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1-Theme : STATURE A. Achondroplasia B. Anorexia nervosa C. Constitutional delay D. Cornelia-de-Lange syndrome E. Familial short stature F. Growth hormone deficiency G. Primordial dwarfism H. Psychosocial poor growth I. Prader-Willi syndrome J. Russell-silver dwarfism Select the most appropriate diagnosis from the above options to explain the following presentations: 1) A child has short stature, a triangular face and facial and limb length asymmetry. J. Russell-silver dwarfism Note: describes a child with Russell –silver syndrome. A condition of short stature, hemi-hypertrophy and the child often has triangular facies, frontal bossing and clinodactyly of the 5th finger. 2) A child has short stature and is noted to have a large head with a prominent forehead. A. Achondroplasia Note: describes a child with achondroplasia. Short stature, rhizomelia (short limbs especially the proximal part). Affected individuals usually have a large head with hydrocephalus being a complication. 3) A baby is born on the 50th centile for height and weight. By the age of 2 her length has fallen to the 2nd centile and weight remains on the 50th. She has a rounded face with small hands and feet. F. Growth hormone deficiency Note: describes a growth hormone deficient child. Early recognition and initiation of treatment is required to reach satisfactory adult height.
Select the most appropriate diagnosis from the above options to explain the following presentations: 1) A 9 year old boy statemented for special educational needs is investigated for short stature. He has a weight over the 91st centile. He is noted to have small hands and feet and hypogonadism. I. Prader-Willi syndrome Note:
describes a child with Prader-Willi syndrome. A condition characterised by obesity after the first year of life. Hypotonia, hypogonadism and learning difficulties due to a deletion of chromosome 15 (the deletion occurring in the paternal gene, if the deletion of chromosome 15 in the child was inherited from the mother the child would have the phenotype of Angelman's syndrome).
2) A 15 year old girl in foster care is referred to outpatients because of delayed puberty. On examination her weight is on the 2nd centile and her height is on the 25th centile. She has poor dentition and her temperature is measured at 35°C. B. Anorexia nervosa Note:
describes an adolescent girl with anorexia nervosa. A condition due to fear of becoming obese or disturbed body image. There is usually a tendency to deny hunger, excessive dieting, laxative abuse or excessive physical activity. The diagnosis is classified as weight of 15% below that expected for age and height and is associated with physical characteristics including amenorrhoea, bradycardia, hypothermia and electrolyte disturbances.
3) A 7 year old girl presents with short stature with weight being on the 9th centile and height less than 0.4th centile. Examination is normal as well as all investigations including a bone age, which is compatible with her chronological age. Her mother is 5”1 (134cm), her father is 5”5 (143cm). E. Familial short stature Note: describes a child with familial short stature. From the measurements of the parents the child's height is compatible with this diagnosis. It is expected that most children will reach a height within 8cms of the mid-parental height centile.
Gaza E-mail: kyh10557@yahoo. On arrival he has a pulse rate of 220 beats per minute.MCQs PEDIATRICS 1-Theme : EMERGENCY MEDICINE A. H.Kamel Youssef Hassan. slows AV conduction interrupting the tachycardia. In many life-threatening conditions venous cannulation is difficult. Diving reflex G. IV Morphine J. Intraosseous line Note: Item 2 relates to a child in shock.com 2. Atropine D. Diving reflex Note: Supraventricular tachycardia is the diagnosis in Item 3. It is important to obtain vascular access very quickly and therefore intraosseous infusion is recommended. Intraosseous line I. Palestine . Pediatrician Consultant . Dr. The diving reflex increases vagal tone. Peripheral cannulation is difficult. Adrenaline C. 3) A 13 year old boy is admitted with meningococcaemia. G. F. DC shock E. Endotracheal intubation H.CARDIOLOGY 4 . Adenosine B. Endotracheal intubation Note: Item 1 relates to burns. She is admitted tachypnoeic and tacchycardic. Amongst the indicators of inhaled smoke injury is deposits around the mouth and nose. 2) A 3 month old baby is admitted with a history of poor feeding. Oedema follows thermal injury and therefore any suspicion of airway compromise should result in endotracheal intubation. Most deaths following house fires occur secondary to smoke inhalation. He is in shock. Vagal stimulation is the treatment of choice and the diving reflex is the simple procedure elicited by submerging the baby's face in to ice or placing an ice bag over the face. Dobutamine F. Naloxone Select the most appropriate emergency treatment for the following children: 1) A 4-year-old child is rescued from a house fire. She has soot in her nostrils.
The clinical features are tall stature. X genotype. aortic incompetence. Each option may be used once or not at all. However they have normal intellectual development. Marfan's syndrome Note: Marfan's syndrome  This is an autosomal dominant disorder. Tetrology of Fallot H. Charcot-Marie. mitral valve prolapse and mitral incompetence. Marfan's syndrome E. arachno-dactyly. supravalvular aortic stenosis. 2) Coarctation of Aorta I. Noonan syndrome F. 1) Supravalvular aortic stenosis J. William's syndrome For each of the cardiac lesions described below. William's syndrome Note: William's syndrome  is characterized by short stature. Turner's syndrome J. Pediatrician Consultant .Kamel Youssef Hassan. short stature. characteristic facies. wide carrying angles and wide spaced nipples. webbing of the neck. The cardiac manifestations include dilated aortic root. Down syndrome C. Palestine .MCQs PEDIATRICS 2-Theme : SYNDROMES ASSOCIATED WITH CONGENITAL HEART DISEASE A. Tourette syndrome I. 3) Dilatation of aortic root/aortic regurgitation D. high arched plate and increase in length of the lower segment of the body compared to the upper segment. mild to moderate learning difficulties and transient neonatal hypercalcemia. ovarian dysgenesis leading to infertility. Fragile X syndrome D.com 5 . Sturge-Weber syndrome G. Turner's syndrome Note: Turner's syndrome  This is characterized by 45. choose the most commonly associated syndrome from the above list of options.Tooth syndrome B.Gaza E-mail: kyh10557@yahoo. Dr.
About 40% of patients have cardiac anomalies mainly endocardial cushion defects leading to ASD and VSD. Tetrology of Fallot Note: Tetrology of Fallot This is a cyanotic heart disease and the cardinal features include: 1. short webbed neck.MCQs PEDIATRICS 4) Cardiac cushion defects (leading to ASD. mild learning difficulties. VSD) B. ASD.com 6 . short stature and congenital heart disease (pulmonary valvular stenosis. prominent mandible and forehead) Noonan syndrome Facies. large ears. Pediatrician Consultant . Palestine . Tourette syndrome Tics. Infundibular pulmonary stenosis 2. Down syndrome Note: Down syndrome  Features include characteristic facies. hypotonia.Gaza E-mail: kyh10557@yahoo. left ventricular hypertrophy) Sturge-Weber syndrome Haemangiomas in the distribution of trigeminal nerve and in the brain. Right ventricular hypertrophy Over-riding of the aorta Comments: Charcot-Marie-Tooth syndrome dystrophy. severe learning difficulties and small stature. VSD 3. macrocephaly. Sometimes can have intractable epilepsy. characteristic facies (long face. compulsive utterances of obscene words (coprolalia) Dr. Autosomal dominant peroneal muscular Fragile X syndrome Moderate learning difficulty.Kamel Youssef Hassan. 5) Infundibular pulmonary stenosis G.
Apgar scores 3 at 1 minute and 5 at 5 minutes. Adenosine B. Dobutamine F. Naloxone Select the most appropriate emergency treatment for the following children: 1) A 5 year old boy is brought to the hospital with 15% scalds to his chest. I.Kamel Youssef Hassan. A bradycardia in an unstable newborn requires oxygenation. ECG shows ventricular fibrillation. D.Gaza E-mail: kyh10557@yahoo. IV adrenaline is administered as Atropine is ineffective in this age group. Endotracheal intubation H. Adrenaline Note: Item 3 describes a baby born in poor condition. IV Morphine J. DC shock Note: Item 2 describes a child in ventricular fibrillation. If the arrest is witnessed a precordial thump is carried out otherwise electrical de-fibrillation at 2 joules per kilogram.com 7 . At 10 minutes he remains bradycardic. Diving reflex G. This is uncommon in childhood although may occur as a result of tricyclic antidepressant overdose and hypothermia. Children who have been burnt are in severe pain and therefore IV Morphine is the analgesic of choice. Atropine D. Palestine . ventilation and cardiac compressions. Pediatrician Consultant . Adrenaline C. 2) A 14-year-old girl with a history of previous overdoses is admitted to A&E apnoeic and unconsciousness. Dr.MCQs PEDIATRICS 3-Theme : EMERGENCY TREATMENTS A. 3) A term baby is born in poor condition. B. CPR is commenced. Intraosseous line I. IV Morphine Note: Item 1 relates to a child with serious burns. CPR is commenced. DC shock E.
Noonan's syndrome Note: In Noonan's syndrome pulmonary valve stenosis due to a dysplastic or thick valve is seen often associated with left ventricular hypertrophy. Pediatrician Consultant . Septal defects also occur as well as peripheral branch pulmonary artery stenosis. Williams syndrome Note: In Williams syndrome supra-valvular aortic stenosis is the most common cardiac lesion.MCQs PEDIATRICS 4-Theme : GENETICS . Foetal alcohol syndrome F.Gaza E-mail: kyh10557@yahoo. 3) Pulmonary stenosis. J. Branch stenosis of the pulmonary artery also is found in Noonan's syndrome. Beckwith-Wiedemann syndrome C.com 8 . Less commonly the thoracic abdominal aorta or pulmonary arteries are affected with secondary aortic regurgitation and mitral valve prolapse. H. Down syndrome E. Noonan's syndrome I. Palestine . G. Turner's syndrome J. Dr. Williams syndrome ABNORMALITIES IN GENETIC Match each of the following cardiovascular abnormalities to the single most likely associated genetic disorder. Marfan's syndrome Note: In Marfan's syndrome dilatation of the ascending aorta is often seen with or without aneurysms.Kamel Youssef Hassan. Angelman's syndrome B. Marfan's syndrome H. Glycogen storage disease G.CARDIAC DISORDERS A. 2) Supra-valvular aortic stenosis. Congenital Rubella syndrome D. 1) Dilation of the aorta with aneurysms.
Foetal alcohol syndrome Note: In foetal alcohol syndrome individuals have poor growth.Gaza E-mail: kyh10557@yahoo. developmental delay and usually characteristic facial features including microcephaly and a short smooth philtrum. Noonan's syndrome I. Glycogen storage disease G. 1) Endocardial cushion defect. 2) Coarctation of the aorta. Down syndrome E. Foetal alcohol syndrome F. Angelman's syndrome B. Beckwith-Wiedemann syndrome C. E. Congenital Rubella syndrome D. Williams syndrome Match each of the following cardiovascular abnormalities to the single most likely associated disorder. Dr. Pediatrician Consultant .MCQs PEDIATRICS 5-Theme : CONGENITAL CARDIAC DEFECTS A. Turner's syndrome J. The most common cardiac lesion in these children are septal defects primarily ventricular septal defects. ASDs and PDA also occur. 30% include bicuspid aortic valves with the second most common heart defect being coarctation of the aorta.Kamel Youssef Hassan. The most common being endocardial cushion defects although VSDs. Down syndrome Note: In Down syndrome approximately 40% of children have a congenital heart disease. D. Turner's syndrome Note: In Turner's syndrome cardiac defects are common. Palestine . 3) Septal defects.com 9 . Marfan's syndrome H. Aortic stenosis. mitral valve prolapse and hypertension are also found. I.
Tuberculosis D. PCP has an insidious onset and often there are no chest signs in children. Ventricular septal defect G. Dr. Asthma B. A VSD has a pan systolic murmur and if large may have a lower grade as there is less resistance to flow. sweaty and has a tachycardia. as he appears to become breathless on feeding. which tend to occur in crowded shops. Pneumocystis carinii Note: This has resulted from congenitally acquired HIV. E. 3) A 4-month-old baby has not gained much weight since birth and only takes small milk feeds. complaining of pins & needles around her mouth and in her hands. Bronchiolitis J. When he was 2 years old he had chicken pox for 4 weeks.com 10 . Her chest is clear and her blood gases show a normal pO2 and low pCO2. Ventricular septal defect Note: Poor feeding is a symptom of heart failure in babies. Hepatomegaly is an early sign of heart failure in infants. Atrial septal defect I. his weight is below the 0. A blood count shows severe lymphopenia. His mother was an intravenous drug abuser.4th centile. Cystic Fibrosis E. he has a temperature of 37.6°C and he has generalized crepitations on auscultation of his chest. Pneumocystis carinii F. Hyperventilation C. On examination. Treatment is with septrin or nebulised pentamidine as second line. he has an emaciated appearance. He is tachypnoeic. She feels the need to take deep breaths and then breathes very quickly.Kamel Youssef Hassan. His liver is enlarged and he has a harsh grade 2-pansystolic murmur at the left lower sternal edge F. select the most likely diagnosis 1) A thirteen-year-old girl who has intermittent episodes of breathlessness. The blood gas picture is one of hyperventilation. Hyperventilation Note: This description is one of anxiety. Gastroesophageal reflux H. Palestine . 2) A three-year-old boy who presents with worsening cough and breathlessness of 3 weeks’ duration. Pediatrician Consultant .Gaza E-mail: kyh10557@yahoo. Lymphopenia is consistent. Mitral stenosis For each of these patients with breathlessness. He has always been prone to infections. B.MCQs PEDIATRICS 6-Theme : BREATHLESSNESS A.
2) A 7-week-old infant presents with breathlessness on feeding and failure to thrive. There is no obvious cyanosis but a suggestion of mild desaturation. On the chest X ray there is a concavity on the left heart border and decreased pulmonary vascular markings. The ejection systolic murmur is from the infundibular stenosis. but is a symptomatic. 1) A 13-year-old girl is referred for evaluation of her short stature. Coarctation of the aorta Note: Absent or weak femoral pulses suggest coarctation. Coarctation of the aorta I. Tetralogy of Fallot Note: Tetralogy of Fallot may present later than in the neonatal period. which could also be a left peripheral pulmonary stenosis. Ostium secundum atrial septal defect B. Pulmonary valve stenosis H.Kamel Youssef Hassan. Hypoplastic left heart syndrome Which of the above is the most likely diagnosis in the following cases. Ventricular septal defect C. Atrioventricular septal defect F. The desaturation results from the right to left shunt across the VSD. H. Patent ductus arteriosus G. Remember association with Turner’s syndrome. On examination his femoral pulses are difficult to feel but present. Palestine .MCQs PEDIATRICS 7-Theme : CONGENITAL HEART DISEASE A. Tetralogy of Fallot J. Dr. G.com 11 . Transposition of the great arteries D. She is prepubertal. Chest radiograph shows cardiomegaly and increased vascular markings. On auscultation she has an ejection systolic murmur in the second and third left intercostals spaces radiating to the back. Pulmonary valve stenosis Note: The murmur describes pulmonary stenosis. Total anomalous pulmonary venous drainage E. 3) An infant is seen for his 6-week check and found to have a loud ejection systolic murmur in the third left intercostal space and a single second heart sound on examination. I.Gaza E-mail: kyh10557@yahoo. Pediatrician Consultant . She is short and has delayed puberty and coupled with the cardiac findings would suggest Noonan’s syndrome.
E. The left to right shunt results in excess blood flow through the lungs and frequently oxygen dependency and difficulty in weaning from the ventilator. On auscultation there is a soft systolic murmur heard inconsistently at the left sternal edge and a single second sound. Transposition of the great arteries J. Fixed splitting is typical of ostium secundum defects Dr. Transposition of the great arteries Note: Cyanosis on the second day is suggestive of a duct-dependent lesion. The ECG shows a normal neonatal pattern. An incidental finding of a short systolic murmur with fixed splitting of the second heart sound is detected. Ostium secundum atrial septal defect E. Total anomalous pulmonary venous drainage I. 2) A 3-week-old premature infant born at 27 weeks gestation remains ventilated following surfactant deficient respiratory distress syndrome. I. The chest X ray shows a narrow upper mediastinum. Coarctation of the aorta C. A loud systolic murmur radiating to the back with easily palpable pulses are typical.Kamel Youssef Hassan. hypertrophied right ventricle and increased pulmonary vascular markings. Pediatrician Consultant . Palestine . Tetralogy of Fallot H. His blood pressure is normal and all pulses are normal. Patent ductus arteriosus Note: PDA is a relatively common problem in premature babies. Patent ductus arteriosus F. There is pulmonary plethora on chest X ray.MCQs PEDIATRICS 8-Theme : CONGENITAL HEART DISEASE A.Gaza E-mail: kyh10557@yahoo. D. Pulmonary valve stenosis G. Ventricular septal defect Which is the most likely diagnosis in the following cases? 1) An infant is found profoundly cyanosed and lethargic in his cot on day 2. On auscultation of his chest a systolic murmur is heard at the left sternal edge and pulses are very easy to feel.com 12 . Hypoplastic left heart syndrome D. The rest of the answer describes TGA. 3) A 7-year-old boy is examined for a chest infection. Ostium secundum atrial septal defect Note: Ostium primum defects are unlikely to present incidentally but rather with heart failure or pulmonary hypertension. Atrioventricular septal defect B.
Menkes Kinky hair Note: Menkes. Acrodermatitis enteropathica H.Gaza E-mail: kyh10557@yahoo. Trichotillomania D. Palestine . Dermatitis artefacta Note: Dermatitis artefacta. Aplasia cutis E. 2) A 15 year old girl with a history of emotional difficulties presents with linear markings to her forearms and an inconsistent history.com 13 . Pediatrician Consultant . Dermatitis artefacta C.DERMATOLOGY 1-Theme : SKIN AND HAIR ABNORMALITIES A. Alopecia areata B. The condition is usually found in individuals with emotional difficulties arising from a disorder of personality. Telogen Effluvium Select one option from the list above that is most suitable for the following patients 1) A genetic syndrome resulting in abnormal dentition and ichthyosis F. It is X linked recessive and the underlying aetiology is an abnormality of Copper transport resulting in low Copper and low Caeruloplasmin. These individuals have characteristic facies. hypodontia and a defect in sweating. 3) A congenital diffuse cause of hair loss due to an abnormality of the hair shaft with a child with intractable seizures. Ectodermal dysplasia G. B. Sutural alopecia F. Menkes Kinky hair I. Dr.Kamel Youssef Hassan. kinky hair syndrome is a progressive cerebral deterioration associated with seizures and twisted fractured hair. skin lesions are deliberately produced by patients who conceal this fact from their doctors. Ectodermal dysplasia Note: Ectodermal dysplasia is an X linked recessive condition with features of alopecia. Trichorrhexis nodosa J. H.MCQs PEDIATRICS 3.
Gaza E-mail: kyh10557@yahoo. 1) Simian creases C. Russell Silver syndrome I. This is a single horizontal palmer crease. They have downward slanting eyes and a high arched palate and most children with Sotos' syndrome have learning difficulties. flat feet and deep plantar creases. Cockayne's syndrome C. Rubinstein-Taybi syndrome Note: Children with Rubinstein-Taybi syndrome are short in stature. Sotos' syndrome Note: Sotos' syndrome is also called cerebral gigantism. Individuals have large hands and feet and macrocephaly. Down's syndrome D. Dr. Birth length is usually over the 90th centile and there is rapid linear growth there on.Kamel Youssef Hassan. G. Hunter's syndrome F. which has a postnatal onset.com 14 . Ehlers Danlos syndrome E. Also a syndrome 'Sandal gap' is found. 85% of affected individuals have a distal positioning of the palmer axial tri-radius.MCQs PEDIATRICS 2-Theme : GENETICS . Williams syndrome In a child with a suspected genetic disorder and the following clinical abnormalities choose the single most likely diagnosis from the list of options. I. Sotos' syndrome J.CLINICAL ABNORMALITIES OF LIMBS A. Rubinstein-Taybi syndrome H. Examination of the limbs may reveal broad thumbs and toes. Prader-Willi syndrome G. Comments: Examination of the hand sand feet are important in the assessment of a dysmorphic infant. Pediatrician Consultant . They tend to have downward slanting palpable fissures and a hypoplastic mandible. Bloom's syndrome B. 3) Large hands and feet and a high arched palate. Plantar creases between the first and second toes are usually deep and there is characteristic dermal ridge pattern. This is wide gap between the first and second toes. 2) Broad thumbs and toes. Palestine . Down's syndrome Note: Simian creases are found in approximately 45% of babies with Down's syndrome.
Menkes Kinky hair I. 3) An acquired course of hair loss resulting from an emotionally disturbed teenager. Ectodermal dysplasia G. Acrodermatitis enteropathica H. Alopecia areata B. Dermatitis artefacta C. Trichotillomania D. Sutural alopecia F. Trichorrhexis nodosa J.Kamel Youssef Hassan. Palestine . C. Pediatrician Consultant . Trichotillomania Note: Trichotillomania is a term for hair loss as a result of pulling of his/her own hair out.com 16 . Telogen Effluvium Select one option from the list above that is most suitable for the following patients 1) A congenital cause for localised hair loss. particularly Patau syndrome. Alopecia areata Note: Alopecia areata is a local area of hair loss in this case secondary to underlying ringworm.Gaza E-mail: kyh10557@yahoo. This can be an isolated finding although has been associated with Trisomies. 2) An acquired localised area of hair loss related to Tinea capitis A. there is often a history of emotional difficulties. Aplasia cutis Note: Aplasia cutis is a localised defect with the scalp.MCQs PEDIATRICS 4-Theme : SKIN AND HAIR ABNORMALITIES A. D. Dr. Aplasia cutis E.
Karyotype 45XO D. Fragile X C. Renal anomalies such as horse shoe kidneys are often seen 4. wide spaced nipples and cubitus valgus. Klinefelter syndrome G.Gaza E-mail: kyh10557@yahoo. parathyroid as well as great vessels. Palestine . Other features include a webbed neck.MCQs PEDIATRICS 1-Theme : DIAGNOSIS OF CHROMOSOMAL DISORDERS A. Trisomy 9 I. Trisomy 18 J. which is a defect of development of the thymus. C.Kamel Youssef Hassan. Trisomy 21 For each of the following descriptions of clinical abnormalities choose the single most likely genetic disorder from the list of options 1) A 13 year old boy with learning difficulties. Features include short stature and gonadal agenesis. a cystic hygroma and ultrasound appearances of female foetus. undescended testicles and gynaecomastia. Cardiac anomalies are common in Turner’s syndrome the most common being a bicuspid aortic valve and coaptation of the aorta. a broad shield like chest. Individuals with Klinefelter’s usually have learning difficulties. They have reduced cellular immunity and hypoparathyroidism leads to hypocalcaemia and seizures. Dr.GENETICS 3) A cardiac abnormality in a child with immuno deficiency and mild – moderate learning difficulties A. Karyotype 45XO Note: Turner’s syndrome (45XO) affects females. micrognathia and a short philtrum. 2) Gross foetal oedema. Cardiac anomalies are also common for example aortic arch defects. Pediatrician Consultant . F.com 18 . Phenotypically they are relatively tall and slim individuals with small penis and testicles. Karyotype 47XYY F. gynaecomastia and infertility. Di -George Anomaly B. Klinefelter syndrome Note: Klinefelter syndrome (XXY). They tend to have characteristic facies with short palpable fissures. Ultrasound scan of the foetus in the utero may confirm lymphoedema. Karyotype 46XX E. Triploidy H. Di -George Anomaly Note: Di -George syndrome.
Affected individuals have learning difficulties. 1) Abnormal ears and facies. Babies with Edwards syndrome tend to have clenched hands with overlapping fingers and their feet are usually deformed with a “rocker bottom appearance” and equinovarus. Di -George Anomaly B. which can affect both sexes. which has a very poor prognosis with 50% of affected individuals dying within the first week of life. Palestine . Karyotype 45XO D. Karyotype 47XYY F. B. prominent ears and testicular enlargement. 3) Learning difficulties. Klinefelter syndrome G. refractive errors. Pediatrician Consultant . Trisomy 21 For each of the following descriptions of clinical abnormalities choose the single most likely genetic disorder from the list of options. Fragile X C.MCQs PEDIATRICS 2-Theme : DIAGNOSIS OF CHROMOSOMAL DISORDERS A. Eye manifestations include strabismus. Fragile X Note: Fragile X syndrome. They tend to have almond shaped eyes with the outer aspect of the palpable fissure being upwardly slanting. Brushfield’s spots which are flecks on the iris. refractive errors and Brushfield's spors relates to Trisomy 21 or Down syndrome. Trisomy 9 I. epicanthic folds. Trisomy 21 Note: The eye manifestations of squints. Dr. moderate learning difficulties and often speech delay. refractive errors and Brushfield’s spots. Karyotype 46XX E. Trisomy 18 J. J.Gaza E-mail: kyh10557@yahoo. 2) Eye manifestations such as squints.com 19 . Triploidy H. Males with Fragile X have macro-orchidism. Growth is poor and cardiac anomalies are severe.Kamel Youssef Hassan. rocker bottom feet and cardiac abnormalities I. (testicular enlargement). Trisomy 18 Note: Trisomy 18 or Edwards syndrome. prominent ears.
3) An elf like face.Kamel Youssef Hassan.CLINICAL FEATURES OF GENETIC DISORDER SYNDROMES A. Palestine . limb defects and marked retardation of growth. C. Cornelia de-Lange syndrome Note: Cornelia de-Lange – Small stature. Facial dysmorphic features included synophrys. Dr. pectus excavatum and cardiac anomalies include pulmonary valve stenosis and branched stenosis of the pulmonary artery. Noonan's syndrome Note: Noonan’s syndrome is a condition which has a similar phenotype to Turner's syndrome.com 20 . Noonan's syndrome H. Williams syndrome For each of the following descriptions of clinical abnormalities choose the single most likely genetic disorder from the list of options. Turner's syndrome J. Kartagener's syndrome F. moderate to severe learning difficulties. Cri-du-chat syndrome C. Limb abnormalities for example oligodactyly and phocomelia. pectus excavatum and heart defects. Hypercalcaemia is an associated finding and cardiovascular anomalies mainly supra-valvular aortic stenosis has been found in children with Williams syndrome. Epicanthic folds and peri-orbital puffiness. Patau's syndrome I. Marfan's syndrome G. elf like face with prominent lips. 1) Synophrys. Angelman's syndrome B. bushy eyebrows and a long philtrum 2) Learning difficulties. J. G. Pediatrician Consultant . a webbed neck. learning difficulties and hypocalcaemia. Williams syndrome Note: Williams syndrome – The disorder including learning difficulties an unusual characteristic.MCQs PEDIATRICS 3-Theme : GENETICS . Edwards syndrome E.Gaza E-mail: kyh10557@yahoo. Cornelia de-Lange syndrome D. Individuals have learning difficulties.
CLINICAL FEATURES OF GENETIC DISORDER SYNDROMES A. Palestine . Edwards syndrome E. Cri-du-chat syndrome C. Cardiac abnormalities are present in approximately 80% of babies with Patau’s syndrome. Williams syndrome For each of the following descriptions of clinical abnormalities choose the single most likely genetic disorder from the list of options.com 21 . They have a characteristic high pitch cry and facial dysmorphic features including low set ears and epicanthic folds.Kamel Youssef Hassan. Dr. Turner's syndrome J. scalp defects. Pediatrician Consultant . Cardiac anomalies are associated for example dilation of the aorta. Cornelia de-Lange syndrome D. Marfan's syndrome – phenotypically children with Marfan’s syndrome have tall stature. Angelman's syndrome B. aorta regurgitation and mitral valve prolapse. Eye lens dislocation is often seen. microphthalmia and colobomata seen as well as cleft palate and polydactyly. arachnodactyly and joint hyper-extensibility. Marfan's syndrome Comments: Cri-du-chat syndrome is due to a deletion of the short arm of chromosome 5. slim limbs. Patau's syndrome 3) Arachnodactyly. polydactyly. There is an incomplete development of the forebrain and optic nerves and skull defects are common for example cutis aplasia. Noonan's syndrome H. 1) Microcephaly. dysmorphic features and an abnormal cry. high arched palate and lens dislocation.MCQs PEDIATRICS 4-Theme : GENETICS . Patau syndrome is Trisomy 13 affected individuals have a poor prognosis with 80% dying within the first month of life. H. B. Congenital heart disease is common. Patau's syndrome I. Affected individuals have a low birth weight. Marfan's syndrome G. F.Gaza E-mail: kyh10557@yahoo. microcephaly and learning difficulties. Cri-du-chat syndrome 2) Micropthalmia. Kartagener's syndrome F.
Pediatrician Consultant . He recently presented to his family doctor with a painful red swelling on his shin which has now resolved. The abnormal biochemistry is caused by salt loss and may be described as pseudo-bartters syndrome 2) A 15 year old boy presents with delayed puberty and short stature. Irritable bowel syndrome I.Gaza E-mail: kyh10557@yahoo. Ulcerative colitis D. He gives a history of intermittent abdominal pain and diarrhoea. chloride and metabolic alkalosis.Kamel Youssef Hassan. Crohns disease Note: Crohn’s disease may present in this way. Palestine . Initial investigations reveal low serum potassium. Toddlers diarrhoea F.INFECTIOUS DISEASES 1) DIARRHOEA A. He has been treated by his GP with antibiotics on two occasions for chest infections. The diarrhoea is explosive in nature G. It is not prevented by regrading milk following the episode of viral infection. chest infections and diarrhoea (the latter results from failure of pancreatic exocrine function) are indicative of CF. the skin lesions are erythema nodosum which are associated with inflammatory bowel disease. Abdominal migraine J. Dr. Crohns disease C. Haemolytic uraemic syndrome For the following children presenting with diarrhoea which is the most likely diagnosis: 1) An 11 month infant presents with chronic diarrhoea and failure to thrive since breast feeding was discontinued at 9 months. B. Cystic fibrosis G. Coeliac disease B.com 22 .MCQs PEDIATRICS 5. Lactose intolerance Note: Secondary lactose intolerance is a known sequelae of viral gastroenteritis. Mother dates the start of symptoms from the an episode of gastroenteritis. 3) A 8 month old infant has recurrent diarrhoea. F. Cows milk protein intolerance E. Lactose intolerance H. Cystic fibrosis Note: Failure to thrive.
Neomycin or kanamycin as well as children with untreated malignant disease or altered immunity. 3) Contra-indication if known to have an allergy to kanamycin. Those receiving immuno-suppressive drugs or radiotherapy are also contraindicated.com 23 . BCG B. Haemophilus Influenzae B E. Pediatrician Consultant . Hepatitis B D. F. which contra-indicates the Influenza vaccine as there is residual egg protein present. Children who have received another live vaccine by injection within 3 weeks should not be given MMR vaccine. Neomycin or kanamycin as well as children with untreated malignant disease or altered immunity. E. MMR should also not be given within 3 months of receiving an Immunoglobulin injection. Diphtheria Tetanus Polio C.Gaza E-mail: kyh10557@yahoo. Tetanus J. Rubella I. Influenza F. Those receiving immuno-suppressive drugs or radiotherapy are also contraindicated. Influenza Note: relates to hypersensitivity to egg. MMR should also not be given within 3 months of receiving an Immunoglobulin injection. Measles Mumps Rubella Note: refers to contra-indications to MMR. Palestine . Measles Mumps Rubella G. Tuberculin Which of the vaccines listed above would be contra-indicated in the following scenarios: 1) Contra-indication if known to have a hypersensitive reaction to egg. Dr. Children who have received another live vaccine by injection within 3 weeks should not be given MMR vaccine. F. Measles Mumps Rubella Note: refers to contra-indications to MMR.MCQs PEDIATRICS 2) CONTRA-INDICATIONS TO VACCINES A. which include children with allergies to Gelatin.Kamel Youssef Hassan. Polio H. which include children with allergies to Gelatin. 2) Contra-indication if known to have an allergy to gelatin.
Mycoplasma pneumonia F.com 24 . Pediatrician Consultant . Cytomegalovirus C. E. Mycoplasma pneumonia 3) A 5 year old boy presents with painful red swellings of his shins. Group B Streptococcus Comments: The commonest cause of pneumonia in the 2month – 6 month age group is Respiratory syncytial virus. Chlamydia B.Kamel Youssef Hassan.6month age group. G. Respiratory syncytial virus H. Ureaplasma Select the most appropriate pathogen from the above list that would account for the following presentations: 1) The commonest cause of pneumonia in the 2 month . Rhinovirus I.Gaza E-mail: kyh10557@yahoo. The majority of episodes are caused by viruses although beta haemolytic streptococcal infection is also responsible and has systemic reactions such as erythema nodosum. which results in bronchiolitis and occurs in epidemics. Group B Streptococcus D. C. Parainfluenza G. Staphylococcus aureus J. Palestine . Examination of his throat reveals an exudative tonsillitis. Haemophilus Influenza E.MCQs PEDIATRICS 3) CHILDHOOD CHEST INFECTIONS A. Chest x-ray demonstrates a reticular nodular pattern with high adenopathy and a small pleural effusion. Mycoplasma pneumonia mainly affects older children (between 5 and 15 years) resulting in community acquired pneumonias. Tonsillitis can occur at any age although is frequently seen in the 4-7 age group. Respiratory syncytial virus 2) A 9 year old boy presents with a cough and fever. rheumatic fever and glomerular nephritis Dr.
Cytomegalovirus C. H. It should be suspected if there is a history of travel or a history of ingestion of poorly prepared food. 2) Can follow ingestion of dust containing dried faecal material. Giardia Lamblia F.Gaza E-mail: kyh10557@yahoo. D. Epstein-Barr virus D. Salmonella species J. Many of its effects are a consequence of an exotoxin. Bacterial diarrhoea usually results in bloody diarrhoea. Hepatitis A G. 3) Attaches the small intestinal border and releases extoxin. It causes fever and watery diarrhoea.MCQs PEDIATRICS 4) CHILDHOOD DIARRHOEA A. Rotavirus I. Coli E. Staphylococcus aureus Select one option from the list above that is most suitable for the following patients 1) Accepted as the most common cause of infectious diarrhoea in children in the developed society. It is a double stranded RNA virus. especially prevalent in the winter months. Adenovirus B. F. Dr. Pediatrician Consultant .Kamel Youssef Hassan. Coli Note: E-coli and enteropathogen is one of the bacterial causes of diarrhoea. E. Rotavirus Note: Rotavirus is the most common virus responsible for diarrhoea worldwide. Hepatitis A Note: Hepatitis A is an RNA virus typically transmitted by the faecal-oral route.com 25 . Norwalk virus H. Palestine . E.
Various agents have been implicated including E.MCQs PEDIATRICS 5) URINARY TRACT DISEASE A. asphyxia. Renal vein thrombosis Note: describes a child with renal vein thrombosis. Nephrotic syndrome D.coli (0157) Salmonella. If both kidneys are involved it may result in acute renal failure. Nephrotic syndrome Note: relates to a child with Nephrotic syndrome. The child needs to be monitored carefully as hypovolaemia and circulatory collapse. Renal vein thrombosis I. Haemolytic uraemic syndrome B. 2) A 9 day old baby is admitted with a 2 day history of vomiting and diarrhoea. vomiting and diarrhoea. Palestine .6 and Creatinine 163 mmol / liter A. During the admission haematuria is noted and he has had 2 convulsions. oliguria and hypertension. There may also be a history of abdominal pain. Dr. This occurs when there is proteinuria resulting in hypoalbuminaemia and oedema with an unknown aetiology. Manifestations include sudden onset of haematuria and identification of an enlarged kidney. Wilm's tumour Select the most appropriate diagnosis from the above list of options that would best explain the following cases: 1) A 2 year old boy is admitted with a history of bloody diarrhoea.Gaza E-mail: kyh10557@yahoo. His urea is 12. Henoch Schonlein purpura C. which is of unknown aetiology. Steroids are the treatment of choice with careful management of fluids. abdominal pain and puffiness around his eyes. Laboratory investigations may reveal microangiopathic haemolytic anaemia. Systemic lupus erythematosus J. He is found to be slightly jaundiced. Pyelonephritis F.Kamel Youssef Hassan. Pediatrician Consultant . Urinalysis confirms proteinuria with a trace of blood. Renal tubular acidosis H. Peri-orbital or dependant oedema is usually noted first. shock or sepsis. In neonates it is associated with dehydration. Shigella and viruses. 3) A 5 year old girl presents with puffiness around the eyes.com 26 . It usually presents with a prodromal symptoms of an upper respiratory tract infection or gastroenteritis and later develops in to pallor. Polycystic kidneys E. Haemolytic uraemic syndrome Note: describes a child with haemolytic uraemic syndrome. thrombocytopenia and urinalysis may reveal proteinuria. H. Renal Calculi G. A mass is palpable in the left hypochondrium. C.
Galactosaemia Note: Galactosaemia typically presents around 2 weeks of age with jaundice. Galactosaemia H. Pediatrician Consultant . Cystic fibrosis Note: Meconium ileus and jaundice may be presenting features of CF in the neonatal period.Gaza E-mail: kyh10557@yahoo. Congenital spherocytosis F. Rhesus incompatibility E. dry skin. The community midwife has been unable to gain access to the home for the last week. Hypothyroidism D. 2) A caucasian infant has required surgery at the regional neonatal unit for meconium ileus and has developed jaundice. C.com 27 . select the most likely cause: 1) A 13 day old infant who was noted to have an umbilical hernia and has very dry skin presents with jaundice. The serum conjugated bilirubin is 65 micromol/L.MCQs PEDIATRICS 6) NEONATAL JAUNDICE A. urine cultures were clear. G. Treatment is by removing galactose from the diet. Biliary atresia C. The screening test is immunoreactive trypsin. He was investigated for sepsis and blood cultures demonstrated E-coli septicaemia. 3) A 12 day old male baby has a conjugated and unconjugated hyperbilirubinaemia. Her bilirubin is checked and is found to be elevated and mainly unconjugated. Dr. He is breast fed and has become more disinterested in feeds. I. hypotonia and jaundice are features of congenital hypothyroidism. Cataracts are a later feature even if treatment instituted early. Glucose-6-phosphate dehydrogenase deficiency I.Kamel Youssef Hassan. Hypothyroidism Note: Umbilical hernia. Palestine . She is a floppy baby. Fructose intolerance For each of the following jaundiced babies. Physiological jaundice B. Congenital cytomegalo virus infection G. E coli septicaemia is a feature. The diagnosis is eventually confirmed from the neonatal screening tests. Cystic fibrosis J. His clotting is deranged.
A. Serious complications include a giant cell pneumonia and encephalitis (SSPE). More seriously it is also responsible for encephalitis. Polio myelitis I. Chicken Pox D. Herpes Simplex Note: Herpes simplex infection may be transmitted verdantly to an infant from their mother's genital tract. Herpes Simplex E. Measles Note: Measles infection is uncommon due to world-wide immunisation.Gaza E-mail: kyh10557@yahoo. I. a Keratoconjunctivitis or a paronychia. D. 3) Caused by an RNA virus with no known carrier state. Palestine . Pediatrician Consultant . which is caused by an RNA virus. Measles B. Glandular fever G. A child with measles usually has a fever. Dr. upper respiratory tract symptoms and a morbilliform rash. Rubella C.com 28 . It has an incubation period of between 15-50 days and treatment is usually symptomatic only. 2) May result in a Keratoconjuctivitis. Hepatitis A For each description below choose the single most likely viral infection from the list of options. Mumps F. It may cause isolated skin lesions. is usually transmitted by the oral route. Hepatitis A Note: Hepatitis A.MCQs PEDIATRICS 7) VIRAL INFECTIONS A. 1) May result in Giant cell pneumonia. Pertussis H.Kamel Youssef Hassan.
Haemolytic uraemic syndrome B. voiding abnormalities. Dr. Renal vein thrombosis I.Gaza E-mail: kyh10557@yahoo. Type 3 is thought to be a variant of type 1. Renal Calculi Note: relates to Urolithiasis. F. gastrointestinal symptoms are also common. Nephrotic syndrome D. Systemic lupus erythematosus Note: describes a child with glomerulonephritis and bone marrow failure suggestive of a connective tissue disease such as SLE. Polycystic kidneys E. She is found to be mildly acidotic.MCQs PEDIATRICS 8) URINARY TRACT DISEASE A. It is a clinical state of systemic hyperchloraemic acidosis resulting from impaired urinary acidification. Treatment may require lithotripsy. Children with isolated forms of proximal or distal commonly present with growth failure.com 29 . Henoch Schonlein purpura C. Renal Calculi G. Dysuria and haematuria. Type 1 distal RTA. Three types exist. Types 1. Pyelonephritis F. 3) A 1 year old girl with a 3 month history of vomiting is investigated for failure to thrive. Renal tubular acidosis Note: Renal tubular acidosis is the answer to Item 3. Renal tubular acidosis H. G. I. dysuria. 2) A 14 year old boy with a history of recurrent urinary tract infections present with severe abdominal pain radiating to his back. Wilm's tumour Select the most appropriate diagnosis from the above list of options that would best explain the following cases: 1) An 11 year old with a previous history of chronic glomerulonephritis presents with bruising and epistaxis.Kamel Youssef Hassan. Palestine . Systemic lupus erythematosus J. Nephro-calcinosis and hypercalciuria may complicate distal RTA and goals of treatment are to correct the acidosis and to maintain normal Bicarbonate and Potassium levels. Children present with abdominal pain. A full blood count confirms a pancytopenia. type 2 proximal RTA and type 4 mineralocorticoid deficiency. 2 and 4 each have several causes. Renal Calculi. Avoidance of dehydration is important. Pediatrician Consultant . haematuria may be present.
E. Ringworm H. C. Pityriasis rosea F. Candidiasis Note: Candidiasis is caused by Candida albicans (yeast). the adult mites lay their eggs in burrows in the skin and it results in an eczematous rash with parotitis skin. F. 3) A boy has an itchy rash over the trunk with a solitary large oval lesion on the back. Pityriasis rosea Note: Pityriasis rosea is a benign condition of the skin resulting in oval pink / brown scaly lesions over the trunk. Tinea pedis E. Pediatrician Consultant . Satellite lesions may also be seen. Transmission is through close body contact.MCQs PEDIATRICS 9) MUCOCUTANEOUS INFECTIONS AND INFESTATIONS A. Napkin dermatitis J. select the most appropriate diagnosis from the list of options: 1) A child complains of an itchy rash over his arms. Chlamydia C. which are usually preceded by a herald patch (a solitary large lesion usually between 1 –10cm).com 30 . His brother and sister have similar symptoms. Enterobiasis vermicularis B. Lichen sclerosis I. Candidiasis D. Lichen planus For each of the following children who present with an itch.Gaza E-mail: kyh10557@yahoo. Scabies G. Scabies Note: Scabies is caused by the mite Sarcoptes scabiei hominis. No treatment is required. Palestine . 2) A baby has an excoriated perineal rash involving the flexures. In babies it presents as a perineal rash which usually affects the flexures. Dr.Kamel Youssef Hassan.
Diphtheria F. He has an absolute lymphocytosis. Whooping cough Note: Whooping cough is caused by Bordetella pertussis infection. coughing. forced inspiration through a closed glottis may or may Dr. J. feeding difficulties and cyanosis. B. more than once or not at all. breathlessness. Asthma B. Epiglottis G.MCQs PEDIATRICS 10) CHILDHOOD RESPIRATORY DISEASES A. haemophilus.com 31 . Whooping cough For each patient below. Cystic fibrosis E. Chest examination reveals dull percussion note over the right base posteriorly with bronchial breath sounds on auscultation. cyanosed and breathless with intercostal recession. G. fever and respiratory distress are common. Chest X ray shows hyperinflation. Pediatrician Consultant . Chest X ray may show consolidation. Pneumonia Note: Pneumonia may occur at any age. cough.Kamel Youssef Hassan. The characteristic whoop. staphylococcus. Pneumonia H. tachypnoea. 2) A 1 year old baby boy is wheezy. Each option may be used once. Bronchiolitis Note: Acute bronchiolitis is very common in infancy. Bouts of coughing ending in vomiting. Common organisms are pneumococcus. especially at night and after feeding suggest the diagnosis. Retropharyngeal abscess J. 1) A six month old baby presents with high fever. In winter epidemics of respiratory syncytial virus infection are the commonest cause. Wheeze. Patients present with fever.Gaza E-mail: kyh10557@yahoo. Examination reveals bronchial breath sounds and crepitations. TB and viruses. Croup D. cough and feeding difficulties. choose the SINGLE most probable diagnosis from the above list of options. Influenza I. 3) A 4 year old non immunized boy presents with bouts of coughing ending in vomiting. Palestine . Bronchiolitis C. mycoplasma.
2. rectal prolapse and bronchiectasis. high fever. It is characterised by sudden onset. or 3). A barking cough. His temperature is 39°C and he is unable to swallow his secretions. Dr. anaesthetic support are usually indicated.com 32 .MCQs PEDIATRICS not be present.Kamel Youssef Hassan. continuous stridor and drooling of secretions. Palestine . 5) A 2 year old boy is very unwell. C. F. Epiglottis Note: Acute epiglottis is due to Haemophilus influenza type B infection. She has a low grade fever. stridor is harsh and occurs only when child is upset. Absolute lymphocytosis is common. Pediatrician Consultant . Causative viruses are Parainfluenza (types 1.Gaza E-mail: kyh10557@yahoo. Onset is over a few days. Her voice is hoarse and has a barking cough. Complications include CNS haemorrhages. Intravenous antibiotics. harsh voice and ability to swallow secretions are typical. 4) A nine month old baby girl is upset and has stridor. Croup Note: Croup usually occurs in epidemics in autumn or spring. respiratory syncytial viruses and measles virus.
Ampicillin plus Gentamicin D. Flucloxacillin H. Dr. Acyclovir B. which is highly contagious. 1) A 4 year old with a 3 day history of vomiting and diarrhoea. Teicoplanin For each case of infectious disease described below choose the single best treatment option from the list. Ciprofloxacin G. Pediatrician Consultant . Ceftriaxone F. Flu-cloxacillin Note: Impetigo is a common staphylococcal skin manifestation. 3) A 7 year old child with widespread impetigo. Symptomatic treatment J. I. Acyclovir plus Cefotaxime C. Most frequent sites being nostrils and the peri-oral area. Benzylpenicillin E. Flucloxacillin is the treatment of choice. Palestine .Gaza E-mail: kyh10557@yahoo.MCQs PEDIATRICS 11) TREATMENT OF INFECTIOUS DISEASE A. A.Kamel Youssef Hassan. Acyclovir Note: A child who is immuno-deficient and therefore must be provided with Zoster Immune Globulin if exposed to Chicken pox through contact. Conservative treatment only is required. Netilmicin I. treatment with Acyclovir is required. 2) A 2 year old child with an immune deficiency develops Chicken Pox. If the Chicken pox develops. G.com 33 . Symptomatic treatment Note: A child with a history of gastroenteritis is a very common childhood illness.
Pediatrician Consultant . erythematous rash which blanches on pressure. erythema followed by desquamation of the hands and feet. Kawasaki’s disease Note: There are major and minor features of Kawasaki disease. F. Palestine . beta haemolytic streptococcal infection. D. Kawasaki’s disease E. Scarlatina G. The rash may be confused with that of Kawasaki disease. Meningococcal infection J. G. punctate. However. Impetigo F. A thick white exudate develops on the tongue which peels leaving a “strawberry tongue” with prominent papillae. The skin feels like “sandpaper”. 3) A 3 year old child presents with high fever for 7 days. Staphylococcal scalded skin syndrome B. Infectious mononucleosis Note: This is a known effect of giving ampicillin during EBV infection.com 34 .Gaza E-mail: kyh10557@yahoo. Dr.e. 2) A maculopapular rash develops in a child with sore throat and fever who has been treated with ampicillin. Stills disease (systemic onset juvenile chronic arthritis) Match the following descriptions of rash with the illness for which they are the most typical exanthem 1) A 5 year old boy has a bright. and a macular rash over the trunk with cervical lymphadenopathy.Kamel Youssef Hassan. Henoch – Schonlein purpura I. The rash fades and desquamates on the hands and feet. High fever and desquamation are typical. red. fissuring of the lips and strawberry tongue. Infectious mononucleosis H. conjunctival injection. desquamation occurs in late in Kawasaki’s disease. beginning in the axillae with some perioral pallor and relative facial sparing.MCQs PEDIATRICS 12) EXANTHEM A. Measles D. Rubella C. Scarlatina(scarlet fever) Note: This description is typical of Scarlatina i.
Chicken Pox B.MCQs PEDIATRICS 13) PRESENTATION OF INFECTIOUS DISEASE IN CHILDHOOD A.Kamel Youssef Hassan. Babies may also present with vomiting and cyanosis. Tuberculosis For each presentation of infectious disease choose the single most likely diagnosis from the list of options. 1) May be complicated by cerebellar ataxia. G.Gaza E-mail: kyh10557@yahoo. encephalitis and thrombocytopenia. Mumps F. Typically causes a mild illness which may go undetected in 25-50% of cases. Measles E. Signs of an upper respiratory tract infection are also common with a paroxysmal cough (whoop). Palestine . Rubella I. Infectious mononucleosis D. Pertussis H. 2) May present with apnoeas during infancy. Mycoplasma G. Complications include broncho-pneumonia and bronchiectasis as sequelae is also associated though uncommon.com 35 . Viral cerebellitis is a complication. 3) Associated with a maculo-papular rash that typically starts on face and extends to rest of body H. A. Rubella Note: Rubella infection is uncommon now due to widespread MMR vaccination. Pediatrician Consultant . Typical symptoms are transient macular papular rash that starts on the face and extends to body and a low grade fever. Pertussis Note: Pertussis is caused by Bordetella pertussis. Complications include arthritis. A blood count will reveal a lymphocytosis. Chicken Pox Note: Chicken pox is a common childhood illness caused by Varicella. Herpes simplex C. Vesicles usually appear as crops over the trunk. In infancy it can be dangerous often presenting with apnoeas. Dr.
Pediatrician Consultant . Palestine . The distribution is not that of HSP which covers typically the buttocks and limbs and is a purpuric rash. associated with painful swollen knees.MCQs PEDIATRICS 14) RASHES A. Henoch – Schonlein purpura I. reticulate macular rash develops mainly over the extensor surfaces of the limbs in a 5 year old boy with swinging temperature. The blood count. Henoch – Schonlein purpura Note: This is a description of HSP and the well recognised complication of HSP nephritis. There is microscopic haematuria on testing. Staphylococcal scalded skin syndrome B. There may be a history of minimal skin trauma which provides a port of entry for the organism. Infectious mononucleosis H. hot. She has areas of desquamation over her finger tips and in the axillae. painful knees and left elbow and palpable spleen.com 36 . Impetigo F. Staphylococcal scalded skin syndrome Note: SSSS results from infection with staphylococci with the exofoliative toxin A and B.Kamel Youssef Hassan. Dr.Gaza E-mail: kyh10557@yahoo. Rubella C. H. Her carer notices that her skin blisters easily following minimal contact. 3) A 5 day old girl has a high temperature and is irritable. These exotoxins cause disruption to the epidermal layer by interfering with intercellular junctions. A positive Nikolsky sign (slippage of the superficial layer of the epithelium on gentle pressure) The desquamation occurs concomitantly with the illness unlike Kawaskis disease and Kawasaki disease does not occur in this age group. 1) A salmon-coloured. Measles D. swollen. 2) A 12 year old boy develops petechiae and papules. The platelet count is normal. A. A proportion of these patients will develop progressive nephritis and end stage renal failure. Stills disease (systemic onset juvenile chronic arthritis) Note: “Salmon-coloured” is the description used to describe the rash of Still’s disease. C-reactive protein and chest X-ray are normal. Kawasaki’s disease E. Stills disease (systemic onset juvenile chronic arthritis) Match the following descriptions of rash with the illness for which they are the most typical exanthem. Meningococcal infection J. The ESR is 95. J. Scarlatina G. Mortality is up to 3% in children. some of which become purpuric over his buttocks and legs.
An alternative milk source such as soy milk can be used until this is done. Cystic fibrosis G. Irritable bowel syndrome I. Lactose intolerance H. 2) A 3 year old has intermittent diarrhoea with stools of varying consistency and sometimes undigested food particles.com 37 . Dr. Cow’s milk should be excluded from the diet and reintroduced between 1-2 years if tolerated. Palestine . To screen.Gaza E-mail: kyh10557@yahoo. Ulcerative colitis D. Coeliac disease Note: Coeliac disease is more occurs more frequently in Downs’s syndrome. When plotting his growth on a chart specific for Downs syndrome children it is clear that both height and weight have fallen across 2 centiles. Haemolytic uraemic syndrome For the following children presenting with diarrhoea which is the most likely diagnosis: 1) A 6 year old boy with Downs’s syndrome has between 3 and 4 loose stools a day. She had now developed diarrhoea and her weight has been static in recent weeks.Kamel Youssef Hassan. Toddlers diarrhoea F. A full blood count shows a slight eosinophilia. 3) A 4 month baby girl has severe atopic eczema and is regularly reviewed in the paediatric clinic. Cows milk protein intolerance Note: CMPI is associated with eczema and eosinophilia. Pediatrician Consultant . Toddlers diarrhoea Note: Toddler diarrhoea (thought to be a normal variant) occurs mainly in preschool children and is evidenced by undigested food observed in the faeces in a well child. anti-TTG antibodies taken with serum IgA must be evaluated. Crohns disease C. Poor growth would indicate a likely pathological cause. D. A. His mother had tried to reduce his intake of diary produce but dietary manipulation has had no impact on the symptoms E.MCQs PEDIATRICS 15) DIARRHOEA A. Cows milk protein intolerance E. He is pale but otherwise the examination is unremarkable. His growth is satisfactory. Coeliac disease B. Abdominal migraine J.
Cytomegalovirus 4) A 7 year old male child is referred to hospital by the general practitioner with acute renal failure. Streptococcus pyogenes being a common pathogen. 4.9 oC. pulse 180/min and the respiratory rate 80/min. there are rhonchi and wheezes all over her chest.Gaza E-mail: kyh10557@yahoo. 2. Pediatrician Consultant . Respiratory syncytial virus Comments: 1. and is the leading cause of bronchiolitis and pneumonia in children. Rheumatic fever results from immune-mediated post Group A streptococcal infection.MCQs PEDIATRICS B. she had a cough and rhinitis. Congenital CMV infection is associated with petechiae. Palestine . intracerebral calcification which may lead to CNS damage with long term sequaelae. 3.com 39 . On examination her temperature is 38. M. On auscultation.Kamel Youssef Hassan. The diagnosis of Meningococcal meningitis is clear. She had subcostal retractions and nasal flaring. E. both resolved with rehydration. Five days previously. Respiratory Syncytial Virus is the commonest cause of lower respiratory tract infections in children worldwide. 5. D. Dr. The child had bloody diarrhoea and a low grade fever a week ago. Escherichia coli 5) A 4 month old female infant is brought to the hospital with severe respiratory distress. coli infection has resulted in Haemolytic Uraemic Syndrome with renal failure. choroidoretinitis. hepatosplenomegaly.
Pertussis 2) Is caused by a paramyxovirus. Pertussis H. F. Mumps F. Glandular fever Comments: Whooping cough is not uncommon in infancy. Polio myelitis I. Mumps 3) This infection is often followed by a transient immuno-deficiency. Measles B. In the older child upper respiratory tract infections and a paroxysmal cough with a whoop is characteristic. Chicken Pox D.MCQs PEDIATRICS 17) VIRAL INFECTIONS A. Dr. E.com 40 . Palestine . Pediatrician Consultant . Mumps is caused by a paramyxovirus. Rubella C. Hepatitis A For each description below choose the single most likely viral infection from the list of options 1) Caused by a gram negative pleomorphic bacillus G. Glandular fever G. Herpes Simplex E.Gaza E-mail: kyh10557@yahoo. It typically presents with apnoeic episodes or cyanotic episodes during infancy. Glandular fever virus infects the B lymphocytes which results in an immuno-deficiency which is usually self limiting.Kamel Youssef Hassan.
cellulitis. 2) Spread is due to personal contact as well as by contaminated water supply. E. Palestine . Norwalk virus H. vomiting and diarrhoea approximately between 1-8 hours after ingestion. Pediatrician Consultant . Adenovirus B. Giardia Lamblia Note: Giardia Lamblia is a protozoa and may contaminate water or be transmitted by the faecal or oral route or person to person contact. Hepatitis A G. Epstein-Barr virus D. Symptoms include nausea. Staphylococcus aureus Note: Staphylococcus aureus is a gram positive coccus and the most common cause of osteo-myelitis and arthritis in children. Children are often asymptomatic however diarrhoea and cramps and weight loss may be features of the disease. Rotavirus I. Salmonella species J.MCQs PEDIATRICS 18) CHILDHOOD DIARRHOEA A. It may cause pneumonias and may contaminate food resulting in enterotoxins being released in to the intestinal tract. 3) An organism which is not only associated with gastroenteritis but is also the most common cause of osteomyelitis and arthritis in children.com 41 . E. I. Staphylococcus aureus Select one option from the list above that is most suitable for the following patients 1) Causes diarrhoea by invading the brush border of the small intestine and causes vacuolation. folliculitis and furunculosis. Coli E. It may contaminate skin resulting in impetigo. J.Gaza E-mail: kyh10557@yahoo. Salmonella species Note: Salmonella may contaminate foods improperly foods cooked or stored and invades the brush border of the small intestine. Giardia Lamblia F. Cytomegalovirus C. Dr.Kamel Youssef Hassan.
F.com 42 . Haemophilus Influenzae B E. B. The department of health has advised that HIV positive subjects with or with out symptoms should not receive BCG. Tuberculin Which of the vaccines listed above would be contra-indicated in the following scenarios: 1) Contra-indicated if known to be allergic to Neomycin. Dr. which include children with allergies to Gelatin. Hepatitis B D. Pediatrician Consultant .Gaza E-mail: kyh10557@yahoo. Those receiving immuno-suppressive drugs or radiotherapy. 3) Contra-indicated in subjects with progressive neurological conditions.Kamel Youssef Hassan. Measles Mumps Rubella Note: refers to contra-indications to MMR.MCQs PEDIATRICS 19) CONTRA-INDICATIONS TO VACCINES A. Neomycin or kanamycin as well as children with untreated malignant disease or altered immunity. Polio H. 2) Contra-indicated in HIV positive patients. Palestine . BCG B. BCG Note: relates to vaccines in HIV infection. Diphtheria Tetanus Pertussis C. Tetanus J. A. Influenza F. Children who have received another live vaccine by injection within 3 weeks and children should not be given MMR within 3 months of an Immunoglobulin injection. Diphtheria Tetanus Pertussis Note: relates to DTP (and the pertussis component) which should not be given to subjects with any progressive neurological disorder particularly epilepsy and immunisation should be delayed until the condition is stable. Measles Mumps Rubella G. Rubella I. yellow fever or typhoid vaccinations.
Wheeze. coughing. 3) A 4 year old non immunized boy presents with bouts of coughing ending in vomiting. The characteristic whoop. G. fever and respiratory distress are common. Bronchiolitis Note: Acute bronchiolitis is very common in infancy. Palestine . Retropharyngeal abscess J. Pediatrician Consultant .MCQs PEDIATRICS 20) CHILDHOOD RESPIRATORY DISEASES A. 1) A six month old baby presents with high fever.Kamel Youssef Hassan. mycoplasma. Chest X ray shows hyperinflation. especially at night and after feeding suggest the diagnosis. Epiglottis G. haemophilus. Pneumonia H. more than once or not at all.com 43 . He has an absolute lymphocytosis. Pneumonia Note: Pneumonia may occur at any age. Whooping cough Note: Whooping cough is caused by Bordetella pertussis infection. Patients present with fever. Each option may be used once. Influenza I. Common organisms are pneumococcus. Croup D. Bronchiolitis C. staphylococcus. Chest examination reveals dull percussion note over the right base posteriorly with bronchial breath sounds on auscultation. cough and feeding difficulties. breathlessness. Diphtheria F. tachypnoea. cyanosed and breathless with intercostal recession. forced inspiration through a closed glottis may or may Dr. 2) A 1 year old baby boy is wheezy. Asthma B. J. choose the SINGLE most probable diagnosis from the above list of options. cough. In winter epidemics of respiratory syncytial virus infection are the commonest cause. Whooping cough For each patient below. B. TB and viruses.Gaza E-mail: kyh10557@yahoo. Examination reveals bronchial breath sounds and crepitations. Cystic fibrosis E. feeding difficulties and cyanosis. bouts of coughing ending in vomiting. Chest X ray may show consolidation.
stridor is harsh and occurs only when child is upset. respiratory syncytial viruses and measles virus. Pediatrician Consultant . His temperature is 39oC and he is unable to swallow his secretions F. anaesthetic support are usually indicated. 5) A 2 year old boy is very unwell. Complications include CNS haemorrhages. Epiglottis Note: Acute epiglottis is due to Haemophilus influenza type B infection. or 3). Absolute lymphocytosis is common. Onset is over a few days.com 44 . 4) A nine month old baby girl is upset and has stridor. She has a low grade fever. Dr. Causative viruses are Parainfluenza (types 1. high fever. It is characterised by sudden onset.Kamel Youssef Hassan. 2.Gaza E-mail: kyh10557@yahoo. Her voice is hoarse and has a barking cough. Intravenous antibiotics.MCQs PEDIATRICS not be present. A barking cough. C. Croup Note: Croup usually occurs in epidemics in autumn or spring. Palestine . harsh voice and ability to swallow secretions are typical. and continuous stridor and drooling of secretions. rectal prolapse and bronchiectasis.
choose the SINGLE most probable diagnosis from the above list of options. convulsions. Herpes simplex F. G. Palestine . Infection during pregnancy is treated with acylovir. Varicella immunoglobulin is administered to pregnant women who are exposed to infection. Coxsackie group B D.MCQs PEDIATRICS 21) CONGENITAL AND NEONATAL DEFECTS DUE TO MATERNAL INFECTIONS A. cardiac abnormalities. Listeriosis Dr. limb hypoplasia and convulsions. Cataracts are associated with infections in weeks 89. 1) A newborn baby presents with rudimentary digits. J. His mother had a special liking for soft cheese during her pregnancy. Listeriosis G. Cytomegalovirus (CMV) C. Each option may be used once. This is characterised by cerebral cortical and cerebellar hypoplasia. Rubella H. Diagnosis is based on rising antibody titres in blood taken 10 days apart and the presence of IGM antibodies at 4-5 weeks from incubation period. Syphilis I. Pediatrician Consultant . microcephaly. Prevention is by administering varicella vaccine even before pregnancy.com 45 .Gaza E-mail: kyh10557@yahoo. thrombocytopenia and cerebral calcification. more than once or not at all. Toxoplasmosis J.Kamel Youssef Hassan. 2) A six week old baby is confirmed to have cataracts. 3) A pre term neonate has multi-organ disease with granulomas on his skin. Symptoms are absent in 50% of mothers. F. Varicella For each patient below. Varicella Note: Chicken pox infection within the first 20 weeks of pregnancy may result in the congenital varicella syndrome. AIDS B. Hepatitis B E. It occurs in children of non immunised women. Rubella Note: This baby has congenital rubella. deafness at 5-7 weeks and cardiac lesions from 5-10 weeks. The foetus is most vulnerable in the first 16 weeks of pregnancy. limb hypoplasia and rudimentary digits.
sulphadiazine and folic acid. Dr. soft cheeses and unpasteurised milk should avoid this infection. 5 in 1000 live births are affected. 4) A two week old baby has microcephaly.com 46 . Palestine . Cytomegalovirus (CMV) Note: Maternal CMV infection is usually mild and asymptomatic. Avoidance of partially cooked meats. I.Kamel Youssef Hassan.MCQs PEDIATRICS Note: Maternal listeriosis is usually a mild infection but transplacental infection and premature labour may occur in about 5% of cases. Neonatal infection is usually multiorgan and granulomas may be found on the skin and the pharynx. B. Toxoplasmosis Note: Maternal and foetal toxoplasma infection may be avoided by advising pregnant women to wear gloves when gardening or handling cat litter and to thoroughly cook meat. There is no effective prevention. Pediatrician Consultant . hepatosplenomegaly and microcephaly. Treatment is with ampicillin and gentamicin. 5% will develop cytomegalic inclusion disease. Affected babies are treated with pyrimethamine.Gaza E-mail: kyh10557@yahoo. The foetus is most at risk in early pregnancy. 5) A new born baby is very unwell with jaundice. seizures and chorioretinitis.
Enterobiasis vermicularis B. C. Ringworm H. Candidiasis D. Lichen planus For each of the following children who present with an itch. Chlamydia C. Ringworm Note: Ringworm also known as tinea corporis presents with plaques of scaling eczema which are characteristically itchy. Tinea pedis E. Pediatrician Consultant .com 48 . It is a common infestation in children and present with nocturnal anal pruritus and a perianal irritation. Dr. Palestine . Lichen sclerosis I. G. Scabies G. A.Kamel Youssef Hassan. select the most appropriate diagnosis from the list of options: 1) A child has itching in the vulva region mostly at night. 3) A diabetic child presents with a vulva rash.MCQs PEDIATRICS 23) MUCOCUTANEOUS INFECTIONS AND INFESTATIONS A. Pityriasis rosea F.Gaza E-mail: kyh10557@yahoo. In babies it presents as a perineal rash which usually affects the flexures. Satellite lesions may also be seen. Napkin dermatitis J. Enterobiasis vermicularis Note: Enterobiasis vermicularis is also known as threadworms. 2) A child presents with annular regions over the trunk. Candidiasis Note: Candidiasis is caused by Candida albicans (yeast).
Pleural effusions may also occur as well as cavitations. Pseudomonas aeruginosa J. gut or skin. Tuberculosis Note: TB. Chest x-ray is abnormal with generalised mottling.com 50 . Aspergilloma Note: Aspergilloma is a fungus which may complicate conditions such as asthma and cystic fibrosis. Progression of the primary complex may result in bronchopneumonia or bronchial obstruction secondary to enlargement of the lymph nodes. Tuberculosis From the list above. Examination may reveal hepatosplenomegaly and fundoscopy may reveal choroid tubercles.Gaza E-mail: kyh10557@yahoo. 2) A 5 year old girl with a high temperature presents with painful blisters on the palms and soles of her feet E. Primary TB may spread to the blood stream resulting in TB. It is often associated with a high temperature. select the most appropriate diagnosis for the following presentations: 1) A 5 year old boy with cystic fibrosis undergoes a routine chest x-ray which reveals an apical round lesion on the left of his chest. Mycoplasma pneumonia H.MCQs PEDIATRICS 25) CHILDHOOD RESPIRATORY INFECTIONS A. Pediatrician Consultant . Chlamydia E. Children present with a cough and wheeze and there may be a positive skin test to aspergillus with an eosinophilia and an elevated IgE. Chest x-ray may reveal an apical round mass. anorexia and loss of weight of 3 months duration. Pneumocystis carinii I. The local infection spreads to the surrounding lymph nodes. B. J.Kamel Youssef Hassan. Characteristically individuals develop papules which then progress to vesicles. which is typically caused by Coxsackie B. 3) A 14 year old boy presents with fever. Palestine . which constitutes the primary complex in the lungs. Allergic Bronchopulmonary aspergillosis B. Bordetella pertussis D. Aspergilloma C. They are painful and pruritic and typically affect acral areas. Klebsiella pneumonia G.Mycobacterium Tuberculosis is a primary infection which may occur in the lung. Dr. Coxsackie B Note: describes a child with hand foot and mouth. Scattered crepitations are heard over both lungs. Coxsackie B F.
Listeriosis H. limb hypoplasia and convulsions.MCQs PEDIATRICS 28) CONGENITAL AND NEONATAL DEFECTS DUE TO MATERNAL INFECTION A. Chorio-retinitis suggests The presence of Jaundice. HSM and microcephaly suggests CMV infection. 1) A newborn baby presents with rudimentary digits. Pediatrician Consultant . AIDS B. Dr. thrombocytopenia and cerebral calcification. The presence of Choroido-retinitis strongly suggests a diagnosis of Toxoplasmosis. Cytomegalovirus (CMV) Comments: Rudimentary digits and limb hypopkasia suggest congenital chicken pox infection. I. Palestine . C. Herpes simplex G. Syphilis I. Varicella J.Kamel Youssef Hassan. Listeriosis 4) A two week old baby has microcephaly. Coxsackie group B C. Rubella 3) A pre term neonate has multi-organ disease with granulomas on his skin. seizures and chorioretinitis. E. cardiac abnormalities. Varicella 2) A six week old baby is confirmed to have cataracts. Each option may be used once. cardiac abnormalities. Toxoplasmosis 5) A new born baby is very unwell with jaundice. choose the SINGLE most probable diagnosis from the above list of options. The baby born with granulomas and whose mother has a penchant for soft cheeses suggests Listeria Monocytogenes infection. The presence of cataracts. thrombocytopaenia and cerebral calcification suggest a diagnosis of Congenital rubella. Rubella F. Hepatitis B E. more than once or not at all. Cytomegalovirus (CMV) D. His mother had a special liking for soft cheese during her pregnancy.com 53 . J.Gaza E-mail: kyh10557@yahoo. hepatosplenomegaly and microcephaly. G. Toxoplasmosis For each patient below.
B. Infection is via the faeco-oral route and often occurs in children aged between six months to six years. Measles F. 2) A two year old boy is mildly unwell. 3) A Three-year baby girl presents with a macular confluent rash which appeared initially behind the ears and is spreading. sore throat and ulcerating vesicles in palms. 1) A two year old infant boy is admitted to hospital with vomiting. palms and soles of his feet. His mother has noticed vesicles in his mouth. Over the previous five days she has had a low grade fever. Incubation period is 5-7 days and these heal without crusting. Her mother is vague about her immunization history. Epstein barr E. Treatment is symptomatic. Mumps H. Each option may be used once. choose the SINGLE most probable causative agent from the above list of options. foot and mouth disease characterized by fever. catarrh and conjunctivitis. This RNA virus replicates in the intestinal mucosal cells damages transport mechanisms leading to salt and water depletion which results in diarrhorea and vomiting. Pediatrician Consultant . Cytomegalovirus D. none bloody watery diarrhoea and is dehydrated. Varicella For each patient with the group of symptoms listed below.Gaza E-mail: kyh10557@yahoo.com 54 . Diagnosis is made from clinical features and culture of virus from stools and also by Polymerase chain reaction techniques. Adenovirus B. Treatment is mainly re-hydration and correction of any electrolyte imbalance. Palestine . H. orophaynx and on soles. Coxsackie Note: Coxsackie A16 virus is the cause of hand. Rotavirus I. more than once or not at all. Rotavirus Note: Rotavirus is the most common cause of severe viral gastroenteritis worldwide. Coxsackie C.Kamel Youssef Hassan. It emerges other children from his play group have developed a similar illness.MCQs PEDIATRICS 29) CHILDHOOD VIRAL INFECTIONS A. Rubella J. Molluscum contagiosum G. Dr.
C.Kamel Youssef Hassan. Many organs may be affected and congenital abnormalities result. Dr.Gaza E-mail: kyh10557@yahoo. runny nose and coughing lasts for five days. Outbreaks are common in areas with high numbers of non immunized children. Pediatrician Consultant . Antiviral therapy is reserved for systemic disease in the immunocompromised. Cytomegalovirus Note: Cytomegalovirus inclusion disease is the result of infection of the foetus. Incubation period is 14-21 days and following a brief period of malaise. 4) A Ten year old girl develops an itchy rash on her body which is spreading to her body. pneumonia. The typical macular confluent rash appears on the face from day 3-5 and spreads to the rest of the body. Palestine . hepatosplenomegaly. Diagnosis is made from clinical features. viral culture from lesions and a grater than 4-fold rise in antibody titres. She traveled to see her grandmother who was unwell with a painful rash three weeks ago. Varicella Note: Varicella (Chicken pox) is transmitted by respiratory droplets and contact with somebody with shingles. neonatal jaundice. meningitis and very rarely several years after primary infection subacute sclerosing panencephalitis (SSPE). 5) The four month old baby daughter of an HIV positive mother is admitted to hospital with seizures. Infection is transmitted via respiratory droplets and incubation period is 10-21 days. These are virtually diagnostic. deafness and mental retardation are some of the features that may occur. Koplik’s spots are bright red lesions with a central white dot which appear on the buccal mucosa. The rash evolves from papules to vesicles. Otitis media. The prodromal stage fever conjunctivitis. an itchy papulovesicular rash appears appears on trunk and spreads to the head and the extremities. J. Measles Note: Measles is caused by and RNA paramyxovirus and occurs worldwide.MCQs PEDIATRICS E. Microcephaly. She has neonatal jaundice and microcephaly. pustules and finally crusts. seizures.com 55 .
30) CUTANEOUS MANIFESTATIONS OF INFECTIOUS DISEASE A. Rheumatic fever B. TB C. Lyme's disease D. Chicken pox E. Histoplasmosis F. Cat scratch disease G. Measles H. Parvovirus I. Hepatitis B J. Herpes simplex For each cutaneous manifestation described below choose the single most likely associated infectious disease. 1) Erythema nodosum in presence of abnormal chest x-ray. B. TB Note: Erythema nodosum may be associated with streptococcal reactions, rheumatic fever and Tuberculosis. In the presence of an abnormal chest X-ray TB is the most likely answer. 2) Erythema marginatum A. Rheumatic fever Note: Erythema marginatum is one of the five major criteria to make a diagnosis of rheumatic fever. It is a pink rash with pale centres and a serpiginous margin, found on the trunk and proximal limbs. 3) Erythema chronicum migrans. C. Lyme's disease Note: Erythema chronicum migrans found in Lyme's disease. A febrile illness caused by Borrelia burgdorferi transmitted by bites of animal tic. The rash is characterised by red margins and central clearing.
1) Theme: ABDOMINAL PAIN A. Peritonitis B. Appendicitis C. Constipation D. Urinary tract infection E. Mesenteric lymphadenitis F. Migraine G. Intussusception H. Henoch-Schonlein vasculitis I. Psychosomatic J. Shigella dysentery For the following patients with abdominal pain, choose the most likely diagnosis. 1) A previously well 10 month old baby presenting with drawing up of her legs with crying and some bloody runny stools. G. Intussusception Note: This is the right age group for intussception. It is often preceded by an URTI and it is thought that mesenteric lymphadenopathy may precipitate intussception. A red currant jelly-like stool is a late sign. In the older child, the cause of intussception may be HSP or lymphoma. 2) A 4-year-old child, with poor eating habits, iron deficiency anaemia and intermittent colicky abdominal pain. C. Constipation Note: Constipation is common in children and should be managed aggressively to establish regular bowel habit quickly. 3) A 2-year-old girl with nephrotic syndrome who has developed a fever and abdominal pain. A. Peritonitis Note: The causes of abdominal pain in nephrotic syndrome are peritonitis (usually pneumococcal), renal vein thrombosis and hypovolaemia.
2) Theme: Skin lesions A. Café au lait spots B. Capillary haemangioma C. Port-wine stain D. Shagreen patch E. Adenoma sebaceum F. Cutis Marmorata G. Herald's patch H. Peri-oral pigmentation I. Hypo pigmentation J. Tuber Select one option from the list above that is most suitable for the following patients 1) An 11 year old boy with learning difficulties has an acne type rash over the nose E. Adenoma sebaceum Note: relates to the condition known as Tuberous sclerosis. It is a condition where by hamartomatous lesions become evident in early childhood. Seizures and learning difficulties are common and skin manifestations include fibrous angiomatous lesions in the naso labial folds known as adenoma sebaceum. White macules are seen over the trunk known as Ash leaf macules and Shagreen patches resemble goose like flesh. Subungual fibromata are also common. 2) A 4 year old boy with a history of focal seizures and a birth mark C. Port-wine stain Note: relates to Sturge-Weber syndrome. The association and localization of aberrant vasculature in the facial skin, eyes and meninges. Most commonly in the trigeminal nerve distribution. 3) An infant with Down's syndrome has mottled appearance to the skin. F. Cutis Marmorata Note: relates to Cutis Marmorata, a mottled, marbled type appearance to the skin. Common in Down's syndrome as well as other Trisomies, hypothyroidism and Cornelia-de-Lange syndrome.
Palestine . alopecia and stomatitis.g. Alkylating agents such as Cyclophosphamide may cause a haemorrhagic cystitis.Kamel Youssef Hassan. Asparaginase results in a dose related Pancreatitis. It also has an affect on the autonomic system resulting in severe constipation and paralytic ileus. G. vomiting and bone marrow suppression. Vincristine 2) A drug inhibiting initiation of DNA synthesis resulting in conjunctivitis and cerebellar toxicity. Monitoring with echocardiograms is advised.Gaza E-mail: kyh10557@yahoo. More specific side-effects are listed in the questions above. Bleomycin Comments: All cytotoxic agents have adverse effects. which is often very difficult to detect. D.com 60 . J.MCQs PEDIATRICS 4) Theme: Chemotherapy Select the most appropriate chemotherapeutic agent from the above list that corresponds with the following actions and side effects: 1) A drug disrupting microtubule leading to loss of deep tendon reflexes. Pediatrician Consultant . Cytosine arabinoside 3) A drug resulting in dose related lung damage. The anthracyclines e. It may also result in sensory changes with parathesis progressing to loss of tendon reflexes. Vincristine is an alkaloid agent and results in sensory motor neuropathy with long-term use. Doxorubicin and Daunorubicin are cardiotoxic. The damage is dose related. Bleomycin is the main drug resulting in lung damage and occurs in up to 10% of patients. General side-effects include nausea. Dr.
Pediatrician Consultant . Dr. J. Hepatoblastoma 2) A malignant transformation of a skin resulting from an autosomal recessive condition. Xeroderma pigmentosum Select the most appropriate oncological diagnosis from the above list of options to explain the following scenarios 1) A 13-year-old boy presents with abdominal pain. It may present with anorexia.Kamel Youssef Hassan. Melanoma F. C.MCQs PEDIATRICS 5) Theme: Childhood malignancies A. Burkitt's nasopharyngeal carcinoma B. Diagnosis is made by hypoglycaemia with high serum Insulin and treatment is by Pancreatectomy. Wilm's tumour J. This boy has a past medical history of biliary atresia. Ewing sarcoma C. Teratoma I. Xeroderma pigmentosa is an autosomal recessive condition of defective DNA repair. abdominal mass and jaundice.Gaza E-mail: kyh10557@yahoo. Neuroblastoma H. Nesidio-blastosis is also known as beta cell endocrine benign hyperplasia and affects the pancreas. F. Nesidio-blastosis G. It is associated with cirrhosis as well as biliary cirrhosis secondary to biliary atresia. Hodgkin's lymphoma E.com 61 . An abdominal mass is found. Palestine . Skin damage arise and malignant transformation results at multiple sites. Hepatoblastoma D. Xeroderma pigmentosum 3) A baby on the neonatal unit is found to be hypoglycaemic. Nesidio-blastosis Comments: Hepatoblastoma is a malignant liver tumour.
MCune Albright syndrome Which is the most applicable diagnosis for the following children. 1) A 3-year-old boy with delayed motor development is reviewed regularly in the child development clinic. Other associated features include coarctation of the aorta. A. Down's syndrome B. They should also be regularly assessed for the development of myopia and hearing loss. She has been referred to the growth clinic because of short stature. Klippel-feil syndrome I. Down's syndrome Note: Children with Down’s syndrome are screened yearly for the development of hypothyroidism. Dr. Turner's syndrome C. Other associated features include coarctation of the aorta. Laurence Moon Biedl syndrome J. Sotos syndrome H.com 62 . In her notes it is recorded that she had swollen feet at birth but she was lost to follow-up. infertility. Turner's syndrome Note: A karyotype should be performed in all girls presenting in this way. 2) A 16-year-old girl is being investigated for delayed menarche and short stature. Alzheimer’s-like dementia and Atlanto-axial subluxation. hypothyroidism and horse shoe kidney. B. hypothyroidism and horse shoe kidney. Noonan's syndrome D. Pediatrician Consultant . Palestine . He attends for routine annual blood tests to check his thyroid function.Gaza E-mail: kyh10557@yahoo. Turner's syndrome Note: A karyotype should be performed in all girls presenting in this way. Marfan's syndrome G. Treacher-Collins syndrome F. Pedal lymphoedema at birth is a known presentation.MCQs PEDIATRICS 6) Theme: SYNDROMES A.Kamel Youssef Hassan. B. Klinefelter's syndrome E. infertility. These children have a predisposition to acute lymphoblastic leukaemia (ALL). 3) A girl of 6 years has been found to have hypertension and coarctation of the aorta. Pedal lymphoedema at birth is a known presentation.
I. Subsequent investigation demonstrates undetectable oestradiol levels and a prepubertal response to an LHRH test. Premature thelarche J. He has long-standing constipation. Congenital adrenal hyperplasia Which is the most likely diagnosis in the following cases: 1) A 5-year-old girl presents with rapid breast development. deteriorating school performance and increased weight. In this case the alphafetoprotein tumour marker will be raised. Premature thelarche Note: There may be a slight FSH predominance on the basal gonadotrophin levels. Pediatrician Consultant .Kamel Youssef Hassan. G.MCQs PEDIATRICS 7) Theme: PRECOCIOUS PUBERTY A. Neurofibromatosis type 1 G. Granulosa-theca cell tumour Note: The rapid onset of puberty is indicative of a tumour. McCune Albright syndrome D. over a few months and an abdominal mass. 2) An 8 year old boy presents with testicular volumes of 8 mls bilaterally. Granulosa-theca cell tumour H. Symptoms result from the very high oestradiol levels. Dr. Thelarche variant F. pubic hair stage 3 and genital stage 3. Hypothyroidism Note: Long standing hypothyroidism can cause precocious puberty through high levels of TRH driving gonadotrophin secretion and cross reactivity of the FSH receptor with TRH. H.Gaza E-mail: kyh10557@yahoo.com 63 . Examination is otherwise normal as is her height velocity. Palestine . Premature thelarche is self-limiting and thought to be the result of the body being exquisitely sensitive to low levels of oestradiol. 3) A 2year old girl presents with isolated bilateral breast development. Hypothalamic hamartoma E. Hypothyroidism I. Exaggerated adrenarche C. Craniopharyngioma B. breast stage 4. There was no pubic hair or cliteromegaly.
Phenytoin F. Beta Blockers D. Sodium Valproate H. Sulphonamides I. Aminoglycosides (such as Gentamicin) infused over a prolonged period during pregnancy will result in ototoxicity in approximately 2-3 % of cases.MCQs PEDIATRICS 8) Theme: Drugs During Pregnancy A. Pediatrician Consultant .Kamel Youssef Hassan. Warfarin Select the drug from the above list of options that is most likely to be associated with the following effects if taken during pregnancy: 1) This drug when taken in late pregnancy may result in the baby developing jaundice H. Aminoglycosides Comments: Sulphonamides taken in late gestation may compete with Bilirubin for protein binding sites resulting in a neonatal hyperbilirubinaemia. B. Pethidine G. Lithium E. Sulphonamides 2) This drug when taken in pregnancy may result in premature closure of the ductus arteriosis. Dr. A. Aspirin 3) Prolonged use of this drug may result in a permanent hearing impairment. Thiazide diuretics J. Aspirin has been associated with premature closure of the ductus arteriosis as well as haemorrhagic disorders. Aspirin C. Palestine .Gaza E-mail: kyh10557@yahoo. Amino glycosides B.com 64 .
There is autonomous secretion of insulin that is independent of the serum glucose concentration. Pseudohypoparathyroidism C. 1) A 13-year-old boy presents with polyuria and polydipsia. Cerebral palsy J. Hypothyroidism For each of the following patients.4 mmol/L. 2. He has fed voraciously since birth.com 65 . These babies will have detectable insulin at the time of hypoglycaemia.MCQs PEDIATRICS 9) Theme: OBESITY A. G. Persistent hyperinsulinaemic hypoglycaemia of infancy D. Hypothalamic tumour I. previously well. Hypothalamic tumour Comments: 1. increasingly severe headache and a convulsion.4 mmol/L (normal) and a serum glucose concentration of 1. Type 2 diabetes 2) A 3-month-old baby presents with a generalized convulsion. Acanthosis nigricans is indicative of insulin resistance and is found typically in the axillae and around the nape of the neck. However polydipsia and polyuria suggest insulinopenia and a failing pancreas which may occur in the later stages of type 2 DM. Coupled with obesity would suggest a hypothalamic tumour as this area of the brain is involved in appetite regulation. Type 1 DM is unlikely to present with obesity but rather weight loss.Gaza E-mail: kyh10557@yahoo. some require pancreatectomy. PHHI is a defect of the K+ ATP channels in the beta cell of the pancreas. Persistent hyperinsulinaemic hypoglycaemia of infancy 3) A 9-year-old boy. headache and seizures suggest intracranial pathology. Treatment is with diazoxide and chlorothiazide. choose the most likely cause for their obesity. C. Behavioural disturbance. Asthma treated with Fluticasone E. Initial investigations demonstrate a serum calcium concentration of 2. Type I diabetes B. insulin resistance. Prader Willi Syndrome G. consuming in excess of 250 mls/milk/kg/day. Pediatrician Consultant . 3. These findings suggest type 2 DM i. There have been no previous concerns regarding his health and development.Kamel Youssef Hassan. Dr. H. Type 2 diabetes H. presents with a 6-month history of increasing behavioural disturbances. Palestine .e. Simple obesity F. He has mild asthma treated with prophylaxis in modest doses over the winter months only. On examination he has signs of acanthosis nigricans. which would not occur normally.
2) A 6-year-old child presents with acute onset symmetrical flaccid paralysis initially affecting the legs then involving the trunk. The CSF shows raised protein but no pleocytosis. plantar responses are up-going. He has mild ptosis. which typically presents in the teenage years. Fascioscapulohumeral dystrophy J.Gaza E-mail: kyh10557@yahoo. Guillain-Barre syndrome Note: The description is of Guillain-Barre syndrome. Fascio-scapulo-humeral dystrophy Note: This is a description of fascio-scapular-humeral dystrophy. A. He has a low-grade fever and the thigh and buttock muscles are notably tender on examination. F. which may be preceded by an URTI. Spinal abscess For these children with lower limb weakness select the most likely diagnosis. 2 weeks prior to this he had been unwell with URTI and fever. Guillain-Barre syndrome B.MCQs PEDIATRICS 10) Theme: WEAKNESS IN THE LOWER LIMBS A. Chronic fatigue syndrome E. Distal sensory losses are demonstrable. Congenital myopathy H.Kamel Youssef Hassan. deep tendon reflexes are absent. Duchenne muscular dystrophy I. On examination there is minimal movement with gravity eliminated in all muscle groups in the lower limbs. Sometimes there is cranial nerve involvement (Miller Fisher syndrome) 3) A 9-year-old boy has a gradual onset of proximal weakness in the pelvic girdle and to a lesser extent in the shoulder girdle also. Spinal tumour F.com 66 . There are lower motor neurone signs but also with absent reflexes due to progressive distal demyelination. Dermatomyositis Note: Proximal myopathy. 1) A 15-year-old boy started walking at 18 months of age. Transverse Myelitis C. absence of facial expression and neck weakness. Pediatrician Consultant . Juvenile Multiple sclerosis D. heliotrope rash over eyelids and the description of Gotrens papules over the knuckles indicate dermatomyositis. His mother has similar symptoms I. There is a faint violaceous rash over the eyelids and some telangiecasia over the finger knuckles. The family history does not suggest an X-linked disorder rather autosomal dominant. Palestine . Dr. and now some mild weakness in the arms. Dermatomyositis G.
Kamel Youssef Hassan. 10 months E. Milestones are grouped under 4 headings:     Gross motor Fine motor Hearing and language Social You should know the age range for each milestone. Palestine .com 67 . 5 years J.MCQs PEDIATRICS 11) Theme: DELAYED MILESTONES A. Pediatrician Consultant . 2 months Comments: It is important to be familiar with the developmental milestones.Gaza E-mail: kyh10557@yahoo. 4 weeks B. 6 years At what age would you refer a child for investigation if they were unable to do the following:1) Sit unsupported D. 10 months 2) Walk independently F. 2 months C. Dr. 18 months G. 2 years H. 18 months 3) Smile B. particularly up to the age of 3 years. 3 years I. Developmental milestones are in Illingworth: 'The Normal Child'. 12 months F. 7 months D.
Salt poisoning H. C. Nephrotic syndrome Note: Hypoalbuminaemia (serum albumin falls below 25g/L). Pediatrician Consultant . renal vein thrombosis and hypotension (due to hypovolaemia & hypercoagulable state with low antthrombin III) .6g/dl. So are peritonitis (pneumococcal peritonitis due to low immunoglobulins). proteinuria (exceed 2g/24 hr.MCQs PEDIATRICS 12) Theme: Renal disease A. E. Remember it is important to establish whether nephrogenic in origin (treatment indomethacin or chlorthiazide – thiazides – carbamzepine . 3) A 2 week old boy presents to casualty with weight loss and inconsolable crying.)(In urine dipstick +3 – +4 for proteinuria) and hypercholestrolaemia (LDL . Palestine . or more than 40 mg/m2/hr. triglycerides) are features of nephrotic syndrome. Urinary tract infection E. oedema. 2) A 15 years old boy has felt tired.Kamel Youssef Hassan. Acute nephritis B.Gaza E-mail: kyh10557@yahoo.com 68 . His serum urea is 20mmol/l and serum creatinine is 575µmol/l. Her urine dipstick shows proteinuria. Nephrotic syndrome C. lost his appetite and has not grown in the last year. Cystinosis Which diagnosis is most appropriate for the following patients? 1) A 2-year-old girl has become puffy in her face and has developed swollen feet. Haemolytic uraemic syndrome I. Chronic renal failure Note: Chronic renal failure may have an insidious onset and may present with slowed poor growth and delayed puberty. B. Diabetes insipidus D.chloramphenicol) or cranial (treatment DDAVP = exogenous ADH = Desmopressin = ADH analogue). His serum sodium is 150mmol/l and his urine osmolality is 100 mosm/kg (normal > 600). Diabetes insipidus Note: Hypernatraemia with concomitant low urine osmolality suggest DI. Dr. Barrter syndrome J. Chronic renal failure F. Diabetes mellitus G. His Hb is 9.
Congenital cytomegalovirus infection F. The infant was born at a gestational age of 36 weeks and weighed 2680g at birth. Haemolytic disease of the newborn K. Preterm birth M. Pediatrician Consultant . The following are some of the clinical findings and results of investigations. The raised bilirubin is initially unconjugated. Galactosaemia 4) On initial assessment. Palestine . Cephalhaematoma 2) The baby has a temperature of 38 oC and tends to bring up its feeds. ABO incompatibility B. H. thrombocytopenia and partially conjugated hyperbilirubinaemia are Dr. and on investigation. Sepsis 3) The liver and spleen are palpable and there is a family history of lethargy. Congenital biliary atresia E. M. 1) The infant was born after a difficult forceps delivery and the head appeared to be swollen in the right parieto-occipital area. hepatosplenomegaly and poor feeding. Glucose-6-phosphate dehydrogenase deficiency J.MCQs PEDIATRICS 13) Theme : Neonatal Jaundice A. In each case. Galactosaemia I. select the most likely cause of the jaundice from the list of options.Gaza E-mail: kyh10557@yahoo. Sepsis A 6 day old infant is admitted with jaundice (serum bilirubin 300 micromol/l) and feeding poorly for the past 48 hours. petechiae and hepatosplenomegaly are noted. Microscopy of urine from a suprapubic aspirate shows large numbers of neutrophil polymorphs. The circulating white cell count is 18x109 /l. the conjugated fraction tended to rise.com 69 . C. Cephalhaematoma D. Congenital haemolytic anaemia G. Congenital spherocytosis H. Jaundice developed after 24 hours. in the second sample. Breast milk jaundice C. The haemoglobin is 12 g/dl. Hypothyroidism L. Urine examination is positive for reducing substances using Clinitest. there is indirect hyperbilirubinaemia.Kamel Youssef Hassan.
Formula milk feeds caused a rapid fall in bilirubin levels. thriving. vomiting.9mg/dl. Complications result from anaemia due to bleeding into the haematoma. Breast milk jaundice is defined as  neonatal jaundice persisting for more than 28 days. and jaundice due to haemolysis within it 2.Gaza E-mail: kyh10557@yahoo. 5. Chorioretinitis is noted later and intra-cranial calcification is reported on a CT brain scan. diarrhoea and failure to thrive. Galactosaemia is an autosomal recessive condition due to the absence of galactose-1-phosphate uridyl transferase. Upon commencement of milk feeds the child develops jaundice. This results in the intracellular accumulation of galactose-1-phosphate which is toxic. Breast milk jaundice Comments: 1. in an otherwise healthy. Palestine . B. with a total bilirubin level greater than 5. E. Sepsis likely due to urinary tract infection. CNS damage from congenital CMV infection exceeds that due to any other infectious cause. Congenital Cytomegalovirus infection is typically characterized by the signs described. Pediatrician Consultant . A cephalhaematoma is a subperiosteal swelling which can arise as a result of forceps delivery.Kamel Youssef Hassan. Congenital cytomegalovirus infection 5) The baby was mostly breast fed and 20% of the bilirubin is conjugated.MCQs PEDIATRICS found. 4. 3. Dr. breast-fed infant.com 70 .
A multi system disorder which results in fever.com 71 . Kawasaki disease G. Palestine . Juvenile chronic arthritis F. The condition has variable inheritance with autosomal dominant and recessive forms. There is widespread osteopaenia resulting in bone fragility. abdominal pain and nephritis. Kidneys are also affected resulting in glomerulonephritis. Dipstick of her urine reveals proteinuria. 3) A 4 year old boy is admitted to casualty with fracture of her ulna after minor injury. Count) purpura nodules.MCQs PEDIATRICS 14) Theme : Connective tissue disease A. J.Kamel Youssef Hassan. Henoch Schonlein purpura Note: Henoch Schonlein purpura also known as anaphylactoid purpura result in nonthrombocytopenic = (normal plat. Ankylosing spondylitis B. Osteogenesis imperfecta Note: Osteogenesis imperfecta. D. Systemic lupus erythematosus Select one of the above diagnoses that would explain the following presentations: 1) A 10 year old boy presents with arthralgia.Gaza E-mail: kyh10557@yahoo. arthritis and a photosensitive rash. Henoch Schonlein purpura E. Blue sclera – differential diagnosis 1) Marfan syndrome 2) Ehler-Danlos syndrome 3) Osteogenesis imperficta 4)Pseudo-xanthoma elasticum Dr. G. the latter being more severe. Double stranded DNA with muscle antibodies. Dermatomyositis C. Osteogenesis imperfecta H. Pediatrician Consultant . Rheumatic fever I. She is noted to have blue sclerae and hearing impairment. Ehlers Danlos syndrome D. arthritis. arthritis. Scleroderma J. Diagnosis is made by elevated  anti-nuclear antibody. which can be divided in to 4 separate types. 2) A six year old girl presents with fever. Systemic lupus erythematosus Note: describes a child with SLE. Individuals characteristically have blue sclerae and hearing impairment (conductive deafness). a syndrome of fragile bones due to defect in the α-chain of type 1collagen. malaise. an urticarial rash on the lower limbs and buttocks and abdominal pain. rashes typically photosensitive rash and a butterfly rash. bow legs.
Urinary tract infection E. She has blond hair and blue eyes and has developed hypothyroidism. Haemolytic uraemic syndrome I. D. Cystinosis Which diagnosis is most appropriate for the following patients? 1) A 4 1/2 year old girl was admitted to hospital with a 10 day history of progressive shortness of breath and puffiness of the face. J. There is often macroscopic haematuria and hypertension. Barrter syndrome J. Cystinosis Note: This is a description of cystinosis which is confirmed by having high white cell cystine levels.MCQs PEDIATRICS 15) Theme : NEPHROLOGY A. red cells 10/hpf. He had been thriving otherwise and was well previously. Chronic renal failure F. Diabetes insipidus D. Dr. Children typically have ‫ أﺷﻘر‬blond hair and blue eyes. A. Acute nephritis Note: The picture is one of fluid overload and with a preceding URTI making poststreptococcal glomerulonephritis the most likely diagnosis. Clinical examination revealed a raised JVP. Urinary tract infection Note: UTI should be ruled out in fractious pyrexial infants as the symptoms are non-specific. She was seen by her family doctor for a sore throat 2 weeks previously. Pediatrician Consultant . normal heart sounds.000/ml. 3) A 9 year old girl has chronic renal failure of unknown aetiology. feeds well and is afebrile. pulse rate of 160/min. hepatomegaly 2cm and bilateral basal lung crepitations. Nephrotic syndrome C.com 72 . Deposits of cystine may occur in the thyroid and lense.Kamel Youssef Hassan. Salt poisoning H. Pyuria alone is not sufficient to make the diagnosis of UTI.Gaza E-mail: kyh10557@yahoo. He seems settled during assessment. organisms >100. Palestine . 2) A 4 month baby boy is admitted because of inconsolable crying. Acute nephritis B. It is important to document whether there has been previous recent antibiotic usage and where possible a clean catch urine sample should be taken prior to starting antibiotic in this age group. She also has cataracts that are worsening over the last 2 years. Urinalysis reveals white cells 45/HPF. Diabetes mellitus G.
16) Theme : Personal and Social Development A. 3 months B. 8 months C. 12 months D. 18 months E. 2 years F. 3 years G. 4 years H. 5 years I. 6 years J. 7 years For each description of a child's personal and social development choose, from the list of options, the highest development age the child is most likely to have achieved. 1) The baby is reliably reacting to sounds and is able to comply with a formal hearing test. B. 8 month 2) A child who is starting to seek adequate role models and assumes feelings and habit of thought. G. 4 years 3) Is friendly to strangers but is not yet ready to play games such as peek-a-boo. B. 8 months Comments: This question relates to the personal and social aspects of normal development. 1) Between 8- 10 months babies become anxious when separated from the main carer, usually the mother for example if mother leaves the room. 2) Between 9-10 months the infant is able to wave bye bye and enjoys games such as peek-a-boo. 3) Between 18-24 months most children start to express their toilet needs. 4) Up until the age of 3 play is usually solitary, playing alongside their peers. 5) By 4 years the children usually start to role play for example pretending to be the same sex parent and play involves other children in parallel first and then interactively at around this age.
17) Theme : Emergency treatment A. 100% Oxygen plus nebulised Salbutamol B. 100% oxygen, adrenaline and hydrocortisone C. Adrenaline IV D. Dexamethasone E. Hyperbaric oxygen F. Intubation G. IV Hydrocortisone plus oral anti-Histamines H. Paralysis with Sodium Thiopentone I. Skin desensitisation J. Supportive treatment Select the most appropriate emergency treatment for the following cases: 1) A 13 year old boy is brought to A&E with a grossly swollen face and difficulty breathing following a bee sting. ‫ﻟﺳﻌﺔ ﻧﺣﻠﺔ‬ B. 100% oxygen, adrenaline and hydrocortisone 2) A 2 year old boy presents with a barking cough and stridor. D. Dexamethasone 3) A 4 month old baby with cough fever and mild respiratory distress has widespread crackles on auscultation. J. Supportive treatment Comments: 1) describes an anaphylactic reaction also known as angioneurotic oedema. In this case there is difficulty breathing i.e. life-threatening. Treatment includes 100% oxygen, IM adrenaline and IV Hydrocortisone. Intubation may be necessary. 2) The second case has croup as characterized by the barking cough. Humidified oxygen can help for mild cases but more severe cases require dexamethasone. 3) The principles of management for bronchiolitis includes supportive treatment only. There is no specific treatment other than humidified oxygen; broncho dilator therapy may be of some use
18) Theme : Fine Motor Development A. 3 months B. 6 months C. 9 months D. 12 months E. 18 months F. 2 years G. 3 years H. 4 years I. 5 years J. 6 years For each description of a child's fine motor development choose, from the list of options, the highest development age the child is most likely to have achieved. 1) Can copy a circle and a cross and climbs and descends stairs, one foot per step. H. 4 years 2) A child can scribble and draw a straight line but not yet a circle. F. 2 years 3) Spontaneously scribbles ‫ ﺷﺧﺑطﺔ‬with a crayon ‫ طﺑﺎﺷﻳر‬and is starting to build a tower. E. 18 months Comments: This question relates to the fine motor area of development.
1) At 4 months the infant is able to grasp big objects and move them in to the mid-line. 2) At 6 months the baby can grasp an object such a rattle and starts to transfer it from hand to hand. He or she also starts to discover the rest of his or her body parts. 3) The pincer grip develops between 6 or 9 months and by 10 months the fine pincer grip is achieved with the baby being able to pick up small pellet like objects between thumb and forefinger. 4) At 18 months the baby starts to spontaneously scribble if offered a crayon for example 5) At 24 months the child is able to copy a straight line. 6) By age 3 years the child can copy a circle. 7) By 4 years can copy cross. 8) By 4½ years can copy a square. 9) By 5 years of age can copy a triangle 10) A diamond at about 6 years of age. 11) At the age of 3 the child starts to draw people usually starting as a “head and stick” extremity person and as development progresses the person becomes more sophisticated.
Gaza E-mail: kyh10557@yahoo. 2) A one year old boy with a history of intermittent bleeding pr presents with features of an interception D. Pyloric stenosis J.MCQs PEDIATRICS 19) Theme : Causes of vomiting A. Urinary tract infection Select one option from the list above that is most suitable for the following patients 1) A 2 day old breast fed baby is vomiting after each feed. It is frequently found in babies with Down's syndrome. Meconium ileus G. The Meckel's diverticulum is remnant of the vitilo-intestinal duct and can present with features of intussusception or diverticulitis. Babies present with bilious or non-bilious vomiting and a “double bubble” are seen on abdominal xray. Pediatrician Consultant . Duodenal atresia Note: Duodenal atresia is the most common cause of duodenal obstruction in infancy. Dr. Abdominal x-ray demonstrates a double bubble. Gastro-enteritis H. Gastro-oesophageal reflux I. 3) A 4 month old baby who is thriving has persistent vomiting which is occasionally blood stained. Meckel's diverticulum Note: Meckel's diverticulum is most common under the age of 2. Ulcerative colitis F. Commonly presents with painless bleeding and is diagnosed by a Meckel's scan. Palestine . Once the abdominal segment of the oesophagus lengthens in the first few months of life reflux improves. Cyclical vomiting B.Kamel Youssef Hassan. Gastro-oesophageal reflux Note: Gastro-oesophageal reflux. Reflux of gastric contents in to the oesophagus is a common event in infancy. Duodenal atresia C. Over feeding D. B. Meckel's diverticulum E.com 76 . H. This is the result of distension of the stomach and duodenum with a constricting pylorus between them.
3) Phenytoin is well known for causing the foetal hydantoin syndrome. Warfarin Select the drug from the above list of options that is most likely to be associated with the following effects if taken during pregnancy: 1) This drug taken in early pregnancy may result in Ebstein's anomaly in 3% of cases. G. If given in early pregnancy is associated with a wide variety of cardiac defects with approximately 8% having severe cardiac disease. Aspirin C. Lithium E. when taken in pregnancy may result in a baby being born with cranio-facial abnormalities.MCQs PEDIATRICS 20) Theme : Drugs During Pregnancy A. compromising cranio-facial abnormalities and learning difficulties as well growth impairment. compromising the foetal Valproate syndrome. D. Aminoglycosides B.Kamel Youssef Hassan. It is also associated with abnormalities of the orofacial and digits. Lithium 2) This drug may result in a neural tube defect in approximately 2% of cases. Dr. Pethidine G.Gaza E-mail: kyh10557@yahoo. Sulphonamides I. Pediatrician Consultant . Sodium Valproate H. Palestine . Phenytoin F. 2) Sodium Valproate tends to induce a neural tube defect (spina bifida) in approximately 2% of pregnancies and therefore should be avoided. Thiazide diuretics J. Phenytoin Comments: 1) Lithium. Beta Blockers D. E. Ebstein's anomaly being the most common (3% of all cases). growth impairment and learning difficulties. a drug used in the treatment of bipolar affective disorder. Sodium Valproate 3) This drug.com 77 .
Pancreatitis I. E. diarrhoea and possibly dehydration. Acute gastro-enteritis B. They may have a flitting arthritis affecting large joints. Dr.com 78 . Mesenteric Adenitis G. Appendicitis C. Acute gastro-enteritis Note: relates to a child with gastroenteritis. Wilm's Tumour Select one option from the list above that is most suitable for the following patients 1) A 12 year old boy with a 3 week history of coryza is brought to A&E complaining of severe abdominal pain. purple rash is rather characteristic with buttocks and extensive surfaces of the legs and arms being affected.Gaza E-mail: kyh10557@yahoo. 2) A 10 year old girl has just returned from Thailand. She denies any history of vomiting or excessive exercise. polydipsia and polyphagia. a known diabetic. has similar symptoms. D. protein and fats. A. Henoch Schonlein Purpura F.Kamel Youssef Hassan. which do not disappear with pressure. In bacterial gastroenteritis. papular. Her mother. Nephroblastoma H. 60% of cases are due to viruses for example Rotavirus. Palestine . Sickle Cell crisis J. Children present with polyuria. Diabetes mellitus results from low Insulin levels resulting in abnormal metabolism of carbohydrate. Constipation D. Children present with abdominal pain. Children sometimes complain of abdominal discomfort and there is a history of weight loss. fever is common and children present with colicky abdominal pain. Diabetes Mellitus E. 3) A 12 year old girl with a 2 month history of weight loss and increased appetite weight loss is brought to Casualty with severe abdominal pain. possibly melaena due to haemorrhage and oedema of the gut wall.MCQs PEDIATRICS 21) Theme : Abdominal Pain A. The nephritis presents with microscopic haematuria and proteinuria and the macular. Pediatrician Consultant . Henoch Schonlein Purpura Note: Henoch Schonlein purpura also known as anaphylactoid purpura has an unknown aetiology. The commonest metabolic / endocrine problem in childhood. Diabetes Mellitus Note: describes a child with diabetes mellitus. He has swollen ankles and nodules on his buttocks. She is brought to history of severe diarrhoea associated with abdominal pain. In the developed world gastroenteritis is very common and usually mild. Her mother says that the child has been wetting her bed over the past 4 months. vomiting.
She has a fever and develops a non-blanching rash. 3) Migraine is a recurrent headache with symptom free interval. a complete ophthalmoplegia which lasts several days. Other symptoms include abdominal pain. nausea or vomiting. cardiovascular instability.MCQs PEDIATRICS 22) Theme : Causes of Headaches A. Sub arachnoid haemorrhage J. Pediatrician Consultant . irritability and later develop in to a rash and shock. Most commonly symptoms start off as being non-specific. Migraine Comments: 1) Bacillus Meningitis is a severe infection that carried serious morbidity and mortality. aura.com 79 . Meningitis 2) A 17 year old male with a 4 day history of cough and fever presents with altered sensorium and vomiting. Subdural haemorrhage I. Other visual disturbances may take the form of blurred vision. visual sensory or motor (photophobia may also occur). anorexia. Encephalitis 3) A 10 year old girl with a 6 month history of episodic abdominal pain presents with a severe headache. 2) Encephalitis refers to inflammation of the brain and children present with an encephalopathy. Encephalitis E. for example fever. Herpes viruses have been implicated as well as other viruses and often there is a devastating consequence. For example hemiplegic migraine. 1) A 16 year old girl develops headache and vomiting. It may present suddenly or insidiously. Cerebral tumour C. seizures and complications include cerebral oedema. Palestine . Cluster headache D. F.Kamel Youssef Hassan. Dr. More specific signs include neck stiffness and seizures. G. Benign intra-cranial hypertension B. Meningitis G. Complicated migraine occurs when there are neurological signs during a headache that may persist after the headache has terminated. Initial symptoms may be non-specific or flu-like followed by changes in mental state. Migraine H. D. Tension headache Select the most appropriate diagnosis from the above list that would explain the following cases.Gaza E-mail: kyh10557@yahoo. fluid and electrolyte disturbances. Extradural haematoma F. fortification spectra and flashing lights.
Babies also are seen to have sweating as a prominent symptom. In the second case the unilateral nature of the reduced breath sounds and wheeze strongly suggest inspissation of a foreign body. Tension pneumothorax J. Dr. Palestine . It may be possible to pick up heart enlargement clinically and chest x-ray may reveal cardiomegaly and plethoric lung fields. Examination reveals reduced breath sounds over one lung and a localized wheeze. Oedema may be seen around the dependant parts of the body. The baby may be having difficulty completing feeds and as a result there may be a problem with poor weight gain. lethargy and shortness of breath. Hysterical over-breathing F. Pulmonary crepitations may also be heard. Inhalation of foreign body 3) A boy presents with a dry cough. Diabetic ketoacidosis E. Acute severe asthma B. A murmur may be present or a gallop rhythm.com 80 . Inhalation of foreign body G. The baby becomes breathless particularly after crying or feeding. J. commonly in the first year of life. Cardiac failure C.Kamel Youssef Hassan. Pediatrician Consultant .MCQs PEDIATRICS 23) Theme : Dyspnoea in children A.Gaza E-mail: kyh10557@yahoo. Examination reveals reduced breath sounds over one side which is dull to percussion. Pleural effusion Comments: Heart failure – A number of congenital heart lesions will result in cardiac failure. Costochondritis D. Pulmonary embolism I. F. Pleura effusion H. On examination the baby may be tachycardic and tachypnoenic. The final case has again unilateral signs but on this occasion the dullness to percussion suggest a pleural effusion. Pleural effusion Select the most appropriate diagnosis from the options above that best explains the following cases: 1) A 3 month old baby presents with tachycardia and tachypnoea with widespread crepitations B. Cardiac failure 2) A 3 year old presents with cough and haemoptysis.
Hirschsprung's disease Note: Hirschsprung's disease is absence of ganglia cells in part or all of the wall of the colon. Aerophagia B. if unsuccessful surgery is required.Kamel Youssef Hassan. J. constipation and distension. degenerative changes of the brain and Kayser-Fleischer rings on the cornea. It presents as paroxysmal pain occasionally with vomiting and palpation may reveal a sausage shaped mass  in the right upper abdomen. Galactosaemia D. 2) A 9 month old baby presents with a sudden onset of abdominal pain and loose stools which have the appearance of red currant jelly. It is as a result of low Caeruloplasmin and low Copper excretion.MCQs PEDIATRICS 24) Theme : Abdominal diseases of Childhood A. Lactose intolerance G. E. Alpha 1 antitrypsin deficiency C.Gaza E-mail: kyh10557@yahoo. Intussusception F. Thalassaemia J. Pediatrician Consultant . Palestine . Mesenteric adenitis H. 3) A 4 day old infant presents with severe abdominal distension and feculent vomiting D. Reyes syndrome I. The child presents with bilious or feculent vomiting. A delay in diagnosis results in the child passing blood stained mucus rectally some times known as red currant jelly. Hirschsprung's disease E. Wilson's disease Select one of the above options that is the most appropriate diagnosis for the following cases: 1) Usually presents with chronic liver disease often in association with neurological features. Wilson's disease Note: describes a child with Wilson's disease also known as hepatolenticular degeneration.com 81 . Dr. Intussusception can sometimes be reduced hydrostatically. It is an autosomal recessive condition characterized by cirrhosis of the liver. Intussusception Note: Intussusception is an invagination of the bowel in to an adjacent segment.
7. At 12 months the baby can raise ‫ ﻳﻘوم‬independently and often starts to take a few steps alone. Cruising is usually achieved by about 10 months. At 5 months the baby starts to roll over and 4. 1) A baby can crawl. 8. J.Gaza E-mail: kyh10557@yahoo. 1. weight bare and is starting to cruise. Pediatrician Consultant . 1 month B. 10 months 2) A baby rolls from front to back and back to front however is not yet sitting unsupported. 1 year H. 18 months I. At 3 months when placed prone an infant can lift his head with his arms extended. 8 months F. 2. At 3 years the child can ascend stairs in an adult fashion using alternating feet per step however is unable to descend the stairs in such a fashion until 4 years of age. He or she can ascend stairs with assistance 10. 6 months E. 3 years For each description of a child's gross motor development choose. By 4 months head lag is lost and this is evident when raised from supine to the sitting position. 2 years J. D.com 82 . Palestine . 3 years Comments: This question relates to gross motor skills area of development. Dr. 9. the highest development age the child is most likely to have achieved. 4 months D. At 18 months the toddler can run although this is usually in a tiff fashion.Kamel Youssef Hassan. 5. At 20 months the child can climb the stairs holding on to a rail. 2 months C. Sitting unsupported is usually seen by 6-7 months 6. 10 months G. 6 months 3) A child ascends stairs using alternating feet and is able to stand on one foot for a few seconds. F. from the list of options. At 6 months the baby is starting to sit up with support for example cushions. 3. At 9 months the baby can start to crawl.MCQs PEDIATRICS 25) Theme : Gross motor development A.
Gluten free diet Note: relates to Coeliac disease. abdominal pain. A sensitivity and intolerance to the gliadin protein  in rice. diarrhoea. wheat and barley. Children present with failure to thrive. Dr. She is found to have anaemia and colonoscopy reveals a cobble stone appearance. 2) A 7 year old child presents with a 3 month history of abdominal pain. No action Note: Describes a child with toddler diarrhoea due to a fast gut transit time. High fibre diet I. Pancreatic enzyme supplements G. B. Praziquantel Select one option from the list above that is most suitable for the following patients 1) A 2 year old girl is taken to the A&E department by her mother who says that her child has diarrhoea and describes the stool as looking like peas and carrots.Kamel Youssef Hassan. Crohn's disease and ulcerative colitis respectively. Vitamin D H. Gluten free diet C. Lactose free diet F. Steroids E. Children between the ages of 6 months and 3 years may have this complaint which manifests as a chronic diarrhoea. She has an itchy rash over her limbs. Metronidazole B. In Crohn's disease the colonoscopy will reveal cobbled stone mucosal appearances with fistulae where as in ulcerative colitis  (crypt abscesses + Collar button ulcers)are present. Pediatrician Consultant . No action D.MCQs PEDIATRICS 26) Theme : Treatment of Diarrhoeal illness A.Gaza E-mail: kyh10557@yahoo. Diagnosis is suspected by elevated (anti-gliadin / anti-reticulin / anti-endomysial) antibodies and confirmed by jejunal biopsies. anorexia and abdominal distension. C. Children are otherwise healthy and thriving with all investigations carried out being normal. Steroids Note: Relates to inflammatory bowel disease. Breast milk allergy J. D. 3) A 12 year old girl whose height and weight are on the 3rd centile complains of diarrhoea with a history that the stools are difficult to flush away. Palestine .com 83 .
MCQs PEDIATRICS 27) Theme : TREATMENT OF CHILDHOOD CONDITIONS A. Erythromycin D. Cefotaxime Note: Meningitis should be suspected in any ill baby and may present with unusual crying. Paracetomol H. 3) A 5 month old baby presents with a fever. Bulging or tense anterior fontanelle. select the single treatment option most likely to alter the clinical course of the disease in each case. Palestine . An examination of the cerebrospinal fluid shows an elevated number of neutrophil polymorphs B. Pediatrician Consultant . poor feeding and a generalized convulsion.Kamel Youssef Hassan. opisthotonus and shock may be present. No medication G. fever. or not at all 1) A playful and active 5 year old boy presents with a low grade fever and bruising. Penicillin I. fits and vomiting.com 84 . poor feeding. 2) A 10 year old girl comes back from school camp with a temperature. Dr. Gentamicin E. Based on the symptoms presented below. Cefotaxime C. His platelet count is 14 x 109 /L F. No medication Note: Childhood thrombocytopenia may occur in the setting of viral illness. Immunoglobulin F. Each option may be used once. Acyclovir B. stiff neck. Quinine All of the following children present with a febrile illness. coma. The most vulnerable children are not immunized. which has been going on for 10 days C. more than once. Erythromycin Note: Outbreaks of whooping cough may in school camps. The rest of the examination is normal. For children more than three months old cefotaxime is the treatment of choice. Prednisolone J. lethargy.Gaza E-mail: kyh10557@yahoo. breathlessness and cough.
com 85 . cervical lymphadenopathy. polymorphous rash. she is completely alert again. 5) A 4 year old girl presents with a temperature of 39oC having just had a generalized convulsion lasting 3 minutes. Her older brother had similar fits at the age of 3 years G. Inflammatory markers are elevated and treatment is with intravenous immunoglobulin.Kamel Youssef Hassan. Pediatrician Consultant . oral mucosal changes with red sore tongue. E.Gaza E-mail: kyh10557@yahoo. Palestine . There is a generalized rash. Paracetomol Note: Febrile convulsions are generalized tonic/clonic symmetrical seizures which occur with rapid rises in temperature in children between the ages 3 months and 5 years who have no history of epilepsy or CNS disease. conjunctivitis and a red tongue. lymphadenopathy and desquamation of palms and soles. with desquamation of the skin of the fingers and toes. twenty minutes later. Immunoglobulin Note: Kawasakis disease is characterized by bilateral conjunctival injection.MCQs PEDIATRICS 4) A 3 year old Asian girl presents with a high temperature for six days. Dr.
3 years H. 3 years Comments: This question relates to the fine motor area of development. Palestine . 9 months D. Pediatrician Consultant . 5 years 2) A baby transfers objects to his mouth and has a fine pincer grip using thumb and forefinger.MCQs PEDIATRICS 28) Theme : Fine Motor Development A.com 86 . 3) The pincer grip develops between 6 or 9 months and by 10 months the fine pincer grip is achieved with the baby being able to pick up small pellet like objects between thumb and forefinger. from the list of options. He or she also starts to discover the rest of his or her body parts. 3 months B. D. 2 years G. 12 months E. 5) At 24 months the child is able to copy a straight line. 18 months F. 6 years For each description of a child's fine motor development choose. 4 years I. 1) A child can copy a square and a triangle but not yet a diamond.Kamel Youssef Hassan. G. 1) At 4 months the infant is able to grasp big objects and move them in to the mid-line. Dr. 5 years J. 2) At 6 months the baby can grasp an object such a rattle and starts to transfer it from hand to hand. 6) By age 3 years the child can copy a circle. 12 months 3) Can only copy a circle and builds a tower of 9 cubes. 7) By age 4 years the child can copy a cross. I. 8) By 4½ years the child can copy a square 9) By 5 years of age a triangle.Gaza E-mail: kyh10557@yahoo. the highest development age the child is most likely to have achieved. 4) At 18 months the baby starts to spontaneously scribble if offered a crayon for example. At the age of 3 the child starts to draw people usually starting as a “head and stick” extremity person and as development progresses the person becomes more sophisticated. 6 months C. 10) A diamond at about 6 years of age.
Diabetic ketoacidosis E. Pleura effusion H. Children may be shocked and will be hypoxic with reduced air entry and hyperresonance. The clue in the third case the relatively silent chest associated with pulsus paradoxus. however no crackles or wheeze. Tension Pneumothorax 2) A 17 year old presents with a sudden onset of chest pain. It is a potentially life threatening event with air accumulating under the pleura in the pleural space.Kamel Youssef Hassan. Dyspnoea is common associated with pain. Other Causes of pulsus paradoxus include  (pericardial tamponade /effusion/ constriction and myocarditis). This would suggest severe asthma. which pushes the mediastinum across the chest. Acute severe asthma Comments: Tension pneumothorax may result following trauma. He has a pulsus paradoxus. H. I. Examination reveals a sinus tachycardia and a pleural rub. It may arise in children as a result of surgery for example scoliosis surgery. Palestine . Pulmonary embolism I. Distended neck veins may also be visible. Hysterical over-breathing F.Gaza E-mail: kyh10557@yahoo. Pulmonary embolism is uncommon in infants and children. Examination reveals reduced expansion and hyperresonance over one side with reduced breath sounds.com 88 . Examination of the chest reveals poor air entry. Inhalation of foreign body G. Pulmonary embolism 3) A 13 year old boy presents with tachypnoea and tachycardia. recent abortion or the oral contraceptive may be predisposing problems.MCQs PEDIATRICS 30) Theme : chest pain in children A. Clinical manifestations may suggest pneumonia. Costochondritis D. Unilateral pneumonia Select the most appropriate diagnosis from the options above that best explains the following cases: 1) 14 year old presents to Accident & Emergency with a sudden onset of chest pain and shortness of breath. It may also occur following prolonged inactivity. Pediatrician Consultant . In adolescents drug abuse. A. Cardiac failure C. There may be no physical signs although the embolism is sufficiently large there may be a pleural friction rub. Acute severe asthma B. Dr. Tension pneumothorax J.
Treatment is supportive Dr. Pancreatitis I. It is as a result of mucus obstructing the lumen causing ischaemia of the mucosa and ultimately perforation. B. Nephroblastoma H. Children present with vomiting and abdominal pain which radiates through tot he back.Kamel Youssef Hassan.com 89 . She is found to have sclerae and painful fingers. It is also a feature of chronic hyperlipidaemia or congenital anomalies of the biliary retract or pancreas. Usually seen in children over the age of 5. Constipation D. Sickle Cell crisis J. Acute gastro-enteritis B. Henoch Schonlein Purpura F. Palestine . Clinical suspicion is confirmed by elevated amylase levels and calcification of the pancreas on abdominal x-ray. Sickle Cell crisis Note: Sickle cell disease is a haemoglobinopathy caused by substitution of Valine for Glutamic acid at the 6th position of the Beta chain. rebound tenderness. Diabetes Mellitus E.Gaza E-mail: kyh10557@yahoo. I. It results in a haemolytic anaemia resulting in vaso-occlusive episodes leading to splenic infarction and dactylitis. fever and vomiting. Appendicitis Note: describes acute appendicitis.MCQs PEDIATRICS 31) Theme : Abdominal Disease A. 2) An 11 year old boy with a 12 hour history of anorexia and polyuria complains of severe abdominal pain. Mesenteric Adenitis G. Children present with a temperature. The commonest acute surgical emergency of childhood. H. On examination he has a temperature of 38°C and is tender posteriorly on pr examination. vomiting and fever. Pediatrician Consultant . 3) An 11 year old boy with cystic fibrosis presents with recurrent attacks of abdominal pain. BM is 4mmol per litre. Pancreatitis Note: relates to description of chronic Pancreatitis in a child with cystic fibrosis. Appendicitis C. Wilm's Tumour Select one option from the list above that is most suitable for the following patients 1) A 9 year old Italian girl has severe abdominal pain. abdominal pain and guarding in the right iliac fossa.
Laboratory findings include abnormal liver and muscle enzymes. Mesenteric adenitis H. Aerophagia B. Mesenteric adenitis Note: Mesenteric adenitis commonly accompanying upper respiratory tract infections and is due to inflammation in the abdominal lymph nodes. Examination often reveals cervical lymphadenopathy and central tenderness. Alpha 1 antitrypsin deficiency C. Intussusception F. liver and brain and clinical manifestations include jaundice. There is often a history of pharyngitis and abdominal pain.Gaza E-mail: kyh10557@yahoo. Dr. hepatomegaly. Treatment is dietary adjustment. Hirschsprung's disease E. G. Thalassaemia J. Galactosaemia D. It accumulates in kidneys. Diagnosis is made by identifying urinary galactose. Reyes syndrome Note: Reyes syndrome is an acute disease of the liver often associated with a viral infection or Salicylate toxicity . 2) A 3 year old child with a 2 day history of headache and pharyngitis complains of severe abdominal pain. Treatment is supportive. hypoglycaemia.com 90 . Galactosaemia Note: Galactosaemia results as a result of galactose 1 phosphate uridyl transferase. Palestine . H. 3) A 28 day old jaundice baby with early onset vomiting and diarrhoea. seizures and poor weight gain. Wilson's disease Select one of the above options that is the most appropriate diagnosis for the following cases: 1) A 10 year old child develops severe vomiting and becomes encephalopathic during a viral illness. Lactose intolerance G.Kamel Youssef Hassan. Pediatrician Consultant . vomiting.MCQs PEDIATRICS 32) Theme : Abdominal diseases of Childhood A. Reyes syndrome I. C.
com 91 . Palestine . Herald's patch H.Gaza E-mail: kyh10557@yahoo. Hypopigmentation J. 2) A child with learning difficulties is described as having goose like flesh. Café au lait spots Note: relates to Neurofibromatosis type 1. Capillary haemangioma C. White macules are seen over the trunk known as Ash leaf macules and Shagreen patches resemble goose like flesh. Subungual fibromata are also common. Peri-oral pigmentation I.Kamel Youssef Hassan. Shagreen patch Note: relates to Tuberous sclerosis.MCQs PEDIATRICS 33) Theme : Skin lesions A. It is a condition where by hamartomatous lesions become evident in early childhood. Café au lait spots B. A history of Iron deficiency anaemia. colonoscopy may reveal polyps. Peri-oral pigmentation Note: refers to Peutz-Jeghers syndrome characterized by peri-oral pigmentation. Adenoma sebaceum F. Cutis Marmorata G. Tuber Select one option from the list above that is most suitable for the following patients 1) A child has an abundance of birth marks associated with axillary freckling. A. H. D. Dr. Seizures and learning difficulties are common and skin manifestations include fibrous angiomatous lesions in the naso labial folds known as adenoma sebaceum. Pediatrician Consultant . 3) A child with a history of Iron deficiency anaemia presents with per rectal bleeding and is found to have this characteristic appearance. Shagreen patch E. Café au lait lesions are brown pigmented marks found in abundance in Neurofibromatosis as well as other genetic conditions for example Tuberous sclerosis. Port-wine stain D.
G. Palestine . from the list of options. 1) A baby shows stranger awareness. 7 years For each description of a child's personal and social development choose. C. Pediatrician Consultant . 18 months E.10 months babies become anxious when separated from the main carer. 4 years 3) A child is starting to indicate the need to sit on the potty. Dr. play is usually solitary at this age and the child tries to control objects over other children. 3) Up until the age of 3 plays is usually solitary.com 92 . E. 12 months D. usually the mother for example if mother leaves the room. 4 years H. 8 months C. playing alongside their peers.MCQs PEDIATRICS 34) Theme : Personal and Social Development A. 2 years F. 5 years I. 5) By 4 years the children usually start to role play for example pretending to be the same sex parent and play involves other children in parallel first and then interactively at around this age. 2 years Comments: This question relates to the personal and social aspects of normal development. Between 18-24 months most children start to express their toilet needs.Gaza E-mail: kyh10557@yahoo. is able to wave and clap his hands and is starting to spoon feed himself. the highest development age the child is most likely to have achieved.Kamel Youssef Hassan. 12 months 2) Can dress and undress including buttons and can imitate the construction of bridges and steps with blocks. 3 months B. 1) Between 8. 2) Between 9-10 months the infant is able to wave bye bye and enjoys games such as peek-a-boo. 3 years G. 6 years J.
Testicular feminisation syndrome Note: The third case has testicular feminisation.com 93 . XO syndrome H. Testicular feminisation syndrome G. Individuals are tall and thin. Aarskog syndrome B. oligomenorrhoea and hirsutism. She has normal female external genitalia but intra-abdominal testicles with an XY karyotype. XXY syndrome J. Gonadal dysgenesis D. Pediatrician Consultant . Palestine . F. depression and a conduct disorder. Seizures are common 2) A 16 year old female presents with obesity. Dr. XYY syndrome Select the most appropriate diagnosis from the list above that best describes the following cases 1) A 12 year old girl has seizures. 3) A 14 year old phenotypic female presents with primary amenorrhoea.Gaza E-mail: kyh10557@yahoo. Fragile X C. Hermaphroditism E.Kamel Youssef Hassan. They have behavioural problems and are mildly dysmorphic with epicanthic folds and hypertelorism. Polycystic ovaries Note: relates to Stein-Leventhal also known as polycystic ovarian syndrome. E. XXX syndrome Note: describes a girl with XXX syndrome. During adolescence there is change in body habitus and there is excess hair grown and chronic and ovulation.MCQs PEDIATRICS 35) Theme : Genital disorders A. a condition associated with testosterone receptor defects that result in insensitivity to testosterone with resultant female genitalia. H. Polycystic ovaries F. XXX syndrome I.
Congenital cytomegalo virus infection Note: Low birth weight. Palestine . Investigations show a haemoglobin of 10 g/dL and an unconjugated bilirubin of 426 mmol/L. It is mainly unconjugated bilirubin. Pediatrician Consultant . He has gained a small amount of weight already. D. Biliary atresia C. Cystic fibrosis J. Haemolysis causes an unconjugated hyperbilirubinaemia. Galactosaemia H. She was delivered at home following a concealed pregnancy. and the haemoglobin is normal. white reflex suggesting congenital cataracts. Physiological jaundice B. Congenital spherocytosis F. jaundice and hepatosplenomegaly are indicative of a congenitally acquired infection. Levels can normally increase to 300 mmol/L with no adverse effects on the baby. Glucose-6-phosphate dehydrogenase deficiency I. A. Her mother had a late miscarriage one year previously and is blood group A negative. Hypothyroidism D.9 kg.MCQs PEDIATRICS 36) Theme : NEONATAL JAUNDICE A. Dr. 3) A 5 day old baby appears jaundiced but otherwise well and feeds normally. F.Kamel Youssef Hassan. Congenital cytomegalo virus infection G. Rhesus incompatibility Note: The previous miscarriage has sensitized the maternal immune system to the Rhesus antigen. Some reports say that levels are safe up to 400 mmol/L in a term well baby. Fructose intolerance For each of the following jaundiced babies. moderate jaundice.Gaza E-mail: kyh10557@yahoo. 1) A two-week-old full term baby with a birth weight of 1. Rhesus incompatibility E. select the most likely cause. The serum bilirubin is checked by the community midwife and found to be moderately elevated at 298 mmol/L. She was thought to be pale initially but her skin subsequently became more yellow. Physiological jaundice Note: This is a well baby and with only a slightly elevated unconjugated bilirubin.com 94 . On examination he has a white reflex on shining a bright light into both pupils. The rash is likely to be petechiae secondary to bone marrow failure from the infection. hepatosplenomegaly and a rash. a pansystolic murmur at the left lower sternal edge. 2) A 48 hour old baby who presents with poor feeding. ABO incompatibility unlikely unless the mother is blood group O. The blood film shows evidence of haemolysis but otherwise normal red cell morphology.
The baby often chokes or coughs with feeds and becomes cyanotic. Necrotising enterocolitis H. There is an inability to pass a nasogastric tube and there is often a history of maternal polyhydramnios. Hirschsprung's disease. bloody stools and signs of a sepsis. 3) A term baby is admitted to Special Care Baby unit with hypoglycaemic episodes. Pyloric stenosis J. It is most prevalent in low birth weight babies and the babies present with abdominal distension. Mid gut volvulus G. Necrotising enterocolitis Note: Necrotising enterocolitis is a life threatening condition resulting in mucosal and transmural necrosis. Meckel's Diverticulum F.MCQs PEDIATRICS 37) Theme : Causes of vomiting A. G. infant of a diabetic mother or maternal drug abuse. By day 4 the abdomen appears erythematous and the baby becomes apnoeic. D.Kamel Youssef Hassan. Dr. J. 2) A baby born at 33 weeks develops vomiting and abdominal distension on day 3. Pediatrician Consultant .com 95 . Meconium ileus D. Palestine . Tracheo-oesophageal fistula with atresia Note: Tracheo-oesophageal fistula with oesophageal atresia results in excessive oral secretions. Tracheo-oesophageal fistula with atresia Select the most appropriate option from the above list that would account for the following presentations: 1) A baby on the postnatal ward is seen to have a cyanotic episode during feeding. Meconium plug syndrome E. Meconium plug syndrome Note: Meconium plug syndrome is as a result of a plug of meconium causing obstruction. Peptic ulcer I.Gaza E-mail: kyh10557@yahoo. gastric retention. There is usually an underlying disease such as cystic fibrosis. Abdominal x-ray may reveal pneumatosis intestinalis. Gastro-oesophageal reflux B. His mother is a poorly controlled diabetic. Intussusception C. By day 4 the hypoglycaemia has resolved but the baby has not yet opened his bowels.
High reticulin or more specifically now anti-TTG antibodies are expected. Mum is a known asthmatic. Palestine . Gluten free diet Note: refers to Coeliac disease where a gluten free diet is appropriate. Metronidazole B. The disorder is usually temporary and can be managed by dietary adjustment. Gluten free diet C. 2) A 13 year old Irish girl complains of diarrhoea. Pediatrician Consultant . The diagnosis is confirmed by jejunal biopsy. Dr.Gaza E-mail: kyh10557@yahoo. 3) A 10 year old boy presents with faecal urgency and bloody diarrhoea. E. D. Breast milk allergy J. Crohn's disease and ulcerative colitis respectively. No action D. Praziquantel Select one option from the list above that is most suitable for the following patients: 1) A 7 month old baby has diarrhoea.MCQs PEDIATRICS 38) Theme : Treatment of Diarrhoeal illness A. Lactose free diet Note: refers to Cow's milk protein intolerance is mainly a clinical diagnosis with a history that symptoms appeared at the time of cow's milk ingestion. In Crohn's disease  the colonoscopy will reveal cobbled stone mucosal appearances with fistulae where as in ulcerative colitis  crypt abscesses are present. Steroids E. He is also under the care of ophthalmologists for a chronic iritis. High fibre diet I. She has high antireticulin antibodies B. Steroids Note: relates to inflammatory bowel disease. Vitamin D H. Lactose free diet F. She is Iron deficient and denies any history of GI upset after eating rice or potatoes.Kamel Youssef Hassan. which mother feels has been brought on by the introduction of weaning. Pancreatic enzyme supplements G.com 96 .
Pediatrician Consultant . This may also be accompanied by an excessive weight gain and dietary adjustment is indicated. Over feeding D. Cyclical vomiting B. 3) An 11 year old boy with a 3 month history of abdominal pain and weight loss presents with bloody diarrhoea. Gastro-oesophageal reflux I.MCQs PEDIATRICS 39) Theme : Causes of vomiting A. C. Ulcerative colitis Note: The last question relates to ulcerative colitis a form of inflammatory bowel disease. pyoderma gangrenosum. Her abdomen is soft and she has had 3 similar episode in the past year. 2) A 12 week old infant vomits after each feed. Gastro-enteritis H. Dr. E.Gaza E-mail: kyh10557@yahoo. Pyloric stenosis J. Meckel's diverticulum E. Cyclical vomiting Note: Cyclical vomiting.com 97 . A. Urinary tract infection Select one option from the list above that is most suitable for the following patients 1) An 8 year old girl shows signs of moderate dehydration. Associated features include arthritis. Over feeding Note: Over feeding frequently results in regurgitation and vomiting. In this case the child presents with recurrent bouts of profuse bloody diarrhoea often with mucus and abdominal pain.Kamel Youssef Hassan. Palestine . She has vomited all fluids of 24 hours and the vomit is not bile stained. This is thought to be a variant of migraine. Meconium ileus G. Ulcerative colitis F. He is developmentally normal and is fed by bottle at 260mls per kilo per day. erythema nodosum and anaemia. The child presents with bouts of vomiting which may persist for days and at times a headache is associated. Duodenal atresia C.
Laxatives if used over a prolonged period may enter the breast milk resulting in the baby developing diarrhoea. Lactulose G. Amiodarone needs to be avoided as it may result in neonatal thyroid abnormalities as there is a theoretical risk from the release of Iodine. Pediatrician Consultant . Lithium H.Kamel Youssef Hassan. Dr. Warfarin Which of the above drugs when prescribed to the mother is associated with the following abnormalities in the breast-fed infant: 1) May result in neonatal hypothyroidism. Sulphonamides J. Benzodiazepine D.Gaza E-mail: kyh10557@yahoo. Other drugs inhibit lactation.com 98 . A. C. Amiodarone 2) May result in drowsiness and failure to thrive. Palestine .MCQs PEDIATRICS 40) Theme : Drugs to be avoided during breastfeeding A. Benzodiazepine 3) May result in neonatal diarrhoea. F. Chloramphenicol E. Lactulose Comments: Administration of certain drugs to breast feeding mums may result in toxicity in the infants if the drug enters the milk in pharmacologically significant quantities. Heparin F. Amiodarone B. Some drugs also inhibit the babies sucking reflex. Sulfasalazine I. Aspirin C. Benzodiazepine may render the infant drowsy resulting in poor growth.
palpitations. G. Polyglandular endocrinopathy J. 95% of cases are due to 21 Hydroxylase deficiency and can be diagnosed by increased levels of 17OHP. Children present with headaches. E. 3) A 10 year old girl complains of headaches and vomiting. The salt wasting results in hyponatraemia (Na ) and hyperkalaemia (k ). Children present with accelerated head growth or headaches and examination findings include papilloedema and a bitemporal hemianopia This tumour may result in diabetes insipidus. Craniopharyngioma F. Examination reveals a phallus with pigmented labial scrotal folds and the baby is found to be hyponatraemic. They are found to be hypertensive. Hypoadrenalism G. Phaeochromocytoma H. which is a tumour arising from the adrenal medulla or chromaffin cells.MCQs PEDIATRICS 41) Theme : Paediatric endocrinology A. Panhypopituitarism I. hypothyroidism and growth hormone deficiency. Pediatrician Consultant . Phaeochromocytoma Note: describes a child with Neurofibromatosis complicated by  phaeochromocytoma. Examination reveals a bi-temporal hemianopia and papilloedema. vomiting and night sweats. 3 Beta hydroxysteroid dehydrogenase deficiency B. Numerous café au lait lesions are found over her trunk.com 99 . On examination she is noted to be pale and her blood pressure measures 135/90. Dr.Kamel Youssef Hassan.Gaza E-mail: kyh10557@yahoo. Palestine . 17 Hydroxylase deficiency C. Craniopharyngioma Note: refers to a child with a Craniopharyngioma which is the commonest supratentorial tumour found in children. C. 2) A term baby is born with ambiguous genitalia. Adrenal hyperplasia E. 21 Hydroxylase deficiency Note: describes a baby with congenital adrenal hyperplasia. pallor. 21 Hydroxylase deficiency D. Primary aldosteronism Select the most appropriate diagnosis from the above options to explain the following presentations: 1) An 8 year old boy presents with a history of enuresis.
42) Theme : Drugs to be avoided during breastfeeding A. Amiodarone B. Aspirin C. Benzodiazepine D. Chloramphenicol E. Heparin F. Lactulose G. Lithium H. Sulfasalazine I. Sulphonamides J. Warfarin Which of the above drugs, when prescribed to the mother, is associated with the following abnormalities in the breast-fed infant: 1) May result in hypotonia and cyanosis. G. Lithium 2) May result in prolonged jaundice. I. Sulphonamides 3) May result in platelet dysfunction. B. Aspirin Comments: Administration of certain drugs to breast-feeding mums may result in toxicity in the infants if the drug enters the milk in pharmacologically significant quantities. Some drugs also inhibit the babies sucking reflex. Other drugs inhibit lactation. Lithium is also to be avoided as it may result in reduced tone and cyanotic episodes. Aspirin may result in a possible risk of Reyes syndrome; regular use may impair platelet function, as well as producing a hypoprothrombinaemia, especially if the infant is low in Vitamin K stores.
43) Theme : Genital disorders A. Aarskog syndrome B. Fragile X C. Gonadal dysgenesis D. Hermaphroditism E. Polycystic ovaries F. Testicular feminisation syndrome G. XO syndrome H. XXX syndrome I. XXY syndrome J. XYY syndrome Select the most appropriate diagnosis from the list above that best describes the following cases 1) A young child is noted to have Cryptorchidism and a shawl scrotum. A. Aarskog syndrome Note: describes a boy with Aarskog syndrome. Features include mild – moderate learning difficulties, short stature, facial dysmorphic features include hypertelorism anteverted nostrils and a webbed neck. Genital abnormalities include shawl ‫ ﺷﺎل‬scrotum and cryptorchidism ► (hidden or obscure testis). 2) A 12 year old boy is noted to have a long thin face, micropenis, hypospadias and has learning difficultie J. XYY syndrome s Note: relates to a child with XYY syndrome. Individuals are usually tall and have learning difficulties and abhorrent ‫ ﻣﺷﻣﺋز‬behaviour. 3) A child is noted to have macrocephaly and macroorchidism. B. Fragile X Note: describes a boy with Fragile X syndrome. Features include moderate learning difficulties, speech delay and autistic features. They have large heads and prominent ears as well as testicular enlargement.
44) Theme : ABDOMINAL PAIN A. Peritonitis B. Appendicitis C. Constipation D. Urinary tract infection E. Mesenteric lymphadenitis F. Migraine G. Intussusception H. Henoch-Schonlein vasculitis I. Psychosomatic J. Shigella dysentry For the following patients with abdominal pain, choose the most likely diagnosis. 1) A 7 year old girl who has felt anorexic since the previous evening and has vomited 3 times since. She has abdominal pain, which was made worse by the bumpy car journey to hospital. B. Appendicitis Note: A typical description of appendicitis. In the younger child/ baby there is often a later presentation with perforation of the appendix being relatively more common, as these children are not able to articulate their pain and localization of pain is more difficult to discern with examination. 2) A 4 year old boy who has a sore throat, mild fever and peri-umbilical abdominal pain. E. Mesenteric lymphadenitis Note: Preceding sore throat and periumbilical pain are typical of mesenteric lymphadenitis in a relatively well child. 3) A 9 year old boy has intermittent severe generalized colicky abdominal pain which is getting worse. He has started to vomit over the last 24 hours. He has a history of recurrent abdominal pain. Examination reveals a mass in the left iliac fossa. C. Constipation Note: This is a description of chronic severe constipation, which in extreme cases can cause obstruction. There is faecal loading implying the chronicity. When it is this severe it is important to rule out other pathology and consider the possibility that is a manifestation of child abuse
thyroxine. Congenital adrenal hyperplasia Note: Virilising Congenital adrenal hyperplasia (CAH) typically presents with symptoms of androgen excess. Congenital adrenal hyperplasia Which is the most likely diagnosis in the following cases: 1) A 4 year old girl present s with vaginal bleeding and café –au-lait pigmentation which stops at the midline. Premature thelarche J. Cliteromegaly and a sustained increase in height velocity does not occur in adrenarche. Palestine . There was an acceleration in her height velocity and no symptoms of oestrogen excess. 2) A 3 year old girl presents with pubic hair development. Premature thelarche Note: There may be a slight FSH predominance on the basal gonadotrophin levels. Craniopharyngioma B. J. I. There is often behavioural disturbance with mood swings. McCune-Albright syndrome Note: McCune Albright syndrome is caused by an activating mutation of the GS alpha subunit. Neurofibromatosis type 1 G. Exaggerated adrenarche C.Gaza E-mail: kyh10557@yahoo. Hypothyroidism I. Subsequent investigations demonstrate gonadotrophin-independent puberty C. Premature thelarche is self limiting and thought to be the result of the body being exquisitely sensitive to low levels of oestradiol.MCQs PEDIATRICS 45) Theme : PRECOCIOUS PUBERTY A. oestradiol. Examination is otherwise normal as is her height velocity. McCune-Albright syndrome D. This results in autonomous secretion of certain hormones e. There may be associated skin pigmentation and fibrous dysplasia. Granulosa-theca cell tumour H. Hypothalamic hamartoma E. Diagnosis is confirmed by a raised 17 hydroxyprogesterone. 3) A 2year old girl presents with isolated bilateral breast development.Kamel Youssef Hassan. Dr. cortisol.g.com 103 . Neurological examination was normal. Pediatrician Consultant . Thelarche variant F. cliteromegaly and acnes. Subsequent investigation demonstrates undetectable oestradiol levels and a prepubertal response to an LHRH test.
Palpation of the abdomen reveals a sausage shaped mass. Dr.com 104 . tumour or an area of oedema secondary to Henoch Schonlein purpura. C. B. vomiting and constipation. Mid gut volvulus G. The child presents with pain. Pyloric stenosis J. Intussusception C. Meckel's diverticulum. Meconium ileus Note: Meconium ileus syndrome is the commonest form of small bowel obstruction and the baby presents with distension.Kamel Youssef Hassan. An x-ray may reveal a ground glass appearance. vomiting and signs of shock. Necrotising enterocolitis H. On examination an olive sized mass is palpable. Meconium plug syndrome E. Babies present with projectile vomiting and examination may reveal visible peristaltic waves and an olive sized mass may be palpable in the upper epigastrium. Tracheo-oesophageal fistula with atresia Select the most appropriate option from the above list that would account for the following presentations: 1) 5 week old breast fed baby is admitted with a 2 week history of vomiting and dehydration.Gaza E-mail: kyh10557@yahoo. Meconium ileus D. 3) A baby with cystic fibrosis develops vomiting and abdominal distension. Intussusception Note: Intussusception – a segment of bowel becomes telescoped in to an adjacent of bowel often in areas where the bowel is aperistaltic. On examination he is mottled and has a delayed capillary refill time. Pediatrician Consultant . 2) A 3 month old baby boy is admitted with episodic screaming. for example Peyer's patches. Meckel's Diverticulum F. A ground glass appearance is seen on x-ray. Gastro-oesophageal reflux B. A mass may be palpable in the right upper quadrant. Peptic ulcer I. Pyloric stenosis Note: Pyloric stenosis is most prevalent amongst first born male and age of onset is usually between 3-6 weeks of age. I.MCQs PEDIATRICS 46) Theme : Causes of vomiting A. Palestine .
Is starting to take 1-2 steps. Palestine . 4 months 2) A baby can rise independently and stands momentarily alone. from the list of options. 2 months C. 1 year H. He or she can ascend stairs with assistance. 5) Sitting unsupported is usually seen by 6-7 months and 6) At 9 months the baby can start to crawl. Dr. 4) At 6 months the baby is starting to sit up with support for example cushions. 1 month B. 3 years For each description of a child's gross motor development choose.com 105 . 2) By 4 months head lag is lost and this is evident when raised from supine to the sitting position. 1) A baby has good head control with no head lag when pulled from supine to sitting. 11)At 3 the child can ascend stairs in an adult fashion using alternating feet per step. 18 months I.Gaza E-mail: kyh10557@yahoo. 10 months G. 6 months E. 1) At 3 months when placed prone an infant can lift his head with his arms extended. 7) Cruising is usually achieved by about 10 months.MCQs PEDIATRICS 47) Theme : Gross motor development A. the highest development age the child is most likely to have achieved. however is unable to descend the stairs in such a fashion until 4 years of age.Kamel Youssef Hassan. 2 years J. C. 4 months D. 10)At 20 months the child can climb the stairs holding on to a rail. G. 2 years Comments: This question tests your knowledge of the development stages of gross motor skills. 8) At 12 months the baby can rise independently and often starts to take a few steps alone. I. 1 year 3) A child who is walking and runs stiffly can climb stairs if hand is held. Pediatrician Consultant . 9) At 18 months the toddler can run although this is usually in a tiff fashion. 8 months F. 3) At 5 months the baby starts to roll over.
Gaza E-mail: kyh10557@yahoo. Turner’s syndrome I. Hypothyroidism G. An insulin tolerance test demonstrates a peak growth hormone level of 25 mU/l. 2) A 7 year old boy was referred to clinic for investigation of short stature. 3) A 3 year old girl presents with stature well below the 0. Familial short stature E. Skeletal dysplasia F. Hypothyroidism Note: Height velocity will improve once abuse is removed. Constipation and poor attention span are common symptoms of hypothyroidism in children. GH deficiency is not suggested here.Kamel Youssef Hassan. other wise she is very well. Turner’s syndrome Note: The insulin tolerance test should only be performed if there is growth data that suggests growth failure and other causes of short stature have been ruled out. Dr. Psychosocial deprivation D. Familial short stature Note: Short stature with no evidence of growth failure and a height within the target centile range indicate familial short stature which requires no further investigation. She is very short and also well i. Previous height measurements from his GP show no evidence of a reduction in height velocity. His height is below the 0. She had a past history of pedal oedema at birth and uncomplicated repaired coarctation of the aorta. He is well and apart from occasional headaches has no other complaints. H. Craniopharyngioma H. She suffers with constipation and her teacher has noticed her attention span has got worse recently.4 th centile and within the target centile range calculated from his parents heights. Her height velocity has slowed down and she has gained weight. Palestine . Pediatrician Consultant .4 th centile. D. Constitutional delay of growth B.com 106 . Growth hormone deficiency C. F.MCQs PEDIATRICS 48) Theme : SHORT STATURE A. She was placed in foster care for the last 18 months and is said to much happier. other pathology unlikely. A previous history of coarctation and pedal oedema suggests Turner’s syndrome. She has been treated for constipation in the past but this has resolved.e. Cushing’s syndrome Which is the most likely diagnosis in the following cases? 1) A previously abused 4 year old child presents with growth failure over the last 12 months.
usually found in long bones particularly the femur. This genetic predisposition is contrary to the Burkitt's nasopharyngeal carcinoma which is more common in black children than white (by 7 fold). Pediatrician Consultant . This malignancy is 30 times more common in white children compared to black children. Dr. It may present with pain. There is a poor prognosis. This tumour has been associated with the Epstein-Barr virus and children present with sore throats. A solid tumour found in new-borns with girls being affected more than boys. Burkitt's nasopharyngeal carcinoma Comments: Item 1 relates to a baby born with a sacrococcygeal teratoma.Gaza E-mail: kyh10557@yahoo. Neuroblastoma H. Palestine . Wilm's tumour J. Ewing sarcoma 3) A child of Nigerian parents presents with a unilateral tender cervical node. A. Burkitt's nasopharyngeal carcinoma B. Ewing sarcoma is a tumour of the bone.com 107 .MCQs PEDIATRICS 49) Theme : Childhood malignancies A. Hodgkin's lymphoma E. Teratoma 2) A young child presents with fevers and a mass in the femur is noted and a diagnosis of malignancy is made. It is a mixed germ cell tumour and may be associated with gastrointestinal or genital urinary symptoms.Kamel Youssef Hassan. fever and tenderness and sometimes pathological fractures. cervical lymphnodes. A diagnosis of malignancy is made with this malignancy being 7 times more common in Black Children compared with White children. trismus and weight loss. 1) A baby is born with a solitary mass over the right buttock. Xeroderma pigmentosum Select the most appropriate oncological diagnosis from the above list of options to explain the following scenarios. H. Melanoma F. Ewing sarcoma C. B. Nesidioblastosis G. Teratoma I. unilateral tenderness. It is 30 times more common in white children than black children. Hepatoblastoma D.
I.Gaza E-mail: kyh10557@yahoo. Complete paralysis of the oculomotor nerve causes ptosis. Facial 3) A 15 year old girl on treatment for Nephrotic syndrome presents with a vesicular rash involving the right conjunctiva and right forehead. Dr. The pupil is enlarged and the eyes deviated inferiorly and laterally. Trigeminal Comments: The oculomotor nerve innovates the superior inferior and medial rectus as well as the inferior oblique and the levator palpebrae muscles. Oculomotor F.Kamel Youssef Hassan. maxillary and the mandibular routes and motor function may be tested by examining the masseter and temporalis muscles. E. Palestine . Trochlear I.MCQs PEDIATRICS 50) Theme : Cranial Nerves A. Glossopharyngeal E. dilatation of the pupil and displacement of the eye outwards and downwards. The Trigeminal nerve – sensory distribution to the face is divided in to ophthalmic. Olfactory G. He is unable to whistle or show is teeth on that side. Optic H. Oculomotor 2) A 12 year old boy complains of a numb feeling to the left side of his face.com 108 . An upper motor neurone facial nerve palsy is diagnosed by decreased voluntary movement of the lower face with flattening of the nasal folds. There is a right sided ptosis. Auditory C. Vagus Which of the above cranial nerves is affected in the following cases? 1) A 3 year old girl recovering from a pneumococcal meningitis complains of a painful right eye. Trigeminal J. Abducens B. where as a lower motor neurone lesion tends to involve the upper and lower facial muscles. which is very tender to touch. C. Facial D. Pediatrician Consultant .
Benign intra-cranial hypertension Comments: Intra-cranial tumours. Causes of which are multiple for example metabolic disorders. 1) A 6 year old girl with a history of Still's disease presents with a 2 month history of headache and diplopia She is admitted to hospital. Sub arachnoid haemorrhage 3) A 16 year old obese girl with a long history of headaches is found to have papilloedema. Pseudotumour Cerebri 2) A 4 month old infant presents with poor feeding and irritability. E. drugs. LP usually reveals high opening pressures and treatment includes removal of any precipitant with possible serial LP and removal of CSF. Tension headache Select the most appropriate diagnosis from the above list that would explain the following cases. tetracyclines and rarely Growth Hormone therapy.Gaza E-mail: kyh10557@yahoo. Pediatrician Consultant . Dr. Cerebral tumour C. Encephalitis E. I. Meningitis G. The rest of the neurological examination is normal as is the CT scan. infections. Pseudotumour Cerebri F.brain tumours are second to leukaemia as the most prevalent malignancy in childhood. Investigations carried out include a normal CT scan.com 109 . Infratentorial tumours are more common in the paediatric age group than supratentorial tumours and the MRI scan is the best radiological tool for delineating brain tumours.Kamel Youssef Hassan. Subdural haemorrhage I. Pseudotumour cerebri is a clinical syndrome mimicking brain tumours and characterised by normal CSF pressure and cell count and a normal structure to the brain. Palestine . normal CSF profile and normal opening pressures. Cluster headache D. Migraine H. Sub arachnoid haemorrhage J. On examination he has a torticollis and his head circumference has increased form the 50th – 98th centile since his last measurement 6 weeks ago. It is more common in association with obesity. Children present with either signs of increased intra-cranial pressure or with focal neurological signs. Treatment focuses towards the underlying aetiology and pseudo tumour cerebri is mainly self limiting.MCQs PEDIATRICS 51) Theme : Causes of Headaches A. Benign intracranial hypertension is associated with pregnancy as well as drugs such as the oral contraceptive. haematological disorders. Benign intra-cranial hypertension B. A.
Pediatrician Consultant . 3) A 14 year old haemophiliac patient presents with lower abdominal pain and a limp. A. It is sharp and steady.8°C.MCQs PEDIATRICS 52) Theme : Causes of abdominal pain A.com 110 . Temperature is 38. nausea and has not passed a bowel motion for 24 hours. Pyelonephritis J. Psoas haematoma Note: Bleed into the Psoas muscle which may be due to coagulopathy or secondary to sepsis (DIC) results in back pain radiating to the hip with painful flexion at the hip joint.Kamel Youssef Hassan. weight loss and tenesmus. B. Inflammatory bowel disease C.Gaza E-mail: kyh10557@yahoo. Meckel's diverticulum E. Attempts to straighten his leg results in excruciating pain H. Inflammatory bowel disease Note: Inflammatory bowel disease results in recurrent lower abdominal pain. emesis and local tenderness. it results in nausea. Palestine . Irritable bowel syndrome D. Ovarian cysts G. Ureteric calculus Select the most appropriate diagnosis from the above list for the following presentations 1) A 13 year old boy with umbilical pain for the last 4 days presents with anorexia. The pain is dull and crampy in nature and is associated with fever. He is tender in the right lower quadrant and has an anal fistula. Pelvic inflammatory disease H. Acute appendicitis B. Muscle strain F. often radiating to the back. Acute appendicitis Note: The pain of acute appendicitis starts off as a peri-umbilical pain which then locates to the right iliac fossa and is some times referred to the back. Psoas haematoma I. Dr. 2) A 10 year old boy with lower abdominal pain for the last 10 days presents with a history of passing 6-8 loose stools.
com 111 . 5 years 3) Able to identify colours H. 3 years Comments: It is important to be familiar with the developmental milestones. draw a triangle from copy.MCQs PEDIATRICS 53) Theme : NORMAL DEVELOPMENT A. Developmental milestones are in Illingworth: 'The Normal Child'. E. 18 months G. Pediatrician Consultant . 4 years J. 4 weeks B. Dr.Kamel Youssef Hassan. 2 years H. 5 years At what age would you expect the average child to achieve the following milestones:1) Show casting. 12 months F. name the heavier of 2 weights. count up to ten and ask questions about meaning of words. Milestones are grouped under 4 headings:     Gross motor Fine motor Hearing and language social You should know the age range for each milestone. 3 years I. 2 months C. 12 months 2) Able to skip. particularly up to the age of 3 years. able to pick up small objects with a neat pincer grasp and have developed concept of object permanence. 10 months E.Gaza E-mail: kyh10557@yahoo. Palestine . J. 7 months D.
Asparaginas 3) An anthracycline with a serious risk of cardio-toxicity. Bleomycin is the main drug resulting in lung damage and occurs in up to 10% of patients. General side-effects include nausea. Asparaginase results in a dose related Pancreatitis. It also has an affect on the autonomic system resulting in severe constipation and paralytic ileus. Doxorubicin I. Cyclophosphamide 2) A drug inhibiting protein synthesis may result in a dose related Pancreatitis. Doxorubicin Comments: All cytotoxic agents have adverse effects. C. vomiting and bone marrow suppression. It may also result in sensory changes with parathesis progressing to loss of tendon reflexes. F. More specific side-effects are listed in the questions above. alopecia and stomatitis.Kamel Youssef Hassan. which is often very difficult to detect. Monitoring with echocardiograms is advised.com 112 . Vincristine is an alkaloid agent and results in sensory motor neuropathy with long-term use. The damage is dose related. (Doxorubicin and Daunorubicin) are cardiotoxic. Actomyosin D C. H. 6-Mercaptopurine B. Alkylating agents such as Cyclophosphamide may cause a haemorrhagic cystitis. Dr. Bleomycin E. Cyclophosphamide G. Pediatrician Consultant .g. Vincristine Select the most appropriate chemotherapeutic agent from the above list that corresponds with the following actions and side effects: 1) An alkylating agent resulting in haemorrhagic cystitis.MCQs PEDIATRICS 54) Theme : Chemotherapy A. Palestine . Cytosine arabinoside H. The Anthracyclines e.Gaza E-mail: kyh10557@yahoo. Methotrexate J. Asparaginase D. Cisplatin F.
Klinefelter's syndrome E. 2) Boy is seen in cardiology clinic for investigation of a murmur heard on routine check. Laurence Moon Biedl syndrome J. He is clumsy and previously been investigated for hypotonia. MCune Albright syndrome Which is the most applicable diagnosis for the following children? 1) A boy with learning difficulties and short stature is found to have pulmonary stenosis when investigated for a murmur. G. downslanting eyes. Turner's syndrome C. bossed forehead and prominent jaw. He has some dysmorphic features including wide carrying angle of the arms.MCQs PEDIATRICS 55) Theme : SYNDROMES A. He has a large head. Klippel-feil syndrome I. F. Treacher-Collins syndrome F. 3) A child with learning difficulties was noticed to be long at birth. C. Pulmonary stenosis is the most frequent congenital heart lesion. Down's syndrome B. Sotos syndrome H. He is noted to be above the 98th centile in height for his age. Dr. arachnodactly and a predisposition to pneumothoraces. Noonan's syndrome D. Palestine . Marfan's syndrome Note: Marfans syndrome is also associated with a high arched palate.Gaza E-mail: kyh10557@yahoo.com 113 . Noonan's syndrome Note: Children with Noonan’s syndrome have short stature and may have delayed puberty. Pediatrician Consultant . Sotos syndrome Note: This is a typical description of Sotos syndrome which is one of the overgrowth syndromes. His father died at an early age from aortic dissection. There is also associated short sightedness. Marfan's syndrome G.Kamel Youssef Hassan.
Dermatomyositis C. a chronic fibrotic disturbance which tends to be relapsing and remitting. Kawasaki diseas Note: Kawasaki's disease  is also known as mucocutaneous lymph node syndrome. The condition is often associated with underlying malignancy. Juvenile chronic arthritis F. a multi system disease where individuals have a violaceous heliotrope rash around the eyes.Kamel Youssef Hassan. Cardiac involvement is present in approximately 30% of cases and this is a serious complication.MCQs PEDIATRICS 56) Theme : Connective tissue disease A. Ehlers Danlos syndrome D. It affects the GI tract. Pediatrician Consultant . I. F. Osteogenesis imperfecta H. Palestine . Rheumatic fever I. It is a clinical diagnosis made by a history of fever for 5 days. Scleroderma J. Kawasaki disease G. bilateral conjunctivitis. 2) A 5 year old presents with conjunctivitis fever and desquamation of the periphery. Scleroderma Note: describes a child with scleroderma. Dermatomyositis Note: relates to the diagnosis of Dermatomyositis. mucosal involvement and peripheral changes including erythema and desquamation. Henoch Schonlein purpura E. Guttron’s patches on the knuckles and inflammation of muscles and joints resulting in weakness in muscles and arthritis. 3) A 10 year old girl presents with weight loss.Gaza E-mail: kyh10557@yahoo.com 114 . Ankylosing spondylitis B. heart lungs and kidneys. peri-orbital oedema. Dr. weakness and is noted to have a photosensitive rash. Systemic lupus erythematosus Select one of the above diagnoses that would explain the following presentations: 1) A 12 year old girl presents with oesophageal dysmotility. B. interstitial pneumonitis and has cardiac conduction abnormalities (arrhythmias).
rash. Herpes simplex encephalitis 2) A baby is born at term weighing 2. encephalitis and sub arachnoid haemorrhage. Congenital toxoplasmosis D. white cell count. Congenital rubella C. high protein and low glucose. Congenital toxoplasmosis affected infants may have fever.Gaza E-mail: kyh10557@yahoo.5-6 ) (normal protein g/l 0. Pneumococcal meningitis H. Tuberculous meningitis Comments: Examination of the cerebral spinal fluid is essential in confirming the diagnosis of conditions such as meningitis. Glucose is reduced (1/3 the serum) however the protein concentration is elevated (0. Prognosis is guarded as affected patients may have persistent neurological disability.5kilos. Bacterial meningitis B. Routine CSF study includes red cell count.Kamel Youssef Hassan. hepatosplenomegaly. (Brain Calcification in CMV infection periventricular . The main contraindication for performing a lumbar puncture is any condition that may lead to “Coning” or Herniation of intra-cranial contents. in toxoplasmosis  widespread No calcification in rubella) Dr. They may have dysmorphic features such as microcephaly or hydrocephalus. In meningitis typical CSF findings include A neutrophilic pleocytosis with an elevated protein and reduced glucose. Tuberculous meningitis J. Varicella cerebellitis Select the most likely diagnosis from the above list that would account for the following presentations 1) A child is admitted with alternating levels of consciousness and a high temperature. Status epilepticus I. Leukaemic infiltration F. Therefore fundoscopy to exclude the presence of papilloedema is essential. Pediatrician Consultant .4). petechiae. Palestine .MCQs PEDIATRICS 58) Theme : Causes of headache and fever A. EEG shows periodic. microphthalmia and chorioretinitis. An ultrasound scan of his head reveals calcification. Herpes simplex encephalitis E. D. Meningococcal meningitis G. Cerebral calcification is common. I. C. Further cytopathology studies may be indicated. He is noted to have microcephaly.com 116 . In Tuberculous meningitis  the cell count is elevated and the predominance of lymphocytes. His CSF shows 10 white cells predominantly lymphocytes.2-0. With Leukaemic infiltration of the central nervous system atypical  Leukaemic cells may be present in the CSF. Congenital toxoplasmosis 3) A baby of 6 months has a full septic screen. In encephalitis CSF is typically  normal. lateralised epileptiform discharges. Gram stains reveal organisms in approximately 80% of cases of bacterial meningitis. glucose protein and bacterial cultures.
The abducens nerve innovates bilateral rectus muscle of the eye therefore paralysis causes medial. G. maxillary and the mandibular routes and motor function may be tested by examining the masseter and temporalis muscles. Trochlear I. deviation of the eye and inability to abduct the eye beyond the mid-line. I. Trigeminal J.com 117 .Gaza E-mail: kyh10557@yahoo. Abducens Comments: The first case has probable benign intracranial hypertension causing papilloedema. Trigeminal 3) A 15 year old boy recovering from a head injury is unable to abduct his right eye beyond the mid-line. Vagus Which of the above cranial nerves is affected in the following cases? 1) A 16 year old female who is pregnant complains of headaches and has blurring of the disc margin on fundoscopy. Auditory C. Olfactory G. A.MCQs PEDIATRICS 59) Theme : Cranial Nerves A. Facial D. He develops seizures in the second week of life. Oculomotor F.Kamel Youssef Hassan. Glossopharyngeal E. Abducens B. The Trigeminal nerve – sensory distribution to the face is divided in to ophthalmic. Optic H. Dr. The optic nerve is examined by fundoscopy as well as visual acuity and visual fields. Optic 2) A baby is born with an ipsilateral diffuse birth mark over the right side of his face. Palestine . Pediatrician Consultant .
Vitamin D deficiency J. Laryngomalacia G.Gaza E-mail: kyh10557@yahoo. It can also complicate immune-deficiency states and Cystic fibrosis. This process may follow a severe pneumonia for example pertussis. Broncho pulmonary dysplasia E. Cardiac failure F. She is born in poor condition and stridor is noted shortly after birth. Asthma B. Tracheal oesophageal fistula I.MCQs PEDIATRICS 61) Theme : Childhood Breathlessness A. J. Bronchiectasis typically produces clubbing and haemoptysis as well as persistent crepitations in the chest.com 119 . Tracheal oesophageal fistula 2) A girl with hypogammaglobulinaemia develops haemoptysis and a purulent sputum. such as hydrocephalus. Tracheal haemangioma H. C. H. Bronchiolitis C. Bronchiectasis 3) A baby is born by a ventouse delivery following failed forceps.Kamel Youssef Hassan. Palestine . Vocal cord palsy Select the most appropriate choice from the above list that is the most appropriate diagnosis in the following cases 1) A premature baby presents with a cough and cyanotic episodes during feeds. Vocal cord paralysis is the answer to Item 6. The features result from abnormal ciliary function. Bronchiectasis D. measles. Stridor from birth may occur as a result of birth trauma or an abnormality of the central nervous system. Vocal cord palsy Comments: Item 1describes a baby with tracheo-oesophageal fistula. Dr. TB. which typically presents with a cough and choking cyanotic episodes during feeds. Pediatrician Consultant . Kartagener's syndrome is a triad of 1) bronchiectasis 2) sinusitis 3) dextrocardia.
On arrival hyponatraemia and hyperkalaemia is revealed. Craniopharyngioma F. Addison's disease. Within the first few weeks hypoglycaemia is diagnosed. Dr. This is due to haemorrhage into the adrenal glands. 3) A baby is born at term. gonadotrophin's and prolactin as well as growth hormone. Palestine . 21 Hydroxylase deficiency D. Primary aldosteronism Select the most appropriate diagnosis from the above options to explain the following presentations: 1) A child is admitted to ITU with meningococcaemia. 3 Beta hydroxysteroid dehydrogenase deficiency B. Hypoadrenalism G. 17 Hydroxylase deficiency C. In Panhypopituitarism the deficiency may be of growth hormone only or of multiple hormones and therefore laboratory investigations should include thyroid function tests. In this case a child with diabetes. Panhypopituitarism I. I.Kamel Youssef Hassan. Hypoadrenalism Note: describes a child with meningococcaemia complicated by hypoadrenalism of WaterhouseFriderichsen syndrome. IV fluids and Glucose).com 120 . The growth of the baby is monitored closely and By 9 months of age parameters have fallen to the second centile. She is found to have thin hair. Urinary electrolytes reveal high levels of Sodium and Chloride and low levels of Potassium. They are usually normal in birth size. If the condition is unrecognised adrenal crisis may result and therefore treatment must be immediate and vigorous (Hydrocortisone. H. Panhypopituitarism Note: The last question describes a baby with growth hormone deficiency. 2) A child attending diabetic clinic complains of feeling tired. Blood tests reveal low Calcium and high Phosphate. Polyglandular endocrinopathy Note: describes a child with Polyglandular endocrinopathy. hypoparathyroidism and chronic mucocutaneous Candidiasis (type 1 Polyglandular endocrinopathy.MCQs PEDIATRICS 62) Theme : Paediatric endocrinology A. Babies with growth hormone deficiency present with episodes of hypoglycaemia and may present as an emergency with apnoeic episodes or cyanotic episodes. patches of vitiligo and the tongue is coated in white. cortisol and ACTH. Polyglandular endocrinopathy J. F. Pediatrician Consultant .) Type 2 Polyglandular endocrinopathy is diagnosed if there is history of hyperthyroid disease or diabetes plus Addison's disease. Adrenal hyperplasia E. however by 1 year of age growth has tailed off. vitiligo.Gaza E-mail: kyh10557@yahoo. From the above option Panhypopituitarism is the answer. Phaeochromocytoma H. Birth weight is on the 50th centile.
On examination there is power with gravity eliminated in her legs. Spinal tumour F. very brisk ankle and knee jerks and upgoing plantar responses. Duchenne muscular dystrophy I. Transverse Myelitis C. She has been passing urine frequently and with difficulty.MCQs PEDIATRICS 63) Theme : WEAKNESS IN THE LOWER LIMBS A. scoliosis and calf pseudohypertrophy are also features. Multiple sclerosis D. Duchenne muscular dystrophy Note: DMD occurs in boys(X-linked recessive) and presents with delayed walking i. Speech delay.com 121 .> 18months. Congenital myopathy H. Transverse Myelitis Note: The features are suggestive of a lower motor neurone lesion which could also be Dr. On examination his lower limb reflexes are normal.weighted images. Her bladder is palpable up to the umbilicus. Guillain-Barre syndrome B. Sensation is reduced to touch below T5. vibration and position sense are preserved 3 weeks previously she had a presumed viral illness. Fascioscapulohumeral dystrophy J. H. He walked independently at 20 months and has received speech therapy for a mild speech delay. his muscles are well developed distally although weak proximally. B.Kamel Youssef Hassan. Palestine . cardiomyopathy. Lumbar puncture shows 33 lymphocytes and monocytes per microlitre and protein 570 mg/L in the CSF. Dermatomyositis G. Pediatrician Consultant .Gaza E-mail: kyh10557@yahoo. 2) A 12 year old girl presents with a 5 day history of progressive weakness in her legs and is now unable to walk. MRI brain is normal but shows swelling and increased signal over the spinal cord T5-7 on T1. Chronic fatigue syndrome E.e. Spinal abscess For these children with lower limb weakness select the most likely diagnosis 1) A 4 year old boy is brought to clinic by his mother who feels he has weak legs and is finding climbing the stairs difficult.
Gaza E-mail: kyh10557@yahoo. D. 3) A 14 year old girl has been off school for 4 months with headaches. In the initial weeks of her illness she had a low-grade fever.com 122 . The CSF lymphocytosis and increased protein may be seen in transverse myelitis. Chronic fatigue syndrome Note: The previous viral illness and subsequent lethargy with no consistent abnormal investigations suggest chronic fatigue syndrome.MCQs PEDIATRICS caused by a spinal tumour / abscess however the MRI would demonstrate these latter pathologies. These were re-checked 1 month later when they had normalised and thyroid function. Dr. symmetrical with downgoing plantar responses. Pediatrician Consultant .Kamel Youssef Hassan. Transverse myelitis has unknown aetiology but has been postulated to have a viral or mycoplasma origin. It is difficult to get her full co-operation for examination but there are no objective signs of weakness and reflexes are all present. Palestine . A blood count showed atypical lymphocytes and liver function tests show a raised AST. urine culture urea & electrolytes were also normal. sore throat and cervical lymphadenopathy. tiredness and weakness of her legs.
3) A 10 year old girl presents with back pain. Osteogenesis imperfecta Note: Collapsed vertebra and osteopenia are uncommon in children. I. She is otherwise healthy and well-grown for her age. type 1 osteogenesis imperfecta is likely. A. Rickets E. She now presents with a greenstick fracture of the femur following a trivial fall in the care of the experienced foster-mother who has been known to social services for many years.MCQs PEDIATRICS 64) Theme : FRACTURES IN CHILDREN A. A spinal X ray shows collapsed lumbar vertebrae at L3 and L4 and generalized osteopenia. Palestine . Osteogenesis imperfecta J. I. 1) A 15 month girl is in foster care following child protection procedures when she presented with a spiral fracture at the age of 11 months. This condition is an important differential of NAI.Gaza E-mail: kyh10557@yahoo. Dr. There had been no explanation offered for the original injury.com 123 . Hypoparathyroidism G. Metabolic bone disease of prematurity F. Pediatrician Consultant . Child physical abuse C. She is just walking independently. Her mother is single. poorly supported and had been suffering from postnatal depression at the time. 2) An 11 month old girl is brought to casualty refusing to move her left arm. The mother says that 30 minutes previously she lifted her daughter out of the bath and lost grip of her right hand and her body momentarily twisted round her left arm. Accidental fracture Note: There is no delay in presentation and the mechanism of injury fit the description of the episode. An xray demonstrates a spiral fracture of the humerus. Accidental fracture B.Kamel Youssef Hassan. Skull X-ray shows several Wormian bones. Osteoporosis D. Hypophosphatemic rickets H. Osteopetrosis For each patient select the most likely diagnosis. Coupled with low trauma fractures and no dysmorphism. Osteogenesis imperfecta Note: Wormian bones are indicative of osteogenesis impefecta. Pseudohypoparathyroidism I. She has a history of 3 previous limb fractures after relatively trivial falls.
Gaza E-mail: kyh10557@yahoo. Child physical abuse Note: It is imperative to determine whether the mechanism of injury is compatible with the history. Hypophosphatemic rickets H. The excessive head growth is likely to be secondary to a previous shaking injury which has resulted in an intracerebral bleed and hydrocephalus. Osteoporosis D. Palestine .com 124 . 1) A toddler of 3 years presents to the accident and emergency department with swelling of his leg and is found to have a spiral fracture of the tibia. Rickets E.Kamel Youssef Hassan. B. His mother reports that he had tripped and fallen the previous day but she had not noticed any sign of injury at the time.MCQs PEDIATRICS 65) Theme : FRACTURES IN CHILDREN A. Dr. A. Accidental fracture Note: This history could be compatible with an accidental injury. Osteogenesis imperfecta J. On assessment it is also apparent that his head circumference has increased at an excessive rate and has crossed 3 centiles since birth. B. Child physical abuse C. There is delay in presentation and also spiral fracture indicates “twisting injury” rather than falling over. 2) An infant is admitted with symptoms and signs of respiratory infection and is found to have several posterior rib fractures on chest radiograph. The child is not on the child protection register. 3) A 4 month baby girl is presented with swelling of her right arm and is found to have a spiral fracture of the humerus. Metabolic bone disease of prematurity F. Accidental fracture B. She had been in the care of her mother’s boyfriend who reported that he had nearly dropped her that day when reaching for her bottle and had inadvertently pulled on her arm to save her. Osteopetrosis For each patient select the most likely diagnosis. Hypoparathyroidism G. Pseudohypoparathyroidism I. She is a single parent with little family support. He was born prematurely at 37 weeks gestation and was observed overnight on the special care baby unit for tachypnoea which settled by the following day. Child physical abuse Note: Posterior rib fractures are highly suggestive of non accidental injury (NAI). Pediatrician Consultant .
66) Theme : DELAYED MILESTONES A. 4 weeks B. 2 months C. 7 months D. 10 months E. 12 months F. 18 months G. 2 years H. 3 years I. 5 years J. 6 years At what age would you refer a child for investigation if they were unable to do the following:1) Speak in intelligible short sentences G. 2 years 2) Be reliably dry at night (i.e. primary nocturnal enuresis) whilst continent of urine and faeces by day and otherwise well and asymptomatic. J. 6 years 3) Be able to sit unsupported D. 10 months Comments: It is important to be familiar with the developmental milestones, particularly up to the age of 3 years. Milestones are grouped under 4 headings:
You should know the age range for each milestone. Developmental milestones are in Illingworth: 'The Normal Child'.
67-Theme : GASTRO-INTESTINAL DISORDERS IN NEONATES A. Ano-rectal atresia B. Hirschsprung’s disease C. Infantile hypertrophic pyloric stenosis D. Intestinal atresia E. Intussusception F. Meconium ileus G. Necrotizing enterocolitis H. Tracheo-oesophageal fistula I. Volvulus neonatorum Select the most appropriate diagnosis from the list above that would explain the presentation of the following neonates: 1) A newborn baby girl presents with gross abdominal distension and bilious vomiting. She has also got cystic fibrosis and her abdominal x-ray shows distended coils of bowel, but no fluid levels. F. Meconium ileus 2) A premature infant (31-week gestation) presents with distended and tense abdomen. She is passing blood and mucus per rectum, and she is also manifesting signs of sepsis. G. Necrotizing enterocolitis 3) A newborn baby boy presents with mild abdominal distension and failure to pass meconium after 24 hours. X-ray reveals dilated loops of bowel with fluid levels. B. Hirschsprung’s disease Comments: One in 15 000 newborns will have a distal small bowel obstruction secondary to abnormal bulky and viscid meconium. Ninety percent of these infants will have cystic fibrosis and the abnormal meconium is the result of deficient intestinal secretions. This condition presents during the first days of life with gross abdominal distension and bilious vomiting. X-ray of the abdomen shows distended coils of bowel and typical mottled ground glass appearance. Fluid levels are scarce as the meconium is viscid. Necrotizing enterocolitis is more common in premature infants. Mesenteric ischemia causes bacterial invasion of
the mucosa leading to sepsis. Terminal ileum, caecum and the distal colon are commonly affected. The abdomen is distended and tense, and the infant passes blood and mucus per rectum. X-rays of the abdomen shows distended loops of intestine and gas bubbles may be seen in the bowel wall. Hirschsprung’s disease is an absence of ganglion cells in the neural plexus of the intestinal wall. It is more common in boys than girls. The delayed passage of meconium together with distension of abdomen is the usual clinical presentation. A plain abdominal x-ray will demonstrate dilated loops of bowel with fluid levels and a barium enema can be helpful when it demonstrates a cone with dilated ganglionic proximal colon and the distal aganglionic bowel failing to distend.
Palestine .51 (7.PEDIATRICS BEST REPONSE. 1) The following laboratory results were returned in a 6 week old boy admitted with 6 days of severe projectile vomiting: pH PO2 PCO2 Blood Urea Sodium Potassium Chloride 7. Dr. rather than respiratory alkalosis as CO2 is not reduced. hypokalaemic metabolic alkalosis.Kamel Youssef Hassan. Pyloric stenosis would highly likely as because of the age and hypochloraemic. Pediatrician Consultant . Dilated bowel would not be expected. He should be resuscitated with normal saline first.7 KPa (35 mmHg) 11 mmol/l 131 mmol/l 3 mmol/l 83 mmol/l Which of the following is true concerning this patient? 1-He has respiratory alkalosis 2-He is likely to have a bulging anterior fontanelle 3-He should be resuscitated immediately with normal saline 4-He should be commenced immediately on half strength soy protein. He is likely to have a sunken fontanelle as he is very dehydrated.MCQs PEDIATRICS 7. low lactose formula 5-X-ray of abdomen is likely to show dilated loops of small bowel Comments: He has a metabolic.35-7.Gaza E-mail: kyh10557@yahoo. as pyloric rather than small bowel obstruction is present.com 128 .45) 12 KPa (95 mmHg) 4.
and GI symptoms (vomiting. occasional intussusception). haematuria. Glycogen is stored in both liver and kidney causing enlargement. 3) A 2 month old baby is admitted with seizures and failure to thrive. with restricted movement. In contrast thrombocytopaenic purpura are not raised. No drugs or medications. Other biochemistry reveals a lactic acidosis and hyperlipidaemia.Kamel Youssef Hassan. hence the lesions are often palpable. This is classical of Henoch-Schonlein purpura. Fully immunized. McArdle's disease is a glycogen storage disease affecting muscle rather than liver as is Pompe's disease. Pediatrician Consultant . What is the most likely diagnosis? 1-Viral infection 2-Trauma/ child abuse 3-Streptococcal infection 4-Vasculitis eg HSP 5-Thrombocytopaenia Comments: The history is of preceding URTI followed by vasculitis on the shins and buttocks.Gaza E-mail: kyh10557@yahoo. PR bleeding. Follwoing a seizure he is found to have a blood glucose concentration of 1.com 129 . Both Gaucher and Niemann-Pick disease are lipid storage disorders. On examination she has palpable non-blanching purple spots 1-4 mm in diameter especially over the shins and buttocks. 39+1/40. 2. Dr. The classical features are rash. Palestine . Her left ankle is swollen.96kg. No neonatal problems. and ankle swelling. Neither would be expected to produce profound hypoglycaemia. The pathological lesion is a vasculitis. This is a glycogen storage disease due to deficiency of glucose-6-phosphatase. Examination reveals hepatomegaly with palpable kidneys. warm and tender. associated with lactic acidosis and hepatomegaly which would point to a diagnosis of von Gierke's disease.MCQs PEDIATRICS 2) A 7 year old girl presents with a 3 day history of rash and ankle swelling. joint swelling.2 mmol/l. but has otherwise been healthy. abdominal pain. She had a cold 4 weeks previously. What is the most likely diagnosis? 1-Gaucher's disease 2-McArdle's disease 3-Niemann-Pick disease 4-Pompe Disease 5-Von Gierke disease Comments: This baby has hypoglycaemia accounting for fits.
decreased internal rotation.Gaza E-mail: kyh10557@yahoo. adolecent boys with a positive family history. There is a family history of hay fever. with a respiratory rate of 55/min and moderate recession. The likely diagnosis is: 1-Chondromalaichae patella 2-Osteosarcoma 3-Perthe’s disease 4-Septic arthritis 5-Slipped upper femoral epiphysis Comments: Slipped upper femoral epyphesis is most common in obese. On examination his knee appears normal but there is restricted range of movement at the hip.com 130 . Dr. Pediatrician Consultant . thigh and knee pain. in which case recurrent episodes of cough and wheeze can be anticipated. On examination his saturations are 92% in air. 5) An overweight twelve year old boy attends A+E complaining of hip and knee pain after a minor fall from his bike.Kamel Youssef Hassan. thigh atrophy and hip.MCQs PEDIATRICS 4) A 15 month old child with flexural eczema presents with a 3 day history of cough and wheeze. 25% are bilateral. He may well be an early asthmatic. Palestine . What is the most likely diagnosis? 1-Gastroesophageal reflux 2-Allergic rhinitis 3-Sinusitis 4-Asthma 5-Croup Comments: This child has virus-induced wheeze on an atopic background. Presentation may be with a coxalgic externally rotated gait. The heart rate is 150/min.
OFC 25%. temperature is 36. Pott's fracture is a general term applied to fractures around the ankle.98kg. HR 150/min.5°C (tympanic). She has occasional twitching of the eyelids and mouth. Evaluation should include electrolytes. No rash or dysmorphic features. No FH/SH of note. What is the most likely diagnosis? 1-Congenital adrenal hyperplasia 2-Congenital heart disease 3-Inborn errors of metabolism 4-Sepsis Comments: This child is dehydrated. a metabolic condition should be strongly suspected. and urine organic acids. vomiting and lethargy. no neonatal problems. Although infection and a cardiac abnormality are possible. Dr.Kamel Youssef Hassan. Weight <3%. Chest clear. blood gases. No immunizations.com 131 . She responds slightly to voice. X-ray reveals a fracture of the distal radius. Examination suggests possible subtle fits. NH4. Palestine .MCQs PEDIATRICS 6) A 15 year old boy presents with a painful lower right arm after falling from his motorbike. vomiting and lethargic.Gaza E-mail: kyh10557@yahoo. No organomegaly. RR 40/min. On examination she is thin and wasted. 2. Pediatrician Consultant . Uncomplicated pregnancy and delivery. Born at 37+6/40. serum and urine aminoacids. What is the name for this fracture? 1-Bennett's fracture 2-Colle's fracture 3-Galeazzi' s fracture 4-Monteggia' s fracture 5-Pott's fracture Comments: Bennett's fracture is an intra-articular fracture of the base of the first metacarpal. No drugs or medications. Galeazzi's fracture involves the radial shaft with dislocation of the distal radioulnar joint. no murmur. 7) A 12 day old girl presents with poor feeding.
and has been finding it increasingly uncomfortable to open her mouth.Kamel Youssef Hassan.0kg and there were no neonatal problems. What is the most likely diagnosis? 1-Retropharyngeal abscess 2-Foreign body aspiration 3-Anaphylaxis 4-Croup 5-Peritonsillar abscess Comments: The history suggests a peritonsillar abscess (quinsy) on the left side. ENT examination shows left tonsillar enlargement and exudate. She was born at 41/40 gestation weighing 4. Dr. A fever greater than 39. Her temperature is 40. sore throat. Pediatrician Consultant . Palestine .2°C (tympanic). She has had difficulty in swallowing over the last 2 days.MCQs PEDIATRICS 8) 7 year old girl presents with high fever and severe left-sided throat pain. 9) Feeding difficulties in the neonatal period may be due to all of the following except: 1-Prematurity.com 132 . RR 15/min and HR 100/min. a complication of Group A Strep. and treatment is by surgical drainage. 4-Physiological jaundice 5-Congenital heart disease Comments: All of the options are associated with feeding difficulty except for physiological jaundice which is benign. 2-Hiatus hernia. with a uvula deviated to the right. shortlived and not generally associated with symptoms. Her voice is muffled and she dribbles saliva.4°C is associated with severe disease.Gaza E-mail: kyh10557@yahoo. On examination she looks ill. 3-Cerebral birth trauma.
MCQs PEDIATRICS 10) Features of Down’s syndrome include all of the following except: 1-A third fontanelle.Kamel Youssef Hassan. Southern blotting is a technique that uses denatured fragments of DNA in a gel to bind to DNA probes in order to detect the presence of particular genes or sequences of DNA. 5-mRNA is used in the Southern blotting technique. 3-Ataxic gait. 5-Susceptibility to acute leukaemia Comments: Cerebellar dysfunction is not a feature of Down’s syndrome. Dr. Pediatrician Consultant . Comments: The structure of mRNA is similar to DNA except that uracil replaces thymine as one of the bases. 4-Reverse transcriptase uses mRNA as a template to produce complementary DNA. Translation occurs in the cytoplasm. 2-Duodenal atresia. Palestine . 4-Increased incidence of hypothyroidism. however an Alzheimer’s like syndrome of memory loss and cognitive decline develops when patients reach the mid thirties. The enzyme reverse transcriptase can be used by viruses to insert viral mRNA into the host genome.com 133 . 3-mRNA contains the bases cytosine and thymine. Both coding (exons) and non-coding regions of DNA are initially transcribed into mRNA. 11) Which of the following statements regarding messenger RNA (mRNA) is correct? 1-mRNA never contains introns.Gaza E-mail: kyh10557@yahoo. Splicing is required for mature mRNA to be produced only consisting of introns. 2-mRNA is translated into proteins in the nucleus.
and promotes a sense of well-being in patients with mild to moderate disease with purulent secretions.Kamel Youssef Hassan. or through manual reinsertion by the patient or parent. Palestine .MCQs PEDIATRICS 12) Which of the following is a recognized treatment for complications of cystic fibrosis? 1-DNAase to assist in reinflating collapsed lung segments. the nuclei from dead cells accounts for much of the viscidity of secretions. Following defecation the prolapse usually resolves spontaneously. Dr.com 134 . 13) Characteristic features of physiological jaundice include all of the following except: 1-Onset after the first 24 hours of life. ulcerative colitis. 4-Normal feeding behaviour 5-Associated anaemia. 2-Disappearance by the tenth day of life. malnutrition. Rectal prolapse is usually idiopathic. Anaemia if present would imply pathological cause of jaundice eg haemolytic anaemia. or where infection is difficult to control at home. in the inflamed airway. 2-Rectal pull-through and anastamosis for rectal prolapse.Gaza E-mail: kyh10557@yahoo. Intestinal parasites. meningocele. acute diarrhoea. decrease the frequency of chest exacerbations. Hypernatramic dehydration should be treated in the usual way. 4-Nebulised Tobramycin for pseudomonas colonization of the lower respiratory tract. 3-A serum bilirubin level below 250 mmol/L. Comments: Physiological jaundice occurs in 90% of infants and manifests after the first 2-3 days of life it is related to increased red cell breakdown and relative ‘immaturity’ of hepatic function. 5-Hypotonic saline drinks for hypernatraemic dehydration. cystic fibrosis. Comments: Human recombinant DNAase given as a single daily aerosol seems to improve pulmonary function. Ehler's Danlos Syndrome. Nebulised Tobramycin or Gentamicin may be given when airway pathogens are resistant to oral antibiotics. and chronic constipation can also predispose to it. 3-Pancreatic transplant for diabetes mellitus. pertussis. occurring between 1 and 5 years. Pediatrician Consultant . This may be because.
Chest auscultation reveals scattered wheeze. 15) A 4 year old girl is referred with behavioural problems. There are no specific abnormalities to find. particularly at night.ﻧوﺑﺎت ﻏﺿب‬Born at 39+6/40. What is the most likely diagnosis? 1-Speech delay. No drugs. What is the most likely diagnosis? 1-Gastroesophageal reflux 2-Allergic rhinitis 3-Sinusitis 4-Asthma 5-Croup Comments: The examination findings suggest chronic undertreated asthma. allergies. with repetitive obsessive play. These symptoms are characteristic of Asperger syndrome. 3.MCQs PEDIATRICS 14) A 3 year old by presents with a 2d history of coryza and cough. If he does not respond rapidly to asthma therapy a sweat test may be indicated to exclude CF. Pediatrician Consultant .com 135 .Gaza E-mail: kyh10557@yahoo. No FH/SH of note. dressing and undressing them repeatedly. Her speech is normal in form. isolated 2-Pervasive developmental disorder 3-Global developmental delay 4-Impaired hearing 5-Autism Comments: This child has problems with reciprocal social interaction. On examination she is on the 50% for height and weight. and is regarded by some as 'high-functioning autism'. She plays on her own for hours with her dolls. It is likely that he will respond to regular inhaled low-dose steroids. However. She avoids eye contact. This is part of the spectrum of Pervasive Developmental Disorders. On examination he has Harrison's sulci and is on the 3rd centile for weight and height. Fully immunized.18kg no neonatal problems. Her speech is generally well-formed.Kamel Youssef Hassan. Attempts to play with others results in tantrums ‫ . she finds it difficult to sustain conversations because she talks obsessively about her own interests. Palestine . Dr. Such children may be regarded as eccentric by their peers.
Gaza E-mail: kyh10557@yahoo. On examination his temperature is 36. 17) 15 year old boy is knocked out for 2 minutes while playing rugby. most likely due to sinusitis. Pediatrician Consultant . The Colorado Medical Society guidelines grade such injuries into 3 groups: Dr. but cannot recall the incident. What is the most likely diagnosis? 1-Gastroesophageal reflux 2-Allergic rhinitis 3-Sinusitis 4-Asthma 5-Croup Comments: The picture is one of upper airways obstruction associated with nasal discharge. Apart from mild asthma requiring beta-agonists before sport he is otherwise well. In this case the maxillary and frontal sinuses are most likely to be involved. On examination he is apyrexial. At night he has a cough and snores loudly. which refers to a diffuse brain injury.com 136 .Kamel Youssef Hassan. He is tender over the maxillae and forehead. RR 12/min and HR 65/min. The headache is exacerbated by leaning forwards. He recovers rapidly. His GCS is 15/15 and no focal neurological abnormalities are present. Palestine . It is not necessary to be knocked out to have concussion. but has a persistent nasal obstruction and nasal speech. What is the most likely diagnosis? 1-Child abuse 2-Head injury 3-Hypoglycaemia 4-Diabetic ketoacidosis 5-Substance abuse Comments: He has had a traumatic concussion.MCQs PEDIATRICS 16) A 9 year old boy presents with a history of headache and persistent green nasal discharge.5°C (tympanic).
rather than advanced bone age. Short stature and delayed bone age are associated. Dr. Dietary Vitamin D deficiency stimulates secondary hyperparathyroidism. Raised alkaline phosphatase results from osteoblasts forming unmineralised matrix. thickening of forearm at the wrist. low serum phosphate.Gaza E-mail: kyh10557@yahoo. craniotabes (soft skull). and of the costo chondral junction (rachitic rosary). Calcium concentrations may be low or low normal.com 137 . Palestine . Rotational vertigo and tinnitus suggest an organic disorder.MCQs PEDIATRICS 1. and reduced urinary calcium excretion. Confusion. Which one of the following additional features is most suggestive that she has an anxiety disorder? 1-elevated diastolic blood pressure 2-nocturia 3-paraesthesiae in the hands 4-rotational vertigo 5-tinnitus Comments: Parasthesiae is often associated with anxiety of any description. Which of the following features would argue against a diagnosis of osteomalacia? 1-Bow legs 2-raised alkaline phosphatase 3-Low serum phosphate level 4-Normal serum calcium 5-advanced bone age Comments: Clinical features include: bowing of tibia and fibula. which causes increased renal excretion of phosphate. Confusion alone 2. 1 week (group 2) or 1 month (group 3) respectively. Confusion and amnesia 3. whilst anxiety disorder would normally be associated with raised systolic blood pressure 19) A young boy is presents with aches and pains.Kamel Youssef Hassan. 18) A 17 year old student presented with recurrent attacks of dizziness. Pediatrician Consultant . amnesia and loss of consciousness To avoid the Second Impact Syndrome return to sport should be allowed after 20 mins (group 1).
5kPa. In this case. Blood gas analysis shows a pH of 7. the pH is reduced. This is. and a base excess of -4. insufficient to explain the acidosis from metabolic causes. normal or high? Inspect the CO2: Is it low. and inspecting the CO2 will enable you to determine whether this is due to respiratory or metabolic causes. with a base deficit of only -4. a PO2 of 8. Pediatrician Consultant . Which of the following interpretations is correct? 1-Results are consistent with bronchopulmonary dysplasia.Gaza E-mail: kyh10557@yahoo. 5-Bicarbonate may be necessary to correct the acidosis. the following sequence may be useful:    Inspect the pH: Is it low. Palestine . Inspecting the PO2 will tell you whether the patient is hypoxic or not.com 138 . In bronchopulmonary dysplasia. end stage asthma or neurogenic causes such as guillain-Barre. Comments: In interpreting blood gas results.0kPa. with this climbing only to accompany failing respiration. normal or high? Inspect the PO2: Is it low. 2-Blood gases suggest type 1 respiratory failure. a PCO2 of 7. there is usually long-term CO2 retention with compensatory increase in bicarbonate leading to a positive base excess and normal pH. 4-Results are consistent with late severe asthma.MCQs PEDIATRICS 20) A 16 year old girl presents with a 2 day history of deteriorating breathlessness and dyspnoea. normal or high? If the pH is low then an acidosis is present. The results would therefore be consistent with late severe asthma. Dr. Bicarbonate is usually only considered if the base deficit exceeds about -8. a respiratory acidosis. Possible causes would include severe pneumonia. and the PO2 is also low suggesting type 2 respiratory failure. and the CO2 is high.Kamel Youssef Hassan. In asthma. 3-Immediate intubation is required. therefore. the initial stages show a low CO2.25.
On examination he looks well. He sat at 12/12. Other investigations may be indicated if a specific disorder is suspected. on no medications. A detailed developmental assessment should be performed plus investigations for an underlying cause. He is able to make a tower of 2 inchhigh bricks.MCQs PEDIATRICS 21) An 18 month old boy because of maternal concerns about delayed speech. At minimum these should include TFTs and karyotype to rule out Fragile X Syndrome.Kamel Youssef Hassan. and social development. and now pulls to stand. Pediatrician Consultant . and there is no FH/SH of note. Dr.Gaza E-mail: kyh10557@yahoo. There are no specific findings of note. He is saying 2-3 single words which his mother can understand and seems to hear well. What is the most likely diagnosis? 1-Speech delay. hearing and speech. He is fully immunized. Palestine . He is on the 25th centile for height and weight and OFC.com 139 . He was born at 39+4/40 weighing 2.6kg and there were no neonatal problems. The history gives no indication of an underlying cause for the delay. isolated 2-Pervasive developmental disorder 3-Global developmental delay 4-Impaired hearing 5-Autism Comments: The history suggests moderate global developmental delay. fine motor and vision. He is functioning at about the 12 month level in gross motor. He drinks from a bottle.
What is the most likely diagnosis? 1-Retropharyngeal abscess 2-Foreign body aspiration 3-Anaphylaxis 4-Croup 5-Peritonsillar abscess Comments: The history suggests a viral croup (laryngotracheobronchitis).MCQs PEDIATRICS 22) A 15 month old girl presents with stridor and respiratory distress. with exercise-induced symptoms and a general deterioration on commencement of smoking. Pediatrician Consultant . Dr. She went to bed as usual at 8pm. but are not required in mild cases. What is the most likely diagnosis? 1-Gastroesophageal reflux 2-Allergic rhinitis 3-Sinusitis 4-Asthma 5-Croup Comments: A typical history of asthma in later childhood.Kamel Youssef Hassan. Palestine . She has marked stridor with moderate recession and a barking cough. O2 saturations are 95% in air. and admits to have started smoking.com 140 . Oral dexamethasone or inhaled budesonide are effective in reducing symptoms. On examination she has a fever of 37.8°C (tympanic).Gaza E-mail: kyh10557@yahoo. Reassurance of the mother often calms down both child and mother. Previous history was unremarkable. RR of 55/min (crying). She has had a crusty nasal discharge for 2 days with low grade fever. 23) A 14 year old girl presents with a history of cough and breathlessness on exercise. and HR of 150/min. but awoke 2 hours later. Clinical examination is unremarkable. She has seasonal rhinitis. Unfortunately this is all too common these days.
and flame-shaped haemorrhages. comatose state of the child.Gaza E-mail: kyh10557@yahoo. 25) A 9 week old infant is brought in unresponsive. He has recently been unwell. Pediatrician Consultant . What is the most likely diagnosis? 1-Child abuse 2-Hepatic failure 3-Hypoglycaemia 4-Diabetic ketoacidosis 5-Substance abuse Comments: The history suggests a previously healthy child with colic of inexperienced parents. which last several hours at a time. It is important to exclude infection with DIC or a coagulopathy. BM stix is 3. On examination he is apyrexial and movement at his hip is uncomfortable.MCQs PEDIATRICS 24) A 10 year old boy attends A+E with a two day history of a limp. Given the full fontanelle. 1-Congenetal dislocation. Palestine . The cause is unknown but it can be related to viral infection. She has a temperature of 34.9 mmol/l.5°C. She is floppy with a full fontanelle. Dr. Parents are unmarried teenagers. 2-Perthes disease 3-Septic arthritis 4-Slipped upper femoral epiphesis 5-transient synovitis Comments: Transient synovitis is the most common cause of hip pain in childhood but other more serious causes should be excluded before it is diagnosed. Fundoscopy shows flame-shaped haemorrhages. RR 30/min (irregular pattern). On examination she has 3 small possible bruises on her face. allergic reaction or trauma.com 141 .1kg and there were no neonatal problems.Kamel Youssef Hassan. The facial bruising suggests grip marks. Mother says she has well apart from episodes of screaming every evening. She was born at 38+2/40 weighing 3. Shaken baby syndrome is most likely. HR 130/min.
21kg and there were no neonatal problems. No dysmorphic features. Gross motor. and only mother understands them. ENT examination reveals normal tonsils. there is no murmur nor organomegaly. She was born at 36+6/40 weighing 2. RR 20/min and HR 100/min. vision and fine motor development are normal. 27) A 3 year old girl presents with a 5 day history of neck pain and fever. with increasing difficulty in swallowing. She has moderate neck stiffness. She has audible stridor when agitated. Over the previous night she woke several times with difficulty in breathing. These children often need Speech Therapy input. and she has very tender glands in the neck. HR 90/min. Mother complains that he 'doesn't listen' especially when he is in another room. What is the most likely diagnosis? 1-Speech delay. This usually resolves with time. On examination he is apyrexial.8kg and there were no neonatal problems. What is the most likely diagnosis? 1-Retropharyngeal abscess 2-Foreign body aspiration 3-Anaphylaxis 4-Croup 5-Peritonsillar abscess Dr.MCQs PEDIATRICS 26) A 2 year old child presents with delayed language development.com 142 . On examination her head held to the right. Palestine .Kamel Youssef Hassan. clear nose and bilaterally dull drums. isolated 2-Pervasive developmental disorder 3-Global developmental delay 4-Impaired hearing 5-Autism Comments: The child has hearing impairment and isolated language delay. Chest is clear. He was born at term weighing 3. The examination suggests bilateral 'glue ear' (Otitis media with effusion). Pediatrician Consultant . though it may require tympanostomy tube insertion. RR 16/min.Gaza E-mail: kyh10557@yahoo. Her temperature is 38. His speech is restricted to single words.6°C.
This required surgical drainage and removal with antibiotic cover. ritualistic behaviour and lack of reciprocal social interaction. isolated 2-Pervasive developmental disorder 3-Global developmental delay 4-Impaired hearing 5-Autism Comments: The history is of poor speech development.Gaza E-mail: kyh10557@yahoo.5 year old boy is referred with behaviour problems and poor speech. He speaks very seldom.Kamel Youssef Hassan. It is part of the wider spectrum of pervasive developmental disorders. and there are no specific abnormalities to find. He always prefers to play on his own. lining up his Thomas the Tank engine set repetitively. in imaginative activity. This includes: autism. Palestine . childhood disintegrative disorder. In this case it revealed a massively enlarged right tonsil with profuse exudate. and is unable to sustain a conversation. Pediatrician Consultant . The most likely diagnosis is Autism. Dr. What is the most likely diagnosis? 1-Speech delay. He throws tantrums when his routine is disturned. He was born at 37+3/40 weighing 3. ignoring his older and younger siblings. ENT examination in children with stridor should take place where facilities are available for immediate intubation. 28) A 2.com 143 . On examination he is apyrexial. Aspergers. and in reciprocal social interactions.51kg and there were no neonatal problems.MCQs PEDIATRICS Comments: The history suggests a tonsillitis progressing to retropharyngeal abscess with increasing upper airways obstruction. which starts before 30 months of age and is characterized by a qualitative impairment in verbal and nonverbal communication. and Rett's syndrome. Pregnancy had been uncomplicated.
Temperature is 37. He rarely requires beta agonist inhaler. and pink nonpurulent conjunctivae.8°C. Mother hears him making odd noises on the baby monitor. Although skin prick testing may be helpful in resistant cases. Scattered coarse crepitations are audible in both lung fields. Sometimes he has an associated cough. When she investigates she finds him floppy. On arrival at hospital he is self-ventilating in facemask oxygen.Gaza E-mail: kyh10557@yahoo.MCQs PEDIATRICS 29) A 12 year old boy complains of persistent clear nasal discharge during the spring and summer. and HR of 140/min. What is the most likely diagnosis? 1-Gastroesophageal reflux 2-Allergic rhinitis 3-Sinusitis 4-Asthma 5-Croup Comments: This atopic boy has classical symptoms of seasonal rhinitis. with saturations of 94%. They give bag ventilation and he starts breathing again. attempts mouth-to-mouth resuscitation and calls an ambulance. He was diagnosed with asthma at 2 years. it is usual to treat sufferers symptomatically with oral antihistamines or topical steroids to eyes and nose. but this has improved with age. On examination he has a clear nasal discharge. pale and not breathing. What is the most likely diagnosis? 1-Acute life-threatening event 2-Cardiac dysrhythmias 3-Seizures 4-Sudden infant death syndrome Comments: Dr.com 144 . The symptoms usually get better in the autumn. 30) 5 month old boy has had a mild coryza for 2 days. Pediatrician Consultant . Since discharge he has been thriving. Born at 32/40 gestation weighing 1. Palestine . She stimulates him.7kg he required 3d ventilation for surfactant-deficient lung disease. He constantly rubs his nose and his eyes. O2 is given on the way to hospital. nasal speech.Kamel Youssef Hassan. mild recession. with RR 35/min.
In this case the problem involves mainly expression rather than reception of speech. 32) The parents of an eight year child divorce. and comes from a middle class articulate family. weight and OFC. Although he seems to understand full sentences and commands he says only occasional single words.Gaza E-mail: kyh10557@yahoo. the child is sullen and irritable but when his father leaves the boy cries. Palestine . On his father's visits. He is fully immunised.com 145 .MCQs PEDIATRICS This child has RTI followed by acute life-threatening event (ALTE). Pediatrician Consultant . There are a large number of potential causes. What is the most likely diagnosis? 1-Speech delay. given the examination findings. isolated 2-Pervasive developmental disorder 3-Global developmental delay 4-Impaired hearing 5-Autism Comments: The history is of isolated speech delay in a child who apparently hears normally.Kamel Youssef Hassan. He was born at 41/40 weighing 3. 31) A 3 year old child presents with delayed speech. Hearing should be formally checked. ENT examination is unremarkable. 3-I will see you next weekend 4-You take care of the house now I've left Dr. The child lives with his mother with his father visiting at weekends.4kg and there were no neonatal problems. What is the most appropriate response that the father can make during these episodes? 1-Big boys don't cry 2-I left your mother but I am not leaving you. clings to his father and askes his father to come back to live with his mother. Such speech problems may interfere significantly with schooling. There are no specific abnormalities to find. as it is the commonest reason for speech delay. On examination he is on the 25th centile for height. on no medications. In this case bronchiolitis is most likely.
surgical treatment is by pyloromyotomy. Pathologically. After randomizing the patients a small proportion of the drug plus physiotherapy group decide to drop out of the study or omit some treatment sessions specified in the research protocol. Pediatrician Consultant . 2-Is more common in females.Gaza E-mail: kyh10557@yahoo. 4-Is due to hypertrophy of the longitudinal muscle layer of the pylorus. Palestine . Comments: Infantile hypertrophic pyloric stenosis presents most commonly at approximately 6 weeks of age. 34) A study has been designed to investigate whether a certain drug plus physiotherapy treatment is better than drug treatment alone in the management of rheumatoid arthritis. 33) An infant is diagnosed with pyloric stenosis. the pyloric 'tumour' arises from hypertrophy the circular muscle layer. Following resusciation and correction of any electrolyte abnormality.com 146 . It is more common in boys with a male: female ratio of 4:1. What is the correct way of analysing the subsequent data? 1-Assume the patients have withdrawn their consent 2-Exclude these patients from all analysis 3-Extend the trial recruitment to make up the numbers 4-Include these patient outcomes in the drug plus physiotherapy group 5-Interview the patients and report their group separately Dr.MCQs PEDIATRICS 5-Sorry son but I just couldn't live with your mother Comments: The child's reactions typically represent a feeling of abandonment and it is important that his father reaffirms that he is not leaving his son.Kamel Youssef Hassan. There is a strong familial predisposition with 5% of affected infants having a mother who also developed the problem. 3-There is a strong familial predisposition. Which of the following is true of this diagnosis? 1-Typically presents between 6 and 12 months of age. 5-Presents with bile-stained projectile vomiting. Patients present with projectile vomiting that is not bile stained.
Intention to treat helps to reduce bias by sticking to the original allocation of treatment and analyzing the patient in that treatment group even (and concentrate for this bit) even if they don''t get it! 35) A 17 year old female presents with acute breathlessness. The panic in crowds suggests an anxiety disorder and grandiose ideations suggest hypomania Dr. Pediatrician Consultant . Which agent may be responsible for this exacerbation? 1-Salmeterol 2-Theophylline 3-Beclomethasone 4-Ipratropium bromide 5-Monteleukast Comments: Salmeterol has been reported to produce an acute exacerbation of asthma. Which of the following suggest a diagnosis of Schizophrenia? 1-incongruity of affect ‫ﻣﺷﺎﻋر ﻣﺗﺿﺎرﺑﺔ – ﺗﺿﺎرب اﻟﻣﺷﺎﻋر‬ 2-auditory hallucinations with clouding of consciousness 3-memory impairment 4-feelings of panic in buses and shops 5-grandiose ideations Comments: Incongruity of affect is emotion inappropriate to circumstances. 36) A 17 year old male is brought to clinic as his parents are concerned about changes in his behaviour.com 147 . Auditory hallucinations with clouding of conciousness suggest delirium and memory impairment possible organic brain disease. She has had asthma for approximately 3 years and recently commenced new therapy.Gaza E-mail: kyh10557@yahoo.MCQs PEDIATRICS Comments: This is the principle of 'intention to treat'. possibly through an acute hypersensitivity reaction. It is possible that the physiotherapy intervention was harmful to the patients and this is why they left.Kamel Youssef Hassan. There may be intellectual defects from prolonged institutionization ‫ اﻹﻗﺎﻣﺔ ﺑﻣؤﺳﺳﺎت ذوى اﻟﮫﺎھﺎت‬or treatment rather than the illness itself. Palestine .
There is no delusion with regard to the food being poisoned. Palestine . 38) Which of the following organelles contains enzymes responsible for the digestion of constituents of cells and tissues? 1-endoplasmic reticulum 2-Gogli apparatus 3-lysosomes 4-microtubules 5-mitochondria Comments: The lysosomes contain the enzymes and molecules such as oxidases. The secretive abuse of laxatives would fit with the diagnosis rather than anabolic agents.MCQs PEDIATRICS 37) An 18 year old female is reluctant to eat food that is prepared for her. Which one of the following would be most consistent with a diagnosis of anorexia nervosa? 1-she believes the food is poisoned 2-she has a full-time job 3-she has bouts of heavy drinking 4-she regards herself as ill 5-she secretly abuses anabolic steroids Comments: Anorexia nervosa is associated with the abnormal perception of body image. The mitochondria produce energy for cellular functions.com 148 . They generally feel well despite the protestations of others who feel that they look awful. Micortubules are involved in mitotic processes and intracellular transportation. Pediatrician Consultant . Dr. They exercise avidly and until the very late stages of the disease hold down full time jobs. free radical etc responsible for the breakdown of intracellular components.Gaza E-mail: kyh10557@yahoo.Kamel Youssef Hassan. Heavy drinking associated with food refusal would suggest alcoholism and alcoholic gastritis.
Carbohydrates constitute 30-45% of total caloric intake in children. all are required to maintain nitrogen balance. Palestine . 40) Apoptosis is the process of programmed cell death and occurs in cells that have damaged DNA.com 149 . which provide a sufficient source of protein. Pediatrician Consultant . Dr. 2-The absence of any of the essential amino acids results in a negative nitrogen balance 3-Protein constitutes about 30-45% of total daily calorie intake in infants and children 4-Essential amino acids can be synthesized in the liver and kidneys 5-Human milk as the only food provides an insufficient source of protein for a 1 year old healthy infant Comments: There are 9 essential amino acids.MCQs PEDIATRICS 39) Which one of the following is true regarding protein metabolism? 1-There are 5 essential amino acids.Gaza E-mail: kyh10557@yahoo. Essential amino acids cannot be synthesized and must be obtained from the diet. This gene is:1-bcl-2 2-caspases 3-fas (CD95) 4-p53 5-ras Comments: bcl-2 is an inhibitor of apoptosis.Kamel Youssef Hassan. ras is an oncogene. A mediator of this process is a tumour suppressor gene that inhibits mitosis and promotes apoptosis. Human milk contains the proteins casein. lactoglobulin and lactalbumin. fas is a cell receptor and caspases are present in all cells both promote apoptosis but are not tumour suppressor genes.
Pediatrician Consultant .MCQs PEDIATRICS 41)Which one of the following conditions is transmitted by means of an X-linked recessive inheritance : 1-Cystic fibrosis 2-Galactosaemia 3-Huntington’s chorea 4-Duchenne muscular dystrophy 5-Facio-humero-scapular dystrophy Comments: Cystic fibrosis and Galactossaemia are autosomal recessively inherited conditions. Haemophilia and Duchenne muscular dystrophy are X. 42)A 10 year old child is found to have neurofibromatosis. 30-50% of new cases are due to spontaneous mutations.linked recessive and Facio-humero-scapular dystrophy and Huntington’s chorea are inherited in an autosomal dominant manner.com 150 .Gaza E-mail: kyh10557@yahoo. and optic nerve gliomas. The condition is autosomal dominant. along with other clinical findings such as Lisch nodules. Six or more café au lait spots before the age of puberty would assist in making a diagnosis. Freckling of the inguinal and axillary regions occur. Dr.Kamel Youssef Hassan. Palestine . Which of the following statements correctly applies: 1-She will most probably be mentally retarded 2-The finding of 2 café au lait spots in her 6 year old sibling suggests he may be affected 3-Her condition was inherited in an autosomal recessive fashion 4-Freckling of the back would be expected 5-There may be no family history of the condition Comments: Mental retardation may be a clinical feature of the condition but is not a usual clinical feature.
com 151 . Affected children are taller and may have high arched palate. long ears. Dr. Comments: Affected males are usually but not always mentally retarded . Pediatrician Consultant .sensitive fragile X site (X q27. Palestine .Gaza E-mail: kyh10557@yahoo. a long face and macro orchidism. confirmatory amniocentesis may be required in some cases.One third of females with the mutation will be mentally retarded. The diagnosis of fragile X syndrome was originally based on the expression of a folate.3) induced in cell culture under conditions of folate deprivation.Kamel Youssef Hassan.MCQs PEDIATRICS 43)Which of the following statements applies to fragile X syndrome? 1-Mental retardation is found in all males 2-Mental retardation is not found in females 3-Cytogenetic finding of fragile-X is induced in a vitamin B12 deficiency culture medium 4-Affected children are taller than average 5-The condition can only be diagnosed after birth. Diagnosis can be made by detection of the mutant FMR 1 gene by chorionic villus sampling .
Of the following. the MOST likely diagnosis is A. Findings on physical examination are normal except for wheezing only in the mid-right lung field.A 6-month-old previously healthy infant presents with a 2-day history of cough and difficulty breathing. bacterial pneumonia B." Further questioning reveals that the child coughs when he has an upper respiratory tract infection. Of the following. continuous positive airway pressure via face mask B. postnasal drip Dr. the MOST appropriate therapy for this infant is A. She exhibits marked tachypnea.Gaza E-mail: kyh10557@yahoo. no abnormality E." His mother dismisses this. and poorly perfused. stating that her son "keeps a cold. his father states that the boy is "always coughing. poorly controlled asthma E. Palestine . cystic fibrosis D. upon exposure to the neighbor's cat. On physical examination. Results of the physical examination are normal. asthma B. endotracheal intubation and positive pressure ventilation D. during exercise.MCQs PEDIATRICS 1. the MOST likely diagnosis for this child is A. pale. inhaled foreign body D. endotracheal administration of surfactant C. chronic sinusitis C.During the health supervision visit for a 5-year-old child. vascular ring 3.com 152 .A previously healthy 12-year-old girl presents to the emergency department with sudden onset of wheezing after running through the woods.Kamel Youssef Hassan. Pediatrician Consultant . nitric oxide 2. She has supraclavicular and intercostal retractions. and auscultation of the chest reveals decreased breath sounds bilaterally and poor aeration. she appears lethargic. and almost every night. Of the following. exercise-induced asthma C. negative pressure ventilation E.
A 9-year-old girl presents to the emergency depart-ment with an exacerbation of her asthma. right middle lobe pneumonia 6. On further questioning. Pediatrician Consultant . depression D. An exercise test is terminated when fatigue and breathlessness are induced. but the results of pulmonary function testing remained normal throughout the test. Of the following. Physical examination reveals mild respiratory distress and diffuse expiratory wheezing. hyperinflated chest without infiltrate C. pleural effusion D. pneumothorax E.The father of a 12-year-old girl is concerned about her recent lack of interest in physical activity. Of the following.com 153 . atelectasis of the right middle lobe B. pulmonary function testing E. In addition to chest radiography and a sweat test. A thorough history and physical examination is otherwise unrevealing. but is afebrile. and chest radiography are normal. The MOST likely explanation for these symptoms is A. allergy testing B.MCQs PEDIATRICS 4. and whenever she has an upper respiratory tract infection. skin testing for tuberculosis 5. the MOST appropriate initial diagnostic study to determine the etiology of this child's cough is A. She says that it is "just too hard.Kamel Youssef Hassan. bronchoscopy D. her mother reports that over the past several years the child has coughed at night. physical examination." Findings from a complete history. Palestine . and I get out of breath. barium swallow C. asthma B.A 7-year-old girl coughs frequently during a health supervision visit. cardiac disease C. during exercise. muscle weakness E.Gaza E-mail: kyh10557@yahoo. She felt warm to touch at home. Chest radiography shows a consolidation between the fissures on the right side with volume loss. sarcoidosis Dr. the MOST likely interpretation of this radiographic finding would be a(n) A.
perform pulmonary function spirometry Dr. and breath sounds decreased bilaterally with diffuse expiratory wheezing. obtain inspiratory and expiratory chest radiographs E. Pediatrician Consultant . Palestine . initiate a trial of oral antibiotics D. spirometry is MOST useful to measure A.A 12-year-old girl presents with signs and symptoms suggestive of asthma. Of the following.A 2-year-old child who has asthma that is well controlled with home nebulizer therapy suddenly develops coughing after playing with a small plastic toy. arrange for a pH probe study C. the appropriate NEXT step in determining the cause of this patient's symptoms is to A. administer a nebulized bronchodilator B. You order pulmonary function studies. airway resistance B.A 4-month-old previously healthy infant presents in January with a 2-day history of coughing and breathing difficulty and a 1-day history of refusing to take oral fluids.Gaza E-mail: kyh10557@yahoo. administration of intramuscular ceftriaxone B.MCQs PEDIATRICS 7. with an intermittent.com 154 . Physical examination reveals a pale infant who has dry mucous membranes. intrapulmonary shunting E. Of the following. expiratory flow rate C. the BEST management is A. hospital admission for cardiorespiratory monitoring 8. Of the following. static compliance 9.Kamel Youssef Hassan. functional residual capacity D. retractions. He has no history of choking. administration of nebulized albuterol at home C. administration of oral albuterol D. nonproductive cough and diffuse expiratory wheezing that is greater on the right side. Physical examination reveals unlabored breathing. a respiratory rate of 70 breaths/min.
foreign body B. respiratory rate 11.A 7-year-old child has had persistent nighttime cough for 1 year. arterial PO2 B. Palestine . Pediatrician Consultant . Administration of over-the-counter cough syrups has not been helpful. the MOST likely cause of the cough is A. the MOST important factor affecting your decision whether to intubate the child for assisted ventilation is A.com 155 .You are asked to assess a hospitalized 3-year-old girl who has asthma and respiratory distress without cyanosis while receiving 3 L/min of oxygen by nasal cannula.MCQs PEDIATRICS 10. respiratory effort E.Kamel Youssef Hassan. immotile cilia syndrome D. Of the following. hyperresponsive airway disease C. magnitude of pulsus paradoxus D. Among the following.Gaza E-mail: kyh10557@yahoo. tuberculosis Dr. heart rate C. psychogenic cough E. Blood pressure and hemoglobin concentration are normal.
identification. documentation. www. road and rail as well as sea. a specialist United Nations (UN) agency responsible for developing and maintaining regulatory frameworks for sea transport. packing. known as the ‘Model Regulations’ because the document provides a framework of rules for the safe transport of dangerous goods by all modes – air. These are published in the UN ‘Recommendations on the Transport of Dangerous Goods’.existec.com © Exis Technologies 2014 The UN Model Regulations provide a uniform set of safety procedures covering consignment and transport issues such as classification. marking and labelling. The Code’s provisions are based on recommendations developed by the UN. security and training. .What is the IMDG Code? The International Maritime Organization (IMO) The IMDG Code is produced by the International Maritime Organization (IMO).
toxicity (poisonous) and corrosivity being the most common. handling and transport decisions. Many dangerous goods are essential in the manufacture of other products such as cars. They can exist in three physical states – as a solid.com © Exis Technologies 2014 . The physical state and properties affect packing. property and/or the environment. liquid or gas – and can present a range of dangers in a transport environment – flammability. electronics and pharmaceuticals on which progress and world trade depend.What are dangerous goods? What are dangerous goods and why are they useful? Dangerous goods are substances or articles which can pose a threat to people. www.existec. plastics.
. whether it can be loaded in the same freight container as other dangerous goods. For example.g. www. These are as follows: Class 1 .Different types of dangerous goods Different types of dangerous goods For transport purposes.Corrosive substances Class 9 .1.Flammable liquids Class 4 . where it needs to be stored within the port or stowed on board the ship. according to the main danger they present. toxic substances are allocated to Class 6.Oxidizing substances and organic peroxides Class 6 .com © Exis Technologies 2014 The danger(s) presented by a particular substance or article determine the safe transport procedures for it e.Flammable solids and other flammable substances Class 5 . dangerous goods are allocated to one of nine ‘classes’. the way it needs to be packed.2.Toxic and infectious substances Class 7 .Miscellaneous dangerous substances and articles Many of these classes are sub-divided. infectious substances are allocated to class 6.Radioactive material Class 8 .Gases Class 3 . Substances or articles are classified as ‘dangerous goods’ for sea shipment if they meet the criteria prescribed in the IMDG Code for any of these classes.existec.Explosives Class 2 .
hazcheck.com © Exis Technologies 2014 You can try Hazcheck Online for free at www. the UN Number for it is UN 1223 – see the example below taken from Hazcheck Online. and appropriate actions in an emergency. ‘Kerosene’ is a recognised PSN.com .existec. stowage..Identifying Dangerous Goods Identifying dangerous goods All dangerous goods are uniquely identified for transport using a number and name allocated by the United Nations (UN Number and ‘Proper Shipping Name’ or PSN). The UN number and PSN facilitate rapid and precise identification during transport to ensure correct handling. For example. segregation etc. Kerosene is classified as a flammable liquid (class 3). www.
com continued © Exis Technologies 2014 .existec.Application of the IMDG Code Application of the IMDG Code The IMDG Code’s requirements apply to all ships which are subject to the following two conventions: International Convention for the Safety of Life at Sea. 1974 (SOLAS 1974) – this covers the safety implications of dangerous goods onboard ships. and International Convention for the Prevention of Pollution from Ships (MARPOL) – which covers the pollution aspects for ships carrying dangerous goods www.
continued © Exis Technologies 2014 .com While some SOLAS Member Governments incorporate the requirements of the IMDG Code without amendment into their national legislation. others apply some different and/or additional (usually more stringent) national requirements.Application of the IMDG Code Application of the IMDG Code The IMDG Code amplifies the relevant safety and pollution prevention provisions of these Conventions. Most of the requirements in the IMDG Code apply on a mandatory basis but there are a few provisions which are recommendatory. and has a worldwide application to the movement of dangerous goods by sea.existec. www. The IMDG Code is applied automatically by the governments of all the States which are members of SOLAS.
approve or grant exemptions from particular requirements of the IMDG Code. When shipping dangerous goods.com © Exis Technologies 2014 . Also. e. as appropriate. www.Application of the IMDG Code Application of the IMDG Code Other international and national modal regulations also exist.existec. it is also important to be aware of any further restrictions or requirements which may apply in a particular country or port. road transport rules in Europe (ADR).g. competent authorities may authorise. compliance with these is required. they may recognise all or part of the provisions of the IMDG Code.
These provisions require that dangerous goods are correctly and safely: • Classified and identified • Packed • Marked.com © Exis Technologies 2014 . www. Appropriate training must be given to all personnel involved in the transport of dangerous goods by sea.Overview of the IMDG Code Overview of the IMDG Code The IMDG Code requires certain provisions to be followed whenever dangerous goods are shipped by sea. The Code also contains security requirements designed to minimise the opportunity for terrorists to access and misuse dangerous goods.existec. labelled and placarded • Documented • Stowed on board the vessel • Segregated from other goods with which they may react dangerously Appropriate emergency response information must be made available.
existec. presented in two volumes – Volume 1 and Volume 2. Windows. www. There is also a Supplement which provides additional guidance.com © Exis Technologies 2014 .Layout of the IMDG Code Layout of the IMDG Code The IMDG Code comprises 7 parts. Both volumes must be used to obtain the required information and instructions when dangerous goods are shipped by sea. The IMDG Code is available in Printed. Web and Intranet formats.
. an initial point of reference being provided at the head of each column. www. arranged in UN Number order. stowage. segregation and other shipping and transport duties generally stem from the columns of the DGL. Much of the information is in a coded form to make it easier to present in a table. presented as a two page spread in the printed books. most of the decisions on safe shipping and transport procedures stem from the use of the DGL located in Volume 2. It comprises 18 columns of information for each listed substance/article.com © Exis Technologies 2014 Decisions on packing arrangements. The DGL is an index of substances and articles. marking and labelling requirements.Dangerous Goods List (DGL) Dangerous Goods List (DGL) In the IMDG Code. The meaning and implications of these codes are explained in the relevant chapters and sections of Volumes 1 and 2.existec. documentation entries.
there is an alphabetical index of substances/articles – see example below taken from Hazcheck Online. the DGL can be used as the source of further information.existec. . as indicated on the previous page. This can be used as the initial point of reference when the name of the substance rather than the UN Number is known.Alphabetical Index Alphabetical Index At the end of Volume 2 of the IMDG Code. www.com © Exis Technologies 2014 Once the relevant UN Number is discovered from this index.
in general. new technology and new methods of handling dangerous goods. the basic principles remain constant and once you have understood them. safety concerns which arise as a result of human experience. and new materials and designs for packaging Although the Code is updated every two years. These changes reflect: • • • • the inclusion of newly classified dangerous substances/articles. you will be able to look up information in future versions of the IMDG Code. www.existec. amendments to or deletions of existing entries.Identification of Dangerous Goods Updating the IMDG Code The IMDG Code is an international regulation that is updated every two years to reflect biennial revisions in the UN Recommendations on the Transport of Dangerous Goods (UN Model Regulations).com © Exis Technologies 2014 .
existec. A new Amendment is published every two years. Each Amendment is valid for up to three years New Amendments can be used from 1 January of odd numbered years (shown in yellow) subject to the timing of National Competent Authority adoption During even numbered years (shown in green) only the current Amendment can be used The years before an Amendment comes into force on a mandatory basis are known as transition years (shown in yellow) when either the current or newly published Amendment may be used www.Amendment cycle of the IMDG Code The Amendment Cycle of the IMDG Code New Amendments to the IMDG Code are released according to the timeframes in the chart below.com © Exis Technologies 2014 .
.existec.com © Exis Technologies 2014 continued .3 of the IMDG Code deals with the training of shore-side staff. The training requirements for shore-side personnel are mandatory www. Training requirements Training requirements for shore side personnel The successful application of dangerous goods transport regulations is greatly dependent on all persons concerned appreciating the risks involved and having an appropriate understanding of the requirements. Chapter 1. This can only be achieved by properly planned and maintained training and retraining programmes for all relevant personnel.
Staff directly involved in dangerous goods operations must have function specific training while general awareness training is required for those who although not directly involved. do require a familiarisation with the IMDG Code. the level of training required and appropriate methods for conducting the training. www.com © Exis Technologies 2014 . Companies must determine which personnel need to be trained. Exis Technologies developed IMDG Code e-learning in collaboration with the International Maritime Organization to meet the challenge of training large numbers of shore side staff to the IMDG Code requirements.Training requirements Training requirements for shore-side personnel Personnel engaged with the transport of dangerous goods by sea must be trained according to their role and responsibilities.existec.
existec. ferry operators. These tools are available for all sectors of the transport of dangerous goods by sea chain.com Hazcheck Systems Exis also supply compliance tools for the automatic validation of dangerous goods shipments. trials and to purchase please click here www. For more information about these course.Compliance solutions Compliance solutions from Exis Technologies IMDG Code e-learning Shippers. freight forwarders and 11 of the top 20 container lines use our IMDG e-learning courses to train their staff worldwide. and to purchase please click here www.com www.com © Exis Technologies 2014 . For more information. free demos.hazcheck.imdge-learning. port operators.