SMLE Paediatrics 2 — Questions and Answers
Question 1: A 2-year-old child presents with high fever for 5 days, bilateral non-exudative conjunctivitis, strawberry tongue, cervical lymphadenopathy, and a polymorphous rash. What is the most important treatment to prevent complications?
- Oral antibiotics
- IV immunoglobulin (IVIG) and aspirin (Correct answer)
- Corticosteroids alone
- Antipyretics and observation
Correct answer: IV immunoglobulin (IVIG) and aspirin
Kawasaki disease requires treatment with IV immunoglobulin (2 g/kg single infusion) and high-dose aspirin to reduce the risk of coronary artery aneurysms. Treatment should be initiated within 10 days of fever onset for maximum benefit.
Question 2: An infant presents with 'red currant jelly' stools, colicky abdominal pain, and a sausage-shaped mass in the right upper quadrant. What is the initial diagnostic and therapeutic procedure?
- Barium enema
- Air-contrast enema (pneumatic reduction) (Correct answer)
- Immediate surgery
- Abdominal ultrasound only
Correct answer: Air-contrast enema (pneumatic reduction)
Intussusception (most commonly ileocolic) is initially managed with air-contrast enema (pneumatic reduction), which is both diagnostic and therapeutic. Ultrasound (showing target/doughnut sign) confirms the diagnosis, and air enema achieves reduction in approximately 80% of cases.
Question 3: A 3-year-old child with sickle cell disease presents with sudden pallor, tachycardia, and a rapidly enlarging spleen. Haemoglobin is 4 g/dL. What is the diagnosis?
- Vaso-occlusive crisis
- Aplastic crisis
- Acute splenic sequestration crisis (Correct answer)
- Haemolytic crisis
Correct answer: Acute splenic sequestration crisis
Acute splenic sequestration crisis occurs when sickled red cells pool in the spleen, causing rapid splenic enlargement, severe anaemia, and hypovolaemic shock. It is a life-threatening emergency in young children with SCD requiring urgent transfusion.
Question 4: A term neonate develops jaundice within the first 24 hours of life. The mother is blood group O positive and the baby is blood group A positive. Direct Coombs test is positive. What is the diagnosis?
- Physiological jaundice
- ABO haemolytic disease of the newborn (Correct answer)
- Breast milk jaundice
- Gilbert syndrome
Correct answer: ABO haemolytic disease of the newborn
Jaundice within the first 24 hours is always pathological. ABO incompatibility (mother O, baby A or B) with a positive direct Coombs test confirms ABO haemolytic disease. Maternal anti-A IgG antibodies cross the placenta and attack fetal red blood cells.
Question 5: A 7-year-old child presents 2 weeks after a sore throat with dark-coloured urine, periorbital oedema, and hypertension. Serum complement C3 is low. What is the most likely diagnosis?
- Minimal change disease
- Post-streptococcal glomerulonephritis (Correct answer)
- IgA nephropathy
- Membranous nephropathy
Correct answer: Post-streptococcal glomerulonephritis
Post-streptococcal glomerulonephritis typically presents 1-3 weeks after a pharyngeal (or skin) streptococcal infection with nephritic syndrome (haematuria, oedema, hypertension) and low serum C3 complement. ASO titre is usually elevated.
Question 6: What is the most common congenital heart defect?
- Atrial septal defect
- Ventricular septal defect (Correct answer)
- Patent ductus arteriosus
- Tetralogy of Fallot
Correct answer: Ventricular septal defect
Ventricular septal defect (VSD) is the most common congenital heart defect, accounting for approximately 25-30% of all congenital heart disease. Small VSDs often close spontaneously, while large VSDs may cause heart failure and require surgical repair.
SMLE Paediatrics 2
A 2-year-old child presents with high fever for 5 days, bilateral non-exudative conjunctivitis, strawberry tongue, cervical lymphadenopathy, and a polymorphous rash.
What is the most important treatment to prevent complications?