PAEDIATICS MCQ
SUSAN TUCKER
1.What is a normal direct bilirubin in neonates?
a) <10
b) <20
c) <30
d) <40
e) <50
2.Which is not a cause of neonatal jaundice in the first 24 hours?
a) rhesus incompatability
b) ABO incompatability
c) Sepsis
d) Congenital infections..rubella/CMV
e) Physiological jaundice
3.Which is not true about the cause of neonatal jaundice listed?
a) breast milk jaundice---occurs late after 10 to 14 days
b) biliary atresia will cause pale stools
c) galactosemia---jaundice occurs at 2-5 days and is diagnosed by reucing
substances in the urine
d) cephalohematoma do not to cause jaundice
e) breast milk jaundice does not rise to harmful levels
4.In a term baby at what unconjugated bilirubin level do you consider phototherapy?
a) 200mmol/L
b) 280mmol/L
c) 350mmol/L
d) 450mmol/L
e) 500mmol/L
5.Which is not true of hyaline membrane disease?
a) it is also caused respiratory distress syndrome
b) it tends to occur in those <30 weeks gestation
c) the CXR has a reticular ‘ground glass’ appearance
d) associated respiratory difficulty may not appear until days 4 or 5
e) treatment involves surfactant down ETT
6.Which is not true of the listed causes of respiratory distress?
a) transient tachypnoea of the newborn usually produces only mild early respiratory
distress
b) pneumothorax is often associated with meconium aspiration and RDS
c) the commonest early cause of bacterial pneumonia is Grp B hemolytic strep
d) meconium aspiration is due to in utero fetal distress
e) the initial management o f meconium aspiration involves PPV by bag and mask
7.Which is not true of the listed non respiratory cause of respiratory distress?
a) cyanosis of cardiac aetiology does not improve with oxygen
b) respiratory distress due to cardiac aetiology causes significant intercostal
retraction
c) respiratory distress associated with metabolic acidosis causes tachypnoea with
deep, ineffective breaths
d) cerebral anoxia can produce tachypnoea
e) PDA and VSD can cause cardiac cyanosis
8.Which is not a cause of early neonatal sepsis which originates form the maternal genito
urinary tract?
a) herpes
b) Gp B strep
c) E Coli
d) Listeria moncytogenes
e) Pseudmonas
9.Which is an incorrect statement with regards to neonatal meningitis?
a) cefotaxime 50mg/kg 6hourly should be given
b) benzyl penicillin is not required in this age group
c) if a gram stain show pneumococci then vancomycin should also be given until
sensitivities are proven
d) the possible causes include E coli, Grp B strep, listerisia as well as pneumococcus
haemophilus type B and meningococcus
e) all of the above are true
10.Which is incorrect with regards to a 6 year old infant?
a) its weight is 20 kg
b) its blood volume is 1600 ml
c) its tidal volume is 200ml
d) the appropriate size ETT is 5.5
e) an oral ETT should be secured at 15 cm
Answer may be wrong.
11.What is a normal capillary return?
a) <1 sec
b) <2 sec
c) <3 sec
d) <4 sec
e) <5 sec
12.Which is false regarding resuscitation of the newborn?
a) there is one umbilical vein and two umbilical arteries
b) the number of compressions per minute in CPR is 120
c) the compressions: ventilation ratio is 3:1
d) a term baby usually requires a size 4.5 ETT
e) the initial dose of adrenaline in a term baby is 30 microgm, the second dose is 300
microgm
Old question, no longer applicable
13.which is false?
a) the oropharyngeal airway is measured from the incisors to the angle of the
mandible
b) the nasopharyngeal airway is measured from the tip of the nose to the angle of
the mandible
c) The maintenance fluid requirements for a 16 kg child are 52 ml/hr
d) The potassium requirements for a 16 kg child are 26 mmol/day
e) 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?
a) Severe pulmonary stenosis
b) Severe coartation of the aorta
c) Severe VSD
d) Severe fallots tetralogy
e) Severe aortic stenosis
?agree with answer
15.Which is not a major criteria for Rheumatic fever?
a) fever
b) carditis
c) erythema marginatum
d) subcutaneous nodules
e) choreform movements
16.Which is not used to treat rheumatic fever?
a) bed rest
b) aspirin
c) steroids
d) benzyl penicillin
e) digoxin
17.Which should definitely not be used to treat SVT in a 6 month old child.?
a) adenosine
b)
c)
d)
e)
verapamil
amioderone
vagal maneuver
digoxin
18.In which condition are steroids not proven to be of any benefit?
a) asthma
b) bronchiolitis
c) croup
d) Addisons disease
e) Angioneurotic oedema
19.Which feature below would be more likely to be found in croup than eppiglottitis?
a) temp>38.5 degrees Celsius
b) drooling saliva
c) soft stridor
d) minimal cough
e) no preceding coryzal illness
20.Which statement is true about adrenaline usage in croup?
a) it reduces the duration of hospitalization
b) it reduces the length of the illness
c) it reduces the need for intubation
d) it reduces the clinical severity of the illness
e) the dose is 5ml of 1:1000
More than 1 correct answer
21.Which is the most common cause of pneumonia in an 8 year old child?
a) mycoplasma
b) pneumococcus
c) viral, esp RSV
d) haemophillus
e) staph aureus
22.Which statement is incorrect with regards to how the RCH recommends the use of
MDI and spacers?
a) 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.
b) Below six years of age, 6 puffs of the MDI equals one nebule
c) Above six years of age, 12 puffs of the MDI equals one nebule
d) 4 puffs of the MDI can be put in the spacer at a time
e) Atrovent should also be given by MDI and spacer
23.Which antibiotic regimen would you give empirically to treat a previously well 3 year
old child with suspected meningitis?
a) cefotaxime
b) cefotaxime and benzyl penicillin
c) cefotaxime and benzyl penicillin and gentamicin
d) cefotaxine and gentamicin
e) benzyl peniciilin and gentamicin
24.Which of these is not one of the possible criteria for the diagnosis of Kawasakis
disease?
a) fever for 5 days
b) polymorphous rash
c) erythema or oedema of the palms or soles
d) cervical LN,
e) vomiting
f) conjunctivitis, non purulent
25.Which is not a feature of/or true of scarlet fever?
a) it is caused by group A beta hemolytic strep
b) the rash appears within 2 hours of the onset of fever, vomiting, headache and abdo
pain
c) Koplicks spots
d) Strawberry tongue
e) Circumoral pallor
26.Which is false about the stated illness?
a) a child with hand, foot and mouth disease does not need to be excluded from
school
b) a child with fifth disease does not need to be excluded from school
c) Neonatal HSV infection has few serious consequences as long as an adequate
course of aciclovir is given
d) rubeela is characterized by posterior auricular lymphadenopathy which precedes a
fine maculopapular rash by five days
e) children with measles and rubella should be excluded from school until at least
five days after the onset of the rash
27.Which is incorrect with regards to the RCH guidelines for the management of a
previously well, low risk child with “fever without a focus”?
a) 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 results
b) a 2 year old child who looks otherwise well does not need investigation (perhaps a
urine culture) or admission
c) a 3 month old child needs a full work up including CSF
d) and unwell 2 yearold should have a full work up including CSF and can be
discharged if results are normal
e) a 3 month old child should be admitted if any results are abnormal or the
WCC>15
28.Which is not true of pyloric stenosis?
a) it most commonly occurs in first born males
b) it is usually seen between four and six weeks of age
c) ABGs show a metabolic alkalosis
d) The chloride is usually <100 and the sodium <130
e) Hyperkalemia is sometimes seen
29.Clinical signs of pyloric stenosis include all of the below except?
a) projectile vomiting
b) palpable rubbery tumour
c) blood in vomitus
d) visible peristalsis
e) dehydration
More than 1 right answer
30.The normal maintenance fluid required in a 24kg child is?
a) 64ml/hr
b) 54ml /hr
c) 74 ml/hr
d) 44ml/hr
e) 84ml/hr
31.The best maintenance fluid for a fasting well 10kg child is?
a) 0.9% saline
b) 5% dextrose
c) 0.18% saline and dextrose 4%
d) 0.45%saline and 4 % dextrose
e) hartmans solution
?agree with answer
32.A 6 year old boy presents with hip pain. Which is not likely to be the diagnosis in this
age group?
a) perthes disease
b) irritable hip/transient synovitis
c) septic arthritis
d) slipped capital femoral epiphysis
e) fracture
33.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?
a) perthes disease
b) irritable hip/transient synovitis
c) septic arthritis
d) slipped capital femoral epiphysis
e) fracture
34.A child presents with unilateral hip pain. Which feature would not make you think of
slipped capital femoral epiphysis as the diagnosis?
a) age about13 years
b) wt > 90th centile
c) hip externally rotated and shortened
d) decreased ROM especially internal rotation
e) febrile, effusion on ultrasound
35.Which statement is false with regards to acute pharyngitis/tonsillitis? (Pg305)
a) Group A strep is very uncommon as the cause of sore throat in children less than
4 years of age, and 25 % of children > 8
b) GAS is less likely if the child has a cough or coryza
c) The most appropriate antibiotic for GAS is amoxycillin
d) GAS is more likely if the child has enlarged tender tonsillar lymph nodes
e) The presence of a tonsilar exudate is not helpful in differentiating viral form GAS
tonsillitis
f) Antibiotic treatment only causes a modest improvement in symptom resolution
36.Which is false with regards to acute otitis media?
a) antibiotics only confer a modest benefit in most cases of ASOM
b) acute symptoms resolve within 24 hours in 60% without antibiotics
c) if antibiotics are used amoxycillin is the agent of choice
d) the degree of redness is relatively unhelpful in deciding whether bacterial
infection is present
e) An unwell infant with a fever often have ASOM as the sole diagnosis
37.Which is false about a 1 year old with burns to half of both its legs?
a) the approximate area burnt is 15 %
b) the fluid used to replace losses should be normal saline
c) the maintenance fluid in such a child would be 1000ml/hr
d) the additional fluid requirement would be 600ml/day
e) this child should be managed as an inpatient at a specialized facility
2 wrong answers
38.How many umbilical veins are there?
a) 0
b) 1
c) 2
d) 3
e) 4
39.Which is a false statement about spine injuries in children?
a)
b)
c)
d)
e)
most commonly the upper cervical spine is involved
the thoracolumbar spine is rarely damaged in children
up to 40% of children under seven have pseudosubluxation of C3/C4 and C2/C3
Spinal Cord injury usually only occurs with radiological abnormality
The gap between C1 and the anterior surface of the dens should not exceed 5mm
40.With regards to childhood gastroenteritis, which statement is false?
a) rotavirus is responsible for 2/3 of the the cases of gastroeneteritis
b) A rotavirus vaccine has been invented but is no longer in use as an association
between it and intersusseption is being investigated
c) Bacterial causes of diarrohea, without bacteremia should be treated with
appropriate antibiotics
d) Adenovirus is most common under 12 months of age
e) Rotavirus Ds and Vs can last as long as 21 days
41.With regards to febrile convulsions which statement is incorrect?
a) they occur in 3% of children aged 6 months to 5 years
b) 3% of sufferers will go on to develop epilepsy
c) a recurrence of a febrile convulsion is more likely if there is a family history of
febrile convulsions
d) 30% will experience a second febrile convulsion in their lifetime
e) appropriate investigations include EEG with or without CT/MRI
42.Which statement is incorrect with regards to Duchenes muscular dystrophy?
a) it is sex linked recessive usually, making it much more common in boys
b) symptoms appear in the first 5 years of life
c) death is usually between the ages of 15 and 25 and due to respiratory illness
d) prominence of the calf muscles is an early feature
e) the CK level is not elevated until muscular weakness becomes profound making
CK a poor screening test
43.Where are the majority of childhood CNS tumours found?
a) infratentorial
b) spinal cord
c) in the hypothalamic- pituitary axis
d) cerebral hemispheres
e) optic nerve
44.Which is incorrect with regards to childhood UTIs?
a) 15% of test stips are –ve for leucs and nitrites in children with UTI
b) prophylactic antibiotics should be given to all kids with UTI until renal tract
imaging is done
c) there is no need to investigate asymptomatic siblings of a child with Vesico
Ureteric Reflux , for VUR
d) all children with a previous UTI should have a DMSA scan 2-4 years after the last
UTI to look for scarring
e) a child with UTI should have and ultrasound and if less then four years old
should also have a MCU
45.A 3 week old babe presents with an inguinal hernia which is reducible, how quickly
should this babe be operated on?
a) never if it does not happen again
b) within 48 hours
c) within 2 weeks
d) within 2 months
e) within 6 months
46.Which is the most common cause of a transient arthritis in a child?
a) post viral
b) post streptococcal
c) chronic juvenile arthritis
d) henoch schonlein purpura
e) reiters syndrome
47.Which is not true of henoch schonlein purpura?
a) there is usually palpable purpura on the lower limbs
b) the patient is thrombocytopenic
c) they usually suffer abdominal pain
d) they usually suffer nephritis
e) they usually suffer large jt migratory arthritis
48.Which statement is false about Reiters syndrome?
a) it occurs post enteric infections eg.salmonella, shigella, yersinia
b) they can suffer anterior uveitits and sterile pyuria
c) treatment involves NSAIDS and immunosuppressive agents
d) it tends to affect lower limb joints the most
e) there is often a positive family history of the same
49.Which is not true of diptheria?
a) child presents with sore throat and inflamed tonsils
b) in the second week an exotoxin is releases which may cause myocarditis
c) in week 3-7 neuritis with paralysis my occur
d) treatment of the disease involves administraion of benzylpenciillin
e) diptheria antitoxin is given to counteract systemic effects
50.Which type of rash is seen in meningococcal septicemia?
a) purpuric
b) no rash
c) erythematous
d) a combination of the above
e) all of the above
51.When bacterial meningitis is suspected, when should iv dexamenthasone prior to
antibiotics as recommended by the RCH?
a) all suspected cases
b) only if purpuric rash
c) not at all
d) if previous hearing difficulties
e) if no previous HiB vaccination, or uncertain
ANSWERS
1)A 2)E
3)D 4)B
5)D 6)E
7)B
8)E
9)B
10)E 11)B
13)B 14)C 15)A 16)E 17)C 18)B 19)C 20)D 21)A 22)D 23)A
25)C 26)C 27)D 28)E 29)C 30)A 31)C 32)D 33)B 34)E 35)C
37)B 38)B 39)D 40)C 41)E 42)E 43)A 44)C 45)B 46)A 47)B
49) treatment is diptheria antitoxin, and erythromycin is given to eradicated the
organisms
50)E 51)C
Paeds MCQ’s
12)D
24)E
36)E
48)C
Di Flood
1. Which is correct regarding pharyngitis in children?
a. Strep throat should be treated with penicillin to prevent post-streptococcal
glomerulonephritis.
b. Presence of a pseudomembrane could suggest infection with N.gonnorhea.
c. Pharyngitis associated with infectious mononucleosis will improve with
penicillin
d. Clinical examination is reliable in differentiating bacterial and viral
pharyngitis
e. Primary HIV infection can cause pharyngitis associated with GI symptoms
and mucocutaneous lesions.
2. 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?
a. VSD
b. Tetralogy of Fallot
c. Transposition of great vessels
d. Truncus arteriosus
e. Coarctation of aorta
3. Which is true regarding congestive heart failure in children?
a. Peripheral oedema is a common sign
b. The most common cause is myocarditis
c. Presence at birth is likely to be due to a noncardiac cause e.g. anaemia
d. Frusemide is used in the treatment at doses of 5mg/kg.
e. Severe coarctation of the aorta with cause CHF thru increased preload.
4. Which is incorrect of dysrhythmias in the paediatric population?
a. First degree heart block is benign unless associated with ASD.
b. A narrow complex tachycardia of 250 is more likely to be sinus
tachycardia than SVT.
c. Atrial flutter is associated with congenital heart disease 90% of the time.
d. Digoxin is effective in the majority of children with atrial fibrillation.
e. Ventricular tachycardia is sometimes found on routine examination of
stable asymptomatic children with congenital heart disease.
5. 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?
a. Previous history of Rh fever
b. A CRP of 200
c. Elevated antistreptolysin titres
d. Presence of subcutaneous nodules on extensor surface of wrists
e. Prolonged PR interval on ECG.
1=E 2=C 3=C 4=B 5=D
6. A 4 day old neonate presents with bilateral pink eyes with watery, discharge.
What is the most likely pathogen?
a. Strep pneumoniae
b. N. gonorrhoea
c. Chlamydia trachomatis
d. H. influenzae
e. Adenovirus
7. Which is incorrect regarding pneumonia in children?
a. Viral pneumonia is the most common cause in all age groups except
neonates.
b. The best physical examination finding for ruling out pneumonia in an
infant or child is absence of tachypnea.
c. 10% of children with Mycoplasma pneumoniae will have a variable rash.
d. Blood cultures are often positive in bacterial pneumonia (> 50%).
e. Cold agglutinin tests with be positive in 72-92% with M.pneumoniae.
8. Which is the most correct statement regarding childhood asthma?
a. Untreated paediatric patients have a lower risk of respiratory failure
compared to adults.
b. Degree of wheezing, is not a good predictor of asthma severity
c. IV methyl prednisolone is advantageous over oral prednisone in the acute
setting of asthma.
d. Long acting beta-agonists are useful in the management of acute severe
asthma.
e. Salbutamol via MDI with spacer is inferior to nebulised salbutamol in a
mild exacerbation of asthma.
9. 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?
a. Adenovirus is the most likely cause of this illness.
b. An oxygen saturation of 92 % on arrival mandates admission.
c. Dehydration should be treated with NG replacement.
d. A routine NPA is indicated
e. Salbutamol is not indicated in the management.
10. A 5 year old child presents with an afebrile seizure. Which is the correct
management?
a. Rectal diazepam 0.2 mg/kg if prolonged seizure.
b. 5ml/kg of 10% dextrose or 2mls/kg 25% dextrose if BSL 1.2
c. IV diazepam of 0.5 mg/kg if seizure lasting longer than 10 mins
d. CT scan, EEG and admission regardless of duration.
e. Pyridoxine 100 mg IV if refractory seizure.
6=C 7=D 8=B 9=E 10=B
11. Which pathogen is unlikely to cause dysentery?
a. Salmonella
b. Clostridium difficile
c. Shigella
d. Yersinia
e. Campylobacter
12. A 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?
a. Bilious vomiting can be explained by a diagnosis of pyloric stenosis.
b. An abdominal USS is indicated to make the diagnosis of pyloric stenosis.
c. This condition is more common in boys and has a familial propensity
d. The most common age for this presentation is 3 months.
e. The presence of jaundice excludes pyloric stenosis.
13. Which is incorrect of intussusception?
a. This is the most common cause of intestinal obstruction in children less
than 3 months.
b. The cause is unknown in the majority of patients.
c. The classic current-jelly stools are a late manifestation only present in
50%.
d. A sausage shaped tumour should be palpable in about 2/3rds of patients.
e. 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=E
16. 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 days
b. presence of inspiratory and expiratory stridor
c.child sitting in tripod position with symptoms worse on lying supine
d. seal like cough
e.hoarse voice
17.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 amnesia
c. 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.
c.compartment 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=C
21. 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?
a. This condition is more common in females.
b. The cause of this syndrome is unknown but suspected to be super antigen
bacterial toxins.
c. This child has a 75% chance of developing carditis.
d. If untreated the risk of sudden death from thrombosis coronary artery
aneurysms is 5%.
e. 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. medulloblastoma
b.astrocytoma
c. meningioma
d.germinomas
e. schwannomas
21=b 22=b 23=b 24=a 25=a
53.
All of the following can cause jaundice in neonates < 24 hours old except
a.
b.
c.
d.
e.
54.
A 2 week old term baby has presented to ED with signs of congestive heart
failure. The most likely diagnosis is:
a.
b.
c.
d.
e.
55.
e.
3-4% of young children have febrile seizures.
Myoclonic seizures in neonates indicate a good prognosis.
Phenytoin is the 1st line drug of choice in treating neonatal seizures.
Patients with immediate seizures post head injury have a 20-25% risk of
recurring seizures.
About 20% of children with epilepsy experience one bout of status
epilepticus (grand mal).
Paediatric abdominal emergencies are relatively common. Which of these
answers is correct?
a.
b.
c.
d.
e.
57.
Hypoplastic left ventricle
VSD
PDA
Myocarditis
Coarctation of aorta
Regarding seizures in children
a.
b.
c.
d.
56.
Sepsis
ABO incompatibility
Congenital atresia of bile ducts
Toxoplasma congenital infection
Excessive bruising from birth trauma
Pyloric stenosis – affects approximately 1:750 male patients.
Intussusception – the most common cause of intestinal obstruction in
children under 3 months.
Appendicitis – is excluded if the child presents with diarrhoea.
Incarcerated herniae – incidence is highest in the first year of life.
Pancreatitis in children is most commonly caused by mumps virus.
Children with rashes often present diagnostic dilemmas to ED physicians. Which
of the following statements is correct?
a.
b.
c.
The exanthem in measles develops about the 14th day following exposure.
The rash of varicella spreads centripetally.
Exanthema subitum is most common in children aged 5-10.
d.
e.
The rash of erythema nodosum begins with a “herald patch”.
“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.
b.
c.
d.
e.
59.
Children who present with fever represent a large group of patients in Eds.
Which of the following statements is correct?
a.
b.
c.
d.
e.
60.
An infants’ larynx is situated at the C5 level of the neck.
The narrowest portion of the paediatric larynx is at the glottis.
A laryngeal mask size 2.0 should be used if needed in an infant weighing 5
– 10kg.
Needle cricothyroidotomy is the preferred surgical airway access
technique in the paediatric population.
Cricoid pressure is not indicated in paediatric intubation situations as it
makes the cords too hard to see.
Neonates with a fever (38) have a 5% risk for bacteraemia.
Group B streptococci are the most common bacterial pathogens causing
neonatal disease.
Strep pneumoniae infection in children aged 3 months to 3 years carries a
10% risk of complicating serious bacterial illness.
A documented fever in a neonate warrants full sepsis work up and
admission.
All of the above are true.
Which of the following pairings pertaining to paediatric infection is correct?
a.
b.
c.
d.
e.
Viral croup / peak incidence 3-4 years of age.
Retropharyngeal abscess / rare > 4 years of age.
Epiglottitis / “steeple” sign on xray.
Bacterial tracheitis / drooling = common.
Peritonsillar abscess / symptoms improve with patient supine.
58= ? 59= ?E 60= ?
2Factors associated for SIDS include all EXCEPT:
a) Sleeping in the prone position
b) Previous episode of apparent life threatening event (ALTE)
c) Maternal alcohol use
d) Winter months
e) Family history of SIDS
9A 12 month old child sustains partial thickness burns to the whole of its left lower limb.
The percentage of total body area burnt is:
f)
g)
h)
i)
j)
10
14
16
18
20
12In a neonate who is 24 hours old, jaundice is likely to be due to:
k)
l)
m)
n)
o)
ABO incompatibility
Breastmilk
Congenital haemolytic anaemia
Physiological causes
Hypothyroidism
16A 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:
a)
b)
c)
d)
e)
Xray the left elbow for comparative films
Forced supination of the right elbow
Immobilisation with a full plaster cast
Referral to an Orthopaedic surgeon
Repeating the elbow Xray
17Criteria for the diagnosis of Kawasaki Disease includes
p)
q)
r)
s)
t)
An ESR greater than 60 seconds
Fever of 4 days, polymorphous rash and suppurative conjunctivitis
Positive serum Kawasaki antibodies
Cervical lymphadenopathy, strawberry tongue and polymorphous rash
Fever of 5 days, arthritis and erythema nodosum
21Croup can be caused by the following EXCEPT:
u)
v)
w)
x)
y)
allergy
Parainfluenza virus
RSV
Rhinovirus
EBV
27In children with urinary tract infections:
z) Klebsiella species are the commonest causative organism
aa) Trimethoprim is contraindicated
bb) The incidence of renal scarring is greatest in those under 1 year of age
cc) Renal ultrasound is not indicated in girls with the first presentation
dd) Fluoroquinolones are recommended first line antibiotics
31Regarding childhood supracondylar fracture:
ee) It is most commonly associated with ulnar nerve damage
ff) Posterior angulation of 5 degrees requires manipulation
gg) It is associated with a fall on the point of the elbow
hh) Following manipulation, the ideal position is flexion of the elbow
ii) In a 2 year old the medial epicondyle should be visible on x-ray
33Regarding non-accidental injury in children:
jj) A bruise with any yellow is older than 18 hours
kk) A pulled elbow is pathognomonic
ll) Non accidental trauma occurs most commonly in children over 5 years of age
mm)
Purple bruises cannot occur within 2 hours of the injury
nn) It has no association with prematurely born children
35Regarding Paediatric resuscitation:
oo) The internal diameter (mm) of a suitable endotracheal tube is
age/2 + 4
pp) The initial dose of IV adrenaline for asystole is 0.01mg / kg
qq) Primary cardiac disease is the commonest cause of cardiac arrest
rr) The initial energy for monophasic defibrillation of VF is 4 Joules / kg
ss) Head extension achieves optimal airway opening in neonates
39Regarding intussusception:
tt) The female to male ratio is 4:1
uu) Ileo-colic intussusceptions are the most common form
vv) Red currant jelly stools present as an early sign
ww)
It most frequently occurs in the 2-3 year age group
xx) It is uncommonly idiopathic
42A 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:
yy) 280 ml
zz) 560 ml
aaa)
780 ml
bbb)
1060 ml
ccc)
1413 ml
44. A Salter-Harris type 5 injury is best described as :
a) Crushing of all or part of the epiphysis
b) The whole epiphysis is separated from the shaft
c) The epiphysis is displaced carrying with it a small triangular metaphyseal
fragment ( the commonest injury)
d) Separation of part of the epiphysis
e) Separation of part of the epiphysis with a metaphyseal fragment
54. Fallot’s Tetralogy does NOT include:
a) ventricular septal defect (VSD)
b) right ventricular hypertrophy
c) transposition of the great vessels
d) overriding aorta
e) pulmonary stenosis
60. 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:
a)
b)
c)
d)
e)
Congenital hip dislocation
Slipped upper femoral epiphysis
Septic arthritis
Transient synovitis
Legg-Calvē-Perthes disease
No answers.
21.In resuscitation of children which is false?
a) a lone rescuer should provide 20 cycles of resuscitation and if no help has been
summoned, then contact emergency services
b) the head position to maximize airway patency in an infant is in the neutral
position
c) in a small child the chest compressions are done one fingers breadth above the
ziphisternum
d) in an infant the chest compession are done on the internipple line
e) the ratio of chest compressions to breaths is 5:1 in all ages above and including
infants
22.In resuscitation of children which false?
a) in neonates the should be 120 chest compressions per minute with a 3:1 ratio with
breaths
b) chest compressions should be commenced if the pulse rate is less than 60 in an
infant
c) the depth of chest compressions at all ages is one half of the chest wall
d) chest compressions should be commenced is the pulse rate is less than 40 in a
small child
e) after assessing that there is no spontaneous breathing then five slow rescuer
breaths should be given in all children
38.Which drug dose is incorrect with regards to neonatal resuscitastion?
a) 1ml/kg of 10% dextrose
b) first dose of adrenaline is 0.1 ml/kg 1:10 000
c) 2nd dose of adrenaline is 0/1ml/kg of 1:1000
d) atropine 0.02mg/kg
e) 0.01 mg/kg of naloxone then 0.1 mg/kg
39.Which is incorrect with regards to paediatric resuscitation?
a) wt calculation is 2(age + 4)
b) the ETT size is age/2 + 2
c) an oral ETT should be secured at length age/2 + 12
d) straight laryngoscope blades are used up to 12 months of age and sometimes up to
5 years
e) defibrillation if unstable VT or VF is 2J/kg, 4J/kg then 4J/kg
40.Which is incorrect when comparing the paediatric airway to the adult?
a) the paediatric airway has a larger tongue
b) the head is large and the neck short tending to cause neck flexion
c) the larynx is higher (C2-3 c.f C5-6) and more anterior in the paediatric airway
d) the cricoid is the narrowest part in the paediatric airway whilst in the adult it is the
glottis
e) the tongue is comparatively the same size in paeds as in adults
21= ???? 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 is
a) 5
b) 4
c) 6
d) 3
e) 2
2. Which of the following is NOT diagnostic criterion for simple febrile convulsion:
a) temperature > 37.5 degrees celsius
b) age 6 months to 5 years
c) seizure lasts < 15 minutes
d) no past history of afebrile seizures
e) less than 1 seizure in 24 hours
5. Which of the following is NOT a diagnostic criterion for Kawasaki’s disease?
a) fever for 5 days
b) bilateral non purulent conjunctivitis
c) generalised lymphadenopathy
d) polymorphous rash
e) changes in extremities ( eg: erythema, oedema, desquamation)
11. With respect to paediatric injuries, which of the following is FALSE:
a) Seizures following traumatic head injury occur in 5% of hospitalised patients
b) The spleen is the most commonly injured solid organ
c) The duodenum is the part of the intestine most commonly injured in seat belt injuries
d) Children are more prone to high cervical injuries than adults
e) Isolated chest trauma carries a 4 – 12 % mortality rate
13. 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:
a) Suctioning of the nose and pharynx should be sufficient treatment
b) Cardiac compressions should be commenced if there is no change after 30 seconds of
ventilatory support.
c) Oxygen administration should be delayed to see if the child responds to suctioning
d) The child should be placed on the mother’s abdomen immediately after birth
e) Ventilation and cardiac massage should be synchronised with a 1:5 ratio
21. Which of the following is consistent with scarlet fever:
a) Punctate rash on neck and trunk
b) Circumoral erythema
c) Geographic tongue
d) Only occurs in association with streptococcal pharyngitis
e) Resolution without desquamation
44. Which of the following is NOT a Revised Jones’ Major criterion for acute rheumatic fever:
a) Pericarditis
b) Arthralgia
c) Subcutaneous nodules
d) Chorea
e) New cardiac murmur
47. Which statement best defines a Salter Harris Type III fracture:
a) Involves crushing to all or part of the epiphyseal plate
b) Involves separation of part of the epiphysis
c) Involves separation of part of the epiphysis with a metaphyseal fragment
d) Involves fracture of the epiphyseal plate only
e) Involves the epiphysis being displaced carrying with it a small triangular metaphyseal
fragment
48. Pyloric stenosis
a) Is best diagnosed with plain AXR
b) Presents with projectile bile stained vomiting
c) Results in hyperchloraemic metabolic acidosis
d) Is familial
e) In adults can be due to chronic pyloric ulceration
USS is the investigation of choice
Presents with NON-bilious projectile vomiting
Hypokalaemic, hypochloraemic metabolic alkalosis
Male 1 in 150, female 1 in 750
Commonest in first born males
Familial incidence in 50% of cases
2 weeks to 2 months
In adults can be due to chronic pyloric ulceration: Acid ingestion may scar the pylorus and cause outlet
obstruction
59. In comparing the area of burns sustained in adults to children, which is TRUE:
a) The head in children is proportionately twice the area of adults
b) In children of all ages, each leg occupies 14%
c) Neck in children is proportionately the same as in adults
d) The arms in children are proportionately less than in adults
e) None of the above
Head area changes with age and is not a constant proportion of adults
Legs 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 adults
1=B 2=A 5=C 11=B
C
13= B 21=A 44= B (rather arthritis??) 47=B 48=E 59=
1. Regarding ketamine in paediatric sedation:
a) The intravenous dose is 4mg/kg
b) It may cause reduced blood pressure
c) Laryngospasm may result in patients with respiratory tract infection
d) Atropine should be administered concurrently owing to induced bradycardia
e) It may be safely used in neonates
Tint 898
2. The scenario most suggestive of child abuse is
a) a 3yo who sustains a spiral fracture of the tibia while playing on a slide
b) an 18 month old with multiple bruises to the shin and forehead
c) a 3yo boy with a pulled elbow after wrestling with his 10yo brother
d) a 5 month old boy who ingests 2 of his mother’s Fe tablets
e) a 2yo who tries to hide when approached by medical staff
Tint 1951
3. An X-ray of a child’s elbow reveals ossification of the capitulum and radial head. The
child’s age is likely to be
a) 1-2 years
b) 4-5 years
c) 6-7 years
d) 10-11 years
e) None of the above
McR 130
4. A 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 with
a) rifampicin 600mg orally bd for 2 days
b) rifampicin 600mg orally as a single dose
c) ciprofloxacin 500mg orally as a single dose
d) rifampicin 250mg orally, daily for 4 days
e) none of the above
Ab guidelines(2000) 41-42
41. With regard to paediatric trauma all of the following are true except:
a) the spleen is the most commonly injured organ
b) a child with a splenic injuries is more likely to be treated non-operatively than an adult
with similar injuries.
c) False negative DPL’s are common
d) Physical examination alone is unreliable in approximately 50% of cases
e) CT is preferable to DPL in a stable patient
Tint 1621
42. 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 injury
c) the Salter-Harris fracture with the best prognosis
d) a Salter-Harris I fracture
e) associated with torsion mechanisms and growth plate tenderness
Tint 1745
44. 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?
a) admit for further observation and investigations
b) arrange for an apnoea monitor at home and discharge
c) observe for 2 hours and discharge
d) observe for 6 hours and discharge
e) discharge with GP follow up only
Ros 1103
59. 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?
a) 0.1
b) 0.6
c) 1
d) 6
e) 60
1=C
2=D
3=B 4=D 41=C
42=A 44=A 59=D
8. 6 year old with septic arthritis
a) BC seldom positive
b) H. Infl is commonest cause
c) Treatment is instillation of Abs into joint
d) Treatment is Abs and surgical drainage
e) Usually spreads from adjacent OM
Children: S. aureus, Grp A Strep (Grp B in neonates), H. Influ
Adults: Gonorrhoeae & Staph
Older adults: Staph, Gram –ve, Grp A Strep
BC positive in 50%
Haematogenous seeding most common
Direct spread from trauma less common
Diclox for treatment + surgical drainage
11. What is not a clinically significant complication of IO needle in 3yr old
a) # tibia
b) cellulites
c) osteomyelitis
d) compartment syndrome
e) pulmonary fat embolus
Complications of IO:
Uncommon in general
Fluid extravasation
Penetration of posterior cortex
Tibial #
Growth retardation
Compartment syndrome
Cellulitis
Osteomyelitis (non-existent if removed <24hrs)
12. Question of Roseola infantum rash features
6-18 months
onset of fever to 40, +/- febrile convulsion
rash appears with defervesence
macular or macularpapular rash
trunk, spares face & limbs
HHV-7 implicated
13. Causative agent of Hand, feet & mouth lesions + treatment
Hand foot & mouth, Coxsackie, enterovirus, EM, EBV, Gonoccocal, Syphilis, no
treatment
10. 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 arrest
10 = b
11. In paediatric resuscitation:
a) endotracheal is the preferred route of drug administration
b) the dose of adrenaline is up to . 1 mg/kg
x
c) sodium bicarbonate is used at a dose of 5meq/kg x
d) the airway will be improved by neck flexion
x
e) 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) 150
b) 140
c) 130
d) 120
e) 110
?
17=D
18. For blood pressure determination in a 6 year old child the cuff width
should be:
a) 3cms
b) 4cms
c) 5cms
d) 6cms
e) 7cms
?
18=E
35.
Paediatric septic arthritis:
a) is usually due to haemophilus influenzae
x probably not any more
b) is empirically treated with ceftriaxone or cefotaxime alone
c) will show a joint aspirate cell count of > 10,000 mm3
?
d) will show a joint aspirate with increased viscosity x low
e) can often be diagnosed on plan radiography
x
35= C
60.
The major Jones criteria for rheumatic fever include:
x
a) chorea
b) erythema marginatum
c) subcutaneous nodules
d) St Vitus dance
e) all of the above
60=E
75.
All of the following are major criteria for Kawasaki syndrome
EXCEPT:
a) fever > 38.5oC for at least 5 days
b) bilateral conjunctivitis
c) erythematous palms and soles
d) marked cervical lymphadenopathy
e) congestive heart failure
75=E
76. A newly born who is limp and non responsive, pale and in which
pulses and breathing cannot be easily detected has an APGAR of:
a) 0
b) 1
c) 2 or 3
d) 3 or 4
e) 4
76=A
77. The most common cause of death in infants aged 6 to 12 months is:
a)
b)
c)
d)
e)
road traffic crashes
SIDS
Homicide
congenital tumours
infectious diseases
77=C
78. The most common neurologic manifestation of child abuse is:
a) retinal haemorrhage
b) brainstem infarction
c) subdural haematoma
d) brain stem haemorrhage
e) extradural haematoma
78=A
79.
a)
b)
c)
d)
e)
Epiglottitis:
is most common in the third year of life
shares a similar aetiology to bacterial tracheitis
is more common in males
is first manifest by signs of airway narrowing
produces a cough in 30% of cases
70=C
80. Nebulised adrenaline when used for croup:
a)
b)
c)
d)
e)
mandates overnight admission
is more efficacious if the racemic mixture is used
is reserved for life threatening obstruction
is given in 50 times the usual IM dose
produces VT in 5% of cases
80=D
81. Mycoplasma pneumoniae is the most common causes of pneumonia
in:
a)
b)
c)
d)
e)
1 - 4 month olds
4 - 12 month olds
1 - 5 year olds
5 - 10 year olds
all of the above
81=D
84. The daily IV fluid replacement of a 25kg child is:
a) 1200 mls
b)
c)
d)
e)
1400 mls
1600 mls
2100 mls
2600 mls
84=C
9)
a.
b.
c.
d.
e.
With respect to fluid administration in paediatrics
Hypoglycaemia is treated with 1ml/kg 10% dextrose
Milk and water administration is at the same volume
9)
With respect to fluid administration in paediatrics
a.
Hypoglycaemia is treated with 1ml/kg of 10% dextrose. Crap – 10mls/kg 10%
dextrose
b.
*Milk and water administration is at the same volume
13)
a.
b.
c.
d.
e.
Regarding the care of croup with airway obstruction
Adrenaline shortens the course of the illness
Commonest cause in RSV
Steroids modify the illness
13)
Regarding the care of croup with airway obstruction
a.
Adrenaline shortens the course of the illness. – Crap, can reduce the risk of need
for intubation but doesn’t alter duration
b.
Commonest cause is RSV. Crap – mostly paraflu, then RSV
c.
*Steroid modify illness. True decreases mortality and need for intubation
15)
a.
b.
c.
d.
e.
Regarding bronchiolitis
Crepitations are rarely heard
Bronchodilators are contraindicated as they increase hypoxaemia
Adenovirus infection is more severe than RSV
Steroids modify the disease
15)
a.
Regarding bronchiloitis
Creps rarely heard. Bosh – heard frequently and generalized
b.
Bronchodilators are contraindicated as they cause hypoxemia. Bosh – but they
rarely improve bronchospasm from bronchiolitis – same with atrovent. Neither are
proven
c.
*Adenovirus infection id more severe than RSV. True – adenovirus is rare but
causes severe obliterative disease
d.
Steroids modify the disease. Bosh – no proof of this
24)
olds
a.
b.
c.
d.
Which of the following is least likely to be a cause of abdominal pain in 6-11 year
HSP
Gut malrotation
DKA
Inflammatory bowel disease
24)
Which of the following is least likely to be the cause of abdominal pain in 6-11
year olds
a.
HSP - common and can even cause intususseption due to lymphoid tissue
hyperplasia within bowel wall
b.
**Gut malrotation – seen up to the age of 2 and presents with volvulus
c.
DKA – any age kid
d.
IBD – older kids
e.
Appendicitis – any age but classic 10-20year olds
27)
a.
b.
c.
d.
e.
In a 13kg child with iron overdose of 700mg elemental iron which is true
AXR will show tablets in over 80% of cases
Must wait for all the lab results and TIBG before commencing Desferoximine
Something to do with vin rose urine in treatment
Something about dialysis clearing desferroximine
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 toxicity
a.
Xray will show tablets in 80% of patients. False – 50% by tintanelli
b.
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 hours
d.
Dialysis does not clear free iron but can clear ferrioxamine complex in those with
renal failure
33)
Regarding increased risk of epilepsy in a child with a febrile convulsion, which of
the following has the lowest association with developing epilepsy
a.
Family history of epilepsy
b.
2 febrile seizures in 24 hours
c.
d.
e.
Further febrile seizure in 6 months time
Prolonged status with presenting seizure >25 minutes
Focal seizure
34)
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 ED
a.
CDT (no pertussis)
b.
DTPa only
c.
DTPa and tetanus immunoglobulin
d.
Need no further immunization
e.
35)
a.
b.
c.
d.
e.
Regarding bone ossification times which is true
Lateral epicondyle age 7-9
Radial head aged 3-5
Medial epicondyle aged 1-3
33)
Regarding increased risk of epilepsy, which of the following has the lowest
association with developing it?
a.
Family history = increased risk
b.
**2 febrile seizures in 24 hours = slightly increased risk – would make you a little
suspicious
c.
*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 infection
e.
Focal seizure = red flag – something else going on
34)
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 ED
IG only if hasn’t had 3 at some point in life – otherwise just a tet tox
If >5 years and dirty wound DTP (kids <8) CDT/ADT/tet tox for >8
If > 10 years boosters for all
a.
CDT only
b.
**DTPa only
c.
DTPa + IG
d.
Nil needed
35)
Regarding bone ossification times
CRITOE 1,3,5,7,9,11
a.
Lateral epicondyle 7-9. No 11
b.
**Radial head 3-5. sounds right
c.
Medial epicondyle 1-3. No 5
4)
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 fibrosis
c.
d.
4)
Regarding pediatric intususseption
a.
Recurrance following barium enema is 20%. 5-10% in first 24-48hrs according to
tintanelli
b.
**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 appendix
6)
a.
b.
c.
d.
e.
Regarding CXR in paediatrics which of the following is false
Normal neonatal CXR cardiothoracic ratio can be up to 0.65
Atrial double shadows are associated with atrial dilatation
Lateral right ventricle lies directly under the sternum
The mediastinal shadow is larger in AP rather than PA films
As
6)
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 0.7
b.
Atrial double shadows are associated with atrial dilatation. Sounds right
c.
*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 question
8)
a.
b.
c.
d.
e.
9)
a.
b.
c.
d.
e.
Regarding congenital heart disease which of the following is FALSE?
ASD is the most common defect
Most VSD abnormalities present in the first year
The components of tetralogy comprise……
8)
Regarding congenital heart disease which is false
Regarding skin xanthems which of the following is TRUE?
Scarlet fever has a rough texture
Hand foot and mouth disease is caused by herpes
Rubella
a.
*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 hypertrophy
9)
Regarding skin exanthems
a.
Scarlet fever has a rough texture. True 1mm punctate lesions giving rough,
sandpaper feel
b.
Hand foot and mouth is caused by herpes. False - coxackie
c.
Rubella. Pink macules involving face neck trunk and then limbs. Occipital and
post auricular lymphadenopathy. No significant illness with it.
20)
Regarding paediatric trauma
a.
The liver is the most commonly injured organ
b.
Rib fractures are not associated with significant pulmonary contusion
c.
SCIWORA is commonest in kids
d.
e.
20)
Regarding paediatric trauma
a.
The liver is the most commonly injured organ. False spleen
b.
Rib fractures are not associated with significant pulmonary contusion. False –
more so than adults
c.
*SCIWORA is commonest in kids. True more common in kids due to laxity of
ligaments
25)
What is the total fluid requirement of a 30kg child whoc is 5% dehydrated
a.
2400ml
b.
3200ml
c.
d.
e.
25)
What is the total fluid requirement for a 30kg child who is 5% dehydrated?
a.
2400ml
b.
**3200ml
0.05 X 30 (rehydration)+ (maintenance) 100 X 10 + 100 X 50 + 100 X 25
27)
a.
b.
c.
d.
Regarding neonatal sepsis which of the following is TREU?
Pneumococcus is a common cause of sepsis
e.
27)
Regarding neonatal sepsis which is true
a.
Pneumococcus is a common cause of sepsis. True but need to consider gp B strep,
listeria, Hib, clamydia and ghonococcus
4. In childhood pneumonia
Chlamydia 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 gentamycin
In neonatal pneumonia, Hemophilus influenza B, Neiserria meningitidis and
pnemococcus are the commonest organisms. GBS, E.coli, Klebsiella most commmon
Commonest cause of pneumonia in over 5yo is pneumococcus TRUE
7. In childhood gastroenteritis
Bloody 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 years
Antibiotics are indicated in all salmonella infections if less than 6 months, toxic,
bacteraemic, chronic GIT disease, haemoglobinopathy
IV fluid is indicated in all cases with >5% dehydration can have ORH
Diet should consist of free fluid for 24h can be restarted after four hour rehydration,
definitely no longer than 24hours
8. Regarding abdominal pain in children
Normal feeding b/w pain excludes significant pathology false
Appendix 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 OFTEN
Radial artery spasm can occur x Brachial, vascular complications uncommon
25. Roseola infantum/herpes virus 6
Is associated with coryzal symptoms – cough, pharangitis
Onset of rash occurs with fever rash after fever, day 3-5 as child improves
Most common in late winter and early spring no seasonal preponderance (Tintinalli)
26. Regarding kidney disease in children
Glomerulonephritis may be managed with fluid restriction Supportive, nephrotic
managed with prednisolone
Thrombocytopenia is a characteristic finding in HUS True
Incidental 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 epilepsy
Focal features in seizure
Incomplete recovery between seizures
Multiple seizures in same febrile illness (increased risk)
Duration does not affect risk of epilepsy (prolonged increases risk, RCH guidelines)
1) Croup
a. Corticosteroids shorten the duration
b. Adrenaline shortens the duration
c. Stridor/noisy breathing is low pitched and mainly expiratory
2) Regarding Neonatal resuscitation
a. Rate is 15:2
b. Extubate on neck extension
c. Glottis is more anterior than the adult
3) Septic arthritis in Children
a. Cefotaxime is the best empirical therapy for a child aged 10
b. Synovial fluid culture is positive in up to 90% case
4) Transient synovitis
a. Most common in age <1yr
b. WCC and CRP are usually normal
c. Seldom associated with a joint effusion
d. Is associated with a fever
7. In neonatal resuscitation
A. the ratio of compressions to ventilations is 3:1
B. the ratio of compressions to ventilations is 15:2
C high dose adrenaline >100ug/kg is beneficial
D dextrose dose in hypoglycemia is 0.5 mls/kg of 10% dextrose
7=A
17. Regarding ingested foreign bodies in children which is incorrect
A. A coin on xray it will be seen in the sagittal plane if it is lodged in the
oesophagus
B. Foreign bodies most commonly lodge at the cricopharyngeus in children
C. A button battery lodged in the oesophagus is not an emergency
17=C
18. In regards to bronchiolitis in infants
A.
B.
C.
D.
E.
ipratropium bromide (atrovent) is a proven treatment
a high white cell count is a prognostic factor
CXR changes are uncommon
May respond to bronchodilators
Steroids are beneficial
18=D
19. Regarding PR bleeding in children
A. 10% of gastroenteritis will have blood in diarrhoea
B. it is an early feature of intussusception
19=A
1.
A 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?
A. Upper GI series to further delineate the exact location of the foreign body
B. Attempt battery removal by the Foley balloon catheter technique
C. Immediate GI consultation for endoscopic removal
D. Immediate surgical consultation
E.
2.
3.
Discharge to home with parental observation and weekly radiographs.
Which one of the following is the LEAST consistent with a diagnosis of
intussusception?
A.
Intermittent colicky abdominal pain, interspersed with symptom-free periods.
B.
Grossly normal appearing stool.
C.
Normal plain films of the abdomen.
D.
Previously healthy 9-year-old.
E.
Altered, lethargic appearance.
A 4-month-old infant presents with a rectal temperature of 38.7ºC, 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 EXCEPT
A.
supplemental O2 (by blow-by or nasal cannula as tolerated by the child)
B.
a trial of nebulized albuterol
C.
a trial nebulized racemic adrenaline
D.
a dose of glucocorticoids
E.
admission.
4.
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
EXCEPT
A.
evaluation for inborn errors of metabolism (including urine for reducing
substances, organic amino acids, serum for lactate, pyruvate and ammonia)
B.
correction of electrolyte, calcium, magnesium, glucose, and acid-base
imbalances
C.
sepsis work-up
D.
administration of diazepam as a first-line drug to control seizures
E.
loading with phenobarbital.
5.
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?
A.
Repeat blood culture, intravenous ceftriaxone, admit.
B.
Repeat blood culture, perform lumbar puncture and CSF culture, start
intravenous ceftriaxone, admit.
C.
D.
E.
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.
6.
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 EXCEPT
A.
sluggish feeding and progressive increase in constipation.
B.
frequent paroxysms of cough, often followed by emesis, but no colour
change.
C.
1-week duration of symptoms.
D.
2-day duration of symptoms.
E.
premature birth.
7.
A non-toxic, playful, 18-month-old toddler is febrile to 40.5ºC but has no focus for
fever on examination. A 24-hour follow-up visit is arranged. Which of the following
would be INAPPROPRIATE management?
A.
Blood and urine cultures; intramuscular ceftriaxone
B.
Blood and urine cultures, intramuscular ceftriaxone only if WBC > 15,000
C.
Intramuscular ceftriaxone, no cultures
D.
Blood and urine cultures, no antibiotics
E.
B, C, and D are all inappropriate.
8.
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?
A.
Isotonic crystalloid bolus of 20 mL/kg
B.
Isotonic crystalloid infusion at 20 mL/kg/h
C.
D5W 0.45 NS bolus of 20 mL/kg
D.
D5W 0.45 NS infusion at 20 mL/kg/h
E.
D5W 0.25 NS infusion at 20 mL/kg/h.