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MRCPCH Part 1 A
mapped to the current Royal College curriculum

Test your knowledge with our Question of the Day, based on recent exam themes.


1) Q

Which of the following conditions can present with breathing difficulty in a 7-day-old child born at 28 weeks' gestation
True / False
A. Bronchopulmonary dysplasia
B. Congenital diaphragmatic hernia
C. Group B streptococcal infection
D. Surfactant deficient lung disease
E. Tracheo-oesophageal fistula

1)
ANSWER Q (1
A) F - B) T - C) T - D) F - E) T

Bronchopulmonary dysplasia (chronic lung disease) is defined as oxygen dependency at 34 weeks corrected age.

Congenital diaphragmatic hernia usually presents on the resuscitaire or soon afterwards, but late presentation does occur.

Group B streptococcal infection can present early or late.

Surfactant deficiency usually presents within minutes or hours of birth with progressive respiratory distress.

Although oesophageal atresia usually presents in the early neonatal period, an H-shaped fistula can present even months after birth.
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2) Q

Respiratory disease

A) Amoxicillin PO
B) Budesonide via nebuliser
C) Cefuroxime IV
D) Co-amoxiclav IV
E) Dexamethasone PO
F) Fibreoptic bronchoscopy
G) Intubation
H) Oxygen via facemask
I) Salbutamol via nebuliser
J) Salbutamol via spacer

For each scenario choose the most appropriate definitive therapy.


1.
. A 13-month-old boy is awoken from sleep with breathing difficulty and presents to the Emergency Department. He has had coryza for 2 days. On examination he is crying, has marked stridor and a barking cough. Oxygen saturations are 95%.
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2.
An 18-month-old boy develops stridor and cough. This came on suddenly whilst he was playing in the kitchen. Oxygen saturations are 93%.

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3.
[/color]3. A 14-month-old boy presents with cough and wheeze. He has had a cold for 2 days. On examination he has a respiratory rate of 60/min, with moderate recession and audible wheeze. Oxygen saturations are 89%.

ANSWERS
Q 2)
1.
E
The 13-month-old boy has viral croup, which is best treated with oral dexamethasone.

Q 2)
2.
F
The 18-month-old boy has probably inhaled a foreign body. This may be radio-opaque on chest x ray or cause a ball-valve effect (hyperinflation on one side of lung fields on chest x ray). Fibreoptic bronchoscopy should be done to remove it.

Q 2)
3.
J
The 14-month-old has moderately severe respiratory distress due to virus-induced wheeze or possibly early asthma. He should be tried on salbutamol via spacer. Nebulised salbutamol may be required if he deteriorates.

Q 3)

A 3-month-old boy presents with a 3cm cavernous haemangioma behind the right ear.

Which is the best advice to give the parents?
(Please select 1 option)

A. He should be referred to the plastic surgeons for surgical removal
B. He should receive 2 mg/kg of prednisolone for 4 months to shrink it down
C. He should receive alpha interferon injections
D. He should receive intralesional triamcinolone injections
E. It is likely to enlarge to about a year of age, then disappear over the next 5-8 years

ANSWER Q 3
E
These lesions usually regress spontaneously. Interventions are used where the lesions affect facial features or vital structures (e.g. larynx, vision).

abeer كتب:

بارك الله بك دكتور كمال وجعله الله في ميزان حسناتك باذن الله

دمت متالق كعادتك

شكرا جزيلا . لك اجمل تحية

MRCPCH Part 1 A & B exam of the Royal College of Paediatrics and Child Health

Q ( 1

The following conditions tend to improve spontaneously:

True / False
A. Breast milk jaundice
B .Erythema toxicum
C .Napkin candidiasis
D .Ranul
E .Stork mark

Q (2

A 6-week-old male is diagnosed with congenital hypertrophic pyloric stenosis. He is found to have hypokalaemia.

Which of the following is the cause of the hypokalaemia in this condition?
(Please select 1 option)

A. Metabolic alkalosis producing a paradoxical renal loss of potassium ions
B. Associated type IV renal tubular acidosis
C. Intracellular potassium shift
D. Paradoxical metabolic renal tubular acidosis
E. Upper gastrointestinal losses

Q (3

: Gross motor development

A 1 month
B 2 months
C 4 months
D 6 months
E 8 months
F 10 months
G 1 year
H 18 months
I 2 years
J 3 years

For each description of a child's gross motor development choose, from the list of options, the highest development age the child is most likely to have achieved.
1.
A baby has good head control with no head lag when pulled from supine to sitting.
2.
A baby can rise independently and stands momentarily alone. Is starting to take 1-2 steps.
3.
A child who is walking and runs stiffly, and can climb stairs if hand is held.

Q (4

In a 2-year-old boy, which of the following conditions are likely to require surgery?

True / False

A. Bow legs
B. In-toeing
C. Knock knees
D. Metatarsus varus
E. Tibial torsion

Q (5


A 3-month-old boy presents with a 3cm cavernous haemangioma behind the right ear.

Which is the best advice to give the parents?

(Please select 1 option)


A. He should be referred to the plastic surgeons for surgical removal
B. He should receive 2 mg/kg of prednisolone for 4 months to shrink it down
C. He should receive alpha interferon injections
D. He should receive intralesional triamcinolone injections
E. It is likely to enlarge to about a year of age, then disappear over the next 5-8 years

Q (6


Treatment of earache

A) Amoxicillin IV
B) Amoxicillin oral
C) Cefotaxime IV
D) Gentamicin IV
E) Paracetamol
F) Penicillin V
G) Supportive treatment only
H) Topical gentamicin

Select the most appropriate treatment for the following cases who present with earache:
1.
A mother is concerned regarding the incessant screaming of her 24-hour-old female infant. On examination, the baby has a temperature of 37.8°C and has an inflamed right tympanic membrane.

2.
A 12-year-old boy presents with earache following an air journey a week ago. On examination the drum is not inflamed, but fluid is noted in the middle ear.

3.
A 3-year-old boy is brought to clinic with a history of tugging at his ear. He has a temperature of 36.7°C, and examination reveals a red inflamed ear canal but the eardrum cannot be observed due to pain.

4.
A 3-year-old girl presents with a two day history of fever, nausea and vomiting. On examination she has a temperature of 39.5°C and her left tympanic membrane appears red and inflamed with fluid behind it.

MRCPCH Part 1 A & B exam of the Royal College of Paediatrics and Child Health

ANSWERS
Q (4
1.
all false

None of these conditions are likely to require surgery, though it may be needed in the occasional extreme case of bow legs, e.g. that associated with long-standing rickets.

Q (5
C is the correct answer
Under the Gillick case, if a child is competent and has an understanding of the full implications of her actions then she can be offered advice and treatment without parental consent. Thus, in this circumstance, the most appropriate option is to offer an abortion with appropriate counselling and support if the patient requests.

If, on grounds of conscientious objection, you decide that you cannot participate in abortion then you must provide an alternative practitioner who will support the patient.

Every effort should be made to persuade her to inform her parents.

Q (6
1.
C
The correct answer is Cefotaxime IV

The neonate has features suggestive of otitis media with an inflamed tympanic membrane.
In newborns, Gram negative enteric bacilli, particularly Escherichia coli, and Staphylococcus aureus cause suppurative otitis media. The most appropriate treatment for the neonate is IV cefotaxime to ensure appropriate coverage of these organisms that may be resistant to penicillins.

2.
E

The correct answer is Paracetamol
This boy has features of serous otitis media and requires only simple analgesia with paracetamol.

3.
H

The correct answer is Topical gentamicin
This child has otitis externa with ear pain and redness of the canal preventing observation of the eardrum.
He requires topical antibiotic therapy which should be adequate together with analgesia. Risk factors associated with otitis externa include swimming and cleaning the ears with cotton wool buds.

4.
A

The correct answer is IV amoxycillin
This girl with fever, vomiting and nausea also has otitis media and should be treated with parenteral antibiotics. Amoxicillin is regarded as the first line treatment for this condition.