1. Iron deficiency anaemia.
2. Malnutrition.
3. Oesophageal reflux.
4. Cardiomyopathy.
1 , 2 , 3 are correct .
BACKGROUND---Dystrophic epidermolysis bullosa (DEB) is an uncommon genetic disorder of the skin and mucosae. In 1996, we reported the occurrence of lethal dilated cardiomyopathy (DCM) in two affected children.
METHODS---In the past seven years we have routinely screened patients with severe DEB who have been under the care of this hospital by yearly clinical review, echocardiography, and quantification of plasma selenium and carnitine concentrations, as deficiency of these micronutrients is known to be associated with the development of DCM.
RESULTS---Six of 61 children have developed DCM over the seven year period of this study, four of whom have not been previously reported, and three of whom have since died. We compared the concentrations of selenium and free and total carnitine in the children who developed DCM to concentrations in those with severe DEB who did not. The concentrations of free and total carnitine when first measured were significantly lower in the children with DCM, but the selenium concentrations were not.
CONCLUSIONS---We now believe that DCM is a not infrequent complication of severe recessive DEB, and may be related in part to carnitine concentrations, though the exact mechanism remains unclear. We therefore recommend that patients with this condition should undergo regular cardiac review including echocardiography.
http://adc.bmj.com/cgi/content/abstract/83/1/59 ---- taken from here SO MAY BE ALL ARE CORRECT . U DECIDE .
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A woman is treated for imminent eclampsia with therapy which includes large doses of magnesium sulphate. A live infant is subsequently delivered by Caesarean section.
Signs in the neonate which are suggestive of hypermagnesaemia include:
1. Hypereflexia.
2. Lethargy.
3. Convulsions.
4. Paralytic ileus.
2 and 4 are true .
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With regard to an infant with a tracheo-oesophageal fistula:
1. The diagnosis is suggested by the inability to pass a feeding tube into the stomach.
2. Other congenital abnormalities commonly occur.
3. Polyhydramnios may well have been a feature of the antenatal period.
4. The child should be intubated soon after birth to reduce aspiration risk.
1 , 2 , 3 are correct .
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With regard to fluid resuscitation in an infant awaiting pyloromyotomy for pyloric stenosis, which of the following are considered reliable indicators of volume status?
1. Serial body weight.
2. Urinary sodium.
3. Serum sodium.
4. Urinary chloride
only 4 is the answer .
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Which of the following conditions typically complicate the syndrome of tetralogy of Fallot?
1. Congestive cardiac failure.
2. Hypoglycemia's.
3. Eisenmenger's Syndrome.
4. Neonatal hypoxaemia.
2 and 4 are correct .
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The most likely cause of persistent hypertension in a six year old child with a normal body mass index is:
A. Reno-vascular disease.
B. Coarctation of the aorta.
C. Phaeochromocytoma.
D. Renal disease.
E. 'Essential' hypertension.
answer is D --- renal disease
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The smallest 'Univent' tube available for paediatric use has an internal diameter of:
A. 3.5 mm.
B. 4.0 mm.
C. 4.5 mm.
D. 5.0 mm.
E. 5.5 mm
answer is A .
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A neonate awaiting repair of a congenital diaphragmatic hernia will typically have which of the following associated problems:
1. Pulmonary hypertension.
2. Aspiration.
3. Other congenital abnormalities.
4. Prematurity.
all are correct .
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Which of the following are true when comparing general anesthesia with halothane in a three year old compared with an adult?
1. Induction is faster.
2. Higher concentrations will be required for maintenance of anaesthesia.
3. Myocardial depression is greater.
4. The risk of aspiration is higher.
all are correct .
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Which of the following statements are true of bronchiolitis:
1. Up to 50% of patients continue to wheeze after recovery
2. Tachypnoea is invariable
3. Air-trapping is normally present
4. The typical pathogen is para influenza virus
1 , 2 , 3 are right .
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A ventricular septal defect in children:
1. Is the commonest congenital heart lesion
2. If of Maladie de Roger type is the most severe form
3. Closes spontaneously in up to 50% of cases
4. Is associated with pulmonary oligaemia
1 and 3 are the right answers .
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The distance from the incisors to the mid-tracheal point in a five year old child is most likely to be:
A. 10 cms.
B. 12 cms.
C. 15 cms.
D. 17 cms.
E. 19 cms.
C is the right answer
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A 3400g neonate is examined at 5 minutes of life with the following findings: temperature: 37.2°C ; heart rate: 120 bpm; respiration rate: 25 bpm (regular); blood pressure: 80/60 mm Hg. His eyes are closed and his pupils are constricted. All four extremities are actively moving with good muscle tone. When you suction the nares there is no response. Skin colour is pink on both the body and the extremities.
What is the correct 5 minute Apgar score for this neonate?
A. 5.
B. 7.
C. 8.
D. 9.
E. 10.
answer is C .
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A 5-month-old female infant presents with persistent tachypnoea of a few weeks duration following an upper respiratory tract infection. The chest X-Ray is shown below. This scenario is compatible with:
1. Congenital lobar emphysema.
2. Aspiration of a foreign body.
3. Congenital cystic adenomatoid malformation.
4. Lobar pneumonia
answer : 1 and 3 are correct .
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In a 3 year old child with congenital heart disease, which of the following murmurs are best heard at the apex?
1. Hypertrophic Obstructive Cardiomyopathy
2. Tetralogy of Fallot
3. Mitral Regurgitation
4. Patent Ductus Arteriosus
answer : 1 and 3 are correct .
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Which of the following may predispose to the development of respiratory distress syndrome (RDS) in the neonate?
1. Low gestational age.
2. Low weight for gestational age.
3. Maternal diabetes.
4. Congenital heart disease in the foetus.
1 and 3 are correct
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One minute after birth, a 2.2 kg term infant has a pink trunk but cyanotic fingers and toes and an irregular respiratory pattern. The child grimaces with nasal suctioning, is immobile, but has flexion of the elbows and knees and a heart rate of 85 bpm.
Which of the following statements are true?
1. The Apgar score is consistent with mild intrauterine asphyxia.
2. Atropine 40 mcg via the umbilical vein is indicated.
3. Bag-mask ventilation with pure oxygen should be initiated.
4. Intubation is indicated.
answer: 1 and 3 are correct .
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The parents of a 10 year old boy are worried that his school performance has decreased over the past 2 months. The boy complains of increasing headache and double vision and on examination you note that he has gait ataxia.
Which of the following is the most appropriate immediate investigation?
A. Computed tomography (CT) scan of the brain.
B. Electroencephalogram.
C. Auditory evoked potentials.
D. Single Photon Emission Computed Tomography (SPECT) scan of the brain.
E. Magnetic resonance imaging (MRI) scan of the brain.
answer is E
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Shortly after birth, a full-term infant weighing 3.1 kgs, is noted to be cyanosed during feeding. The cyanosis is relieved by crying. The infant was delivered normally following an uncomplicated pregnancy.
Which of the following diagnoses is most likely?
A. Tracheo-oesophageal fistula.
B. Tetralogy of Fallot.
C. Respiratory distress syndrome.
D. Patent ductus arteriosus (PDA).
E. Choanal atresia.
answer is E
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The retinopathy of prematurity (ROP):
1. Is a cause of myopia in later life.
2. Is more likely to occur in an infant exposed to supplemental oxygen.
3. Is associated with the development of strabismus in later life.
4. Is unlikely to occur in an infant born at a gestational age of more than 32 weeks.
answer: all are correct .
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The typical biochemical profile of a neonate with severe, newly diagnosed, pyloric stenosis includes:
1. Hypochloraemia.
2. Alkalosis.
3. Hypokalaemia.
4. Unconjugated hyperbilirubinaemia.
answer : 1 2 3 are correct .
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The smallest size of double lumen tube (DLT) which is commercially available for paediatric use is:
A. 24 F
B. 26 F
C. 28 F
D. 30 F
E. 32 F
answer : B
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A 4-day-old, 1500-gram, premature infant recovering from a hyaline membrane disease is noted to have bounding peripheral pulsations and a hyperactive precordium. A continuous machinery murmur is most audible in the left infraclavicular area. Left ventricle hypertrophy is present on the electrocardiogram. The chest x-ray shows slight enlargement of the heart and increased pulmonary venous markings.
Which of the following is the most likely diagnosis?
A. Ventricular septal defect.
B. Atrial septal defect.
C. Patent ductus arteriosus.
D. Pulmonary stenosis.
E. Tetralogy of Fallot.
answer : is C .
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The American Society of Anesthesiologists recommends that a breast fed infant scheduled for elective surgery be fasted for:
A. 30 minutes.
B. 1 hour.
C. 2 hours.
D. 4 hours.
E. 6 hours.
answer : D
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The most appropriate drug for the treatment of an autonomic crisis in a patient with Riley-Day syndrome is:
A. Midazolam.
B. Droperidol.
C. Metoprolol.
D. Sodium Nitroprusside.
E. Morphine.
answer is A .
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Electrocardiographic evidence of left ventricular hypertrophy (LVH) is found in children with:
1. Coarctation of the aorta.
2. Tetralogy of Fallot.
3. Ventricular septal defect.
4. Atrial septal defect.
1 and 3 are correct .
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Which of the following childhood conditions may present with acute stridor?
1. Viral croup.
2. Acute bacterial tracheitis.
3. Epiglottis.
4. Tetany.
all are correct .
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Cleft lip and Palate:
A. Are usually associated with other congenital anomalies.
B. Need to be repaired urgently because the infant will be unable to feed.
C. Are usually a midline defect.
D. Constitute a major intubation problem.
E. Are usually repaired separately.
the single best answer is E .
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Congenital Diaphragmatic Hernia (CDH):
1. Complicates about 1 in 5000 live births.
2. Most often occurs on the left side.
3. Is associated with other congenital abnormalities in at least 50% of cases.
4. May be associated with severe pulmonary hypertension.
2 and 4 are the right answers .
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