PAEDIATICS MCQ



PAEDIATICS MCQSUSAN TUCKER1.What is a normal direct bilirubin in neonates?<10<20<30<40<502.Which is not a cause of neonatal jaundice in the first 24 hours?rhesus incompatabilityABO incompatabilitySepsisCongenital infections..rubella/CMVPhysiological jaundice3.Which is not true about the cause of neonatal jaundice listed?breast milk jaundice---occurs late after 10 to 14 daysbiliary atresia will cause pale stoolsgalactosemia---jaundice occurs at 2-5 days and is diagnosed by reucing substances in the urinecephalohematoma do not to cause jaundicebreast milk jaundice does not rise to harmful levels4.In a term baby at what unconjugated bilirubin level do you consider phototherapy?200mmol/L280mmol/L350mmol/L450mmol/L500mmol/L5.Which is not true of hyaline membrane disease?it is also caused respiratory distress syndromeit tends to occur in those <30 weeks gestationthe CXR has a reticular ‘ground glass’ appearanceassociated respiratory difficulty may not appear until days 4 or 5treatment involves surfactant down ETT6.Which is not true of the listed causes of respiratory distress?transient tachypnoea of the newborn usually produces only mild early respiratory distresspneumothorax is often associated with meconium aspiration and RDSthe commonest early cause of bacterial pneumonia is Grp B hemolytic strepmeconium aspiration is due to in utero fetal distressthe initial management o f meconium aspiration involves PPV by bag and mask7.Which is not true of the listed non respiratory cause of respiratory distress?cyanosis of cardiac aetiology does not improve with oxygenrespiratory distress due to cardiac aetiology causes significant intercostal retractionrespiratory distress associated with metabolic acidosis causes tachypnoea with deep, ineffective breathscerebral anoxia can produce tachypnoeaPDA and VSD can cause cardiac cyanosis8.Which is not a cause of early neonatal sepsis which originates form the maternal genito urinary tract?herpesGp B strepE ColiListeria moncytogenesPseudmonas9.Which is an incorrect statement with regards to neonatal meningitis?cefotaxime 50mg/kg 6hourly should be givenbenzyl penicillin is not required in this age groupif a gram stain show pneumococci then vancomycin should also be given until sensitivities are proventhe possible causes include E coli, Grp B strep, listerisia as well as pneumococcus haemophilus type B and meningococcusall of the above are true10.Which is incorrect with regards to a 6 year old infant?its weight is 20 kgits blood volume is 1600 mlits tidal volume is 200mlthe appropriate size ETT is 5.5an oral ETT should be secured at 15 cmAnswer may be wrong.11.What is a normal capillary return?<1 sec<2 sec<3 sec<4 sec<5 sec12.Which is false regarding resuscitation of the newborn?there is one umbilical vein and two umbilical arteriesthe number of compressions per minute in CPR is 120the compressions: ventilation ratio is 3:1a term baby usually requires a size 4.5 ETTthe initial dose of adrenaline in a term baby is 30 microgm, the second dose is 300 microgmOld question, no longer applicable13.which is false?the oropharyngeal airway is measured from the incisors to the angle of the mandible the nasopharyngeal airway is measured from the tip of the nose to the angle of the mandibleThe maintenance fluid requirements for a 16 kg child are 52 ml/hrThe potassium requirements for a 16 kg child are 26 mmol/day The sodium requirements for 16 kg child are about 35 mmol/day 14.Which condition is not made significantly worse by closure of the ductus arteriosis?Severe pulmonary stenosisSevere coartation of the aortaSevere VSDSevere fallots tetralogySevere aortic stenosis?agree with answer15.Which is not a major criteria for Rheumatic fever?fevercarditiserythema marginatumsubcutaneous noduleschoreform movements16.Which is not used to treat rheumatic fever?bed restaspirinsteroidsbenzyl penicillindigoxin17.Which should definitely not be used to treat SVT in a 6 month old child.?adenosineverapamilamioderonevagal maneuverdigoxin18.In which condition are steroids not proven to be of any benefit?asthmabronchiolitiscroupAddisons diseaseAngioneurotic oedema19.Which feature below would be more likely to be found in croup than eppiglottitis?temp>38.5 degrees Celsiusdrooling salivasoft stridorminimal coughno preceding coryzal illness20.Which statement is true about adrenaline usage in croup?it reduces the duration of hospitalizationit reduces the length of the illnessit reduces the need for intubationit reduces the clinical severity of the illnessthe dose is 5ml of 1:1000More than 1 correct answer21.Which is the most common cause of pneumonia in an 8 year old child?mycoplasmapneumococcusviral, esp RSVhaemophillusstaph aureus22.Which statement is incorrect with regards to how the RCH recommends the use of MDI and spacers?The only time that nebulisers should replace MDI and spacer is in severe acute asthma. A MDI inhaler and spacer is as effective as a nebuliser at all other times.Below six years of age, 6 puffs of the MDI equals one nebuleAbove six years of age, 12 puffs of the MDI equals one nebule4 puffs of the MDI can be put in the spacer at a timeAtrovent should also be given by MDI and spacer23.Which antibiotic regimen would you give empirically to treat a previously well 3 year old child with suspected meningitis?cefotaximecefotaxime and benzyl penicillincefotaxime and benzyl penicillin and gentamicincefotaxine and gentamicinbenzyl peniciilin and gentamicin24.Which of these is not one of the possible criteria for the diagnosis of Kawasakis disease?fever for 5 dayspolymorphous rasherythema or oedema of the palms or solescervical LN,vomitingconjunctivitis, non purulent 25.Which is not a feature of/or true of scarlet fever?it is caused by group A beta hemolytic strepthe rash appears within 2 hours of the onset of fever, vomiting, headache and abdo painKoplicks spotsStrawberry tongueCircumoral pallor26.Which is false about the stated illness?a child with hand, foot and mouth disease does not need to be excluded from schoola child with fifth disease does not need to be excluded from schoolNeonatal HSV infection has few serious consequences as long as an adequate course of aciclovir is givenrubeela is characterized by posterior auricular lymphadenopathy which precedes a fine maculopapular rash by five dayschildren with measles and rubella should be excluded from school until at least five days after the onset of the rash27.Which is incorrect with regards to the RCH guidelines for the management of a previously well, low risk child with “fever without a focus”?all children less than one month of age should have a full workup including CSF and be admitted and given empirical antibodies regardless of the resultsa 2 year old child who looks otherwise well does not need investigation (perhaps a urine culture) or admissiona 3 month old child needs a full work up including CSF and unwell 2 yearold should have a full work up including CSF and can be discharged if results are normala 3 month old child should be admitted if any results are abnormal or the WCC>15 28.Which is not true of pyloric stenosis?it most commonly occurs in first born malesit is usually seen between four and six weeks of ageABGs show a metabolic alkalosisThe chloride is usually <100 and the sodium <130Hyperkalemia is sometimes seen29.Clinical signs of pyloric stenosis include all of the below except?projectile vomitingpalpable rubbery tumourblood in vomitusvisible peristalsisdehydrationMore than 1 right answer30.The normal maintenance fluid required in a 24kg child is?64ml/hr54ml /hr74 ml/hr44ml/hr84ml/hr31.The best maintenance fluid for a fasting well 10kg child is?0.9% saline5% dextrose0.18% saline and dextrose 4%0.45%saline and 4 % dextrosehartmans solution?agree with answer32.A 6 year old boy presents with hip pain. Which is not likely to be the diagnosis in this age group?perthes diseaseirritable hip/transient synovitisseptic arthritisslipped capital femoral epiphysisfracture33.An 8 year old boy presents with Left hip pain whilst ambulating but looks otherwise well. He is afebrile and has a normal WCC. The most likely diagnosis is?perthes diseaseirritable hip/transient synovitisseptic arthritisslipped capital femoral epiphysisfracture34.A child presents with unilateral hip pain. Which feature would not make you think of slipped capital femoral epiphysis as the diagnosis?age about13 yearswt > 90th centilehip externally rotated and shorteneddecreased ROM especially internal rotationfebrile, effusion on ultrasound35.Which statement is false with regards to acute pharyngitis/tonsillitis? (Pg305)Group A strep is very uncommon as the cause of sore throat in children less than 4 years of age, and 25 % of children > 8GAS is less likely if the child has a cough or coryzaThe most appropriate antibiotic for GAS is amoxycillinGAS is more likely if the child has enlarged tender tonsillar lymph nodesThe presence of a tonsilar exudate is not helpful in differentiating viral form GAS tonsillitisAntibiotic treatment only causes a modest improvement in symptom resolution36.Which is false with regards to acute otitis media?antibiotics only confer a modest benefit in most cases of ASOMacute symptoms resolve within 24 hours in 60% without antibioticsif antibiotics are used amoxycillin is the agent of choicethe degree of redness is relatively unhelpful in deciding whether bacterial infection is presentAn unwell infant with a fever often have ASOM as the sole diagnosis37.Which is false about a 1 year old with burns to half of both its legs?the approximate area burnt is 15 %the fluid used to replace losses should be normal salinethe maintenance fluid in such a child would be 1000ml/hrthe additional fluid requirement would be 600ml/daythis child should be managed as an inpatient at a specialized facility2 wrong answers38.How many umbilical veins are there?0123439.Which is a false statement about spine injuries in children?most commonly the upper cervical spine is involvedthe thoracolumbar spine is rarely damaged in childrenup to 40% of children under seven have pseudosubluxation of C3/C4 and C2/C3Spinal Cord injury usually only occurs with radiological abnormalityThe gap between C1 and the anterior surface of the dens should not exceed 5mm40.With regards to childhood gastroenteritis, which statement is false?rotavirus is responsible for 2/3 of the the cases of gastroeneteritisA rotavirus vaccine has been invented but is no longer in use as an association between it and intersusseption is being investigatedBacterial causes of diarrohea, without bacteremia should be treated with appropriate antibioticsAdenovirus is most common under 12 months of ageRotavirus Ds and Vs can last as long as 21 days41.With regards to febrile convulsions which statement is incorrect?they occur in 3% of children aged 6 months to 5 years3% of sufferers will go on to develop epilepsya recurrence of a febrile convulsion is more likely if there is a family history of febrile convulsions30% will experience a second febrile convulsion in their lifetimeappropriate investigations include EEG with or without CT/MRI42.Which statement is incorrect with regards to Duchenes muscular dystrophy?it is sex linked recessive usually, making it much more common in boyssymptoms appear in the first 5 years of lifedeath is usually between the ages of 15 and 25 and due to respiratory illnessprominence of the calf muscles is an early featurethe CK level is not elevated until muscular weakness becomes profound making CK a poor screening test43.Where are the majority of childhood CNS tumours found?infratentorialspinal cordin the hypothalamic- pituitary axiscerebral hemispheresoptic nerve 44.Which is incorrect with regards to childhood UTIs?15% of test stips are –ve for leucs and nitrites in children with UTIprophylactic antibiotics should be given to all kids with UTI until renal tract imaging is donethere is no need to investigate asymptomatic siblings of a child with Vesico Ureteric Reflux , for VURall children with a previous UTI should have a DMSA scan 2-4 years after the last UTI to look for scarringa child with UTI should have and ultrasound and if less then four years old should also have a MCU45.A 3 week old babe presents with an inguinal hernia which is reducible, how quickly should this babe be operated on?never if it does not happen againwithin 48 hourswithin 2 weekswithin 2 monthswithin 6 months46.Which is the most common cause of a transient arthritis in a child?post viralpost streptococcalchronic juvenile arthritishenoch schonlein purpurareiters syndrome47.Which is not true of henoch schonlein purpura?there is usually palpable purpura on the lower limbsthe patient is thrombocytopenicthey usually suffer abdominal painthey usually suffer nephritisthey usually suffer large jt migratory arthritis48.Which statement is false about Reiters syndrome?it occurs post enteric infections eg.salmonella, shigella, yersiniathey can suffer anterior uveitits and sterile pyuriatreatment involves NSAIDS and immunosuppressive agentsit tends to affect lower limb joints the mostthere is often a positive family history of the same49.Which is not true of diptheria?child presents with sore throat and inflamed tonsilsin the second week an exotoxin is releases which may cause myocarditisin week 3-7 neuritis with paralysis my occurtreatment of the disease involves administraion of benzylpenciillindiptheria antitoxin is given to counteract systemic effects50.Which type of rash is seen in meningococcal septicemia?purpuricno rasherythematousa combination of the aboveall of the above51.When bacterial meningitis is suspected, when should iv dexamenthasone prior to antibiotics as recommended by the RCH?all suspected casesonly if purpuric rashnot at allif previous hearing difficultiesif no previous HiB vaccination, or uncertain ANSWERS1)A2)E3)D4)B5)D6)E7)B8)E9)B10)E11)B12)D13)B14)C15)A16)E17)C18)B19)C20)D21)A22)D23)A24)E25)C26)C27)D28)E29)C30)A31)C32)D33)B34)E35)C36)E37)B38)B39)D40)C41)E42)E43)A44)C45)B46)A47)B48)C49) treatment is diptheria antitoxin, and erythromycin is given to eradicated the organisms50)E51)CPaeds MCQ’sDi FloodWhich is correct regarding pharyngitis in children?Strep throat should be treated with penicillin to prevent post-streptococcal glomerulonephritis.Presence of a pseudomembrane could suggest infection with N.gonnorhea.Pharyngitis associated with infectious mononucleosis will improve with penicillinClinical examination is reliable in differentiating bacterial and viral pharyngitisPrimary HIV infection can cause pharyngitis associated with GI symptoms and mucocutaneous lesions.A 3 day old baby presents with cyanosis, poor feeding and on examination has RR 80, poor capillary return but no audible murmurs. Which is the most likely diagnosis?VSDTetralogy of FallotTransposition of great vesselsTruncus arteriosusCoarctation of aortaWhich is true regarding congestive heart failure in children?Peripheral oedema is a common signThe most common cause is myocarditisPresence at birth is likely to be due to a noncardiac cause e.g. anaemiaFrusemide is used in the treatment at doses of 5mg/kg.Severe coarctation of the aorta with cause CHF thru increased preload.Which is incorrect of dysrhythmias in the paediatric population?First degree heart block is benign unless associated with ASD.A narrow complex tachycardia of 250 is more likely to be sinus tachycardia than SVT.Atrial flutter is associated with congenital heart disease 90% of the time.Digoxin is effective in the majority of children with atrial fibrillation.Ventricular tachycardia is sometimes found on routine examination of stable asymptomatic children with congenital heart disease.A 10 year old boy presents with migratory polyarthritis preceded by an episode of tonsillitis 2 weeks earlier (swab Grp A strep). Which other clinical entity needs to be present to make a diagnosis of rheumatic fever?Previous history of Rh feverA CRP of 200Elevated antistreptolysin titresPresence of subcutaneous nodules on extensor surface of wristsProlonged PR interval on ECG.1=E 2=C 3=C 4=B 5=DA 4 day old neonate presents with bilateral pink eyes with watery, discharge. What is the most likely pathogen?Strep pneumoniaeN. gonorrhoeaChlamydia trachomatisH. influenzaeAdenovirusWhich is incorrect regarding pneumonia in children?Viral pneumonia is the most common cause in all age groups except neonates.The best physical examination finding for ruling out pneumonia in an infant or child is absence of tachypnea.10% of children with Mycoplasma pneumoniae will have a variable rash.Blood cultures are often positive in bacterial pneumonia (> 50%).Cold agglutinin tests with be positive in 72-92% with M.pneumoniae.Which is the most correct statement regarding childhood asthma?Untreated paediatric patients have a lower risk of respiratory failure compared to adults.Degree of wheezing, is not a good predictor of asthma severityIV methyl prednisolone is advantageous over oral prednisone in the acute setting of asthma.Long acting beta-agonists are useful in the management of acute severe asthma. Salbutamol via MDI with spacer is inferior to nebulised salbutamol in a mild exacerbation of asthma.A 3 month old child presents with 2 day history of URTI, followed by difficulty feeding. On examination is tachypnea, with widespread wheeze and creps in the chest. Which of the following statements is correct?Adenovirus is the most likely cause of this illness.An oxygen saturation of 92 % on arrival mandates admission.Dehydration should be treated with NG replacement.A routine NPA is indicatedSalbutamol is not indicated in the management.A 5 year old child presents with an afebrile seizure. Which is the correct management?Rectal diazepam 0.2 mg/kg if prolonged seizure.5ml/kg of 10% dextrose or 2mls/kg 25% dextrose if BSL 1.2IV diazepam of 0.5 mg/kg if seizure lasting longer than 10 minsCT scan, EEG and admission regardless of duration.Pyridoxine 100 mg IV if refractory seizure.6=C 7=D 8=B 9=E 10=BWhich pathogen is unlikely to cause dysentery?SalmonellaClostridium difficileShigellaYersinia CampylobacterA 3 week old baby presents with a history of regurgitating feeds for 1 week, and now with projectile vomiting. On examination a small olive is palpable in the RUQ. Which is true regarding this child?Bilious vomiting can be explained by a diagnosis of pyloric stenosis.An abdominal USS is indicated to make the diagnosis of pyloric stenosis.This condition is more common in boys and has a familial propensityThe most common age for this presentation is 3 months.The presence of jaundice excludes pyloric stenosis.Which is incorrect of intussusception?This is the most common cause of intestinal obstruction in children less than 3 months.The cause is unknown in the majority of patients.The classic current-jelly stools are a late manifestation only present in 50%.A sausage shaped tumour should be palpable in about 2/3rds of patients.Most will be reduced with barium enema or air enema, with a recurrence rate of 5-10%.14. Which of the following statements regarding GI problems in children is incorrect?a. the most common cause of pancreatitis in children is trauma.b. Ingested foreign bodies need XRAY surveillance until past antrum of stomach.c.Meckels diverticulum can present with painless rectal bleeding.d. Rectal bleeding from Henoch-Schonlein purpura is rare unless intussusception is present.e. USS is not sensitive enough to detect all ruptured appendices. 15.Which statement is incorrect of diabetic ketoacidosis in children?a. .The child will often have an elevated serum osmolality.b. Kussmaul respirations occur in an effort to compensate for the metabolic acidosis.c. Vigorous fluid resuscitation may precipitate cerebral oedema, so deficits and maintenance fluids should be replaced over 48 hrs.d. Potassium replacement should be with-held if the patient is anuric.e. Use of bicarbonate in severe DKA may precipitate hyperkalemia.11=B 12=C 13=A 14=B 15=E16. A 5 year old child presents with fever and stridor. Which of the following is most supportive of a diagnosis of epiglottitis?a. onset over the last 5 daysb. presence of inspiratory and expiratory stridorc.child sitting in tripod position with symptoms worse on lying supined. seal like coughe.hoarse voice17.Which statement is correct regarding pain relief & sedation in the paediatric population?a. Chloral hydrate has rapid onset of action 5 mins.b. midazolam provides rapid analgesia and amnesiac. ketamine provides a dissociative state and is safe in neonates.d.nitrous oxide is a good analgesic agent in trauma patients for IV insertion.e. asprin use should be avoided in children with varicella and influenza.18. A 5 year old boy presents with a widespread rash. Which of the following is correct?a. presence of a strawberry tongue could suggest scarlet fever.b.vesicles present on oral mucosa, palms and soles of feet would suggest erythema infectiosum.c. presence of Koplik spots on buccal mucosa would suggest rubella.d.petechiae on the soft palate (Forschheimer spots) is pathognomic for rubella.e.desquamation of fingers and toes with strawberry tongue suggests pityriasis rosea.19. Which of the following is incorrect regarding fractures in children?a. Salter Harris 2 fractures usually do not result in growth arrest of bone.b. Torus fractures are due to compressive forces, and cause buckling of periosteum.partment syndrome in supracondylar fractures will always present with poor peripheral perfusion.d.supracondylar fractures require manipulation if there is backward tilting of carrying angle greater than 15 degrees.e. radial head subluxation is diagnosed clinically, and x-rays are usually unhelpful.20. A 10 year old boy presents with a painful hip and antalgic gait. Which of the following statements is correct?a. An AP pelvis view will detect posterior slips of femoral epiphyses.b. transient tenosynovitis is the most common cause of hip pain over 10 years of age.c. Perthes disease presents with no systemic symptoms and can be diagnosed on bone scan.d. If septic arthritis is the cause of this pain H. influenzae is the most likely pathogen.e. Rheumatic fever arthritis is usually monoarticular.16=C 17=E 18=A 19=C 20=C21. A 2 year old child presents with fever of 10 days duration with bilateral conjunctivitis, dry red fissured lips, periungual desquamation, and a widespread macular rash. Which of the following is true?This condition is more common in females.The cause of this syndrome is unknown but suspected to be super antigen bacterial toxins.This child has a 75% chance of developing carditis.If untreated the risk of sudden death from thrombosis coronary artery aneurysms is 5%.The use of IV immunoglobulin has no effect on the risk of developing coronary aneurysms.22. A 10 year old boy presents with acute rheumatic fever. Which of the following is incorrect regarding this boy?a. carditis occurs in a third of cases and may present clinically as a new murmur, tachycardia, gallop rhythm, pericardial rub or CHF.b. arthrits is typically monoarticular and treated with high dose aspirin.c. chorea often presents late and can be treated with haloperidol 0.01 mg/kg/day.d. erythema marginatum is one of the Jones major criteria for diagnosis.e. prophylactic penicillin is advised for 5 years following this attack.23. Which of the following is true of juvenile rheumatoid arthritis?A .systemic JRA is the most common disorder.B polyarticular disease affects one third of cases and often results in long term morbidity secondary to joint destruction.C. pauciarticular disease is common and diagnosed by +ve Rh factor.D. all groups of JRA’s will have a positive rheumatoid factor.E. glucocorticoids are the mainstay of treatment for these disorders.24. Which statement is incorrect of sickle cell disease?a. vasoocclusive crisis is uncommon but may present as bony pain.b. patients suspected of PE should undergo VQ scanning rather than pulmonary angiogram as the contrast can cause more sickling of RBC’s.c. priapism occurs in 30% of males with sickle cell disease.d. aplastic crisis is the most life threatening of all complications.e. prophylactic penicillin and Pneumovax is recommended for children with sickle cell disease due to functional asplenia.25. Which is the most common malignant brain tumour in children?a. medulloblastomab.astrocytomac. meningiomad.germinomase. schwannomas21=b 22=b 23=b 24=a 25=a53.All of the following can cause jaundice in neonates < 24 hours old excepta.Sepsisb.ABO incompatibilityc.Congenital atresia of bile ductsd.Toxoplasma congenital infectione.Excessive bruising from birth trauma54.A 2 week old term baby has presented to ED with signs of congestive heart failure. The most likely diagnosis is:a.Hypoplastic left ventricleb.VSDc.PDAd.Myocarditise.Coarctation of aorta55.Regarding seizures in childrena.3-4% of young children have febrile seizures.b.Myoclonic seizures in neonates indicate a good prognosis.c.Phenytoin is the 1st line drug of choice in treating neonatal seizures.d.Patients with immediate seizures post head injury have a 20-25% risk of recurring seizures.e.About 20% of children with epilepsy experience one bout of status epilepticus (grand mal).56.Paediatric abdominal emergencies are relatively common. Which of these answers is correct?a.Pyloric stenosis – affects approximately 1:750 male patients.b.Intussusception – the most common cause of intestinal obstruction in children under 3 months.c.Appendicitis – is excluded if the child presents with diarrhoea.d.Incarcerated herniae – incidence is highest in the first year of life.e.Pancreatitis in children is most commonly caused by mumps virus.57.Children with rashes often present diagnostic dilemmas to ED physicians. Which of the following statements is correct?a.The exanthem in measles develops about the 14th day following exposure.b.The rash of varicella spreads centripetally.c.Exanthema subitum is most common in children aged 5-10.d.The rash of erythema nodosum begins with a “herald patch”.e.“Slapped cheek” rash (erythema infectosum) is caused by human herpes virus 6.53 = ?C 54 = ?A+E 55= ?A+E 56= ? 57= ?58.Regarding paediatric airway management.a.An infants’ larynx is situated at the C5 level of the neck.b.The narrowest portion of the paediatric larynx is at the glottis.c.A laryngeal mask size 2.0 should be used if needed in an infant weighing 5 – 10kg.d.Needle cricothyroidotomy is the preferred surgical airway access technique in the paediatric population.e.Cricoid pressure is not indicated in paediatric intubation situations as it makes the cords too hard to see.59.Children who present with fever represent a large group of patients in Eds. Which of the following statements is correct?a.Neonates with a fever (38) have a 5% risk for bacteraemia.b.Group B streptococci are the most common bacterial pathogens causing neonatal disease.c.Strep pneumoniae infection in children aged 3 months to 3 years carries a 10% risk of complicating serious bacterial illness.d.A documented fever in a neonate warrants full sepsis work up and admission.e.All of the above are true.60.Which of the following pairings pertaining to paediatric infection is correct?a.Viral croup / peak incidence 3-4 years of age.b.Retropharyngeal abscess / rare > 4 years of age.c.Epiglottitis / “steeple” sign on xray.d.Bacterial tracheitis / drooling = common.e.Peritonsillar abscess / symptoms improve with patient supine.58= ? 59= ?E 60= ? 2Factors associated for SIDS include all EXCEPT:Sleeping in the prone positionPrevious episode of apparent life threatening event (ALTE)Maternal alcohol useWinter monthsFamily history of SIDS9A 12 month old child sustains partial thickness burns to the whole of its left lower limb. The percentage of total body area burnt is:101416182012In a neonate who is 24 hours old, jaundice is likely to be due to: ABO incompatibilityBreastmilkCongenital haemolytic anaemiaPhysiological causesHypothyroidism16A 3 year old girl is referred to the ED because of a reluctance to use her right arm. An hour earlier, she was playing with her older brother.Examination reveals no deformity nor specific tenderness.The GP sent in Xrays of the elbow, on which you see no abnormality.The most appropriate action is:Xray the left elbow for comparative filmsForced supination of the right elbowImmobilisation with a full plaster castReferral to an Orthopaedic surgeonRepeating the elbow Xray17Criteria for the diagnosis of Kawasaki Disease includes An ESR greater than 60 secondsFever of 4 days, polymorphous rash and suppurative conjunctivitisPositive serum Kawasaki antibodiesCervical lymphadenopathy, strawberry tongue and polymorphous rashFever of 5 days, arthritis and erythema nodosum21Croup can be caused by the following EXCEPT:allergyParainfluenza virusRSVRhinovirusEBV27In children with urinary tract infections:Klebsiella species are the commonest causative organismTrimethoprim is contraindicatedThe incidence of renal scarring is greatest in those under 1 year of ageRenal ultrasound is not indicated in girls with the first presentationFluoroquinolones are recommended first line antibiotics31Regarding childhood supracondylar fracture:It is most commonly associated with ulnar nerve damagePosterior angulation of 5 degrees requires manipulationIt is associated with a fall on the point of the elbowFollowing manipulation, the ideal position is flexion of the elbowIn a 2 year old the medial epicondyle should be visible on x-ray33Regarding non-accidental injury in children:A bruise with any yellow is older than 18 hoursA pulled elbow is pathognomonicNon accidental trauma occurs most commonly in children over 5 years of agePurple bruises cannot occur within 2 hours of the injuryIt has no association with prematurely born children35Regarding Paediatric resuscitation:The internal diameter (mm) of a suitable endotracheal tube is age/2 + 4The initial dose of IV adrenaline for asystole is 0.01mg / kgPrimary cardiac disease is the commonest cause of cardiac arrestThe initial energy for monophasic defibrillation of VF is 4 Joules / kgHead extension achieves optimal airway opening in neonates39Regarding intussusception:The female to male ratio is 4:1Ileo-colic intussusceptions are the most common formRed currant jelly stools present as an early signIt most frequently occurs in the 2-3 year age groupIt is uncommonly idiopathic42A 12 month old child with partial thickness burns to 28 % of its body is brought in 2 hours post injury. Fluid requirement in the first 6 hours in hospital is likely to be:280 ml560 ml780 ml1060 ml1413 ml44. A Salter-Harris type 5 injury is best described as :Crushing of all or part of the epiphysisThe whole epiphysis is separated from the shaftThe epiphysis is displaced carrying with it a small triangular metaphyseal fragment ( the commonest injury)Separation of part of the epiphysisSeparation of part of the epiphysis with a metaphyseal fragment54. Fallot’s Tetralogy does NOT include:ventricular septal defect (VSD)right ventricular hypertrophytransposition of the great vesselsoverriding aortapulmonary stenosis60. A 13 year old boy presents with 3 days of right hip stiffness and groin pain after activity. Examination reveals a well, afebrile child with a slight limp and pain on internal rotation of the right hip. The most likely diagnosis is:Congenital hip dislocationSlipped upper femoral epiphysisSeptic arthritisTransient synovitisLegg-Calvē-Perthes diseaseNo answers.21.In resuscitation of children which is false?a lone rescuer should provide 20 cycles of resuscitation and if no help has been summoned, then contact emergency servicesthe head position to maximize airway patency in an infant is in the neutral positionin a small child the chest compressions are done one fingers breadth above the ziphisternumin an infant the chest compession are done on the internipple linethe ratio of chest compressions to breaths is 5:1 in all ages above and including infants22.In resuscitation of children which false?in neonates the should be 120 chest compressions per minute with a 3:1 ratio with breathschest compressions should be commenced if the pulse rate is less than 60 in an infantthe depth of chest compressions at all ages is one half of the chest wallchest compressions should be commenced is the pulse rate is less than 40 in a small childafter assessing that there is no spontaneous breathing then five slow rescuer breaths should be given in all children38.Which drug dose is incorrect with regards to neonatal resuscitastion?1ml/kg of 10% dextrosefirst dose of adrenaline is 0.1 ml/kg 1:10 0002nd dose of adrenaline is 0/1ml/kg of 1:1000atropine 0.02mg/kg0.01 mg/kg of naloxone then 0.1 mg/kg39.Which is incorrect with regards to paediatric resuscitation?wt calculation is 2(age + 4)the ETT size is age/2 + 2an oral ETT should be secured at length age/2 + 12straight laryngoscope blades are used up to 12 months of age and sometimes up to 5 yearsdefibrillation if unstable VT or VF is 2J/kg, 4J/kg then 4J/kg40.Which is incorrect when comparing the paediatric airway to the adult?the paediatric airway has a larger tonguethe head is large and the neck short tending to cause neck flexionthe larynx is higher (C2-3 c.f C5-6) and more anterior in the paediatric airwaythe cricoid is the narrowest part in the paediatric airway whilst in the adult it is the glottisthe tongue is comparatively the same size in paeds as in adults21= ???? E 22=C out of date 38= A (+C out of date) 39= B (+E out of date) 40= E 1. A neonate is delivered in your emergency department. His first observations are: centrally pink but peripherally blue; heart rate 90 bpm; weak cry; some motion with stimulation and is limp. His APGAR score is546322. Which of the following is NOT diagnostic criterion for simple febrile convulsion:temperature > 37.5 degrees celsiusage 6 months to 5 yearsseizure lasts < 15 minutesno past history of afebrile seizuresless than 1 seizure in 24 hours5. Which of the following is NOT a diagnostic criterion for Kawasaki’s disease?fever for 5 daysbilateral non purulent conjunctivitisgeneralised lymphadenopathypolymorphous rashchanges in extremities ( eg: erythema, oedema, desquamation) 11. With respect to paediatric injuries, which of the following is FALSE:Seizures following traumatic head injury occur in 5% of hospitalised patientsThe spleen is the most commonly injured solid organThe duodenum is the part of the intestine most commonly injured in seat belt injuriesChildren are more prone to high cervical injuries than adultsIsolated chest trauma carries a 4 – 12 % mortality rate13. A baby at 38 weeks gestation is delivered in the ED. She is floppy and cyanosed, with a heart rate of 50bpm. Which of the following statements is TRUE about the subsequent management:Suctioning of the nose and pharynx should be sufficient treatmentCardiac compressions should be commenced if there is no change after 30 seconds of ventilatory support.Oxygen administration should be delayed to see if the child responds to suctioningThe child should be placed on the mother’s abdomen immediately after birthVentilation and cardiac massage should be synchronised with a 1:5 ratio21. Which of the following is consistent with scarlet fever:Punctate rash on neck and trunkCircumoral erythemaGeographic tongueOnly occurs in association with streptococcal pharyngitisResolution without desquamation44. Which of the following is NOT a Revised Jones’ Major criterion for acute rheumatic fever:PericarditisArthralgiaSubcutaneous nodulesChoreaNew cardiac murmur47. Which statement best defines a Salter Harris Type III fracture:Involves crushing to all or part of the epiphyseal plateInvolves separation of part of the epiphysisInvolves separation of part of the epiphysis with a metaphyseal fragmentInvolves fracture of the epiphyseal plate onlyInvolves the epiphysis being displaced carrying with it a small triangular metaphyseal fragment48. Pyloric stenosisIs best diagnosed with plain AXRPresents with projectile bile stained vomitingResults in hyperchloraemic metabolic acidosisIs familialIn adults can be due to chronic pyloric ulcerationUSS is the investigation of choicePresents with NON-bilious projectile vomitingHypokalaemic, hypochloraemic metabolic alkalosisMale 1 in 150, female 1 in 750Commonest in first born malesFamilial incidence in 50% of cases2 weeks to 2 monthsIn adults can be due to chronic pyloric ulceration: Acid ingestion may scar the pylorus and cause outlet obstruction59. In comparing the area of burns sustained in adults to children, which is TRUE:The head in children is proportionately twice the area of adultsIn children of all ages, each leg occupies 14%Neck in children is proportionately the same as in adultsThe arms in children are proportionately less than in adultsNone of the aboveHead area changes with age and is not a constant proportion of adultsLegs change with age (14% equates to <10 year old, then 18% as per adults) (Lund and Browder charts accurately express burn % area compared to rule of 9 charts)Neck is proportionately same as adults (1%)Arms are proportionately same as adults1=B 2=A 5=C 11=B 13= B 21=A 44= B (rather arthritis??) 47=B 48=E 59= CRegarding ketamine in paediatric sedation:The intravenous dose is 4mg/kgIt may cause reduced blood pressureLaryngospasm may result in patients with respiratory tract infectionAtropine should be administered concurrently owing to induced bradycardiaIt may be safely used in neonatesTint 898The scenario most suggestive of child abuse isa 3yo who sustains a spiral fracture of the tibia while playing on a slidean 18 month old with multiple bruises to the shin and foreheada 3yo boy with a pulled elbow after wrestling with his 10yo brothera 5 month old boy who ingests 2 of his mother’s Fe tabletsa 2yo who tries to hide when approached by medical staffTint 1951An X-ray of a child’s elbow reveals ossification of the capitulum and radial head. The child’s age is likely to be1-2 years4-5 years6-7 years10-11 yearsNone of the aboveMcR 130A child in your department has been diagnosed with Heamophilus influenzae type B meningitis. His 2 year old brother who lives in the same household should be treated prophylactically withrifampicin 600mg orally bd for 2 daysrifampicin 600mg orally as a single doseciprofloxacin 500mg orally as a single doserifampicin 250mg orally, daily for 4 daysnone of the aboveAb guidelines(2000) 41-4241. With regard to paediatric trauma all of the following are true except:the spleen is the most commonly injured organa child with a splenic injuries is more likely to be treated non-operatively than an adult with similar injuries.False negative DPL’s are commonPhysical examination alone is unreliable in approximately 50% of casesCT is preferable to DPL in a stable patientTint 162142. A compression injury of the epiphyseal plate is:a) often missed and may be evident only after growth disturbance b) the most common type of epiphyseal injuryc) the Salter-Harris fracture with the best prognosisd) a Salter-Harris I fracturee) associated with torsion mechanisms and growth plate tendernessTint 174544. An afebrile 3 month old infant is brought to the ED following an apparent life-threatening event (ALTE). She was apnoeic for 20-30 seconds, with associated circumoral and peripheral cyanosis, but is now normal. Which is the most appropriate management?admit for further observation and investigationsarrange for an apnoea monitor at home and dischargeobserve for 2 hours and dischargeobserve for 6 hours and dischargedischarge with GP follow up onlyRos 110359. A 10kg child is hypotensive post resuscitation, and requires an adrenaline infusion. To set up an infusion such that 1 ml/hr delivers 0.1 mcg/kg/minute, how many milligrams of adrenaline would be added to N saline to make a final volume of 100ml?0.10.616601 = C 2=D 3=B 4=D 41=C 42=A 44=A 59=D8. 6 year old with septic arthritisBC seldom positiveH. Infl is commonest causeTreatment is instillation of Abs into jointTreatment is Abs and surgical drainageUsually spreads from adjacent OMChildren: S. aureus, Grp A Strep (Grp B in neonates), H. InfluAdults: Gonorrhoeae & StaphOlder adults: Staph, Gram –ve, Grp A StrepBC positive in 50%Haematogenous seeding most commonDirect spread from trauma less commonDiclox for treatment + surgical drainage11. What is not a clinically significant complication of IO needle in 3yr old# tibiacellulitesosteomyelitiscompartment syndromepulmonary fat embolusComplications of IO:Uncommon in generalFluid extravasationPenetration of posterior cortexTibial #Growth retardationCompartment syndromeCellulitisOsteomyelitis (non-existent if removed <24hrs)12. Question of Roseola infantum rash features6-18 monthsonset of fever to 40, +/- febrile convulsionrash appears with defervesencemacular or macularpapular rashtrunk, spares face & limbsHHV-7 implicated13. Causative agent of Hand, feet & mouth lesions + treatmentHand foot & mouth, Coxsackie, enterovirus, EM, EBV, Gonoccocal, Syphilis, no treatment10.The likely intact survival rate in paediatric cardiac arrest is:a)less than 1 %b)less than 10%c)less than 25% ?d)greater than 50%e)worse if there is associated respiratory arrest10 = b11.In paediatric resuscitation: a) endotracheal is the preferred route of drug administrationxb)the dose of adrenaline is up to . 1 mg/kgxc)sodium bicarbonate is used at a dose of 5meq/kgxd)the airway will be improved by neck flexion xe)defibrillation is at a dose of 0.5 joules/kg?11=B (?out of date?)17.A one year old child would be expected to have a pulse of:a)150b)140c)130d)120?e)11017=D18.For blood pressure determination in a 6 year old child the cuff width should be:a)3cmsb)4cmsc)5cmsd)6cms?e)7cms18=E35.Paediatric septic arthritis:a)is usually due to haemophilus influenzaex probably not any moreb)is empirically treated with ceftriaxone or cefotaxime alonec)will show a joint aspirate cell count of > 10,000 mm3?d)will show a joint aspirate with increased viscosity x lowe)can often be diagnosed on plan radiographyx35= C60.The major Jones criteria for rheumatic fever include:a)choreab)erythema marginatumc)subcutaneous nodulesd)St Vitus dancee)all of the above60=EAll of the following are major criteria for Kawasaki syndrome EXCEPT: a) fever > 38.5oC for at least 5 daysb) bilateral conjunctivitiserythematous palms and solesmarked cervical lymphadenopathycongestive heart failure75=E76.A newly born who is limp and non responsive, pale and in which pulses and breathing cannot be easily detected has an APGAR of:0 1 2 or 3 3 or 4 4 76=A77.The most common cause of death in infants aged 6 to 12 months is:road traffic crashesSIDSHomicidecongenital tumoursinfectious diseases77=C78.The most common neurologic manifestation of child abuse is:retinal haemorrhagebrainstem infarctionsubdural haematomabrain stem haemorrhageextradural haematoma78=A79.Epiglottitis:is most common in the third year of lifeshares a similar aetiology to bacterial tracheitisis more common in malesis first manifest by signs of airway narrowingproduces a cough in 30% of cases70=C80.Nebulised adrenaline when used for croup:mandates overnight admissionis more efficacious if the racemic mixture is usedis reserved for life threatening obstructionis given in 50 times the usual IM doseproduces VT in 5% of cases80=D81.Mycoplasma pneumoniae is the most common causes of pneumonia in:1 4 month olds4 12 month olds1 5 year olds5 10 year oldsall of the above81=D84.The daily IV fluid replacement of a 25kg child is:1200 mls 1400 mls 1600 mls 2100 mls 2600 mls 84=C9)With respect to fluid administration in paediatricsa.Hypoglycaemia is treated with 1ml/kg 10% dextroseb.Milk and water administration is at the same volumec.d.e.9)With respect to fluid administration in paediatricsa.Hypoglycaemia is treated with 1ml/kg of 10% dextrose. Crap – 10mls/kg 10% dextroseb.*Milk and water administration is at the same volume13)Regarding the care of croup with airway obstructiona.Adrenaline shortens the course of the monest cause in RSVc.Steroids modify the illnessd.e.13)Regarding the care of croup with airway obstructiona.Adrenaline shortens the course of the illness. – Crap, can reduce the risk of need for intubation but doesn’t alter monest cause is RSV. Crap – mostly paraflu, then RSVc.*Steroid modify illness. True decreases mortality and need for intubation15)Regarding bronchiolitisa.Crepitations are rarely heardb.Bronchodilators are contraindicated as they increase hypoxaemiac.Adenovirus infection is more severe than RSVd.Steroids modify the diseasee.15)Regarding bronchiloitisa.Creps rarely heard. Bosh – heard frequently and generalizedb.Bronchodilators are contraindicated as they cause hypoxemia. Bosh – but they rarely improve bronchospasm from bronchiolitis – same with atrovent. Neither are provenc.*Adenovirus infection id more severe than RSV. True – adenovirus is rare but causes severe obliterative diseased.Steroids modify the disease. Bosh – no proof of this24)Which of the following is least likely to be a cause of abdominal pain in 6-11 year oldsa.HSPb.Gut malrotationc.DKAd.Inflammatory bowel disease24)Which of the following is least likely to be the cause of abdominal pain in 6-11 year oldsa.HSP - common and can even cause intususseption due to lymphoid tissue hyperplasia within bowel wallb.**Gut malrotation – seen up to the age of 2 and presents with volvulusc.DKA – any age kidd.IBD – older kidse.Appendicitis – any age but classic 10-20year olds27)In a 13kg child with iron overdose of 700mg elemental iron which is truea.AXR will show tablets in over 80% of casesb.Must wait for all the lab results and TIBG before commencing Desferoximinec.Something to do with vin rose urine in treatmentd.Something about dialysis clearing desferroximinee.27)In a 13kg child with an iron OD 700mg elemental iron which is true.50mg/kg is a moderate OD (<20mg/kg = nothing, 20-60 may need chelation, 60-90 high risk of toxicitya.Xray will show tablets in 80% of patients. False – 50% by tintanellib.Must wait for all lab results and TIBG before commencing desferoxamine – TIBG is useless – treat based on clinical toxicity without blood results. c.Vin rose – is interesting but not a reliable indication of when to cease desferoxamine treatment and its appearance often lags by 3 hoursd.Dialysis does not clear free iron but can clear ferrioxamine complex in those with renal failure33)Regarding increased risk of epilepsy in a child with a febrile convulsion, which of the following has the lowest association with developing epilepsya.Family history of epilepsyb.2 febrile seizures in 24 hoursc.Further febrile seizure in 6 months timed.Prolonged status with presenting seizure >25 minutese.Focal seizure34)6 year old has a rose thorn wound. Immunised with DTPz at 2, 4, 6, months, but no more, what is the best form of treatment in EDa.CDT (no pertussis)b.DTPa onlyc.DTPa and tetanus immunoglobulind.Need no further immunizatione.35)Regarding bone ossification times which is truea.Lateral epicondyle age 7-9b.Radial head aged 3-5c.Medial epicondyle aged 1-3d.e.33)Regarding increased risk of epilepsy, which of the following has the lowest association with developing it?a.Family history = increased riskb.**2 febrile seizures in 24 hours = slightly increased risk – would make you a little suspiciousc.*Further febrile seizure in 6 months = cant find this in the books, maybe?d.Prolonged status = red flag – not a simple febrile seizure may have CNS infectione.Focal seizure = red flag – something else going on34)A 6yo has a rose thorn wound. Immunized DTP at 2, 4 and 6 months but no more, what is the best form of treatment in EDIG only if hasn’t had 3 at some point in life – otherwise just a tet toxIf >5 years and dirty wound DTP (kids <8) CDT/ADT/tet tox for >8If > 10 years boosters for alla.CDT onlyb.**DTPa onlyc.DTPa + IGd.Nil needed35)Regarding bone ossification timesCRITOE 1,3,5,7,9,11a.Lateral epicondyle 7-9. No 11b.**Radial head 3-5. sounds rightc.Medial epicondyle 1-3. No 54)Regarding paediatric intussusception which of the following is TRUE?a.Recurrence following barium enema reduction is up to 20%b.Intussusception is associated with HSP, lymphoma and cystic fibrosisc.d.4)Regarding pediatric intususseptiona.Recurrance following barium enema is 20%. 5-10% in first 24-48hrs according to tintanellib.**Intususseption is associated with HSP, lymphoma and cystic fibrosis. Difinately a risk with HSP and lymphatic tissue in gut wall. CF associated with intussuseption around appendix6)Regarding CXR in paediatrics which of the following is falsea.Normal neonatal CXR cardiothoracic ratio can be up to 0.65b.Atrial double shadows are associated with atrial dilatationc.Lateral right ventricle lies directly under the sternumd.The mediastinal shadow is larger in AP rather than PA filmse.As6)Regarding CXR in paediatrics which of the following is false?a.Normal neonatal Xray cardiothoracic ratio can be up to 0.65. True – Dunn says up to 0.7b.Atrial double shadows are associated with atrial dilatation. Sounds rightc.*Lateral right ventricle lies directly under sternum. False – lies to right of sternum as for adults.d.The mediastinal shadow is larger on AP rather than PA film. True as its further away from the plate and hence magnified Thymus involutes after 3 yo. This is a stupid question8)Regarding congenital heart disease which of the following is FALSE?a.ASD is the most common defectb.Most VSD abnormalities present in the first yearc.The components of tetralogy comprise……d.e.9)Regarding skin xanthems which of the following is TRUE?a.Scarlet fever has a rough textureb.Hand foot and mouth disease is caused by herpesc.Rubellad.e.8)Regarding congenital heart disease which is falsea.*ASD is most common defect. ?False VSD is the commonest of all congenital defects in tintanelli but it is a well known fact that 1/3 of the population have a PFO!b.**Most VSD abnormalities present in the first year. True – relative size of defect decreases with age there for decreasing presentations with age.c.The components of tetralogy comprise……. Of an overriding aorta, pulmonary stenosis, VSD and RV hypertrophy9)Regarding skin exanthemsa.Scarlet fever has a rough texture. True 1mm punctate lesions giving rough, sandpaper feelb.Hand foot and mouth is caused by herpes. False - coxackiec.Rubella. Pink macules involving face neck trunk and then limbs. Occipital and post auricular lymphadenopathy. No significant illness with it.20)Regarding paediatric traumaa.The liver is the most commonly injured organb.Rib fractures are not associated with significant pulmonary contusionc.SCIWORA is commonest in kidsd.e.20)Regarding paediatric traumaa.The liver is the most commonly injured organ. False spleenb.Rib fractures are not associated with significant pulmonary contusion. False – more so than adultsc.*SCIWORA is commonest in kids. True more common in kids due to laxity of ligaments25)What is the total fluid requirement of a 30kg child whoc is 5% dehydrateda.2400mlb.3200mlc.d.e.25)What is the total fluid requirement for a 30kg child who is 5% dehydrated?a.2400mlb.**3200ml0.05 X 30 (rehydration)+ (maintenance) 100 X 10 + 100 X 50 + 100 X 2527)Regarding neonatal sepsis which of the following is TREU?a.Pneumococcus is a common cause of sepsisb.c.d.e.27)Regarding neonatal sepsis which is truea.Pneumococcus is a common cause of sepsis. True but need to consider gp B strep, listeria, Hib, clamydia and ghonococcus4. In childhood pneumoniaChlamydia can present around 2 weeks of age due to colonisation from birth one week to four months. Usually 3-12 weeks, slow onset. Conjunctivitis is 10-14 days. Cefotaxime may be used as empiric antibiotic cover in neonatal infection Benzyl penicillin and gentamycinIn neonatal pneumonia, Hemophilus influenza B, Neiserria meningitidis and pnemococcus are the commonest organisms. GBS, E.coli, Klebsiella most commmonCommonest cause of pneumonia in over 5yo is pneumococcus TRUE7. In childhood gastroenteritisBloody diarrhoea occurs in 10% of gastroenteritis 1 – 4% in tintinali, 20% in Rosen arghh!!!!The commonest cause is adenovirus rotavirus 60% < 2 years, commonest under 5 yearsAntibiotics are indicated in all salmonella infections if less than 6 months, toxic, bacteraemic, chronic GIT disease, haemoglobinopathyIV fluid is indicated in all cases with >5% dehydration can have ORHDiet should consist of free fluid for 24h can be restarted after four hour rehydration, definitely no longer than 24hours8. Regarding abdominal pain in childrenNormal feeding b/w pain excludes significant pathology falseAppendix perforation rate is higher in <1yo TRUE, as well as elderly (Dunn)15. Regarding lateral condyle fracture in a child Varus deformity can result Valgus (Varus occurs in supracondylar)Delayed injury to the ulnar nerve can occur TRUE (Tintinalli)They rarely need manipulation x OFTENRadial artery spasm can occur x Brachial, vascular complications uncommon25. Roseola infantum/herpes virus 6Is associated with coryzal symptoms – cough, pharangitisOnset of rash occurs with fever rash after fever, day 3-5 as child improvesMost common in late winter and early spring no seasonal preponderance (Tintinalli)26. Regarding kidney disease in childrenGlomerulonephritis may be managed with fluid restriction Supportive, nephrotic managed with prednisoloneThrombocytopenia is a characteristic finding in HUS TrueIncidental microscopic hematuria is considered benign if examination and renal function are normal - TRUE, (but need US and referral to nephrologist if persistant)27. After a febrile seizure, there is increased risk of epilepsy in children with all except:First degree relative with epilepsyFocal features in seizureIncomplete recovery between seizuresMultiple seizures in same febrile illness (increased risk)Duration does not affect risk of epilepsy (prolonged increases risk, RCH guidelines)CroupCorticosteroids shorten the durationAdrenaline shortens the durationStridor/noisy breathing is low pitched and mainly expiratory Regarding Neonatal resuscitationRate is 15:2Extubate on neck extensionGlottis is more anterior than the adultSeptic arthritis in ChildrenCefotaxime is the best empirical therapy for a child aged 10Synovial fluid culture is positive in up to 90% caseTransient synovitisMost common in age <1yrWCC and CRP are usually normalSeldom associated with a joint effusionIs associated with a fever7. In neonatal resuscitation the ratio of compressions to ventilations is 3:1the ratio of compressions to ventilations is 15:2C high dose adrenaline >100ug/kg is beneficial D dextrose dose in hypoglycemia is 0.5 mls/kg of 10% dextrose7=ARegarding ingested foreign bodies in children which is incorrectA coin on xray it will be seen in the sagittal plane if it is lodged in the oesophagusForeign bodies most commonly lodge at the cricopharyngeus in childrenA button battery lodged in the oesophagus is not an emergency17=CIn regards to bronchiolitis in infantsipratropium bromide (atrovent) is a proven treatmenta high white cell count is a prognostic factorCXR changes are uncommonMay respond to bronchodilatorsSteroids are beneficial18=DRegarding PR bleeding in children10% of gastroenteritis will have blood in diarrhoeait is an early feature of intussusception19=AA 5-year-old male presents to the ED 3 h after a possible button battery ingestion. The patient is in no acute distress, vital signs are stable, and examination is benign. A chest x-ray shows what appears to be a small button battery in the stomach. Which of the following is the MOST appropriate next action?Upper GI series to further delineate the exact location of the foreign bodyAttempt battery removal by the Foley balloon catheter techniqueImmediate GI consultation for endoscopic removalImmediate surgical consultationDischarge to home with parental observation and weekly radiographs.Which one of the following is the LEAST consistent with a diagnosis of intussusception?Intermittent colicky abdominal pain, interspersed with symptom-free periods.Grossly normal appearing stool.Normal plain films of the abdomen.Previously healthy 9-year-old.Altered, lethargic appearance.A 4-month-old infant presents with a rectal temperature of 38.7?C, a respiration rate (RR) of 60, a heart rate (HR) of 160, and an SpO2 on room air of 92%. He is smiling, drooling, and taking his bottle well, despite prominent intercostal retractions. On auscultation, he has diffuse coarse breath sounds with sibilant wheezes at both bases. All other household members have colds. There is no family history of atopy or asthma; no one smokes. ED therapy for this child could include all the following EXCEPTsupplemental O2 (by blow-by or nasal cannula as tolerated by the child)a trial of nebulized albuterola trial nebulized racemic adrenalinea dose of glucocorticoidsadmission.One day after discharge from the normal newborn nursery, a jaundiced infant exhibits fleeting bicycling movements of the limbs, sucking of the lips, and occasional apneic episodes with colour change. You interpret these as possible neonatal seizures. Work-up and treatment should include all of the following EXCEPTevaluation for inborn errors of metabolism (including urine for reducing substances, organic amino acids, serum for lactate, pyruvate and ammonia)correction of electrolyte, calcium, magnesium, glucose, and acid-base imbalancessepsis work-upadministration of diazepam as a first-line drug to control seizuresloading with phenobarbital.An 11-month-old patient with no primary care physician is called back to the ED for re-evaluation because blood that was drawn the day before as part of a work-up of fever is positive for N. meningitis. The clinical impression at discharge was otitis media, and the patient was treated with amoxicillin and acetaminophen. The patient is now afebrile and playful. What is the MOST appropriate action?Repeat blood culture, intravenous ceftriaxone, admit.Repeat blood culture, perform lumbar puncture and CSF culture, start intravenous ceftriaxone, admit.Repeat blood culture, intramuscular ceftriaxone, home with follow-up in 24 hours.Repeat blood culture, continue oral amoxicillin, follow up in 24 hours or sooner if worse.Home after thorough history and physical examination, with reassurance to the parents.A 2-week-old infant presents with congestion, mild wheezing, and a history of “feeling warm”. Except for wheezing and mildly increased respiratory effort, the baby has normal vital signs and a normal examination. All the following historical elements would place this child at increased risk for apnea EXCEPTsluggish feeding and progressive increase in constipation.frequent paroxysms of cough, often followed by emesis, but no colour change.1-week duration of symptoms.2-day duration of symptoms.premature birth.A non-toxic, playful, 18-month-old toddler is febrile to 40.5?C but has no focus for fever on examination. A 24-hour follow-up visit is arranged. Which of the following would be INAPPROPRIATE management?Blood and urine cultures; intramuscular ceftriaxoneBlood and urine cultures, intramuscular ceftriaxone only if WBC > 15,000Intramuscular ceftriaxone, no culturesBlood and urine cultures, no antibioticsB, C, and D are all inappropriate.A 1-year-old baby presents with signs of severe dehydration and shock during a severe bout of gastroenteritis. Which of the following is the MOST appropriate fluid therapy?Isotonic crystalloid bolus of 20 mL/kgIsotonic crystalloid infusion at 20 mL/kg/hD5W 0.45 NS bolus of 20 mL/kgD5W 0.45 NS infusion at 20 mL/kg/hD5W 0.25 NS infusion at 20 mL/kg/h. ................
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