ABSTRACT
In these questions candidates must select one answer only.
A 7-year-old boy presents with an itchy anus. His mother states that the itching is worse at night in bed. The most likely diagnosis is:
Enterobiasis
Ascariasis
Scabies
Body lice
Crab lice
Treatment for this boy would be:
Derbac-M
Malathion
Mebendazole
Pyrantel pamoate
Permethrin
A 10-year-old boy presents with allergic nasal polyps. What is the best treatment for this boy?
Betnesol nasal drops
Clarityn
Zirtek
Saline nasal drops
Xylometazoline nasal drops
A 4-year-old boy presents with fever, epistaxis and pain in his legs. On examination he has hepatosplenomegaly. The most useful blood test is:
LFTs
FBC
U&Es
ESR
Creatine kinase
A 15-year-old girl presents with fever and sore throat. On examination there is an exudate over both tonsils. She has no drug allergies. The most appropriate treatment is:
Amoxicillin
Penicillin
Metronidazole
Ciprofloxacin
Co-amoxiclavulanic acid
316A 5-year-old boy presents with a maculopapular rash on his buttocks and ankles. He also complains of abdominal pain and knee pain. The most likely diagnosis is:
Rheumatic fever
Juvenile chronic arthritis
Coeliac disease
Henoch – Scho¨nlein syndrome
Chickenpox
A 4-year-old girl presents with pallor, irritability, abdominal distension and fatty diarrhoea. Full blood count shows both a macrocytic and a microcytic anaemia. The next most useful investigation is:
Sweat sodium and chloride test
Abdominal radiograph
Hydrogen breath test
Endomysial antibody
Abdominal ultrasonography
A 6-week-old baby boy is brought in by his mother for failure to thrive. He vomits his food across the room after each feed. His mother states that he is always hungry. The most useful investigation is:
Test feed
Contrast enema
Ultrasonography
Abdominal radiograph
Sweat chloride test
Treatment would be:
Oral rehydration therapy
Ramstedt’s operation
Reduction with contrast enema
Gluten-free diet
Pancreatic enzyme supplementation
An 18-month-old baby presents with fever and vomiting. The throat, chest and abdomen are normal on examination. The most likely diagnosis is:
Gastroenteritis
Viral meningitis
Pharyngeal pouch
Intussusception
Congenital hiatal hernia
317An 8-year-old girl presents with fever, drowsiness and a non-blanching rash. The most likely diagnosis is:
Infectious mononucleosis
Meningitis
Scarlet fever
Chickenpox
Kawasaki’s syndrome
The most useful investigation is:
FBC
Blood cultures
Lumbar puncture
Monospot test
Throat swab
The most appropriate treatment is:
Benzylpenicillin
Erythromycin
Aspirin
Chloramphenicol
Cefuroxime
Dietary iron is required by the age of:
2 months
4 months
6 months
10 months
12 months
An 18-month-old boy presents with fever, bleeding from the lips and an erythematous rash over the face and trunk. The boy does not like to hold anything in his hands and refuses to stand up. The most likely diagnosis is:
Streptococcal scarlet fever
Leptospirosis
Epstein – Barr viral infection
Erythema multiforme
Kawasaki’s syndrome
The most appropriate management would be:
Admit the boy to hospital and give daily aspirin
Admit the boy to hospital for intravenous penicillin
Admit the boy to hospital for intravenous corticosteroids
Treat as an outpatient with oral penicillin
Treat at home symptomatically with Calpol (paracetamol) as needed
318A 4-month-old baby is brought in by his mother. She states that he had been coughing for a few days and is now wheezing and breathless. On examination the baby is febrile with a temperature of 38°C and is breathing at a rate of 70/min with intercostal recession. Widespread raˆles and rhonchi are present on auscultation of the chest. The most likely diagnosis is:
Asthma
Pneumonia
Bronchiolitis
Whooping cough
Acute laryngotracheitis
A 7-year-old boy presents with fever, vomiting and abdominal pain. On examination he is tender in the periumbilical region and in the right lower abdomen. He looks pale and has no appetite. The most likely diagnosis is:
Intussusception
Gastroenteritis
Cystic fibrosis
Appendicitis
Ulcerative colitis
A 14-year-old girl presents with vomiting and severe abdominal pain. She states that she had a sore throat a week ago. This afternoon, she had been playing rugby at school and been knocked in her side. On examination she is pale, apyrexial and acutely tender in the left upper abdomen. The most likely diagnosis is:
Splenic rupture
Hepatic rupture
Acute appendicitis
Perforated peptic ulcer
Acute intestinal obstruction
For which condition is the pneumococcal vaccine indicated over the age of 2?
Cerebral palsy
Coeliac disease
Sickle cell trait
Diabetes insipidus
Cystic fibrosis
319A 4-year-old girl is brought in by her mother. The mother states that her daughter has nightmares and snores. She has a history of recurrent ear infections. On examination the child has large tonsils and nasal speech. The most likely diagnosis is:
Adenoidal hyperplasia
Sleep apnoea
Asthma
Nasal polyps
Gastro-oesophageal reflux disease
A 12-year-old girl presents with a pink macular truncal rash and suboccipital lymphadenopathy. The most likely diagnosis is:
Mumps
Chickenpox
Rubella
Measles
Erythema infectiosum
A 2-year-old girl is able to do the following EXCEPT:
Use two to three words in a sentence
Turn pages of a book
Follow a two-step command
Participate in group play
Turn a door knob
A 6-year-old girl presents with fever and vesicles on the palms and soles and in the mouth. She is drooling saliva and is very irritable.
The most likely aetiology is:
Coxsackie A16 virus infection
Herpes simplex virus infection
Human parvovirus type B12
Treponema pallidum
Measles
A 15-year-old presents with an oval pink rash. She states that it started with a single patch that became scaly but has now spread all over her chest. The most likely diagnosis is:
Scarlet fever
Pityriasis rosea
Rubella
Psoriasis
Discoid eczema
320A 6-month-old baby is brought in with a nappy rash. On examination the rash is isolated red plaques and covered with silvery scales. The most likely diagnosis is:
Ammonia dermatitis
Seborrhoeic eczema dermatitis
Candida dermatitis
Psoriatic dermatitis
Cellulitis
The following are recognized causes of short stature EXCEPT for:
Achondroplasia
Coeliac disease
Hypopituitarism
Homocystinuria
Constitutional
An 8-year-old girl presents with epistaxis and knee pain. On examination she is pale, tachycardic and apyrexial. A pansystolic murmur is auscultated. She has a serpiginous, red, raised rash over her trunk and non-tender subcutaneous nodules near her joints. The most likely diagnosis is:
Idiopathic thrombocytopenic purpura
Juvenile rheumatoid arthritis
Kawasaki’s disease
Rubella
Rheumatic fever
The following investigations are indicated EXCEPT:
A 12-lead ECG
FBC
ESR
Antistreptolysin O test
Creatine kinase
The most appropriate treatment is:
Aspirin
Benzylpenicillin
Corticosteroid therapy
NSAIDs
Cefuroxime
321A 5-month-old baby boy is brought in by his mother. She states that he has blood and mucus in his stool. He had recently been changed from milk to solids. He has episodes of screaming and abdominal pain but appears well between attacks. The most likely diagnosis is:
Volvulus
Intussusception
Gastroenteritis
Anal fissure
Meckel’s diverticulum
A 13-year-old boy presents with fever, sore throat and right hip pain. You suspect irritable hip. Appropriate investigations include all of the following EXCEPT:
FBC
ESR
Ultrasonography of the hip
Radiograph of the hip
Bone scan
Appropriate management includes all of the following EXCEPT:
High-dose regular paracetamol
Skin traction
Skeletal traction
Bed rest
24-hour observation for repeated temperature checks
What is the electrolyte imbalance associated with pyloric stenosis?
Hyperchloraemic alkalosis
Hypochloraemic alkalosis
Hyponatraemia
Hyperkalaemia
Metabolic acidosis
Koplik’s spots are seen in the following condition:
Measles
Mumps
Rubella
Scarlet fever
Erythema infectiosum
322A 4-year old boy presents with anorexia, nausea and vomiting. On examination, he has a blue line on the gums and is noted to have a foot drop. A blood test reveals anaemia. The most likely cause of poisoning is:
Lead
Paracetamol
Methanol
Cyanide
Mercury
A 4-year-old child presents to A&E with a high fever and stridorous breathing. He is sitting forward and drooling saliva. He requires intubation for respiratory distress. The most appropriate antibiotic treatment is:
Amoxicillin
Vancomycin
Trimethoprim
Cefotaxime
Tetracycline
A 12-year-old girl presents with pallor, dyspnoea and a pulse rate of 190. She is noted to have cardiomegaly and hepatomegaly. The most likely diagnosis is:
Kawasaki’s disease
Mitral stenosis
Congestive heart failure
Congenital nephrotic syndrome
Myocarditis
A 10-year-old boy presents to A&E after fainting during gym. On examination, he has a loud systolic ejection murmur with a thrill. The most likely diagnosis is:
Mitral stenosis
Aortic stenosis
Pericarditis
Congestive heart failure
Myocarditis
A 12-year-old boy presents to A&E with a red, painful, swollen scrotum. His MSU is normal. The most likely diagnosis is:
Ureteric colic
Testicular tumour
Hydrocele
Testicular torsion
Phimosis
323A 3-year-old boy presents with a 3-day history of noisy breathing on inspiration and a barking cough worse at night. He has a low-grade fever and is hoarse. The most likely diagnosis is:
Influenza
Asthma
Croup
Pneumonia
Allergic rhinitis
A 4-year-old presents to the GP for night terrors and loud snoring. On examination he is a mouth breather and has large tonsils that meet at the midline. The most likely cause is:
Asthma
Retrotonsillar abscess
Obstructive sleep apnoea
Sinusitis
Gastro-oesophageal reflux disease
A 10-year-old thin boy presents with chronic cough. A chest radiograph reveals bronchiectasis. He also has steatorrhoea. The most likely diagnosis is:
Asthma
Coeliac disease
Cystic fibrosis
Chest infection
Croup
A 4-year-old boy presents with bone pain and weakness. Investigations reveal a pancytopenia and blasts. The most likely diagnosis is:
Acute lymphoblastic leukaemia
Multiple myeloma
Acute myeloid leukaemia
Chronic lymphocytic leukaemia
Chronic myeloid leukaemia
A 10-year-old boy presents with a boiled sweet stuck in his throat. He is in respiratory distress and cyanotic. The most appropriate initial management is:
Heimlich’s manoeuvre
Intramuscular adrenaline 1:1000
Endotracheal intubation
Tracheostomy
Intravenous dexamethasone
324The Guthrie test is carried out for the screening of which condition:
Phenylketonuria
Congenital hypothyroidism
Cystic fibrosis
MCAD (medium-chain acyl-CoA dehydrogenase) deficiency
Sickle cell disease
The Guthrie test should be carried out at what age:
4 months
3 months
2 months
14 days
7 days
A 13-year-old boy with a BMI of 29 has pain in his thigh and knee and is limping. Movements at the hip are limited. The most likely diagnosis is:
Growing pains
Perthes’ disease
Slipped upper femoral epiphysis
Transient synovitis of the hip
Fractured femur
A 9-year-old boy presents with a 2-day history of a sore throat and fever. He has now developed a truncal rash and has a strawberry tongue. The most likely diagnosis is:
Measles
Scarlet fever
Chickenpox
Mumps
Rubella
Coronary artery aneurysms are associated with the following condition:
Meningitis
Kawasaki’s disease
Hand, foot and mouth disease
Henoch – Schönlein disease
Pneumonia
