Section B: Children’s Health

51. Neonatal meningitis is most commonly associated with:

(a) Streptococcus pneumoniae

(b) Group B streptococcus
(c) Neisseria meningitides
(d) Listeria monocytogenes
(e) Staphylococcus epidermis

52. Simon, a boy aged 3 years has been irritable with a high fever for 3 days.
Examination reveals a toxic, febrile child. He has conjunctivitis, a generalised
macular rash, cervical lymphadenopathy and red swollen hands and feet.

Which of the following is the most likely diagnosis?

(a) Measles
(b) Adenoviral infection
(c) Septic arthritis
(d) Kawasaki disease
(e) Toxic shock syndrome

53. A 2 week old infant is admitted to the emergency department with a 12 hour
history of vomiting and poor feeding. The parents are worried as the vomitus
is green in colour. There is no past or family history of note and the baby had
been feeding well and thriving without any symptoms up to the present illness.
On examination he appears unwell and dehydrated. His abdomen is tender, not
distended. His abdominal X-ray revealed a large stomach and very little gas
distally.

Which one of the following is the most likely cause of the problem?

(a) Duodenal atresia

(b) Pyloric stenosis
(c) Volvolus
(d) Intussusception
(e) Hirschsprung disease

54. A 2 year old boy has a diagnosis of Noonan’s syndrome; cardiovascular

exam reveals an easily audible murmur.
Which of the following is the most likely diagnosis?

a. Coarctation of the aorta

b. Small ventricular septal defect
c. Aortic stenosis
d. Pulmonary stenosis
e. Still’s murmur
55: Concerning childhood development, which of the following
statements is true:
a. Majority of normal children walk before 18 months
b. Fine pincer grasp would be expected by 6 months
c. First social smile typically appears at 3 months
d. Most children make 2 word sentences at 9 months
e. Many children are toilet trained by 15 months

56. Acute stridor in a toddler is most likely associated with which of the
following organisms?

(a) Respiratory syncytial virus

(b) Parainfluenza virus
(c) Rhinovirus
(d) Mycoplasma pneumoniae
(e) Adenovirus

57. A 6 month old boy presents with poor feeding, breathlessness, cough and
wheezing. His respiratory rate is 64/min, he has low-grade pyrexia, he is
wheezy with fine crackles at both lung bases.

Which one of the following statements is true?

(a) He should be commenced on corticosteroids

(b) He should receive nebulized salbutamol
(c) His illness is likely to resolve within 2-3 days
(d) He does not require antibiotics
(e) His illness is likely to be caused by coxackie virus

58. Congenital CMV infection is associated with the following except:

(a) Macrosomia
(b) Cataracts
(c) Hearing Loss
(d) Purpuric Rash
(e) Jaundice

59. Which of the following vaccines is not included in the current Irish
Immunisation Schedule?

(a) Meningitis C vaccine

(b) Hepatitis B vaccine
(c) Human papilloma virus vaccine
(d) Pertussis vaccine
(e) Rotavirus vaccine

60.
 A 12-month old infant with spina bifida and similar physical findings as shown
in the picture above presents to the Emergency Department with a 1-day
history of worsening irritability and vomiting.

Which of the following investigations should be prioritised?

a. Cerebrospinal fluid culture

b. Blood Culture
c. Urine Culture
d. Plain film of abdomen
e. CT scan of head

61. Which of the following is the most likely diagnosis for this skin presentation,
in an otherwise well three week old child?

(a) Tuberose sclerosis

(b) Acne neonatorum
(c) Staphlococcal scalded skin syndrome
(d) Impetigo
(e) Herpes simplex infection

62. In the case of a first urinary tract infection in a non-febrile 6 year old
girl, which of the
following investigations should be undertaken?

(a) Renal ultrasound

(b) Full blood count
(c) Erythrocyte Sedimentation Rate
(d) DMSA scan
(e) None of the above

63. A 26 y/o primigravida is delivered by elective Caesarean section at 38

weeks gestation because of breech presentation. The infant delivered is male,
weighs 3.2kg and has Apgar scores of 6 at 1 and 10 at 5 minutes. He is intially
cared for on the postnatal ward, but at 2 hours of age, is noted to be
tachypnoeic with a respiratory rate of 60 and oxygen saturation of 91%.
What is the most likely diagnosis?

(a) Cyanotic congenital heart disease

(b) Transient tachypnoea of the newborn
(c) Congenital pneumonia
(d) Respiratory distress syndrome
(e) Spontaneous pneumothorax

64. A 3 year old boy presents to the ED with difficulty in swallowing and a high
temperature. On exam he appears toxic, anxious and doesn’t want to lie down.
He has drooling from his mouth and has soft stridor.

Which of the following is the most appropriate initial step in this boy’s
management?

(a) Give paracetamol PR.

(b) Give IV antibiotics.
(c) Order x-ray of neck.
(d) Examine throat
(e) Call anaesthetist

65. A 12 month old infant is reviewed in the ED with a 3 day history of bloody
diarrhoea and vomiting and increasingly unwell. The infant is ill appearing,
pale, oedematous with delayed capillary refill time, blood pressure upper limit
of normal.

Which single investigation is most helpful at this point in time to guide diagnosis
and immediate management?

(a) CT brain
(b) CSF sampling for cell count, protein, glucose and culture
(c) Blood culture
(d) FBC, urea and electrolytes
(e) Blood glucose

66. An 18 month-old child presents to the Emergency Department with a

greenstick
fracture of the ulna. X-ray shows evidence of an old fracture to the same limb
and the history given by the parents is inconsistent.

As the SHO on duty, what is your next most appropriate step in investigation/
management?

(a) Refer to orthopaedic team

(b) Refer social worker
(c) Discuss your concerns with Paediatrician on call
(d) CT brain
(e) Discuss your concerns with the parents

67. You are asked by a nurse to chart IV fluids for a boy weighing 25 kgs.

Which of the following most closely approximates to his maintenance fluid

requirements?

(a) 45 mls per hour

(b) 65 mls per hour
(c) 85 mls per hour
(d) 105 mls per hour
(e) 125 mls per hour

68. A male infant, weight 2.5kg is delivered by emergency c-section at 38

weeks for placental abruption. Heart rate 50bpm with no spontaneous
respiratory effort. He is pale, profoundly acidotic, with little response to oro-
pharyngeal suctioning.

Outside of respiratory support the next most appropriate therapeutic intervention

is:

(a) Intravenous naloxone

(b) Therapeutic hypothermia
(c) Hyperventilation
(d) Intravenous magnesium
(e) Intravenous mannitol

69. A 4 year old boy presents with an inability to walk since awaking that
morning. He also complains of insects crawling over his legs. Apart from an
upper respiratory tract infection 2 weeks ago, there is no past or family history
of note. His vaccinations are up to date. On examination his cranial nerves are
normal. He has flaccid paresis and some blunting of sensation in both lower
limbs with bilateral extensor plantar responses. Examination is otherwise
normal.

Which of the following is the most likely diagnosis?

(a) Poliomyelitis
(b) Transverse myelitis
(c) Guillian- Barre Syndrome
(d) Neuroblastoma
(e) Brown Sequard syndrome

70. You are asked to review a 3 day old baby on the postnatal ward. The
nursing staff have noticed that the child is irritable with intermittent rhythmic
jerking of all 4 limbs. Baby was a SVD at term with Apgar scores of 9 at 1
minute and 10 at 5 minutes, birth weight 3.2kg. The parents are from Pakistan,
and have lived in Ireland for the past 3 years. There is no consanguinity or
family history of relevance. On examination the infant appears well, and has a
brief tonic clonic seizure.

What is the most likely diagnosis?

(a) Hypoxic ischaemic encephalopathy

(b) Hypogylcaemia
(c) Hypomagnesaemia
(d) Hypocalcaemia
(e) Urea Cycle Defect

Extended Matching Questions

71. EMQ : The Collapsed Child
Options
( a) Cerebral oedema (f) Vasovagal episode

(b) Anaphylactic reaction (g) Benign paroxysmal vertigo

(c) Reflex anoxic seizure (h) Benign intracranial hypertension

(d) Complex partial seizure (i) Addisonian crisis

(e) Foreign body inhalation (j) Cardiac arrhythmia

For each of the following statements below, please choose the most likely diagnosis from the above list;
options may be used more than once.

1. A 2 year old boy bumps his head. He then becomes extremely pale
and falls to the ground followed by a generalised seizure lasting 10-
15 seconds from which he makes a quick recovery

2. A 5 year old girl has been responding well to treatment for severe
diabetic ketoacidosis for 6 hours when suddenly she becomes
drowsy and complains of headache. Blood pressure rises to 120/80

3. A 10 year old girl suddenly becomes pale and dizzy and then falls to
the ground with loss of consciousness for 2 minutes with gradual
recovery. She had been standing in the classroom when the episode
occurred
 4. A 12 year old boy collapses after hearing a sudden loud noise while
resting and responds to basic life support

5. A 3 year old girl gets recurrent brief episodes when she suddenly
falls to the ground, appears pale and may vomit. Nystagmus was
noted during some of the episodes but there was no loss of
consciousness

72: EMQ: Child Development

Options

(a) 3 months (f) 24 months

(b) 6 months (g) 36 months
(c) 9 months (h) 42 months
(d) 12 months (i) 48 months
(e) 18months (j) 60 months

For each of case descriptions below, select the approximate developmental age at which milestones are
achieved from the above list.Options may be used more than once.

1. Uses whole hand to palmar grasp and passes toy from one hand to another. Drops one object if other is offered.
Primitive reflexes have abated, and protected reflexes begin to appear. Rolls over.

2. Runs safely, climbs stairs two feet to a step. Typically uses two-word combinations. Follows two-step
instructions. Mostly uses preferred hand. Does circular scribble with a crayon/pencil.
3. Independent walking emerges, mature finger grasp, initiating ‘joint attention’, follows simple instructions
associated with gestures.
4. Skilled in complex motor tasks, e.g. skipping, walking along a line. Pencil skills for drawing a person, copying
a triangle, and colouring within outlines. Can give name and age.

5. Sits unsupported on the floor, can adjust body posture when leaning forward to pick up
and manipulate a toy without losing balance. Enjoys casting objects over the side of cot and
chair. Looks in correct direction for falling or fallen toys.

73. EMQ GENETICS

Options:

(a) Noonan Syndrome (f) Tuberous Sclerosis

 (b) 45 XO Karyotype (g) Sturge-Weber Syndrome

(c) 47XXY Karyotype with Trisomy 21 (h)Trisomy 13 (Patau Syndrome)

(d) Fragile X Syndrome (i) Neurofibromatosis Type 1

(e) Trisomy 18 (Edward’s Syndrome) (j) Klippel-Trenaunay-Weber syndrome

Select the most appropriate diagnosis from the list above for each of the following scenarios. Options may be
used more than once.

1. A newborn infant with a port wine stain affecting face and head.
2. A two year-old boy with eight macular coffee-coloured lesions on his abdomen, back and lower limbs

3. A newborn male infant with small head, cleft lip and rocker-bottom feet
4. A two year-old toddler with large head, moderate learning disability, hyperactivity
5. A female infant with weak femoral pulses and webbing of her neck

74. EMQ: Paediatric Haematology

Options:

(a) Aplastic Anaemia (f) Haemophilia A

(b) Beta Thalassaemia Major (g) Immune Thrombocytopenia

(c) Iron Deficiency Anaemia (h) Polycythaemia

(d) Glucose-6-phosphate dehydrogenase deficiency (i) Pyruvate Kinase Deficiency

(e) Neonatal Haemochromatosis (j) Sickle Cell Anaemia

Select the most appropriate haematological diagnosis from the list above that best explains the following
scenarios. Options may be used more than once.

1.
1. May be exacerbated by exposure to antimalarial therapy

2. Characterised by the overgrowth of bones of the face

3. May be an associated feature of cyanotic congenital heart disease

4. Usually associated with jaundice in the newborn

5. Typically presents with anaemia , thrombocytopenia, and leukopenia