O antibody c) Gonococcal antigen d) Rheumatoid factor e) Smith antigen The scenario in our exam was changed to generalised tonic clonic seizures they did not state febrile. The most likely EEG finding in a child who has just had a febrile seizure is: a) No abnormalities b) 3 per sec spike and wave changes c) Generalised slowing d) Hypsarrythmia e) Sharp waves The most likely cause of fulminating nephritis in a child is: a) Minimal change glomerulonephritis b) Focal segmental glomerulosclerosis c) Membraneous glomerulonephritis d) Post streptococcal glomerulonephritis e) Ig A nephropathy The scenario started off with 3 week hx of periorbital edema they didnt state nephrotic directly ff by 2 days of A 4 yr old boy with steroid dependent nephrotic syndrome presented to the ED with a 2day hx of abdominal pain and occasional loose stools. O/E of the abdomen, he has shifting dullness, guarding and rebound tenderness. Of the ff, the most likely organism causing the abdominal problem is a) E. coli b) H. influenzae c) Streptococcus faecalis d) Streptococcus pneumoniae e) Staphylococcus aureus 49. The statement that best describes cerebral palsy is that: a) It involves a motor deficit b)It is a progressive neurological disorder c) It should be diagnosed before the 2nd year of life d)Physical signs remain the same as child grows e) The insult is sustained by a fully mature brain The most likely presentation of a 1 month old child with cerebral palsy is a) Head lag b) Sleeping difficulties c) Abnormally increasing head circumference d) Caf au lait spots e) Absent deep tendon reflexes A 3month old baby who is well grown and pink is found to have high volume pulses in all limbs, a systolic thrill in the left infra clavicular area, normal apex beat and normal heart sounds with a continuous murmur at the left infra-clavicular area. Of the ff, the most likely dx is a) Congenital aortic stenosis b) Patent ductus arteriosus c) Pink atrio-ventricular canal defect d) Transposition of the great vessels e) Ventricular septal defect A term newborn baby product of an uncomplicated pregnancy is noted to be turning blue during feeds however she is pink while crying. Of the following, the most appropriate diagnostic procedure is a) Pass a nasogastric tube through each nostril b) Direct a laryngoscopy of the airway during crying c) Inspiratory and expiratory films during normal breathing d) Measurement of arterial blood gas during the cyanotic spells e) Review maternal notes for a hx of polyhydramnios The ff are features found in children with Down Syndrome a) Polydactyly b) Single palmar crease c) Hypoplastic nails d) Clinodactyly e) Syndactyly Concerning ocular findings at birth, a healthy baby may have a) A paralytic squint b) A white reflex c) Brushfield spots d) Leukokorea e) Sub-conjuctival hemorrhages The scenario was a child a few weeks old with blood in stool but answers the same as per below A 3yr old presents with an enlarged cervical lymph node for which he was prescribed antibiotics with no response. The Mantoux test was 8mm. The next best line of action is: a) Excision biopsy of the node b) ?therapy c) Request ESR d) Order chest x ray e) Give a ff up appointment Of the ff, a poor prognostic indicator for Acute Lymphoblastic Leukemia (ALL) is a) Anemia at presentation b) Detection of t(9:22) translocation, Philadelphia chromosome c) DNA index greater than 1 d) Presence of RBC in CSF e) WBC less than 50 * 109 at presentation A 6 yr old girl presents with ataxia, headaches associated with early morning vomiting and nystagmus. The tumor most likely to cause her symptoms is: a) Astrocytoma b) Brain cell glioma c) Craniopharyngioma d) Ependymoma e) Supratentorial primitive neuro-ectodermal tumor AGE REQUIREMENT (Kcal/kg/day)
0 - 6months 110
12 months 95
1 4 years 100
5 - 9 years 80
A 4 yr old who weighs 9kg has a daily caloric
intake of a) 500kcal b) 650kcal c) 900kcal d) 1200kcal e) 1500kcal Breastfed infants in the first 2 weeks of life have a normal stool consistency that is: a) Formed b) Pasty c) Putty like d) Pellet like e) Watery with small clumps Of the ff the risk factor that has the most consistently been associated with physical abuse is: a) Age of the child b) Gender of the child c) Maternal educational attainment d) Sibling rivalry e) Socioeconomic status Of these, a recognised side effect of phenytoin is a) Hyperphagia b) Peripheral retinal atrophy c) Hirsutism d) Acne e) rickets