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Question 1
Incorrect
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Which one of the following factors is the most likely etiological factor for abnormally short stature amongst children?
Your Answer: a
Correct Answer: Familial short stature
Explanation:Familial/inherited short stature is the most likely and commonest factor resulting in short stature among the children. Klinefelter syndrome is characterised by tall stature, widely spaces nipples and infertility. Other factors include congenital heart disease, maternal deprivation and diabetes mellitus but these are the rare causes.
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This question is part of the following fields:
- Child Health
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Question 2
Correct
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A baby boy born 5 weeks ago with a birth weight of 3.5kg presents to the clinic with jaundice. He is being breastfed and his current weight is 4.5kg. Which of the following is most likely responsible for the baby's jaundice?
Your Answer: Breast Milk Jaundice
Explanation:Breast milk jaundice is associated with breast-feeding. It typically occurs one week after birth and can sometimes last up to 12 weeks, but it rarely causes complications in healthy, breast-fed infants. The exact cause of breast milk jaundice isn’t known. However, it may be linked to a substance in the breast milk that prevents certain proteins in the infant’s liver from breaking down bilirubin. The condition may also run in families. Breast milk jaundice is rare, affecting less than 3 percent of infants. When it does occur, it usually doesn’t cause any problems and eventually goes away on its own. It is safe to continue breast-feeding.
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This question is part of the following fields:
- Child Health
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Question 3
Correct
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A 5-month-old baby was brought by the mother for assessment. The baby can sit with support but not on his own. On examination, there is palmar grasp. How is the current development of this child?
Your Answer: Normal
Explanation:All the given development milestones are compatible with the given age.
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This question is part of the following fields:
- Child Health
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Question 4
Correct
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An 8 year old boy presented with easy bruising following falls. FBC showed leucocytosis and thrombocytopenia with normal haemoglobin levels. His ESR was high and Paul-Bunnell test was positive. Which of the following is the most probable diagnosis?
Your Answer: Glandular fever
Explanation:Glandular fever (Infectious Mononucleosis) is caused by Epstein–Barr virus (EBV). Leucocytosis rules in infectious mononucleosis and thrombocytopenia is not an uncommon association. ESR is elevated in most of the cases. Paul-Bunnell test is a rapid test for infectious mononucleosis due to Epstein–Barr virus (EBV).
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This question is part of the following fields:
- Child Health
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Question 5
Incorrect
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A 3-year-old boy presents with a patchy rash after treatment for an enlarged cervical lymph node and sore throat. What is the antibiotic that caused this rash?
Your Answer: Tetracycline
Correct Answer: Ampicillin
Explanation:An enlarged lymph node does not necessarily need treatment especially if it is caused by a virus. If it is bacterial, antibiotics should be prescribed. Amoxicillin is first line treatment in non-penicillin allergic patients and side effects include allergic reactions like skin rash and itching
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This question is part of the following fields:
- Child Health
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Question 6
Incorrect
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What serious side effect would you expect, after giving IV lorazepam to a 4-year-old boy suffering from febrile convulsions?
Your Answer: Anaphylactic shock
Correct Answer: Apnoea
Explanation:Lorazepam is known to cause respiratory depression and finally apnoea as a side effect.
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This question is part of the following fields:
- Child Health
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Question 7
Incorrect
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A 6 year old boy presents with a history of repeated respiratory and gastro-intestinal infections since birth. His birth was, however, uncomplicated. His mother claims that he's not growing as he should for his age. What is the most likely diagnosis?
Your Answer: Primary B cell immunodeficiency
Correct Answer: Cystic fibrosis
Explanation:Cystic fibrosis is a genetic disease that interferes with the normal development of the child. It manifests with recurrent episodes of pneumonia accompanied by coughing, wheezing and dyspnoea. The appetite is normal but weight gain seems difficult. This condition also affects bowel habits with repeated gastrointestinal infections. The gold standard for the diagnosis is considered the sweat test which reveals abnormally high levels of Cl-.
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This question is part of the following fields:
- Child Health
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Question 8
Correct
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A 2 year old boy is brought by his mother to the emergency department with colicky pain. The boy has experienced such episodes of pain in the past, which radiates from his loin to the groin. After clinical examination and investigations, a 7mm stone has been found in his ureter. What is the single most appropriate next step?
Your Answer: Conservative treatment
Explanation:Renal stones < 5mm generally pass spontaneously with adequate fluid intake. Stones 5mm-10mm with pain not resolving, require medical expulsive therapy with Nifedipine or Tamsulosin. For stones larger than 10mm, ESWL or Ureteroscopy is indicated. For stones as big as 2cm, percutaneous nephrolithotomy should be applied.
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This question is part of the following fields:
- Child Health
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Question 9
Correct
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A 10 year old boy is being bullied by his classmates because he's obese and he is the shortest in his class. His mother is worried and brings him in to the clinic. History reveals he had a renal transplant last year. What is the most likely diagnosis?
Your Answer: Cushing’s syndrome
Explanation:The boy had a renal transplant, for which he needs immune suppression. For the exogenous immune suppression an exogenous steroid is needed, which in this case is responsible for the primary Cushing syndrome manifesting with short stature. The administration of steroids before the physiological fusion of the growth plate can lead to premature fusion with permanent cessation of bone growth.
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This question is part of the following fields:
- Child Health
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Question 10
Incorrect
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A 3-year-old girl presents with pallor and marked gland enlargement. She has been unwell for the past three weeks. She had a full term normal delivery with no neonatal problems. Her immunisations are up to date. There is no family or social history of note. On examination, her temperature is 37.6°C, and she looks pale and unwell. She has a few petechiae on the neck and palate, with moderate generalised lymphadenopathy and a 3 cm spleen. Which is the most likely diagnosis?
Your Answer:
Correct Answer: Acute leukaemia
Explanation:Non-Hodgkin Lymphoma: The history is of enlarged reticuloendothelial system with abnormalities in all 3 cell lines of the bone marrow (pallor, fever and petechiae). The most likely diagnosis is therefore acute (lymphoblastic) leukaemia. Lymphadenopathy may be prominent: mediastinal nodes are characteristic of T-cell leukaemia. In lymphoma the marrow involvement tends to be much less.
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This question is part of the following fields:
- Child Health
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Question 11
Incorrect
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A 6-month-old baby boy presented to the paediatrician with yellow discolouration of his skin and sclera. His mother says his stools are pale. On examination, he was found to be below average weight. What is a likely diagnosis?
Your Answer:
Correct Answer: Biliary atresia
Explanation:Pale stools suggest obstructive jaundice. Initially, the symptoms of biliary atresia are indistinguishable from those of neonatal jaundice, a usually harmless condition commonly seen in infants. However, infants with biliary atresia develop progressive conjugated jaundice, pale white stools and dark urine.
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This question is part of the following fields:
- Child Health
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Question 12
Incorrect
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A lethargic 2-month child was brought in with symptoms of diarrhoea and vomiting for 6 days. What is the appropriate initial investigations?
Your Answer:
Correct Answer: Urea and electrolytes
Explanation:The most commonly requested biochemistry tests for renal function are the urea and electrolytes. They supply important information when it comes to homeostasis and excretion. Glomerular filtration rate is also the essential standard marker of kidney health and is assessed by checking the creatinine levels. In this case as the child has lost fluids and electrolytes, this test will indicate the extent of the loss and allow for more appropriate replacement.
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This question is part of the following fields:
- Child Health
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Question 13
Incorrect
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Question 14
Incorrect
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A 15-month-old child is due for his measles, mumps and rubella (MMR) vaccines. He is feverish due to an acute otitis media and the mother gives a family history of egg allergy. What is the most appropriate action?
Your Answer:
Correct Answer: Defer immunization for two weeks
Explanation:Vaccines should not be given to a feverish child.
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This question is part of the following fields:
- Child Health
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Question 15
Incorrect
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A 6 month old baby presents with uncontrollable movements of her hands and feet, shortly after being unconscious for a while. What is the most likely diagnosis?
Your Answer:
Correct Answer: Infantile spasm
Explanation:Infantile spasm belongs to the spectrum of seizure disorders. Infantile spasm manifests itself with loss of consciousness and jerky movements. The peak age of onset is between 4 and 6 months. Approximately 90% of infantile spasms begin before 12 months of age. It is rare for infantile spasms to begin during the first 2 weeks of life or after 18 months.
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This question is part of the following fields:
- Child Health
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Question 16
Incorrect
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A 30-day-old female was diagnosed with a case of breast milk jaundice. She has no other symptoms. Which is the most suitable next step of management?
Your Answer:
Correct Answer: Continue breastfeeding
Explanation:Breast feeding should be continued for babies with breast milk jaundice as this is a benign condition.
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This question is part of the following fields:
- Child Health
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Question 17
Incorrect
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An 18-month-old girl already speaks ten words but her father says she cannot form a sentence. What is the best management strategy?
Your Answer:
Correct Answer: Reassurance
Explanation:Not being able to form a sentence at the age of 18 months is quite normal. A combination of two words to form a sentence can be done by 2 yrs of age.
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This question is part of the following fields:
- Child Health
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Question 18
Incorrect
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Which of the following are not a recognized feature of Down's syndrome?
Your Answer:
Correct Answer:
Explanation:Ataxic gait is not a direct association of Down’s syndrome. All other given responses are associated with Down’s syndrome.
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This question is part of the following fields:
- Child Health
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Question 19
Incorrect
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An 8-month-old baby was investigated for failure to thrive. On examination, he was irritable with evidence of weight loss. His stools were pale, bulky and malodorous. What is the most appropriate test that can be done to confirm the diagnosis?
Your Answer:
Correct Answer: Jejunal Biopsy
Explanation:Pale, bulky, malodorous stools are evidence of fat malabsorption syndrome. The diagnostic test is jejunal biopsy to rule out other differential diagnoses such as celiac disease, giardiasis or Crohn’s disease etc.
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This question is part of the following fields:
- Child Health
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Question 20
Incorrect
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A woman gave birth to an infant at 39 weeks' gestation. The infant has a pulse of 110 bpm, grimaces upon nasal stimulation and has good muscle tone. Moreover, the colour of the infant is pink except for the extremities, which are blueish. What is the infants APGAR score?
Your Answer:
Correct Answer: 7
Explanation:Apgar is a quick test performed on a baby at 1 and 5 minutes after birth. The 1-minute score determines how well the baby tolerated the birthing process. The 5-minute score tells the health care provider how well the baby is doing outside the mother’s womb. More specifically, five components are assessed and these are the appearance (A), the pulse (P), the grimace (G), the activity (A) and the respiration (R). A normal APGAR score is considered to be 10 points, 2 points given for each normal component. In this case, 1 point is given for the appearance due to the bluish extremities, 2 points are given for the pulse which is higher than 100 bpm, 1 point is given for the grimacing, 2 points are given for the activity due to the good muscle tone and 1 point is given for the respiration due to gasping. Total score is 7 points.
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This question is part of the following fields:
- Child Health
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Question 21
Incorrect
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A 2 month old baby presents to the clinic with vomiting. On examination he has ambiguous genitalia. The labs are as follows: Na: 125mmol/L, K: 6mmol/L. Which of the following is the most likely diagnosis responsible for this patient's presentation?
Your Answer:
Correct Answer:
Explanation:Congenital adrenal hyperplasia (CAH) comprises a group of autosomal recessive defects in enzymes that are responsible for cortisol, aldosterone, and, in very rare cases, androgen synthesis. All forms of CAH are characterized by low levels of cortisol, high levels of ACTH, and adrenal hyperplasia. The exact clinical manifestations depend on the enzyme defect. The most common form of CAH, which is caused by a deficiency of 21β-hydroxylase, presents with hypotension, ambiguous genitalia, and virilization (in the female genotype), and/or precocious puberty (in both males and females). It is further characterized by hyponatremia, hyperkalaemia, and metabolic acidosis. Increased levels of 17-hydroxyprogesterone confirm the diagnosis of 21β-hydroxylase deficiency. Treatment of CAH involves lifelong glucocorticoid replacement therapy. Patients with a 21β-hydroxylase deficiency also require mineralocorticoid replacement with fludrocortisone. Complications of CAH include severe hypoglycaemia, adrenal insufficiency, and/or a failure to thrive.
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This question is part of the following fields:
- Child Health
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Question 22
Incorrect
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A 13 year old patient presents in the A&E with a fracture of his left femur. He was a passenger in a car involved in a traffic accident. Upon clinical examination, his left posterior tibial and dorsalis pedis arteries are not palpable. Which of the following is most probably injured?
Your Answer:
Correct Answer: Femoral artery
Explanation:The femoral artery is the one accompanying the femoral shaft, being the most important blood supplier of the leg. Femoral artery injury during a femur shaft fracture is quite common as a result of blunt trauma.
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This question is part of the following fields:
- Child Health
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Question 23
Incorrect
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A 6 year old presents with fever and multiple vesicles on his back. What is the single most appropriate next step?
Your Answer:
Correct Answer: None
Explanation:This clinical picture is typical of chickenpox, which is treated with antihistamines and calamine lotion. In the case of fever, acetaminophen can be used. Generally treatment is purely for symptomatic relief.
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This question is part of the following fields:
- Child Health
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Question 24
Incorrect
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A 12 year old boy with type I diabetes was reluctant to go to school. According to him, he was unhappy at the school. Which of the following is the next appropriate step?
Your Answer:
Correct Answer: Clinical psychologist
Explanation:The child’s problem should be assessed properly to find the reason for unhappiness at the school. There can be many reasons such as bullying at school, abuse etc. A clinical psychologist should assess this child to take the necessary details and plan the further management.
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This question is part of the following fields:
- Child Health
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Question 25
Incorrect
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An infant born at 34 weeks was kept in the incubator for almost a month. Physical examination revealed a heart murmur, which however was not present at discharge. What is the most probable cause of this murmur?
Your Answer:
Correct Answer: PDA
Explanation:PDA is particularly common in premature babies and it is managed by indomethacin administration. However, if PDA is not the only defect, prostaglandin E1 can be administered in order to keep the ductus open until the surgery takes place.
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This question is part of the following fields:
- Child Health
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Question 26
Incorrect
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From the options provided, which statement would most likely points towards Munchausen's syndrome by proxy?
Your Answer:
Correct Answer: It is a cause of sudden infant death
Explanation:Munchausen syndrome by proxy is a mental illness and a form of child abuse. The caretaker of a child, most often a mother or a father, either makes up fake symptoms or causes real symptoms to make it look like the child is sick. The person with MSP gains attention by seeking medical help for exaggerated or made-up symptoms of a child in his or her care. As health care providers strive to identify what’s causing the child’s symptoms, the deliberate actions of the mother or caretaker can often make the symptoms worse.
The person with MSP does not seem to be motivated by a desire for any type of material gain. People with MSP may create or exaggerate a child’s symptoms in several ways. They may simply lie about symptoms, alter tests (such as contaminating a urine sample), falsify medical records, or they may actually induce symptoms through various means, such as poisoning, suffocating, starving, and causing infection. -
This question is part of the following fields:
- Child Health
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Question 27
Incorrect
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A 3-year-old boy was brought at the hospital by his mother due to sudden onset pyrexia with emesis and bilateral facial swelling. Upon history taking, she mentions that she brought her son to the GP who suggested analgesics for his bilateral parotid pain, 2 days ago. What would be the next step of your management?
Your Answer:
Correct Answer: Reassurance
Explanation:The history is suggestive of mumps. Mumps is a viral disease with initial signs and symptoms including fever, muscle pain, headache, poor appetite, and feeling tired. This is then usually followed by painful swelling of one or both parotid salivary glands. Mumps is a self-limiting condition treated only for symptomatic relief. As he currently is taking analgesics for pain relief, one should only offer reassurance.
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This question is part of the following fields:
- Child Health
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Question 28
Incorrect
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A 7-year-old child presented to the paediatric clinic with a swollen face, hands and feet. She gained 2 kilograms over the last month despite poor feeding. What is the investigation of choice in this case?
Your Answer:
Correct Answer: Urinary albumin
Explanation:This is a case of nephrotic syndrome that can be confirmed by the presence of urinary albumin. It should be further investigated by a tissue sample to confirm the diagnosis.
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This question is part of the following fields:
- Child Health
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Question 29
Incorrect
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A child presents with a history of recurrent tonsillitis. His mother claims he had three attacks in one year. What is the best management?
Your Answer:
Correct Answer: Treat when ill
Explanation:At least seven episodes in the previous year, five episodes in each of the previous two years, or three episodes in each of the previous three years are indications for tonsillectomy. Antibiotics should be administered in the conventional dosage for proved or suspected streptococcal episodes. For now the child should be treated on a case by case basis.
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This question is part of the following fields:
- Child Health
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Question 30
Incorrect
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A child on 70% O2 suddenly crouches down whilst playing to help with breathing. What is the most likely diagnosis?
Your Answer:
Correct Answer: Tetralogy of Fallot
Explanation:Tetralogy of Fallot (TOF), a congenital heart defect, includes the following: right ventricular hypertrophy, ventricular septal defect, abnormal position of the aorta and pulmonary valve stenosis. The O2 saturation in patients with TOF is typically lower than normal and the condition usually becomes symptomatic early in life. A feature of the disease with high diagnostic significance is squatting or crouching of the infant as a compensatory mechanism to increase the peripheral vascular resistance.
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This question is part of the following fields:
- Child Health
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SESSION STATS - PERFORMANCE PER SPECIALTY
