SMLE Paediatrics 4

Question 1

A 4-year-old child presents with easy bruising, petechiae, and a platelet count of 15,000/μL. WBC and haemoglobin are normal. Peripheral smear shows large platelets. What is the most likely diagnosis?

Accepted Answer

Immune thrombocytopenic purpura (ITP)

Answer

ITP in children typically presents after a viral infection with isolated thrombocytopenia, petechiae, and bruising. WBC and haemoglobin are normal, and peripheral smear shows large platelets indicating increased platelet destruction with compensatory bone marrow production.

Question 2

A premature neonate in the NICU develops feeding intolerance, abdominal distension, bloody stools, and pneumatosis intestinalis on abdominal X-ray. What is the diagnosis?

Accepted Answer

Necrotising enterocolitis

Answer

Necrotising enterocolitis (NEC) is the most common GI emergency in premature neonates. Pneumatosis intestinalis (air within the bowel wall) on X-ray is the pathognomonic radiographic finding. Management includes NPO, antibiotics, and surgery if perforation occurs.

Question 3

A 2-year-old child presents with recurrent respiratory infections, steatorrhoea, and failure to thrive. A sweat chloride test result is 75 mmol/L. What is the diagnosis?

Accepted Answer

Cystic fibrosis

Answer

Cystic fibrosis is diagnosed by a sweat chloride concentration ≥60 mmol/L (a result of 75 is diagnostic). The triad of recurrent respiratory infections, malabsorption (steatorrhoea), and failure to thrive is the classic presentation in young children.

Question 4

A 5-year-old child presents with painless rectal bleeding. The blood is dark red and mixed with stool. A Meckel scan (technetium-99m pertechnetate) is positive. What is the diagnosis?

Accepted Answer

Meckel diverticulum

Answer

Meckel diverticulum is the most common congenital GI anomaly (rule of 2s: 2% of population, 2 feet from ileocaecal valve, 2 inches long). It contains ectopic gastric mucosa that causes painless bleeding detected by technetium-99m pertechnetate scan.

Question 5

A newborn has a heart murmur, a single palmar crease, epicanthal folds, and hypotonia. The karyotype shows trisomy 21. Which cardiac defect is most commonly associated with this condition?

Accepted Answer

Atrioventricular septal defect (endocardial cushion defect)

Answer

Atrioventricular septal defect (AVSD/endocardial cushion defect) is the cardiac anomaly most commonly associated with Down syndrome (trisomy 21). Up to 40-50% of children with Down syndrome have congenital heart disease, with AVSD being the most frequent.

SMLE Practice Test

SMLE Practice Test

SMLE Paediatrics 4