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PAFINALS REVISION SESSION who are we? what we do? disclaimer: The content provided is authored by medical students to the best of their knowledge and expertise. Cardiology Respiratory Gastroenterology Stroke Haematology Renal Endocrine Paediatrics ENT + General Surgery Musculoskeletal Ophthalmology online medical school finals Infections revision series & many more!easy medium hardBecome an ambassador of Crash Course Finals! Do you want to build your CV and portfolio? Represent our network and grow yours! Email us! CrashCourseFinalsUK@gmail.comkeep up to date with all our teaching sessionsHouse rules go on mute questions in chat be respectfulROUND: 11. A 13 year old boy presents to the emergency department with a limp and pain in his right hip, which has been ongoing for the past few weeks. What is the most likely diagnosis? He has a BMI of 31. On examination, he has limited movement of the right leg and in A Perthes disease particular internal rotation of the right hip is Juvenile idiopathic arthritis limited. B (JIA) C Transient synovitis Slipped upper femoral epiphysis D (SUFE) Hip Problems in Children SUFE => displacement of the femoral head epiphysis postero- inferiorly (the femoral head slips alongs the growth plate) What is the most likely diagnosis? more common in obese children and boys usually unilateral, but can occur bilaterally in around 20% of cases A Perthes disease Symptoms: limp, hip pain, knee or distal thigh pain is also common Juvenile idiopathic arthritis B (JIA) Signs: loss of internal rotation of the leg in flexion C Transient synovitis Initial investigation of choice: x-ray Treatment: surgery D Slipped upper femoral epiphysis (SUFE) Perthes disease: SUFE: x-ray showing SUFE on left side. AP view shown early changes -> widening of joint space below, frog-leg view x-ray also can be useful later changes -> decreased femoral head size/flattening X-ray below shows bilateral Perthes disease2. A mother attends the GP with her son for a check-up. The child is able to sit without support and walk independently. He knows a couple of Based on the developmental milestones observed, what is the most likely age of words and waves bye. You also observe that he the child? has acquired a pincer grip. A 6 months 9 months B C 12 months 15 months DBased on the developmental milestones observed, what is the most likely age of the child? 6 months A 9 months B C 12 months D 15 months3. A 14-year-old girl is referred to the paediatrics department for primary amenorrhea. On Given the most likely diagnosis, what examination, she is of short stature and also have cardiovascular anomaly is most commonly has a webbed neck and widely spaced nipples. associated with this condition? A Atrial septal defect B Ventricular septal defect C Coarctation of the aorta D Patent ductus arteriosus Turner’s Syndrome => a chromosomal disorder affecting females 45,X Given the most likely diagnosis, what cardiovascular anomaly is most commonly associated with this condition? Atrial septal defect A Ventricular septal defect B Coarctation of the aorta C Patent ductus arteriosus D4. A 6-year-old boy is brought to the GP surgery by his mum. He has been complaining of itching What is the most appropriate management option? around his bottom at night time and has noticed small white strands moving in his stool. He is not Mebendazole + hygiene measures for constipated and is otherwise well. Nobody in the A the patient house has any similar symptoms. The boy lives with Mebendazole + hygiene measures for his parents and his seven-month-old sister. B the whole household C Mebendazole + hygiene measures for the patient and his parents No treatment D What is the most appropriate management option? Threadworms - Management: First line for all members of household (>6months): Mebendazole + hygiene measures for A the patient anthelmintic + hygiene measures Mebendazole 1st line for children >6 months old. Single Mebendazole + hygiene measures for B the whole household dose unless infection persists Mebendazole + hygiene measures for C the patient and his parents D No treatment5. A 2-month-old infant, born at full term without any complications, is brought to the paediatric clinic for Based on the paediatric immunization schedule, what vaccines should be routine immunizations. The infant's parents inquire recommended for this infant at this age? about the vaccines that should be administered today. A BCG Vaccine B Rotavirus Vaccine Measles, Mumps, Rubella C Vaccine D Influenza vaccine Based on the paediatric immunization schedule, what vaccines should be recommended for this infant at this age? A BCG Vaccine B Rotavirus Vaccine Measles, Mumps, Rubella C Vaccine Influenza vaccine D6. A 2-year-old toddler weighing 12 kg is What would be the appropriate maintenance fluid prescription? admitted to the paediatric ward with a diagnosis of viral gastroenteritis and dehydration. A 1300ml B 1200ml C 1100 mL D 1000ml What would be the appropriate maintenance fluid prescription? A 1300ml B 1200ml In this case Weight = 12kg C 1100ml 10 x 100ml/kg = 1000ml 2 x 50ml/kg = 1100ml 1000ml DROUND: 2 1. A 4 year old girl presents to the GP with a Which management option is most persistent cough which has been ongoing for the appropriate for this child? past week. The child’s cough usually occurs in sudden bouts and she can be cough-free in Oral dexamethasone A between. Her mum describes the child making a loud B Clarithromycin + school exclusion for 24 hrs after starting antibiotics whooping noise after the cough ends. The cough is Clarithromycin + school exclusion for worse at night and the child has experienced 2 C 48 hrs after starting antibiotics episodes of vomiting after coughing. PMH: no D Oral amoxicillin relevant health conditions, no history of immunisations. Whooping Cough: caused by bordetella pertussis (gram negative bacteria) Presentation: paroxysmal cough, inspiratory whoop, post-tussive vomiting Which management option is most appropriate for this child? Diagnosis: -per nasal swab culture A Oral dexamethasone -PCR and serology Clarithromycin + school exclusion for Management: B 24 hrs after starting antibiotics -oral macrolide (eg clarithomycin, erythromycin, azithromycin) if onset of cough within previous 21 days Clarithromycin + school exclusion for C 48 hrs after starting antibiotics -school exclusions for 48hrs after starting abx (or 21 days from onset of symptoms if no abx) D Oral amoxicillin -admission if under 6 months -notifiable disease -offer household contacts abx prophylaxis What is the most appropriate initial 2. A 6-month-old infant presents to the diagnostic test for confirming the diagnosis? emergency department with severe, colicky A Contrast enema abdominal pain, vomiting, and passage of "currant Abdominal ultrasound jelly" stools. On examination, you note a sausage- B shaped mass in the right upper quadrant. He Abdominal x-ray C appears lethargic and has a distended abdomen. D Full blood count (FBC) Intussusception => the bowel “telescopes” into itself Presentation: What is the most appropriate initial -intermittent, severe, crampy abdominal pain diagnostic test for confirming the -vomiting, red-currant jelly stool, sausage-shaped mass in RUQ diagnosis? -possibly a preceding viral illness A Contrast enema Diagnosis: US is the investigation of choice (target sign) Treatment: B Abdominal ultrasound -air enema usually 1st line -surgery can be performed if air enema fails or if any signs of peritonitis C Abdominal x-ray D Full blood count (FBC)3. A 2-month-old infant is brought to the emergency department with a fever, irritability, and poor feeding. This has been ongoing for the past 24 hours. On Given the most likely diagnosis, what organism is most likely responsible? examination, the infant is difficult to console, exhibits a high-pitched cry and flexes her hip and knees upon passive A Group B streptococcus neck flexion . The neck is stiff, and there is a petechial B Streptococcus pneumoniae rash on the trunk. Observations reveal a temperature of 38.9°C, heart rate of 170 beats per minute, and Neisseria meningitidis C respiratory rate of 68 breaths per minute. D Haemophilus influenzae Meningitis This is a clinical picture of bacterial meningitis (viral meningitis tends to be less severe) Given the most likely diagnosis, what organism is most likely responsible? Organism causes: -Neonatal to 3 months: Group B Streptococcus (usually Group B streptococcus acquired from the mother at birth), Listeria monocytogenes A Streptococcus pneumoniae -1 month to 6 years: Neisseria meningitidis, Streptococcus B pneumoniae, Haemophilus influenzae C Neisseria meningitidis - >6 years: Neisseria meningitidis, Streptococcus pneumoniae D Haemophilus influenzae Given the likely diagnosis, what is the most appropriate initial management? 4. You are an FY1 working in the emergency department. 4-year-old child presents with Visualise the oropharynx to A confirm diagnosis sudden-onset high fever, drooling, and difficulty B Administer IV antibiotics swallowing. The child is making a high-pitched noise on inspiration and is leaning forward and C Administer dexamethasone extending their neck when sitting down. Call for emergency senior D help and secure airway Acute Epiglottitis => caused by Haemophilus influenzae type B Presentation: sudden, fever, stridor, drooling saliva, tripod position Given the most likely diagnosis, what is Management: the most appropriate initial -call for senior help immediately to secure airway (may need endotracheal intubation) : senior paediatrician, anaesthetist, ENT management? etc -DO NOT examine throat unless senior staff and able to perform Visualise the oropharynx to A confirm diagnosis intubation if necessary -oxygen -IV antibiotics and steroids once airway secure Administer IV antiobiotics B Administer dexamethasone C Call for emergency senior help D and secure airway5. A 4-week-old male infant presents to the paediatric emergency Based on the most likely diagnosis, what department with a history of non-bilious projectile vomiting after would his blood gases demonstrate? feeds, associated with visible peristalsis, and failure to thrive. On examination, the infant appears dehydrated, with a palpable olive- A Hypochloremic metabolic acidosis shaped mass in the epigastrium B Hyperchloremic metabolic acidosis C Hyperchloremic metabolic alkalosis D Hypochloremic metabolic alkalosisBased on the most likely diagnosis, what would his blood gases demonstrate? A Hypochloremic metabolic acidosis B Hyperchloremic metabolic acidosis C Hyperchloremic metabolic alkalosis Hypochloremic metabolic alkalosis D6. A 24-hour-old newborn infant is brought to the What is the most likely diagnosis ? pediatric clinic for a routine examination. On examination, you note a soft, boggy swelling over the vertex of the infant's head, extending beyond the A Cephalohematoma suture lines. Caput succedaneum B Intra-ventricular haemorrhage C D Meningocele What is the most likely diagnosis ? A Cephalohematoma Caput Succedaneum - Crosses suture lines Cephalohematoma - Doesn’t cross suture lines B Caput succedaneum C Intra-ventricular haemorrhage Meningocele Dround three 1. A 3-year-old child presents to the assessment unit with a persistent fever that has lasted for 6 days. On What investigation is most important to examination you notice cervical lymphadenopathy, an consider in this patient? erythematous tongue and signs of a conjunctival infection. Observations are as follows: BP 110/70, A Throat swab temp 39.3C, RR 28, HR 130. B Repeat bloods in 7 days time Bloods have been carried out and are as shown below: Echocardiogram Hb: 135 (115-140 g/L) C Electrocardiography (ECG) RBC: 0.36 (0.34-0.40 x 10(12)/l) D WBC: 27 (5.0-17.0 x 10(9)/l) Platelets: 510 (150-400 x 10(9)/l) CRP: 71 (<10 mg/L) Kawasaki Disease => a systemic, medium-sized vessel vasculitis Presentation: high-grade fever >5 days (usually resistant to What investigation is most important to consider in this patient? antipyretics), conjunctival infection, strawberry tongue, cervical lymphadenopathy, red palsy of hands and soles of feet which later peel, red and cracked lips etc A Throat swab Diagnosis: clinical, no specific diagnostic test B Repeat bloods in 7 days time Management: C Echocardiogram -high-dose aspirin D Electrocardiography (ECG) -IV immunoglobulin -echocardiogram Complications: coronary artery aneurysm What is the most likely diagnosis? 2. A 4 year old boy presents with a history of unexplained bruising and episodes of epistaxis. The Acute lymphoblastic leukaemia parents report that the child has been unusually A fatigued and pale. Blood tests reveal: low Disseminated intravscular B coagulation haemoglobin, low platelets, low erythrocytes, C Aplastic anaemia normal WCC, prolonged prothrombin time. D Myelodysplasia What is the most likely diagnosis? Acute Lymphoblastic Leukaemia most common malignancy affecting children peak incidence: 2-5 year old, boys more commonly than girls A Acute lymphoblastic leukaemia Features: -anaemia: pallor, fatigue -thrombocytopenia: bruising, petechiae, epistaxis Disseminated intravscular -neutropenia: increased infection risk B coagulation -bone pain (due to bone marrow infiltration) -splenomegaly Aplastic anaemia C -hepatomegaly -fever Myelodysplasia More common with Down’s syndrome D3. A 3-week-old term infant presents with a continuous machinery-like murmur heard best at Considering the most likely diagnosis, what is the most appropriate management option for this patient? the left upper sternal border. The infant is asymptomatic and feeding well. On examination, A Immediate surgical repair there are bounding peripheral pulses and a widened pulse pressure. Indomethacin B C Prostaglandin E1 D Ibuprofen Patent Ductus Arteriosus (PDA) a congenital heart defect connection between the pulmonary trunk and descending aorta that doesn’t close after birth Features: L subclavicular thrill, continuous “machinery’ murmur, wide Considering the most likely diagnosis, what is the most appropriate pulse pressure, heaving apex beat and large volume, bounding, management option for this patient? collapsing pulse Management: -indomethacin or ibuprofen (promotes duct closure) Immediate surgical repair -if assc with another congenital heart defect suitable to undergo A surgery: prostaglandin E1 (keeps duct open until after surgical repair) Indomethacin B Prostaglandin E1 C Ibuprofen D Given the likely diagnosis, what is the gold standard diagnostic investigation? 4. A 3 day old infant presents to the emergency department with constipation as he has not been Rectal biopsy able to pass stool since his home birth. He has also A started vomiting yellow/green liquid after feeding. Abdominal x-ray B On examination, his abdomen is grossly distended. C Barium enema Abdominal ultrasound D Hirschsprung’s Disease => a congenital disease affecting large intestine, where there is a developmental failure of Auerbach (myenteric) and Meissner parasympathetic nerve plexuses -> aganglionic segment of bowel -> uncoordinated peristalsis - > functional obstruction more common in males can be associated with Down’s syndrome Given the likely diagnosis, what is the gold Presentation: standard diagnostic investigation? -failure or delay to pass meconium (after 48hrs is a red flag) -constipation -abdo pain and distension -vomiting -poor weight gain and failure to thrive A Rectal biopsy Investigations: -abdo x-ray -GOLD STANDARD for diagnosis: rectal biopsy B Abdominal x-ray Management: -intially: rectal washouts/bowel irrigation -definitive management: surgery Barium enema C D Abdominal ultrasound5. Below is an image of a skin manifestation observed on a 7-year- old child during a routine physical examination. The child presents with intense itching, particularly at night, and skin lesions Based on the clinical presentation, what predominantly on the hands and wrists. is the most appropriate next step in management? A Oral Ivermectin B Topical Permethrin C Topical hydrocortisone D EmollientSCABIES Based on the clinical presentation, what is the most appropriate next step in management? Oral Ivermectin A Topical Permethrin B C Topical hydrocortisone D Emollient6. A 15-day-old new-born is brought to the paediatric clinic by concerned parents due to jaundice, which started on the second day of life. The jaundice appears to be progressive, extending from the face to the trunk and Based on the clinical presentation, which of the following conditions should be considered as a extremities. Despite phototherapy, there is no differential diagnosis in this newborn? improvement noted in the infant's condition. Upon examination, the new-born appears otherwise healthy, with normal vital signs. However, the abdomen is A Physiologic jaundice of the newborn. distended, and hepatomegaly is palpated. Laboratory investigations reveal elevated direct bilirubin levels, along with markedly elevated liver enzymes. Additionally, the B Breast milk jaundice. infant passes pale-coloured stools. C Biliary atresia. D Hemolytic disease of the newborn.Jaundice in the first 24 hours is always pathological Based on the clinical presentation, which of the following conditions should be considered as a Key Hints differential diagnosis in this newborn? Been ongoing for more than 14 days Hepatomegaly Elevated direct bilirubin A Physiologic jaundice of the new-born. B Breast milk jaundice. C Biliary atresia. D Hemolytic disease of the newborn. Thank you very much for listening! 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