SMLE Paediatrics 3 — Questions and Answers
Question 1: A 10-month-old infant presents with fever, irritability, and a bulging anterior fontanelle. CSF analysis shows elevated WBCs with neutrophil predominance, low glucose, and elevated protein. What is the most likely causative organism?
- Group B Streptococcus
- Streptococcus pneumoniae (Correct answer)
- Neisseria meningitidis
- Haemophilus influenzae type b
Correct answer: Streptococcus pneumoniae
In infants aged 1-23 months, Streptococcus pneumoniae is the most common cause of bacterial meningitis, followed by Neisseria meningitidis and group B Streptococcus. The Hib vaccine has dramatically reduced H. influenzae meningitis.
Question 2: A child presents with a unilateral, painless abdominal mass that does not cross the midline. CT shows an intrarenal mass with areas of haemorrhage and necrosis. What is the most likely diagnosis?
- Neuroblastoma
- Wilms tumour (nephroblastoma) (Correct answer)
- Renal cell carcinoma
- Hepatoblastoma
Correct answer: Wilms tumour (nephroblastoma)
Wilms tumour is the most common renal malignancy in children, typically presenting between 3-5 years of age as a painless abdominal mass arising from the kidney. Unlike neuroblastoma, it does not cross the midline and is intrarenal in origin.
Question 3: A 6-year-old child presents with polydipsia, polyuria, weight loss, and a blood glucose of 22 mmol/L. Blood pH is 7.15 and ketones are strongly positive. What is the immediate priority in management?
- Subcutaneous insulin injection
- IV fluid resuscitation with normal saline (Correct answer)
- Oral rehydration therapy
- IV insulin bolus
Correct answer: IV fluid resuscitation with normal saline
In paediatric diabetic ketoacidosis, the immediate priority is IV fluid resuscitation with 0.9% normal saline to correct dehydration and restore circulation. IV insulin infusion (NOT bolus) is started after the first hour of fluid resuscitation to avoid cerebral oedema.
Question 4: A neonate presents with failure to pass meconium within 48 hours of birth, abdominal distension, and bilious vomiting. Barium enema shows a transition zone in the rectosigmoid. What is the diagnosis?
- Meconium ileus
- Hirschsprung disease (Correct answer)
- Imperforate anus
- Necrotising enterocolitis
Correct answer: Hirschsprung disease
Hirschsprung disease (congenital aganglionic megacolon) presents with failure to pass meconium within 48 hours, abdominal distension, and bilious vomiting. Barium enema shows a transition zone between narrow aganglionic distal bowel and dilated proximal bowel.
Question 5: A 3-year-old child presents with abdominal mass, hypertension, and periorbital ecchymosis (raccoon eyes). Urine catecholamines (VMA and HVA) are elevated. What is the most likely diagnosis?
- Wilms tumour
- Neuroblastoma (Correct answer)
- Hepatoblastoma
- Rhabdomyosarcoma
Correct answer: Neuroblastoma
Neuroblastoma arises from neural crest cells (sympathetic nervous system) and is the most common extracranial solid tumour in children. It characteristically produces catecholamines (elevated urinary VMA/HVA), can cross the midline, and causes periorbital metastases (raccoon eyes).
Question 6: What is the recommended initial feeding for a healthy term breastfed newborn according to SCFHS guidelines?
- Formula supplementation for the first 24 hours
- Exclusive breastfeeding initiated within the first hour of life (Correct answer)
- Glucose water for the first feed
- Breastfeeding starting at 24 hours of age
Correct answer: Exclusive breastfeeding initiated within the first hour of life
SCFHS and WHO guidelines recommend initiation of breastfeeding within the first hour of life (golden hour) with exclusive breastfeeding for the first 6 months. Early skin-to-skin contact and immediate breastfeeding promote bonding and colostrum intake.
SMLE Paediatrics 3
A 10-month-old infant presents with fever, irritability, and a bulging anterior fontanelle.
CSF analysis shows elevated WBCs with neutrophil predominance, low glucose, and elevated protein.
What is the most likely causative organism?