7. Malabsorption 1. Coeliac disease is the commonest cause in children 2. May present with weakness and pallor 3. May cause iron-deficiency anaemia 4. Coeliac disease can be diagnosed by a blood test 5. Children with coeliac must avoid wheat and rice 8. Chronic constipation 1. Most children have an underlying pathological cause 2. Requires long term treatment with a stool-softener 3. May cause problems with toilet training in infants 4. Is usually caused by lack of fibre and water in the diet 5. Affects about 10% of young children. 9. Malignancy in children 1. CNS tumours are relatively rare 2. The survival is more than 50% in leukaemia 3. Leukaemia may present with anaemia and petechiae 4. A bone marrow aspirate is required to diagnose leukaemia 5. Malignancy is a relatively common cause of death in children above 1 year of age 10. Nocturnal enuresis 1. Is commoner in girls 2. Always resolves by adolescence 3. May be treated with anti-diuretic hormone 4. 10% of children wet their bed at 5 years of age 5. Is usually caused by a urinary tract infection 11. Anaemia in children 1. Folate deficiency is the commonest cause in children 2. Iron deficiency anaemia is common in toddlers 3. Iron deficiency is usually caused by poor dietary iron intake 4. The red cells are hypochoromic and micorcytic in iron deficiency anaemia 5. May result from increased destruction of red blood cells. 12. Thalassaemia 1. Is relatively common in Malta 2. Is an autosomal dominant condition 3. Is caused by lack of production of beta-chains 4. Newborns are routinely screened for thalassaemia 5. Is treated with iron supplements
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13. Thrombocytopenia in children 1. May be caused by haemophilia 2. May present with non-blanching rash 3. May be a sign of leukaemia 4. Isoimmune thrombocytopenic purpura (ITP) is usually a chronic condition 5. The bone marrow in ITP shows decreased number of megakaryocytes 14. Regarding growth in children 1. A child is obese if his weight is on the 90th centile 2. The height is abnormal if it is on the 10th centile 3. An head circumference above the 97th centile could indicate hydrocephalus 4. Growth hormone secretion is suppressing in emotionally deprived children 5. Chronic disease may cause failure to thrive 15. Puberty 1. Is controlled by FSH and LH in boys 2. If precocious, may lead to short stature 3. If delayed, may be to Turner’s syndrome 4. May be induced by sex hormones 5. Occurs earlier in boys 16. Congenital hypothyroidism 1. Is easily diagnosed by clinical examination of the newborn. 2. Can result in severe neuro-developmental delay 3. Occurs in one in every 100 births 4. Cannot be treated with oral thyroxine 5. All neonates are screened. 17. Diabetes in children. 1. The commonest form is type-2 2. Diabetic children are mostly obese 3. Can present in the first year of life 4. May present initially with rapid breathing 5. Diabetic children requires less calories than other children 18. Diabetic keto-acidosis 1. The patient is dehydrated 2. Caused by lack of insulin 3. The blood pH is typically 7.5 4. Ketones are usually absent in the urine 5. The glucose level is very high
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19. Hypoglycaemic episodes in diabetic children 1. Result from lack of insulin 2. Present with tremors and anxiety 3. If unconscious, the child should be given a glucose drink 4. Can be treated with glucagon injection 5. May occur after missing a meal 20. Regarding child development 1. About 10% of children have some type of developmental problem 2. Most infants start walking by 12 months 3. Most children who are not walking by 18 months will have a serious underlying problem 4. Delay in one are of development may effect other areas 5. Pincer grasp usually occurs by 8 months 21. Regarding vision 1. Amblyopia can be corrected by glasses 2. Roving eye movements is a sign of severe visual impairment 3. The red-reflex test shows that the eye-sight is normal 4. By 6 weeks an infant fixes on the face and follows a bright dangling object 5. Corneal reflection is a helpful sign to detect squints 22. Regarding hearing 1. Deafness may present with behavioural problems 2. Hearing loss is strongly associated with speech and language problems 3. At 3 months an infant responds to his mum’s voice even if she is out of sight 4. Chronic otitis media may cause temporary hearing loss 5. Meningitis may be complicated by deafness 23. Regarding speech and language 1. By 18 months infants should say a few single words 2. By 24 months children should speak two-word sentences 3. May be caused by hearing loss 4. Is a sign of autism 5. Most pre-school children who stutter continue to stammer for life 24. Foetal Alcohol Syndrome 1. Involves poor growth, physical abnormalities and CNS problems 2. Is curable 3. Is preventable 4. Includes mental retardation 5. Small amounts of alcohol in pregnancy is safe
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25. On congenital anomalies of the gut 1. Duodenal atresia presents with vomiting in the second week of life 2. Hirschprung’s disease may present with delayed passage of meconium 3. Pyloric stenosis presents with vomiting on the first day of life. 4. Cleft palate may be complicated by otitis media 5. Cleft lip and palate are usually corrected after the first year of life. 26. Intestinal obstruction 1. Bile-stained vomiting is a significant sign 2. Intussusception is the commonest cause in infancy 3. Intussusception always requires surgical treatment 4. Abdominal x-ray usually reveals the cause of the obstruction 5. Presents with severe colicky abdominal pain. 27. Jaundice 1. In neonates is usually caused by liver disease 2. In breast-fed infants may continue for several months 3. In infants may be caused by biliary atresia 4. May be a sign of hepatitis 5. Maltese children are routinely vaccinated for hepatitis B
