PLAB Pediatrics & Child Health Flashcards

A 12-year-old girl presents with polyuria, polydipsia, weight loss, and a blood glucose of 28 mmol/L. She is alert with Kussmaul breathing and blood gas shows pH 7.1. What is the diagnosis?

Answer: Diabetic ketoacidosis (DKA)

Diabetic ketoacidosis (DKA) in a child is defined by hyperglycemia, acidosis (pH <7.3), ketonemia/ketonuria, and dehydration, with Kussmaul (deep, rapid) breathing as a compensatory response to metabolic acidosis.

Which test is used to screen newborns for congenital hypothyroidism in the UK?

Answer: Heel-prick TSH measurement at day 5

The UK newborn bloodspot (heel-prick) screening program tests TSH on day 5 of life; elevated TSH suggests primary congenital hypothyroidism, which requires prompt treatment to prevent intellectual disability.

A 6-year-old boy is brought in with episodic facial flushing, abdominal pain, and dark spots appearing on his lips and buccal mucosa. His father had similar symptoms. What syndrome does this suggest?

Answer: Peutz-Jeghers syndrome

Peutz-Jeghers syndrome is an autosomal dominant condition characterized by hamartomatous gastrointestinal polyps and mucocutaneous melanin pigmentation (dark spots on lips, buccal mucosa, and fingers), with increased GI and other cancer risk.

What is the primary management of a child with suspected anaphylaxis presenting with urticaria, bronchospasm, and hypotension after a bee sting?

Answer: IM adrenaline (epinephrine) 0.01 mg/kg (1:1000) into the anterolateral thigh

IM adrenaline (epinephrine) 0.01 mg/kg of 1:1000 solution into the anterolateral thigh is the immediate first-line treatment for anaphylaxis in children, rapidly reversing bronchospasm, vasodilation, and mast cell mediator release.

A 10-year-old child presents with a 3-week history of painless, unilateral cervical lymphadenopathy, night sweats, weight loss, and fatigue. What investigation is most important?

Answer: Chest X-ray followed by lymph node biopsy

Painless cervical lymphadenopathy with B symptoms (night sweats, weight loss, fever) in a child raises concern for Hodgkin lymphoma; CXR to assess mediastinal involvement followed by excisional biopsy for histological diagnosis is the appropriate approach.

Which finding on newborn examination is a normal variant and requires no treatment?

Answer: Mongolian blue spot on the lower back

Mongolian spots (congenital dermal melanocytosis) are blue-grey pigmented areas on the lower back/buttocks seen commonly in Asian, Black, and Hispanic neonates; they are benign and typically fade by early childhood.