Get Through MRCPCH Part 1: Best of Fives and Extended Matching Questions

243 Pages·2006·12.748 MB·English

by  Nagi Barakat

April17,2006 Time: 16:9 ClassFile:rsm3-class-v1.cls Project:RSM
Get Through
MRCPCH Part 1: BOFs and EMQs
© 2006 by Taylor & Francis Group, LLC
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April17,2006 Time: 16:9 ClassFile:rsm3-class-v1.cls Project:RSM
To my son Abdul Hakim

© 2006 by Taylor & Francis Group, LLC
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Get Through
MRCPCH Part I: BOFs
and EMQs
Nagi Giumma Barakat
MB,BCh,MRCPCH,MScEpilepsy,
CCST,FRCPCH
ConsultantPaediatrician,HillingdonHospital,London,UK
HonoraryConsultant,NeurologyDepartment,
GreatOrmondStreetHospitalforSickChildren,
London,UK

© 2006 by Taylor & Francis Group, LLC
iii
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Contents
C
o
Preface vii n
t
Acknowledgements viii e
n
Referencesandfurtherreading ix ts
AccidentandEmergency 1
ClinicalPharmacology 17
Genetics 31
Immunology 39
InfectiousDiseasesandMicrobiology 49
Neonatology 63
CommunityPaediatrics 77
InbornErrorsofMetabolism 87
RespiratoryMedicine 99
Cardiology 109
Gastroenterology 125
Neurology 145
HaematologyandOncology 163
Endocrinology 177
Nephrology 189
Rheumatology;BoneandJointDiseases 201
ENTandOphthalmology 217
Dermatology 239

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Preface
P
r
e
f
a
This book has been written in response to changes in the MRCPCH entry c
e
criteria.Itisaimedatbothpaediatriciansintrainingandthosepreparingfor
postgraduateexaminations.Thereare500questions,allofwhichareeither
Best of Fives (BOFs) or Extended Matching Questions (EMQs), selected
accordingtotherevisedentrycriteria.Thequestions,andtheaccompanying
notesonconditions,havebeenwrittendrawingonmanyresources,aswell
as on the wide personal experience of the author as a clinican and teacher.
The content is intended to be comprehensive and easy to read, with both
basicandclinicalknowledgeappliedasmuchaspossible.
My advice to readers is to look at the questions, try to answer them,
andthenturntotheanswers.Ifyouthinkthatyoudisagreewithananswer,
gotooneofthereferencesandreadmoreabouttherelevanttopic.Youmay
findithelpfultoreadthisbooktogetherwithcolleagues–exchangingviews
as well as knowledge will help in understanding the questions and solving
theproblems.
NagiGBarakat
London

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Acknowledgements
A
c
k
n
o IshouldliketotakethisopportunitytothanktheRSMPressteamwhohelped
w
le withthisbookandtheirpatienceformydelayindeliveringitontime.Thanks
d are also due to my secretary Ms Amanda Tisdal and to the junior doctors
g
e whoreviewedandcorrectedmymistakes.Iamgratefulaswelltoalltheother
m
e colleaguesandfamilywhohavegivenmeadviceaboutthissubject.
n
t
s

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References and further reading
R
e
fe
r
Aicardi J.Diseases of theNervous System inChildhood, 2nd edn. London: e
n
MacKeith,1998. c
e
Behrman RE, Kleigman RM, Nelson WE, Vaughan VC. Nelson’s Textbook s
a
ofPaediatrics,17thedn.London:WBSaunders,2003. n
d
Bentley R, Lifschitiz C, Lawson M. Pediatric Gastroentrology and Clinical
f
u
Nutrition.Remedica,2002. r
t
BrookC,HindmarshP.ClinicalPediatricEndocrinology.BlackwellSciences h
e
(UK),2001. r
r
Campbell AGM, McIntosh N. Forfar and Arneil Textbook of Paediatrics, e
a
6thedn.Edinburgh:ChurchillLivingstone,2002. d
Jordan SC, Scott O. Heart Diseases in Paediatrics, 3rd edn. Butterworth in
g
Heinemann,1998.
PostlethwaiteRJ.ClinicalPaediatricNephrology.Bristol:IOPP,1986.

ix
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Accident and Emergency A
c
c
id
e
n
t
a
BOFs n
d
E
m
1. ThefollowingaretrueregardingpaediatricA&Eexcept:
e
r
A The leading reason for A&E Department attendance in young g
e
childrenisinfection. n
c
B Injuries are the second leading cause of morbidity and mortality y
inchildren.
C Mostaccidentsoccurwithinthehomesetting.
D In children presenting with seizures, the seizures are mainly sec-
ondarytofebrileillness.
E The disintegration of the nuclear family is one factor increasing
thedemandonmedicaltime.
2. Thefollowingstatementsaretrueexcept:
A The function of pre-hospital care is to transfer ill or injured
patientstoA&Eandtertiary-levelcareservices.
B Theavailability,freeofcharge,ofauniversalnationalaccesscode
(999)isthemosteffectivecomponentinpre-hospitalcare.
C In units that combine paediatric and adult patients, paediatric
illnessrecognitionandtreatmentskillsmaybedeficientcompared
withdedicatedpaediatricunits.
D In dedicated paediatric units, experience of dealing with major
injury and illness is superior to that of units combining in
paediatricandadultpatients.
E Thenursingstaffonly,andnotthemedicalstaff,shouldperform
triage.
3. Regarding airway management during resuscitation, the following
aretrueexcept:
A The first step in basic life support for a child found lying on the
floorandnotmovingisairwaymaintenance.
B A maintainable airway is defined as one that can be kept open
withsimplemeasures,suchastheuseofanoropharyngealairway.
C An unmaintainable airway is one that is still at risk of complete
obstructionandnecessitateseitherintubationorthecreationofa
surgicalairway.
D Any attempt to intubate taking longer than 30seconds should
be abandoned and the child oxygenated with a bag–valve–mask
device,pendingasecondattempt.
E Allsickorinjuredchildrenrequirehigh-flowoxygen.
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4. Allofthefollowingaretrueregardingthemanagementofbreathing
A
c duringresuscitationexcept:
c
id A The efficacy of breathing can be assessed at any time during
e
n resuscitation.
t
a B Respiratory compromise can be characterized by either an
n
d increasingoradecreasingworkofbreathing.
E C Ifbreathingisabsent,thechildshouldbeintubatedimmediately.
m
D Absent breath sounds and hyper-resonance to percussion on one
e
rg side suggest the diagnosis of a pneumothorax, which should be
e
n confirmedbyanurgentportablechestX-ray.
cy E Tension pneumothorax should be treated immediately by inser-
tionofachestdrain.
5. The following statements about the management of circulation
duringresuscitationarefalseexcept:
A Inachild,thebrachialpulseshouldbepalpatedintheupperarm.
B If no pulse is palpable in a child, cardiac massage should be
startedatarateof80–100bpm.
C All children with circulatory embarrassment should have an
intra-osseousneedleinsertedimmediatelyintothetibiaorfemur.
D Colloids, normal saline and 10% dextrose solutions are equally
good in the initial management of circulatory compromise in
children.
E Blood pressure is a reliable sign of circulatory compromise in
children.
6. Regardingcardiacarrest,thefollowingaretrueexcept:
A Pulseless electrical activity (PEA) is not the commonest form of
cardiacarrestinchildren.
B Electromechanical dissociation (EMD), and ventricular fibrilla-
tion(VF)arethreedifferentformsofcardiacarrestinchildren.
C Theoutcomeofcardiacarrestinchildrenisworsecomparedwith
adults.
D Ifcardiacfunctionisrestored,childrenusuallyrecoverwithnoor
minimalneurologicaldeficit.
E Absence of cardiac complexes on the cardiac monitor confirms
thatthechildisinasystole.
7. In children with cardiac arrest, prolonged resuscitation is indicated
inthefollowingclinicalsituationsexcept:
A Poisoning
B Drowning
C Unknowncause
D Hypothermia
E Post-traumaticcardiacarrest
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