SMLE Paediatrics 2

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?

Accepted Answer

IV immunoglobulin (IVIG) and aspirin

Answer

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?

Accepted Answer

Air-contrast enema (pneumatic reduction)

Answer

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?

Accepted Answer

Acute splenic sequestration crisis

Answer

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?

Accepted Answer

ABO haemolytic disease of the newborn

Answer

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?

Accepted Answer

Post-streptococcal glomerulonephritis

Answer

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.

SMLE Practice Test

SMLE Practice Test

SMLE Paediatrics 2