1. Which of the following statements
concerning children with attention deficit hyperactivity disorder (ADHD) is
TRUE?
a)
Children with ADHD are more
academically able than those without ADHD
b)
Children with ADHD are more
likely to be girls than boys
c)
Children with ADHD are up to
25% more likely to sustain a traumatic head injury than those without ADHD
2. At what body mass index (BMI) is
obesity currently defined?
a)
25
b)
30
c)
35
3. Which of the following statements
about childhood obesity is FALSE?
a)
Obese children are more likely
to come from poorer families
b)
Obese children are more likely
to have obese parents
c)
Obese children are more likely
to suffer from ADHD
d)
Obese children are more likely
to suffer isolation and bullying at school
4. There are many short and long term
complications of obesity in childhood. They include all of the following
EXCEPT:
a)
Slipped femoral epiphysis
b)
Hypertension
c)
Low self-esteem
d)
Skin disease
5. Fathers who are not married to the
Mother of their children do not have automatic parental responsibility for
these children. They may however gain responsibility by doing any of the
following EXCEPT:
a)
Registering the birth with the
Mother
b)
By agreement of the Mother
c)
By living with the Mother
d)
By obtaining a court order
6. Which act governs principles of
consent in children of 16 and 17 years of age?
a)
The Family Law Reform Act
b)
The Children Act
c)
The Fraser Act
7. In taking a history from a child and
their family it is important to begin the consultation with:
a)
Closed questions
b)
Open questions
c)
Leading questions
8. The following are all important
considerations in the clinical examination of children EXCEPT:
a)
To consider the child’s
previous experience of healthcare settings
b)
To consider the interaction of
the child with parents or carers
c)
To consider aspects of your
approach to the child that may appear threatening
d)
To consider the child’s needs
and not that of parents or carers
9. At what age would you expect stranger
anxiety and separation anxiety to be most acute?
a)
Adolescence
b)
6-9 years
c)
12 months
10. Diagnostic decision making is an
increasingly important part of many nurse’s role. The following are all strategies
to aid diagnosis EXCEPT:
a)
Pattern recognition
b)
Decision analysis theory and
differential diagnosis
c)
Documentation
d)
Intuition
11. Which of the following statements
about children’s bones is UNTRUE?
a)
Children’s bones are softer and
more pliable than adult’s bones
b)
Children’s bones have growth
plates that fuse at about 18 years of age
c)
Children’s bones break more
easily than adult’s bones
d)
Children’s bones have sometimes
different fracture patterns than adult’s bones
12. All of the following features of a
young child’s head make it more likely to suffer a head injury EXCEPT:
a)
The head is relatively larger
than in the adult
b)
In young children the parachute
reflex may not be fully developed
c)
Young children have patent
fontanelles
d)
Young children have immature
psychomotor skills
13. Which of the following injuries
would you LEAST EXPECT to see in a 4 year old that has fallen onto an
outstretched hand?
a)
Supracondylar fracture of the
humerus
b)
Fracture of the mid-third of
the clavicle
c)
Fracture of the neck of the
humerus
d)
Buckle fracture of the distal
radius
14. Which of the following statements
describes a Salter-Harris type 5 fracture of the growth plate?
a)
A fracture through the
metaphysis that does not involve the epiphysis
b)
A fracture through the
epiphysis that does not involve the metaphysis
c)
A fracture through the
metaphysis and epiphysis
d)
A crush injury of the growth
plate
15. Which of the following Salter-Harris
growth plate injuries is LEAST LIKELY to cause post injury arthritis and growth
abnormalities?
a)
Salter Harris type 4 injury
b)
Salter Harris type 2 injury
c)
Salter-Harris type 3 injury
16. The following are all signs of
respiratory distress in children EXCEPT:
a)
Nasal flaring
b)
Recession of intercostal
muscles
c)
Capillary refill time of 2
seconds
d)
Expiratory grunting
17.
The following are all reliable means of estimating how well or unwell a child
is EXCEPT:
a)
Checking capillary refill time
b)
Checking the respiratory rate
c)
Checking blood pressure
d)
Checking for non-blanching rashes
18.
The following are early signs of meningococcal disease in children EXCEPT:
a)
Hypotension
b)
Prolonged capillary refill time
c)
Tachycardia
d)
Cool peripheries
e)
Abnormal interaction with
parents or carers
19.
Which of the following is an acceptable way to estimate the weight of a child
when it is impossible to weigh them formally?
a)
(Age in years + 2) X 4
b)
(Age in years + 4) x 2
c)
(Age in months + 4) x 3
20. Which
of the following findings is diagnostic of a bony injury in an x-ray of a
child’s elbow?
a)
An undisplaced anterior fat pad
b)
The presence of an accessory
ossicle
c)
A posterior fat pad
21.
Why is a pulled elbow an uncommon presentation after the age of 5 or 6 years?
a)
At this age the radial head
matures and is held more securely in the annular ligament
b)
At this age the annular
ligament becomes fibrosed and holds the radial head more securely
c)
At this age children’s bones
begin to ossify
22.
The following are all signs of life threatening asthma in children EXCEPT:
a)
Silent chest
b)
Bradypnoea
c)
An expiratory wheeze on
auscultation of the chest
23.
The British Thoracic society define life threatening asthma as being when peak
expiratory flow recordings are:
a)
<75% of predicted
b)
<33% of predicted
c)
<20% of predicted
d)
<50% of predicted
24. Which
one of the following is indicated as a treatment in mild dehydration secondary
to gastroenteritis in a child?
a)
Broad spectrum antibiotic
b)
Anti-motility drugs
c)
Oral rehydration therapy
d)
IV fluid replacement
25.
All of the following are signs of an acute abdomen with peritonitis EXCEPT:
a)
Abdominal guarding
b)
Rebound tenderness
c)
Abdominal distension
d)
Pain on passing urine
26.
Which of the following would you expect to be the LEAST LIKELY cause of an acute
abdomen in a child?
a)
Perforated appendix
b)
Volvulus
c)
Pancreatitis
d)
Intussusception
27.
Which of the following statements about impetigo skin infection is UNTRUE?
a)
It is a staphylococcal or
streptococcal infection
b)
It is most commonly found on
the face and trunk
c)
It is highly contagious
d)
It does not generally need to
be treated with antibiotics
28.
Herpes simplex is commonly seen in children and adolescents. Which of the following statements is
UNTRUE?
a)
It is characterised by
vesicular lesions
b)
Recurrence is often associated
with trigger factors in individuals
c)
It is characterised by macular
lesions
d)
It is contagious
29.
The NICE (2007) guidelines for the management of feverish illness in children
in children less than 5 years of age recommend that:
a)
Paracetamol be alternated with
Ibuprofen in the management of fever
b)
Antipyretics should not be
given in a child with fever who is otherwise well
c)
Antipyretics be given to avoid
febrile convulsion
30. According
to NICE the following signs and symptoms are the 3 main causes of parental
anxiety in their children:
a)
Fever, cough and the
possibility of meningococcal disease
b)
Fever, diarrhoea and the
possibility of meningococcal disease
c)
Fever, weight loss and the
possibility of meningococcal disease
|
Paediatric Multiple
Choice Questionnaire Answers
|
|
1
|
C
|
Children with ADHD are more often boys
and sometimes face difficulties in academic achievement. Hyperactivity
associated with ADHD leads to an increased risk of many sorts of injury
including head injury
|
|
2
|
B
|
Being overweight is currently defined as
a body mass index over 25 whilst obesity is defined as a body mass index
greater than 30
|
|
3
|
C
|
Obesity in children is disproportionately
evident in lower socio-economic groups and obese children may have obese
parents. Bullying and intimidation at school and a limited peer network are
features of obesity in children also
|
|
4
|
D
|
Low self-esteem secondary to isolation
and intimidation is more prevalent amongst obese children. Hypertension is a
long term risk associated with obesity whilst slipped femoral epiphysis is
seen in adolescent boys more than girls and has an association with obesity
|
|
5
|
C
|
Since 2002 fathers not married to the
mother may acquire parental responsibility by registering the birth jointly.
They may also do so by agreement of the Mother or secondary to a court order
in their favour.
|
|
6
|
A
|
The Family Law reform act of 1969 allows
16 and 17 year olds to consent to certain treatments but decisions to refuse
treatment may be overturned by courts. Fraser competence also has to be taken
into account in this age group
|
|
7
|
B
|
Closed and leading questions might be
usefully employed later in the consultation when diagnosis is being
considered and the practitioner wishes to focus the information from the patient.
Open questions at the start of the consultation will yield more information
to base diagnosis on and is a part of actively listening to the patient.
Closed or leading questions at the start of a consultation may lead the
patient to think that they are not being listened to or are being rushed
|
|
8
|
D
|
Children should be treated as part of a
family unit and this is particularly important in young children where
anxiety about separation from parents is also prevalent. Previous experience
of healthcare settings may influence the present consultation especially if
this is recollected as a bad experience. Aspects of how we approach children
and the environment we do this in should also be considered.
|
|
9
|
C
|
Anxiety about being separated from
parents begins when the child is less than 1 year old and is most prevalent
in this very young age group. A degree of independence and being comfortable
for short periods away from parents will become evident at around 2 or 3
years of age
|
|
10
|
C
|
Documentation is an important part of the
consultation but does not help in diagnosis. Pattern recognition and
differential analysis are recognised decision making techniques and certain
authors also argue that intuitive processes inform diagnosis
|
|
11
|
C
|
Being softer and more pliable it
generally requires more force to break a child’s bone than an adult’s as the
bone will absorb a certain amount of force without fracturing. If fractured
children’s bones may show characteristic fracture patterns such as buckle and
greenstick deformities. Growth plates fully fuse at approximately 18 years
|
|
12
|
C
|
The greater relative size of the young
child’s head, immature psychomotor skills and an immature parachute reflex
(the action of putting out an outstretched hand when falling) all make
children more likely to sustain head injury. Patent fontanelles below the age
of about 18 months mean that classical symptoms of rising intracranial
pressure may be evident at a later stage in this age group as the fontanelles
compensate for a certain level of rising pressure
|
|
13
|
C
|
A fall onto an outstretched hand is a
common mechanism of injury and may produce differing injuries according to
the age of the patient. In older patients Colles fractures of the wrist and
fractures of the neck of the humerus are common whilst children are more
likely to sustain supracondylar fractures in the elbow, fractures of the
clavicle and buckle fractures of the wrist
|
|
14
|
D
|
Growth plate injuries in children are
classified according to the Salter Harris system. Salter Harris 5 type fractures
are associated with falls from height in children and are crush injuries - in adults fractures of the calcaneum may
result from similar mechanism of injury
|
|
15
|
B
|
Salter Harris fractures that involve the
epiphysis itself are associated with growth and development problems and
arthritic processes, Salter Harris 3,4,and 5 fractures all involve the
epiphysis whereas Salter Harris type 1 and 2 fractures do not
|
|
16
|
C
|
Respiratory distress in children may be
evidenced by nasal flaring and recession of the intercostal muscles of the
chest wall secondary to increased respiratory effort. An expiratory grunt in
children is secondary to forced closure of the glottis in an effort to
increase positive end pressure in the airway. A capillary refill time of 2
seconds is a normal finding
|
|
17
|
C
|
Children compensate very well for
circulatory failure by maintaining a normal blood pressure for a longer
period of time than many adults. A normal blood pressure in a child should
not therefore be allowed to reassure the practitioner that the child is not
unwell. Earlier signs of circulatory problems include a prolonged capillary
refill time and an increased respiratory rate
|
|
18
|
A
|
Hypotension is a late marker of major
illness or injury in children. In meningococcal disease with septicaemia a
prolonged capillary refill time, cool peripheries and tachycardia may all
indicate peripheral shutdown and peripheral circulatory damage. The
importance of listening to parental reports of abnormal behaviour cannot be
over-emphasised as they are obviously far more able to gauge this than the
healthcare professional
|
|
19
|
B
|
(Age in years + 4) x 2 is an acceptable
means of estimating weight in kilograms in children with BMI within normal
limits. So a 4 year old would weigh 16 kilograms using this formula (4+4 = 8
x 2 = 16)
|
|
20
|
C
|
Bony injuries of the elbow in children
may be particularly difficult to identify on x-ray. On a lateral film of the
elbow an undisplaced fat pad on the anterior aspect of the elbow can be seen
normally – if it is displaced away from it’s position following the curve of
the elbow then this is indicative of a bloody effusion after a fracture. The
posterior fat pad of the elbow should not be visible on a lateral view of the
elbow as it lies within the olecranon fossa – this is therefore always an
abnormal finding
|
|
21
|
A
|
The notched appearance of the radial head
becomes evident at about the age of 5 years and this holds the radial head
more firmly within the annular ligament making pulled elbow much less likely.
|
|
22
|
C
|
An expiratory wheeze on auscultation of
the chest would be expected in asthma whether mild, moderate, severe or life
threatening. A silent chest and decreased respiratory rate are signs of
exhaustion in the child after a period of compensation - they are ominous pre-terminal signs
|
|
23
|
B
|
The British Thoracic Society define mild
asthma as 75% or more of expected peak flow, moderate as between 50% and 75%,
severe as 33%-50% and life threatening as less than 33%
|
|
24
|
C
|
Antibiotics are not indicated in
uncomplicated gastroenteritis in children as the majority are viral in nature
and self-limiting. They may also exacerbate diarrhoea. IV fluid replacement
is not indicated in mild (<5%) dehydration and anti-motility drugs such as
loperamide are not indicated in children or adults unless symptoms are
socially debilitating
|
|
25
|
D
|
Dysuria is not associated with an acute
abdomen and peritonitis. Guarding or being protective of the abdomen, rebound
tenderness of the peritoneum on palpation and distension of the abdomen are
features of an acute abdomen
|
|
26
|
C
|
Volvulus and intussusception are seen in
very young children and infants and appendicitis is the most common surgical
cause of abdominal pain in children. Pancreatitis is seen far more frequently
in adults
|
|
27
|
D
|
As impetigo is highly contagious and seen
more commonly in young children antibiotic administration is generally
necessary. Impetigo is a staphylococcal or streptococcal infection that most
often occurs on the face around the mouth and nose
|
|
28
|
C
|
Herpes simplex is characterised by
vesicular lesions - raised and fluid filled.
They often recur associated with different trigger factors such as
stress and sunlight in individuals. It is contagious at 1-4 days. A macular
rash is a flat rash that involves a change in colour of the skin usually to
red or pink and is seen in diseases such as measles
|
|
29
|
B
|
The NICE guidelines of May 2007
concerning feverish illness in the under 5’s recommend that antipyretics
should not be given solely to reduce fever in children who are otherwise well
as fever is a therapeutic response to illness. They specifically discourage
the routine alternation of paracetamol and ibuprofen to manage fever and
advise that administration of antipyretics does not prevent febrile
convulsions
|
|
30
|
A
|
The NICE feverish illness guidelines
estimate that fever, cough and the possibility of meningitis are the 3 main
causes of parental anxiety
|
