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Imaging modality of choice when evaluating a child for infantile hypertrophic pyloric
stenosis
ultrasonography.
Typical age of intussusception in children:
3 months - 3 years
What are the two typical anamnestic features of acute appendicitis?
First epigastrial and
paraumbilical pain, later the pain is localized on the right lower abdominal quadrant.
Imaging study of the polytraumatized patient
acute CT.
Most common cause of acute abdomen in children
appendicitis.
What is the first test in case of bloody stool
digital rectal examination
What is two-stage splenic rupture?
Splenic rupture occurs in two stages. Initial subcapsular haematoma formation may have only mild symptoms, later second stage may occur after hours or days, and is usually characterised by the rapid development of shock, as the spleen and mesentery tend to bleed rapidly and copiously.
Which are the 4 most important physical signs of congenital heart diseases?
Heart murmur,
heart failure, cyanosis and peripheral pulse abnormalities.
The most common cause of transfusion-requiring haematochezia, without abdominal pain and
without diarrhoea
Meckel's diverticulum
Which is the most common cause of strangulation ileus?
Incarcerated hernia.
What are the features of the perianal fissures in a patient with Crohn's disease?
Not in the
midline, deep, not painful.
What is the first therapeutic choice in Crohn's disease?
Exclusive enteral nutrition.
You find a high GGT in a patient with ulcerative colitis, what should you think about?
Sclerosing cholangitis.
Which congenital heart disease predispose to cyanotic (hypoxic) spell?
Tetralogy of Fallot
What kind of antihypertensive drug would you recommend in hyperkinetic hypertension?
Beta-blocker.
In case of thoracic empyema after drainage or thoracoscopy, what kind of method is used in
order to dissolve the thick, highly viscous pleural fluid (pus)?
Fibrinolysis/urokinase/streptokinase
Which is the most frequent glomerulonephritis type?
IgA nephropathy.
What are the two most frequent chest deformities?
Pectus excavatum and pectus carinatum.
What is the most frequent cause of hypertension before the adolescent age?
Kidney disease.
What are typical signs of bacterial otitis externa?
Pain and/or sensitivity of the tragus.
What can we find in the urine, in the case of glomerulonephritis?
Red blood cells with red
blood cell casts and most commonly in association with proteinuria
What are the 4 most important indication of adenectomy?
Recurrent infections of the upper
respiratory tract, otitis media, inhibition of nasal breathing, obstructive sleeping apnoea.
What is the most frequent pathogen in urinary tract infections?
E. Coli.
The most frequent pathogen of sinusitis and otitis media?
S. pneumoniae.
In which case of inflammatory disease of the middle ear can we suggest tympanostomy tubes
(Grommet)?
Chronic serous otitis media and/or chronic dysfunction of the Eustachian
tube.
What is the prognosis of West-syndrome or infantile spasm?
Usually poor.
What is the essential criterion of cerebral palsy?
Non-progressive, residual brain injury.
What can prevent coronary artery disease (aneurysm) in Kawasaki syndrome?
Intravenous
immunoglobulin (IVIG).
What is the indication of ACTH as an anticonvulsant drug?
West syndrome/infantile
spasm/BNS epilepsy.
Which pathogen does cause most commonly typical pneumonia?
S. pneumoniae.
What is the prognosis of juvenile absence epilepsy?
Usually particularly favourable.
What are the two main components of the home treatment of pseudocroup?
Rectal steroid,
inhalation of (fresh) cool air.
How much part of the mortality is caused by accidents in the children older than 1 year, in
Hungary?
36-40%, this is the main cause of death in children older than 1 year.
What is the most common cause of acute cough?
Viral infection of the respiratory tract.
What is the most common cause of coughing, which has been presenting since birth and
occurring always during feeding?
Tracheoesophageal fistula.
What is the significance of Holzknecht sign?
Airway foreign body aspiration.
List the most important 3 clinical symptoms of NEC
Abdominal distension, nutritional
intolerance, bloody stool.
What is the most serious complication of juvenile idiopathic arthritis?
Macrophage
activation syndrome (MAS).
Which muscles are affected in juvenile polymyositis?
Proximal muscles of the limbs.
What are the upper airway infections that should be treated with antibiotics?
Streptococcus
angina, acute otitis media and acute bacterial sinusitis.
What is the test for acute leukaemia?
Bone marrow examination.
What is the proper approach to a child with haemophilia who suffered a head trauma - even
if he did not faint?
Immediate administration of the coagulation factor concentrates
(FVIII/FIX/bypassing agent) which the child/family keeps with the child and referring
him to the closest haemophilia treatment centre.
What is the diagnostic basis of endocarditis?
Haemoculture and echocardiography.
What kind of diseases are included in `atopic march` and in which order?
Food allergy -
atopic dermatitis - bronchial asthma - allergic rhinitis.
When can we expect the onset of symptoms of Wilson disease?
After 4-5 years of age.
Which 3 criteria are required in order to avoid biopsy in a child with suspected celiac disease?
1. Positive clinical signs and symptoms 2. positive tissue-transglutaminase (TTG)
antibody AND endomysial antibody (EMA) 3. positive genetic results (HLADQ2 and -
DQ8).
What is the typical feature of stool in biliary atresia?
Clay-coloured (acholic) stool.
What is the minimal IgA concentration to reliably evaluate IgA-based anti-tissue
transglutaminase (tTG) and anti-endomyseal antibody (EMA) results as diagnostic tests of
coeliac disease?
0.2 g/l
How to diagnose food allergy - how reliable is allergen-specific IgE testing?
Allergen specific
IgE is not totally reliable. Elimination diet, and after the symptoms disappear, allergen
re-challenge is the suggested method of diagnosis.
What is the frequency of food allergy in childhood according to the parents and in the reality
(after elimination and re-challenge)?
Approx. 7-10%, and 1-2 %, respectively.
What is the diagnostic basis of erythema migrans?
The fact of tick bite and the clinical
picture: growing erythema, which is more than 5 cm in diameter.
What is the ideal age for closing the soft palate defect?
1 year of age
What is the radiological sign of duodenal atresia?
double bubble
What is the most likely diagnosis in the following case: patient with polyuria, polydipsia with
positive urine glucose and acetone test?
Diabetes mellitus.
Patient with typical symptoms has a 18,2 mmol/l blood sugar level in the afternoon. What is
to be done?
Direct the child to a paediatric diabetic centre immediately.
How does the mother iodine deficiency influence the newborn's thyroid function?
It results
temporary primary hypothyroidism.
Which chromosomal abnormality is frequently associated with duodenal atresia?
21 trisomy
What kind of hormonal changes are seen in the salt wasting form of congenital adrenal
hyperplasia due to deficiency of 21-hydroxylase?
Insufficient glucocorticoid and
mineralocorticoid secretion, excessive androgen secretion.
What can be found in the urinary sediment in typical pyelonephritis?
Leucocytes, white blood
cell casts and bacteria
How can we define the premature puberty in girls?
If the secondary sex characteristics
appear before 8 years of age in girls and before 9 years of age in boys.
What is the definition of "graft versus leukaemia"?
Immunologic attack of donor cells
against patient's leukemic cells.
Which is the most common adrenocortical enzyme defect?
The defect of the 21-hydroxylase
enzyme.
What is the most frequently occurring endocrinological disorder causing growth retardation?
Hypothyroidism
What are the 3 most important symptoms in Basedow's disease?
Weight loss, tachycardia,
Graefe symptom.
You experience low blood sugar level in an infant, who has normal temperature and
hepatomegaly, what disease do you think of?
Type I. glycogenosis - von Gierke disease.
How much is the quantity of the fluid bolus which is necessary for the management of septic
shock?
20 ml/kg body weight
What are the most typical histologic findings in ulcerative colitis?
Crypt abscesses.
Which common causative agent of neonatal sepsis can be identified by maternal vaginal
screening?
Group B streptococcus, (GBS)
Name at least 5 extraintestinal abnormalities in celiac disease
hepatitis, osteoporosis,
arthritis, isolated iron deficiency, Duhring-disease (dermatitis herpetiformis).
What is the name of that functional disorders, which is characterised by crying followed by
straining for 10 minutes?
Infantile dyschezia.
What influences decisively the sensitivity of haemoculture?
Blood cultures should be
obtained prior to initiation of antimicrobial therapy. The number of cultures and volume
of blood are the most important factors.
When is it suggested to give cow's milk for children first?
After 12 months of age.
How does the breast milk's protein content relate to the cow's milk protein content?
One-third
What is haploidentical transplant?
A haploidentical transplant is a type of allogeneic
transplant. It uses healthy, stem cells from a half- matched donor to replace the
unhealthy ones. The donor is typically a family member.
What are the two most frequent pathogens causing neonatal meningitis?
Streptococcus
agalactiae, E. coli.
What does allogeneic stem cell transplant mean?
The patient (recipient) gets haemopoietic
stem cells from another person (donor).
In bacterial meningitis, how does the concentration of liquor protein and glucose change?
Protein concentration is elevated, and the glucose content is decreased
How do we give oxygen to a conscious patient who is breathing spontaneously?
Through a
face mask with reservoir, with high flow oxygen (10-15 l/min).
Which are the 4 presenting symptoms of diabetes mellitus?
Polyuria, polydypsia, loss of
body weight despite of good appetite, fatigue-weakness.
What are the most common associated diseases in patients with type 1 diabetes mellitus?
Celiac disease and Hashimoto thyroiditis.
Define the matter of paradoxical breathing! /Define paradoxical breathing!
The chest moves
inward, and the abdomen moves outward during inhalation, and vice versa.
Name five examples, where pulse oximetry is not informative!
Carbon-dioxide intoxication,
methemoglobinemia, severe anaemia, cardiac failure, cold extremities.
What is the most modern therapeutic method of type one diabetes?
Insulin pump with an
integrated glucose sensor.
How much is the starting insulin dose in diabetic ketoacidosis?
0.05-0.1 U/kg/h
Which is the contagious disease that causes severe foetal injuries in 80 percent of the cases?
Rubella.
What is the sixth disease?
Exanthema subitum, roseola infantum.
Since the introduction of expanded screening, how many congenital metabolic diseases are
screened routinely in Hungary?
26
Biliary atresia is the most common cause of childhood liver transplantation. This can be
avoided by early diagnosis. What age should this be diagnosed with?
Earlier, but no later
than 6 weeks of infancy
What is the reactivation of chicken pox (varicella)?
Herpes zoster.
Purpuric skin and mucous membrane lesions emerged 3 weeks after a viral infection in a
patient. Complete blood count showed isolated thrombocytopenia. What is the most likely
diagnosis?
Immune thrombocytopenia (ITP)
How often should be a baby breastfed?
On-demand.
How can be defecation ensured in the case of high (proximal) anus atresia?
With the creation
of a colostoma
What radiological examinations can be done to diagnose VUR? (Name three!).
MCU
(Micturating cystourethrogram), Sonocystography, Dynamic kidney-scintigraphy.
How can you diagnose perforation in a critically ill baby suffering from necrotising
enterocolitis if you cannot move him/her in the incubator?
Horizontal X-ray from side
position while the baby is lying on the back.
For how long do the primitive reflexes exist normally?
Till 6-12 months of age.
In which part of the bone does osteomyelitis start?
In the metaphysis.
What are the diseases which can be easily diagnosed and followed up by cranial ultrasound?
Brain haemorrhage and hydrocephalus.
For how long can we see the shadow of the thymus on the chest X-ray?
Till 3 years of age.
How can be the airway foreign body diagnosed? (At least two methods!)
Expiratory and
inspiratory chest radiograph or fluoroscopy (real-time moving images).
What is the most important question, which we have to ask at functional
gastroenterological complaints in infancy?
How does the infant develop? If the infant's
somatic development is good, organic causes of the complaints are unlikely.
