PEDIATRICS MCQS, TOACS, PEARLS & UPDATES: MRCPH/FCPS PEDIATRIC MCQS: RHEUMATOLOGY AND ORTHOP...

PEDIATRICS MCQS, TOACS, PEARLS & UPDATES: MRCPH/FCPS PEDIATRIC MCQS: RHEUMATOLOGY AND ORTHOP...: WANTS TO LEARN PEDIATRIC RHEUMATOLOGY THROUGH MCQS: CLICK ON THE FOLLOWING: 1. What is the most accurate characteristic of the ANA test a...

MRCPH/FCPS PEDIATRIC MCQS: RHEUMATOLOGY AND ORTHOPEDICS

WANTS TO LEARN PEDIATRIC RHEUMATOLOGY THROUGH MCQS: CLICK ON THE FOLLOWING:

1. What is the most accurate characteristic of the ANA test and its role in establishing the diagnosis of SLE?

2. A SLE diagnosed child with   mild renal involvement, what will be the most appropriate initial treatment regimen in this patient?

and 

many many more MCQS------------ on Pediatric MCQS and TOACS

MRCPH/FCPS PEDIATRIC MCQS: RHEUMATOLOGY AND ORTHOPEDICS

PEDIATRICS MCQS, TOACS, PEARLS & UPDATES: MRCPH/FCPS PEDIATRIC MCQS: IMMUNE DEFICIENCY DISOR...

PEDIATRICS MCQS, TOACS, PEARLS & UPDATES: MRCPH/FCPS PEDIATRIC MCQS: IMMUNE DEFICIENCY DISOR...: MRCPH/FCPS PEDIATRIC MCQS 1. A 5-year-old girl attention-deficit/hyperactivity disorder and autism, with repair of tetralogy of Fallot in ...

MRCPH/FCPS PEDIATRIC MCQS: IMMUNE DEFICIENCY DISORDERS

MRCPH/FCPS PEDIATRIC MCQS

1. A 5-year-old girl attention-deficit/hyperactivity disorder and autism, with repair of tetralogy of Fallot in past, having frequent upper respiratory tract infections, and recurrent tinea capitis: Diagnosis?
2. A 6-year-old girl with severe eczema, recurrent staphylococcal abscesses, mild facial dysmorphism, and scoliosis: What will be the initial test?
3. A 1-month-old infant  with absent thymic shadow on chest radiograph; most appropriate next step in the care of this infant?
4. A 30-month-old boy with recurrent Klebsiella pneumoniae, as well as recurrent fevers and pyoderma; most likely diagnosis in this patient?
5. Newborn screening results positive for severe combined immunodeficiency (SCID). Which of the following is the most appropriate next step in the management of this patient?

MRCPH/FCPS PEDIATRIC MCQS

PEDIATRICS MCQS, TOACS, PEARLS & UPDATES: MRCPH/FCPS PEDIATRIC MCQS: DIABETIC ACIDOSIS

PEDIATRICS MCQS, TOACS, PEARLS & UPDATES: MRCPH/FCPS PEDIATRIC MCQS: DIABETIC ACIDOSIS: DIABETIC KETOACIDOSIS: MRCPH/FCPS MCQS: LEARN ABOUT DIABETES KETOACIDOSIS (DKA)

MRCPH/FCPS PEDIATRIC MCQS: DIABETIC ACIDOSIS

DIABETIC KETOACIDOSIS:
MRCPH/FCPS MCQS: LEARN ABOUT DIABETES KETOACIDOSIS (DKA)

PEDIATRICS MCQS, TOACS, PEARLS & UPDATES: MRCPH/FCPS PEDIATRIC MCQS: IMMUNOLOGY

PEDIATRICS MCQS, TOACS, PEARLS & UPDATES: MRCPH/FCPS PEDIATRIC MCQS: IMMUNOLOGY: MRCPH/FCPS PEDIATRIC MCQS: IMMUNOLOGY   1. An 8-year-old boy with Elevated IgE with normal levels of IgG, IgA, and IgM; What is the diagno...

MRCPH/FCPS PEDIATRIC MCQS: IMMUNOLOGY

MRCPH/FCPS PEDIATRIC MCQS: IMMUNOLOGY 

 1. An 8-year-old boy with Elevated IgE with normal levels of IgG, IgA, and IgM; What is the diagnosis? 

2. A 7 -year-old boy presents with generalized maculopapular rash, hepatomegaly, headache, neutropenia, thrombocytopenia, and hyperlipidemia: What is the diagnosis? 

3. A 14-year-old girl with large tonsils, splenomegaly, and pernicious anemia: How will you treat this child? 

4. A 14-year-old boy presents with progressive debilitating unbalanced gait, making ambulation extremely difficult: What is the mode of inheritance? 

5. A 3-year-old boy with known hemoglobin SS sickle cell disease: What is the most common organism causing infection in this disease?

PEDIATRICS MCQS, TOACS, PEARLS & UPDATES: INFANTILE SPASM and INFANTILE SPASM TREATMENT

PEDIATRICS MCQS, TOACS, PEARLS & UPDATES: INFANTILE SPASM and INFANTILE SPASM TREATMENT: INFANTILE SPASM (WEST syndrome): Steroids and Vigabatrin are considered as the first line medications for infantile spasms and ACTH ...

INFANTILE SPASM and INFANTILE SPASM TREATMENT

INFANTILE SPASM (WEST syndrome):

• Steroids and Vigabatrin are considered as the first line medications for infantile spasms and ACTH injections are not considered superior to oral prednisolone in treatment of infantile spasms.

• For tuberous sclerosis, Vigabatrin should be used as first line, without steroids
• If not tuberous sclerosis: Combination therapy with steroids and vigabatrin has been shown to produce quicker spasm resolution

HIGH DOSE ACTH PROTOCOL IN INFANTILE SPASM:

Schedule	Dose IM
Day 1-14 (week 1 and 2)	75 Units/m2/dose twice a day, may receive only 1 dose on day1
Taper over 2 weeks (weeks 3 and 4)
Day 15-17	30 Units/m2/dose every morning
Day 18-20	15 Units/m2/dose every morning
Day 21-23	10 Units/m2/dose every morning
Day 24-30	10 Units/m2/dose every other morning

Treatment failure: If ACTH treatment has failed after 2 weeks

Then what to do?

• Consider switching to an alternative agent with a different mechanism of action (i.e. vigabatrin). Taper ACTH according to the protocol above, while simultaneously beginning an alternative agent.
• Gastrointestinal prophylaxis: H2 blocker or proton pump inhibitor is required during the full course of ACTH treatment (e.g. ranitidine, omeprazole, or lansoprazole). GI prophylaxis can be stopped when ACTH is stopped.
• PJP prophylaxis: Patients will be immunosuppressed while on ACTH and for weeks after ACTH treatment. PJP prophylaxis is needed with Bactrim 2.5 mg/kg/dose two times a day or BID on three consecutive days each week (preferred practice is Monday, Tuesday and Wednesday) during ACTH treatment and for an additional 4 weeks after ACTH treatment is stopped.
• Immunizations: In general, children receiving high dose systemic corticosteroids (such as ACTH or prednisolone) should NOT receive LIVE-virus vaccines until 4 weeks after discontinuation of steroids. Inactivated vaccines may be temporarily deferred until corticosteroids are discontinued or may be given during corticosteroid treatment if caregiver adherence with follow-up is not likely.
• Stress dose steroids: At the cessation of steroids or with illness, there may be a need for stress dose steroids. Patients will have adrenal insufficiency after the course of ACTH for as long as they received the medication, (e.g. a patient treated with 4 weeks of ACTH will have adrenal insufficiency for 4 weeks following cessation of therapy). They should be evaluated by a physician for any signs of illness including fever, vomiting, diarrhea, or with trauma to assess for hypoglycemia and hypotension.

Monitoring:

• Common side effects from ACTH include hypertension, hyperglycemia, irritability, immunosuppression, stomach irritation, increased appetite, and adrenal crisis (especially if stopped abruptly).
• Hypertension: Blood pressure monitoring is required 2-3 times per week.
• Sustained hypertension is defined as systolic blood pressure (SBP) greater than 95th% (in children 100 is >95th %) on 3 consecutive days.
• Sustained hypertension can be a sign of steroid-induced endocrine dysfunction or cardiomyopathy (septal hypertrophy), which can develop after 5+ days of ACTH treatment. BP monitoring and prompt attention to hypertension is critical.
• Hyperglycemia: Weekly glucose monitoring is required.
• If hyperglycemia occurs (glucose is >200), ensure the patient’s PCP is involved. Draw a BMP to check for hypokalemia. Insulin treatment may be required.

ORAL PREDNISOLONE PROTOCOL:

Low dose 4mg/day vs high dose 8mg/day (max: 60mg/day)

Days	Dose
1-14	2.6mg/kg/day 3 times a day (8mg/kg/day) Maximum dose 60mg/day
15-21	2.6mg/kg/day 2 times a day
22-28	2.6mg/kg/day 1 time a day
29	Stop

Treatment failure: If ACTH treatment has failed after 2 weeks

Then what to do?

Consider switching to an alternative agent with a different mechanism of action (i.e. vigabatrin). Taper ACTH according to the protocol above, while simultaneously beginning an alternative agent.

FOLLOW-UP FOR ALL THERAPIES:

• Following the initiation of any first-line treatment, efficacy of therapy should be assessed by 2 weeks.
• Short-term outcomes include cessation of spasms and EEG confirmation of treatment response showing resolution of hypsarhythmia.
• §  EEG should be used to assess for resolution of spasms and hypsarhythmia at 12-16 days. EEG should be of sufficient duration to include wake and sleep.

If spasms or hypsarhythmia persist at 2 weeks then:

• Many children will respond to an alternative first-line therapy. Consider switching treatment to an alternative first-line treatment with a different mechanism of action. Follow the weaning protocols outlined for the specific first-line agent.
• Efficacy of the alternative therapy should also be assessed at 2 weeks, as above.
• In patients without a clear etiology for IS, consider vitamin B6 diagnostic challenge.
• If spasms or hypsarhythmia persists or recur 2 weeks after treatment with an alternative first-line medication, consider prompt referral to an epileptologist to pursue additional treatment options.
• Consider repeat EEG 1-4 weeks after completion of treatment to confirm sustained efficacy. Also consider repeat EEG if there is concern for developmental plateau/regression or clinical seizures.
• If spasms or hypsarhythmia abnormalities persist or recur in the absence of an established etiology, or if the child does not follow the expected treatment course based on the established etiology, the etiology should be further investigated, to include at least 1 of the following: repeat video EEG monitoring, MRI, or genetic/metabolic studies.
• Neuropsychological testing is recommended within the first two years of life.

VIGABATRIN

Dosing (Infants and children 1 month – 2 years):

• 25 mg/kg/dose twice a day – increase by 25-50 mg/kg/DAY increments every 3 days for spasm control, to max of 75mg/kg/dose twice a day.
• At conclusion of treatment, vigabatrin should be tapered off by 25-50 mg/kg/DAY every 3-4 days.
• Treatment failure: If vigabatrin treatment has failed after 2 weeks, consider switching to an alternative agent with a different mechanism of action (i.e. ACTH or prednisolone).
• Vigabatrin should be weaned by 25-50 mg/kg/DAY every 3-4 days while simultaneously beginning an alternative agent.
• Duration of therapy, if vigabatrin is successful, optimal duration of treatment is unknown. Common practice is 6 months.

Monitoring: 

• Baseline eye exams within 4 weeks of vigabatrin initiation, every 3 months during therapy, and at 3-6 months following discontinuation of therapy are recommended for vigabatrin therapy. Pre-existing visual impairment is not a contraindication for vigabatrin treatment. 
• Baseline MRI is encouraged due to vigabatrin-associated changes on MRI.

Second line treatment may include (in no recommended order as this will depend on the infant’s presentation and possible underlying aetiology):

• Trial of Pyridoxine
• Topiramate or zonisamide
• Sodium valproate
• Nitrazepam
• Ketogenic diet ,
• Evaluation for epilepsy Surgery
• Where prednisolone has been used but ineffective or partially effective, there are occasional children who appear to respond to ACTH 

PEDIATRICS MCQS, TOACS, PEARLS & UPDATES: MRCPH/FCPS PEDIATRIC MCQS

PEDIATRICS MCQS, TOACS, PEARLS & UPDATES: MRCPH/FCPS PEDIATRIC MCQS: DAILY FRESH MRCPH/FCPS PEDIATRIC MCQS 1. A 6-year-old boy is diagnosed to have a coagulation abnormality-----------------? 2. A 14-year-ol...

MRCPH/FCPS PEDIATRIC MCQS

DAILY FRESH MRCPH/FCPS PEDIATRIC MCQS
1. A 6-year-old boy is diagnosed to have a coagulation abnormality-----------------?
2. A 14-year-old girl with blond hair and wearing sunglasses--------------------------?
3. A 1 -month -old neonate with horizontal nystagmus and optic nerve hypoplasia-----? and many more interesting MCQS


MRCPH/FCPS PEDIATRIC MCQS

PEDIATRICS MCQS, TOACS, PEARLS & UPDATES: PEDIATRIC TOP-UPs: A BRIEF GUIDE TO ANTICONVULSANT...

PEDIATRICS MCQS, TOACS, PEARLS & UPDATES: PEDIATRIC TOP-UPs: A BRIEF GUIDE TO ANTICONVULSANT...: A brief guide to anticonvulsant use Infantile spasms: ACTH; prednisolone; vigabatrin (especially in tuberous sclerosis). Generalized ...

PEDIATRIC TOP-UPs: A BRIEF GUIDE TO ANTICONVULSANT USE

A brief guide to anticonvulsant use

Infantile spasms: ACTH; prednisolone; vigabatrin (especially in tuberous sclerosis).

Generalized tonic–clonic:

– <6 months of age: phenobarbital.

– <3 years of age: levetiracetam.

– >3 years of age: levetiracetam; divalproex.

– >16 years of age: lamotrigine; divalproex (avoid in girls); levetiracetam.

Absence: ethosuximide; divalproex; lamotrigine.

Focal: oxcarbazepine; levetiracetam; topiramate; carbamazepine.

Myoclonic: levetiracetam; divalproex (avoid in children with metabolic disorders); lamotrigine.

PEDIATRICS MCQS, TOACS, PEARLS & UPDATES: Pediatric TOP-UPS: Genetic syndrome causing cranio...

PEDIATRICS MCQS, TOACS, PEARLS & UPDATES: Pediatric TOP-UPS: Genetic syndrome causing cranio...: Important genetic syndrome causing craniosynostosis: (a) Crouzon syndrome: autosomal dominant; acrocephaly or brachycephaly due to bil...

Pediatric TOP-UPS: Genetic syndrome causing craniosynostosis

Important genetic syndrome causing craniosynostosis:

(a) Crouzon syndrome: autosomal dominant; acrocephaly or brachycephaly due to bilateral coronal suture closure; proptosis due to underdeveloped orbit. Maxillary hypoplasia and hypertelorism are characteristic features.

(b) Apert syndrome: mostly sporadic; acrocephaly; syndactyle (2nd, 3rd and 4th fingers), mimics crouzon, except asymmetric face and less proptosis of eyes.

 

(c) Carpenter syndrome: autosomal recessive; clover leaf skull; syndactyle (hands and feet); mental retardation.

(d) Pfeiffer syndrome: mostly sporadic; conical head; widely spaced and prominent eyes; short and broad (thumb and toes)

(e) Chotzen syndrome: most comm only seen in genetic syndrome; autosomal dominant; ptosis eyelid; short fingers; syndactyle (2nd and 3rd fingers); and facial asymmetry.

PEDIATRICS MCQS, TOACS, PEARLS & UPDATES: PEDIATRIC MCQS: HEPATOLOGY

PEDIATRICS MCQS, TOACS, PEARLS & UPDATES: PEDIATRIC MCQS: HEPATOLOGY: Interesting Facts about Hepatitis A, B, and C in MCQS FORM 1.  A 10-month-old boy is being seen for reported hepatitis A exposure.  Appropr...

PEDIATRIC MCQS: HEPATOLOGY

Interesting Facts about Hepatitis A, B, and C in MCQS FORM
1. A 10-month-old boy is being seen for reported hepatitis A exposure. Appropriate therapy at this time would include?
2. An 11-year-old boy is being seen for reported hepatitis A exposure. Appropriate therapy at this time would include?
3. Which of the following neonates should receive hepatitis B immune globulin within 12 hours after birth?
and many more-------------------------------------
PEDIATRIC MCQS: HEPATOLOGY

PEDIATRICS MCQS, TOACS, PEARLS & UPDATES: MRCPH/FCPS MCQS: Learn Nocturnal Enuresis, Nuerofi...

PEDIATRICS MCQS, TOACS, PEARLS & UPDATES: MRCPH/FCPS MCQS: Learn Nocturnal Enuresis, Nuerofi...: Nocturnal Enuresis, Nuerofibromitosis type 1, Bartter syndrome, Liddle syndrome, Polycystic kidney disease, Lactose intolerance LEARN MRCP...

MRCPH/FCPS MCQS: Learn Nocturnal Enuresis, Nuerofibromitosis type 1, Bartter syndrome, Liddle syndrome, Polycystic kidney disease, Lactose intolerance

Nocturnal Enuresis, Nuerofibromitosis type 1, Bartter syndrome, Liddle syndrome, Polycystic kidney disease, Lactose intolerance

LEARN MRCPH/FCPS PEDIATRICS MCQS

PEDIATRICS MCQS, TOACS, PEARLS & UPDATES: MRCPH/FCPS MCQS dated 18/9/2019

PEDIATRICS MCQS, TOACS, PEARLS & UPDATES: MRCPH/FCPS MCQS dated 18/9/2019: MRCPH/FCPS MCQS dated 18/9/2019

MRCPH/FCPS MCQS dated 18/9/2019

MRCPH/FCPS MCQS dated 18/9/2019

PEDIATRICS MCQS, TOACS, PEARLS & UPDATES: FCPS/MRCPH PEIATRICS MCQS PART 2

PEDIATRICS MCQS, TOACS, PEARLS & UPDATES: FCPS/MRCPH PEIATRICS MCQS PART 2: FCPS/MRCPH PEIATRICS MCQS PART 2

FCPS/MRCPH PEIATRICS MCQS PART 2

FCPS/MRCPH PEIATRICS MCQS PART 2

PEDIATRICS MCQS, TOACS, PEARLS & UPDATES: PEDIATRIC MCQs 01

PEDIATRICS MCQS, TOACS, PEARLS & UPDATES: PEDIATRIC MCQs 01: PEDIATRIC MCQs 01 PEDIATRIC MCQS Index => PEDIATRIC MCQS Quiz ...

PEDIATRIC MCQs 01

PEDIATRIC MCQs 01

PEDIATRIC MCQS

Quiz

 

1. A boy is admitted to PICU (pediatric intensive care unit) for bacterial pneumonia. He is receiving intravenous antibiotic therapy. The boy was admitted previously for meningitis. Past medical history revealed recurrent otitis media and herpes infection. Physical examination reveals bilateral rales and eczematous skin lesions. Blood test result reveals thrombocytopenia.
   All of the following statements are true for this disease except:
   1. Bone marrow transplantation is effective
   2. Autosomal recessive
   3. Death occurs due to infection or bleeding
   4. Elevated IgA and IgE
   5. Thrombocytopenia is due to intrinsic platelet defects.
2. A 3-year-old boy appeared in the ER with pallor, lethargy, irritability, dehydration, and oliguria. These symptoms and signs are preceded by acute gastroenteritis (e.g., vomiting, diarrhea with bloody stools) for the last 5 days. Physical examination reveals hepatosplenomegaly, edema, and petechiae.
   The following statements are true about this clinical condition except:
   1. Renal failure does occur.
   2. Enteropathogenic E. coli is the most common organism
   3. Endothelial cell injury is the primary event in the pathogenesis.
   4. Peritoneal dialysis is indicated.
   5. Coombs test is positive.
3. full-term newborn developed hypocalcemia. He received intravenous calcium. Chest X-ray revealed absence of thymus.
   All of the following statements are true in this disease except:
   1. Hypoplasia of thyroid gland
   2. Hypoplasia of parathyroid gland
   3. Truncus is common.
   4. Renal anomalies are common
   5. Velopharyngeal insufficiency is common.
4. Routine physical examination of a full-term male newborn reveals cryptorchidism and abdominal muscle deficiency. Renal sonogram and VCUG (voiding cystourethrography) studies reveal obstructive uropathy and dysplastic kidneys. Most common associated anomaly in this syndrome:
   1. Cardiac
   2. Pulmonary
   3. Gastrointestinal
   4. Musculoskeletal
   5. Endocrine
5. A 11-year-old girl came for routine physical examination. Her breasts and papillae form a small mound; areolae are increased in diameter. Her pubic hair is sparse, uncurly, lightly pigmented, and located in medial border of labia. Her development should correspond with Tanner stage:
   1. Stage 1
   2. Stage 4
   3. Stage 2
   4. Stage 4
   5. Stage 5
6. full-term baby was born by forcep delivery with Apgar scores 5 and 7 at 1 and 5 minutes respectively. Physical examination reveals absence of left retinal reflex. Most likely diagnosis:
   1. Retinal hemorrhage
   2. Retinal detachment
   3. Cataract
   4. Bleeding inside anterior chamber of left eye
   5. Corneal trauma
7. All of the following is recommended in an infant who is a high-risk for developing food allergy and atopic dermatitis except:
   1. Discontinue breast feeding if mother has eczema.
   2. Only breast feeding for first 4 to 6 months of life
   3. Use hypoallergenic milk
   4. Delay introduction of solid foods until 4 to 6 months of age.
   5. Delay introduction of cow’s milk until 1 year of age.
8. A 12-year-old boy appears with history of fever (102°F) and pain in lower end of the left thigh for the last 5 days. He had history of trauma 2 weeks ago in the left ankle. Physical examination reveals swelling, tenderness, and redness in the distal thigh, but a full range of motion in the left knee and left hip. CBC reveals WBC count 21,500/Cu mm with polymorphs 85% and lymphocytes 15%. X-ray reveals normal left femur and left knee. The next step in investigation:
   1. MRI of the left femur
   2. CT scan of the left hip
   3. Radionuclide bone scan of left femur
   4. Ultrasonography of left knee
   5. X-ray of the lower back
9. A boy developed anaphylactic reaction after a food intake. This reaction is due to:
   1. IgA
   2. IgG
   3. IgM
   4. IgD
   5. IgE
10. A child releases object to his mother. He can pick up pellet with unassisted pincer movement of forefinger and thumb. He can make postural adjustment to dressing. He can walk by holding hand, says a few words besides “mama” and “dada”. He plays simple ball games. He was unable to build a tower of 2 to 3 cubes. The developmental age of this child:
    1. 9-month-old
    2. 10-month-old
    3. 12-month-old
    4. 15-month-old
    5. 18-month-old