PEDIATRICS MCQS, TOACS, PEARLS & UPDATES FOR MRCPCH/FCPS/MCPS EXAMS: Pediatric Quiz: Pediatric Gastrointestinal disored...

PEDIATRICS MCQS, TOACS, PEARLS & UPDATES FOR MRCPCH/FCPS/MCPS EXAMS: Pediatric Quiz: Pediatric Gastrointestinal disored...: Pediatric Quiz PEDIATRIC SHORT CASE STUDY Index => PEDIATRIC SHORT CA...

PEDIATRICS MCQS, TOACS, PEARLS & UPDATES FOR MRCPCH/FCPS/MCPS EXAMS: PEDIATRIC QUIZ: FOR YOUR CLINICAL EXAMS

PEDIATRICS MCQS, TOACS, PEARLS & UPDATES FOR MRCPCH/FCPS/MCPS EXAMS: PEDIATRIC QUIZ: FOR YOUR CLINICAL EXAMS: PEDIATRIC QUIZ PEDIATRIC QUIZ Index => PEDIATRIC QUIZ Quiz ...

PEDIATRIC QUIZ: FOR YOUR CLINICAL EXAMS

PEDIATRIC QUIZ

PEDIATRIC QUIZ

Quiz

 

1. The peripheral blood smear in a child with sore throat large, vacuolated lymphocytes. The most likely diagnosis is:
   1.   Thyrotoxicosis
   2.   Addison disease
   3.   Tuberculosis
   4.   Brucellosis
   5.   Infectious mononucleosis
2. An ultrasonographic examination of an infant with Biliary atresia reveals all of the following except:
   1.   Small gallbladder
   2.   ‘Triangular cord sign’
   3.   Absent gallbladder
   4.   Increased echogenicity of the liver
   5.   Nonvisualization of the common bile duct
3. The preferred diagnostic test in patients with an early in the course of enteric fever is:
   1.   Blood culture
   2.   Stool culture
   3.   Urine culture
   4.   CSF culture
   5.   Bone marrow culture
4. The most sensitive culture in patients with an enteric fever is:
   1.   Blood
   2.   Stool
   3.   Urine
   4.   CSF
   5.   Bone marrow
5. The most common type of organism in patients with a bacillary dysentery is:
   1.   Shigella dysenteriae
   2.   Shigella flexneri
   3.   Shigella boydii
   4.   Shigella sonnei
   5.   Salmonella ser Typhi
6. A patient with a paroxysmal nocturnal hemoglobinurea can be treated with all of the following except:
   1.   Prednisone
   2.   Fluoxymesterone
   3.   Erythropoietin
   4.   Splenectomy
   5.   Bone marrow transplantation
7. A pregnant mother has a normal platelet count. She is carrying a fetus with alloimmune thrombocytopenia. All of the following therapies are indicated except:
   1.   Monitoring of fetal platelet counts by PUBS (percutaneous umbilical blood sampling)
   2.   Give IVIG to the mother beginning in the second trimester.
   3.   IVIG should not be continued throughout the pregnancy.
   4.   If the newborn develops thrombocytopenia, one unit of washed maternal platelets should be given.
   5.   Genetic counseling is indicated to inform parents about the high risk of thrombocytopenia in future pregnancies.
8. The diagnosis of neonatal alloimmune thrombocytopenic purpura is made by:
   1.   Presence of maternal autoantibodies directed against the father’s platelet
   2.   Presence of maternal autoantibodies directed against the baby’s platelet
   3.   Presence of maternal autoantibodies directed against the mother’s platelet
   4.   Presence of maternal autoantibodies directed against the baby’s platelet that are shared with the mother.
   5.   Presence of maternal autoantibodies directed against antigens present on fetal platelets that are shared with the father.
9. The most common tissues involved in cancers of children are:
   1.   Nervous system
   2.   Embryonal
   3.   Connective tissue
   4.   Cardiac
   5.   Lymphohematopoietic
10. A mother noticed an abdominal mass while bathing the infant. The mass is smooth and firm. The infant is asymptomatic. Hypertension is noted in this patient. The most likely cause of hypertension in patients with a Wilms tumor is:
    1.   Renal artery thrombosis
    2.   Renal vein thrombosis
    3.   Renal ischemia
    4.   Obstructive uropathy
    5.   Tumor causing pressure on the aorta

PEDIATRICS MCQS, TOACS, PEARLS & UPDATES FOR MRCPCH/FCPS/MCPS EXAMS: PEDIATRIC MCQS: EASY & SMART WAY TO LEARN FAST

PEDIATRICS MCQS, TOACS, PEARLS & UPDATES FOR MRCPCH/FCPS/MCPS EXAMS: PEDIATRIC MCQS: EASY & SMART WAY TO LEARN FAST: PEDIATRIC MCQS: EASY & SMART WAY TO LEARN FAST Loading…

PEDIATRIC MCQS: EASY & SMART WAY TO LEARN FAST

PEDIATRICS MCQS, TOACS, PEARLS & UPDATES FOR MRCPCH/FCPS/MCPS EXAMS: PEDIATRIC NEONATOLOGY MCQS: The most accurate asse...

PEDIATRICS MCQS, TOACS, PEARLS & UPDATES FOR MRCPCH/FCPS/MCPS EXAMS: PEDIATRIC NEONATOLOGY MCQS: The most accurate asse...: PEDIATRIC NEONATOLOGY MCQS: To Clear Yours Concept of Basis of Neonatology

PEDIATRIC NEONATOLOGY MCQS: The most accurate assessment of gestational age in the second trimester is? and many more MCQS

PEDIATRIC NEONATOLOGY MCQS: To Clear Yours Concept of Basis of Neonatology

DAILY PEDIATRIC QUIZ: Learn Pediatric and Clear Your exams

DAILY PEDIATRIC QUIZ: Learn Pediatric and Clear Your exams

PEDIATRICS MCQS, TOACS, PEARLS & UPDATES FOR MRCPCH/FCPS/MCPS EXAMS: Indications and Timing of Intervention for Common ...

PEDIATRICS MCQS, TOACS, PEARLS & UPDATES FOR MRCPCH/FCPS/MCPS EXAMS: Indications and Timing of Intervention for Common ...: Indications and Timing of Intervention for Common Congenital Heart Diseases Atrial Septal Defect (ASD) Diagnostic work-up: Phy...

Indications and Timing of Intervention for Common Congenital Heart Diseases (ASD)

Indications and Timing of Intervention for Common Congenital Heart Diseases

Atrial Septal Defect (ASD)

Diagnostic work-up:

Physical examination, ECG, X-ray chest, echocardiography, and cardiac catheterization (may need in select cases).

Types of Atrial septal defect:

Ostium secundum (~75%);

Ostium primum (15%-20%);

Sinus venosus (5%-10%); and

Coronary sinus (<1%). 

Patent foramen ovale:

Small defect in fossa ovalis region with a flap with no evidence of right heart volume overload. Diagnosed on echocardiography, is a normal finding in newborns. 

Indication for closure:

ASD with left-to-right shunt associated with evidence of right ventricular volume overload without evidence of irreversible pulmonary vascular disease.

Indications for ASD closure remain the same irrespective of the method of closure.

Contraindications for closure:

Severe pulmonary arterial hypertension or irreversible pulmonary vascular disease. 

Ideal Age of Closure Asymptomatic child:

2-4 years. For sinus venosus defect surgery may be delayed to 4-5 years.

Symptomatic ASD: Rarely seen in infants. Present with congestive heart failure, pulmonary arterial hypertension. Early closure is recommended after ruling out associated lesions such as left ventricular inflow obstruction, aortopulmonary window, total anomalous pulmonary venous drainage, etc.

If presenting beyond ideal age: Elective closure irrespective of age as long as there is left-to-right shunt with right heart volume overload and pulmonary vascular resistance is within operable range.

Method of Closure:

Surgical: Established mode.

Device: For secundum ASDs with adequate rims and weight of child >15kg.

Recommendations for Follow-up:

Follow-up after surgical closure: Clinical and echo in the first year only. No further follow-up required if no residual disease, no pulmonary hypertension or arrhythmia.

Patient/guardians should be explained about reporting to hospital in case of any cardiac symptoms, or symptoms suggestive of arrhythmias.

Follow-up after device closure:

(a) Anti-platelet agents for total duration of 6 months

(b) Echocardiography: - At discharge, 1 month, 6 months, 1 year, then every 3-5 years.

Infective endocarditis prophylaxis: It is recommended for 6 months after device or surgical closure. However, all patients are advised to maintain good oro-dental hygiene after this period also.

PEDIATRICS DECISION MAKING: NEPHROTIC SYNDROME EXPLAINED IN 10 QUESTIONS AND ANSWERS

PEDIATRICS DECISION MAKING: NEPHROTIC SYNDROME EXPLAINED IN 10 QUESTIONS AND ANSWERS

PEDIATRIC ENDOCRINOLOGY QUIZ: MAKE YOUR KNOWLEDGE WITH REASONING AND TO CONVERT THIS KNOWLEDGE INTO CLINICALS

PEDIATRIC ENDOCRINOLOGY QUIZ

Prolonged Fever: 07 Essential steps to reach the diagnosis? Blind empirical drug therapy when indicated?

Prolonged Fever

STEP # 01: Keep in mind the causes of prolonged fever

These are infections & non-infectious causes

Infections causes:

Bacterial infections 

Systemic infections: Salmonellosis, brucellosis, listeriosis, leptospirosis, tularemia, tuberculosis 

Hidden focal infections: Abscess (liver, perinephric, pelvic), endocarditis, pericarditis, pyelonephritis, osteomyelitis 

Viral infections 

Infectious mononucleosis, cytomegalovirus infection, Human immunodeficiency virus (HIV), hepatitis 

Parasitic infestations 

Malaria, toxoplasmosis, visceral larva migrans

Non-infectious causes:

Rheumatic diseases

Rheumatic fever, systemic rheumatoid arthritis, polyarteritis nodosa, systemic lupus erythematosus, kawasaki disease, mixed connective tissue disease

Malignancies

Leukemia, lymphoma, neuroblastoma

Immune reactions

Drug fever, serum sickness

Other causes

Factitious fever or false fever, Crohn disease, Diabetes insipidus, Anhydrotic ectodermal dysplasia, Familial Mediterranean fever

STEP # 02: Is it  prolonged fever?

Prolonged fever is a fever with duration of more than 10 - 14 days. Although it is not as common as short febrile illness, it causes greater concern of both parents and doctors.

Fortunately, unlike adults, most cases of prolonged fever in children are caused by benign infections and the prognosis for ultimate recovery is generally good.

STEP # 03: Is it  true prolonged fever?

Is it truly a prolonged fever?

• Is there an evident cause?

• Unexplained prolonged fever... What is the cause?

Is it truly a prolonged fever?

The complaint of prolonged fever, as any other prolonged complaint, should not be accepted without careful analysis. Parents may misinterpret normal temperature as a mild fever. Careful history may reveal that the condition represents 2 short febrile illnesses rather than a prolonged one. Documentation of fever is important in accepting the complaint as a true prolonged fever.

STEP # 04: Is there an evident cause for prolonged fever?

With documented prolonged fever, detailed history and meticulous examination may

reveal an evident cause or at least suggest a specific disease.

History and examination in children with prolonged fever

Nonspecific findings denoting significant illness

Symptoms: Anorexia, weight loss.

Signs: Toxic look, pallor, cachexia, lymphadenopathy or Hepatosplenomegaly.

Specific findings suggesting a particular disease

Symptoms related to a specific system: CNS, chest, heart, GIT, urinary.

History of contact to an adult with chronic chest disease: ? Tuberculosis.

History of eating rabbit meat: ? Tularemia.

History of medications: ? Drug fever.

Rigors: Septicemia, pyelonephritis or malaria.

Pharyngitis: Infectious mononucleosis, cytomeglovirus, tularemia, toxoplasmosis.

CNS examination May suggest meningitis.

Chest examination: May reveal pneumonia or empyema.

Cardiac examination: May reveal endocarditis or pericarditis.

Abdominal examination: Liver (hepatitis, abscess) or loin tenderness (perinephric abscess).

Skeletal examination: Arthritis or osteomyelitis (focal tenderness).

Rectal examination: Focal tenderness suggests pelvic abscess.

STEP # 05: After history and examination, did you find any cause for prolonged fever?

With clinical suspicion of any disease, investigations should be directed to confirm or exclude the suspected disease.

Unexplained prolonged fever... What is the cause?

When history and physical examination fail to reveal an evident cause or to suggest a specific disease, the term “unexplained prolonged fever” or “fever of unknown origin

(FUO)” can be used. These terms should be restricted to cases of documented fever with duration of at least 10-14 days.

STEP # 06: Whether to admit or not?

In patients with good general condition and a rather short history, simple investigations (CBC, ESR, CRP, urine analysis) can be made on an outpatient basis.

Normal laboratory findings in this group indicate that the illness is mostly a benign viral infection. Reassurance and follow-up are important.

Patients with clinical findings indicating that the illness is significant should be hospitalized and further investigated. Hospitalization is also indicated in those with abnormal results of initial simple investigations.

Hospitalization is useful for several reasons:

a. Documentation of fever: Temperature should be regularly measured by a reliable person to exclude the possibility of “factitious or false fever”.

b. Drugs should be avoided as much as possible to exclude the possibility of drug fever. In this case, fever will subside within 1-3 days of discontinuation of the responsible drug.

c. Close observation for the general condition (appetite, activity, reaction to stimulation), presence of rigors (septicemia, malaria) or appearance of new symptoms or signs. Frequently, the fever may subside spontaneously without any specific therapy and even before completing the investigations.

STEP # 06: Investigations in children with unexplained prolonged fever

Nonspecific Investigations to confirm the presence of significant illness

Complete blood count (CBC): Leukocytosis, leukopenia or eosinophilia (larva migrans).

Erythrocyte sedimentation rate (ESR): Above 30 mm (first hour).

C-reactive protein (CRP): Above 20 - 30 mg/liter.

Chest X-ray: Pneumonic consolidation or pulmonary infiltrate.

Specific investigations to identify the causative disease

Initial investigations

Blood culture (aerobic and anaerobic): May be repeated.

Urine culture.

Tuberculin test and culture of gastric washing.

Blood film for malaria.

Common serological tests: Typhoid, infectious mononucleosis (monospot), brucella.

When the above specific initial investigations are negative

Specific blood culture for listeriosis, leptospirosis, tularemia.

Specific serological tests for leptospirosis, tularemia, toxoplasmosis.

Bone marrow examination (for leukemic blast cells) and culture (bacteria).

Abdominal ultrasonography: For liver abscess, epinephric abscess.

Echocardiography: In patients with preexisting cardiac disease (infective endocarditis).

When all of above are negative

Lymph node biopsy: May reveal lymphoma.

Radioactive scanning: May reveal osteomyelitis.

Total body CT scanning or MRI: May reveal hidden tumors.

Remember: International studies showed that in 25% of cases, the cause remains unknown even after exhaustive investigations.

STEP # 07: Blind empirical drug therapy may or may not be started? When indicated?

Blind empirical drug therapy should be generally avoided as it may mask the condition and makes the diagnosis more difficult. Exceptions to this rule are:

a. Blind antibiotic therapy in patients with the clinical diagnosis of septicemia but the organism could not be isolated.

b. Blind antituberculous therapy in sick patients with cachexia and weight loss and when the possibility of tuberculosis is strongly standing in spite of the negative laboratory investigations.