Pediatrics Question

7/31/2019 Pediatrics Question

1/11

4th YEAR PAEDIATRICS EXAMINATION

2nd SEMESTER SESSION 2009/2010

OBA

1. An 8-year-old boy presented with vesicles and rash, some of it had become dark and

scalded. History taken revealed that he had visited to his cousin house 3 weeks ago, when

his cousin also developed rash. Counsel the mother about the other 2 children at home.

A. Bring them for vaccination

B. Keep them away from the infected child

C. They are already exposed to the infection, look out for the rash.

2. An 11-month-old child presented with cough and stridor, what is the likely etiological

agent?

A. Adenovirus

B. Haemophilus influenza B

C. Parainfluenza

D. Influenza

E. Respiratory syncytial virus(RSV)

3. Patient presented with periorbital oedema and signs of raised intracranial pressure. What is

the most appropriate investigation?

A. CSF analysis

B. CT scan

8. The earliest sign of patent ductus arteriosus (PDA) is:

A. excessive sweating

B. hepatomegaly

C. tachycardia

9. A baby born @ 30 weeks of gestation had been kept in a close incubator since birth.

Currently he is @ day 11 of life. Investigation was done and showed that his pH is 7.25,

and he has hyperglycemia. What is the appropriate management?

D. Presence of sign of sepsis, give antibiotics


2/11

10. A term baby, postdate + 6days, was diagnosed to have meconium aspiration syndrome. He

was given CPAP and was able to wean off well after 1 day. What is your advice to the mother?

A. ask mother to breastfeed the baby

B. bottlefeed baby with expressed breast milk

EMI


3/11

Theme 1: Respiratory

A. Allergic Rhinitis

B. Asthma

C. Bronchiolitis

D. Croup

E. Epiglotitis

F. Foreign body inhalation

G. Pneumonia

H. Respiratory Distress Syndrome

I. Tonsillitis

J. Upper respiratory infection

11. A 5-month old child was presented to you as a Medical Officer with low grade fever and coryza

for the past 2 days. He could tolerate feeding well, and was active and playful. On examination, he

was slightly tachypnoeic and there was intercostal recession. Upon auscultation, there were

generalized crepitation and rhonchi. - bronchiolitis

12. A child has been coughing for 3 months. He had no history of fever. He had been treated with

multiple antibiotics from general practitioner. On chest auscultation, there was reduced breath sound

on the right lower zone with the presence of rhonchi.

Theme 2: Nephrology, gastroenterology

A.Nephritic syndrome

B.Nephrotic syndrome

C.Protein losing enteropathy

13. A child with proteinuria (?1+ or 2+), hypertension, oliguria. Urine FEME revealed red cell cast.nephritic syndrome

14. A child with pale, bulky, foul-smelling stool. protein losing enteropathy


4/11

Theme 3: Crying baby

A. Intussuception

B. GORD

C. Infantile colic

D. Meningitis

E. Epilepsy

F. UTI

15. A child presented with vomiting and was crying. He had history of rhinorrhoea which had

resolved well. ?fever

16. A child presented with crying which lasted for half to an hour, four times per day. He stops

crying when being carried and swung. There are no signs of infection. No history of fever.

17. A child presented with crying. When he cries, his knee was noted to be flexed (abnormal

posture).

Theme 4: Haematology, malignant disease

A. Acute lymphoblastic leukemia (ALL)

B. Thalassaemia

C. Iron deficiency anaemia

D. Lymphoma

18.

19. A 1-year-old child, with low Hb level. History taken revealed that she was still not started on

weaning. -IDA

20. A child presented with weight loss, multiple lymphadenopathy. lymphoma


5/11

KFQ 1

A 9-month-old infant presented with maculopapular rash over trunk except hand and leg. He had

cough, coryza, and conjunctivitis. Shotty lymph nodes (cervical) were detected on examination.

Respiratory, cardiovascular, gastro systems were all normal.

1. Give 3 differential diagnoses (3m)

2. Give 4 investigations & reasons (8m)

He was managed and discharged well. However, 3days later he developed tachypnea (and

complications of respiratory symptoms).

On examination: dullness on percussion on

bronchial breath sounds & coarse crepitations

3. What is the complication that he has developed?

4. Give 2 investigations to confirm your diagnosis.

5. What is the long term complication of this problem?


6/11

KFQ 2

History of an 11-month-old infant:

His mother had gestational diabetes mellitus, was on diet control. During 3 rd trimester, she took iron

supplements for anaemia.

The baby was born with birth weight 3.7kg. He was noted to be hypoglycemic and was admitted to

NICU for a few days. Otherwise was uneventful.

Gross motor-cant stand unsupported(normal dev)

Social-did not show the ability in clapping hands

-did not respond to peak-a-boo (delayed)

Otherwise others were normal.

For this admission, he presented with pallor, jaundice and failure to thrive.

O/E: hepatomegaly

Results showed:

Hb Bilirubin

MCV ALT

MCH ALP

1. What is the most likely diagnosis? (3m) -thalassaemia major

2. Name one diagnostic investigation and state the result you expected. Electrophoresis. HbA

absent(2 or 4m)

3. Explain your diagnosis why patient had hepatomegaly. (2 or 4m)

History stated that his cousin had repeated blood transfusion.

4. List 3 complications of blood transfusion (3m)


7/11

KFQ 3

A 6-year-old boy, had abdominal pain after taking dinner. At 10pm, he vomited out undigested food

and at 2am, he woke up and vomited clear fluid. At 5am, he vomited again with clear fluid. He was

brought to Accident & Emergency department after that.

O/E: dry mucous membrane

normal blood pressure, respi rate, pulse rate

tenderness @ epigastric & umbilical area

1. Give 2differential diagnoses. (4m)

2. What is his degree of dehydration? (1m)

A. 5%

B. 7.5%

C. 10%

D. 15%

3. Calculate the fluid resuscitation for him. (forgot how many kg was given) (6m)

i) maintenance

ii) replacement of dehydration

Later, he developed pain @ right lower quadrant, with presence of guarding and rebound

tenderness.

4. What is the most likely diagnosis?

5. What is the management of this child?


8/11

KFQ 4

6-year-old? A child presented with fever, epistaxis, myalgia, petechiae @ lower limb. History taken

revealed that there was fogging recently @ his housing area.

O/E: presence of signs of dehydration

Hypotension, tachycardia, CRT 3 seconds

Liver 4cm, dullness @ bilateral lower zone(lung), positive shifting dullness

Ix Results:

-Platelet Hb normal Hematocrit level normal

-Urea Na normal K normal (borderline ) creatinine

-ALT

1. What is the most likely diagnosis? (3m)

2. Name 1 diagnostic test & give your result. (2 or 4m)

3. Give 2 immediate management.

4. What is the respiratory finding that he has developed? Pleural effusion

5. Based on the ix, what other complication he has developed? Give two.

Acute renal failure, hepatitis


9/11

PPD component (Theory)

You are the medical officer, attending to a child and his parent in the clinic. The clinic was crowded

with many patients outside. While you were examining the child, suddenly a man entered the clinic,

asking how long he should wait (he already waited for 4 hours?), telling that he cannot manage his

child who had ADHD anymore outside the clinic.

1. Give 4 immediate management or actions that ull do to cope with this situation (4m)

2. Write out 4 dialogue that ull say to the parent. (4m)

3. What strategy that u think of to prevent this incident to occur next time? (2m)


10/11

Osce

1. A 2-month-old girl, prolonged jaundice, with hepatomegaly 4cm below subcostal margin.

(there was a pale stool specimen)

a) describe the colour of the stool pale stool

b) give one diagnosis - conjugated hyperbilirubinemia secondary to biliary atresia with

liver complication

2. (pic of neck swelling)

A 5 y/o boy presented with 2 days h/o fever (temp 38 o C) andpainful neck swelling.

Otherwise he is well and thriving.

a) give one possible diagnosis (2m) - ?lymphadenitis ?mumps, ?cystic hygroma

b) what is the useful initial ix (1m) - ?full blood count to look sign of infection..

Pic showed an abdominal x-ray of a newborn with abdominal distention and had not passed

meconium yet.

a) state 2 abnormalities of the x-ray

-multiple loops of bowel appearance (?step ladder)

-dilated bowel

b) what is the possible diagnosis?

-hirchsprungs disease

A baby born @ 36 weeks gestation, his weight is 4.0kg, height is 52cm, head circumference is

36cm.

Plot on growth chart (2m) (all values are above the highest percentile)

State one aetiological causes for the above condition (1m) macrosomia (infant of diabetic

mother)

A 1-year-old girl presented with failure to thrive. Full blood count showed: low Hb (8.3), low

MCH(15.8), low MCV(50), WBC 10.5, platelet 254

Interpret the FBC hypochromic microcytic anaemia

Give two differential diagnoses iron deficiency anaemia, -thalassaemia


11/11

PPD station

Puan Aminah, the mother of Daniel (5-month-old), is reluctant to continue the

vaccination to his son, due to the side effects that his son had (fever, rash and lower

limb swelling for 1 week according to clerking hx) after first dose of vaccination

(Hib/IPV/DTP).

Find out the reasons why she is reluctant and obtain consent from her.

-confirm that she is puan aminah, mother of daniel

-explore the reasons she is reluctant

-tell her why he should receive vaccination (give the benefits of taking the vaccination,

risk of not taking)

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Pediatrics Question