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A child with collapse..ecg showing torsades/VT..management DC shock as the patient was in collapse
ecg with left (superior) axis deviation and RBBB..think was ASD Primum ASD
Another ecg I completely got wrong..there was probably RVH and RAD..they asked dx The ECG as I
remembered consists of 2 parts, the first part asked about the finding that were right axis deviation
and right ventricular hypertrophy, the second part asked about the diagnosis and I choosed secundum
ASD as said the patient is asymptomatic
there was CXR which looked like figure of 8/snowman..options were partial
TAPVD,lymphoma,teratoma..i went for lymphoma looked like there was mediastinal shift..not
sure..mostly people wrote partial TAPVD I choosed lymphoma as there were lung oligemia and
mediastinal widening (I am not sure)
Cardiac catheterization data showed TGA with left to right shunt at vent level..options were TGA with
VSD,TGA post septostomy TGA with VSD
A child with PDA..CANT REMEMBER THE AGE..question was management..wait to
close,indomethacin,ligation,or percut obliteration.
There was a quest related to prophylaxis for infective endocardiis.
a child with fever and a murmur..prolonged hx of fever..BC negative..further investigations..repeat
cultures,angio,echo this was a very nice case, for a long scenario of a child with audible murmur
that developed high prolonged fever, and then developed aphasia with negative blood culture then
asked; what is the next investigation repeat blood cultures and ECHO; what is the possible
diagnosis infective endocarditis; what is the cause of aphasia cerebral emboli .
a child with rt sided heart failure..low BP..what to do next..frusemide,dobutamine,prostacyclin.
Pul stenosis+lung fields clear+cyanosis=TOF..
TOF--> cyanotic with single S2
ECG-->WPW
ECG-->SVT, give Adenosine and Vagal maneuver (ice pack on the face)...ocular pressure is not
advvised to do for SVT( I just check)
Long QT syndrome...Tx: Beta blocker, Propanolol.
....
Pt with cough lung function , TLC normal , only high is RV what is the explanation for RV
Poor technique
Mucous blug
Malfunction machine
GENITICS
ans SYND:
Fragile x
skeletal dysplasia x ray
Picture of a child with thin upper lip and short filtrum but eye's were covered.
Case of prader willi syndrome
ENDOCRAINE:
There was data of water deprivation test showing psychogenic polydipsia
A child with accelerated bone age, high BM and obese..options were simple obesity, Cushings?
A preterm child following 0.4th centile..what would u do if still fails to catch up growth at 4 years despite
of adequate diet input..refer to endo,refer to geneticist,refer to social services,refer to dietician refer
to endocrine to start GH therapy
A girl with subclinical hyperthyroidism..what would u do..give propranolol,carbimazole,iodine this is
a very nice case that I cant forget it, this is a case of Hashimoto thyroiditis and developed
Hashitoxicosis (release of the stored thyroid hormones) and the ttt in this case is propranolol (No role
for antithyroid drugs).
an Asian chid with data of rickets.
TSH high and T4 low--->dyshormogenesis.
Case of Swachman Diamond syndrome
case af a baby boy with dehydration, salt losing..urine Na=120.
case of CAH---to do 17 OHP.
about Addison d and its Dx
Teenage girl with early morning vomiting nausea headache .fundoscopy and
examination normal.abdominopelvic USG normal.CBC normal urine beta hcg 2+.Wat
next to diagnose cause of symptoms.
Blood hcg
Transvaginal USG
CT brain.
Thyroid question f thin irritable easily tired yes it is graves but that is not the question What
investigation (T3) (t4) (TSH) (thyroid scan)(antithyroglobulin antibodies).
W tttt (carbimazole alone)(carbimazole+thyroxin)(thyrodectomy)
(Lugosl iodine)(propranolol)
Choose 2.
teenage with symptoms of pregnancy, _ve urine HCG , what to do next ( serum HCG, uss , ...)
pt with results showing hypocalcemia mainly, so they were asking about our concern, then
the investigations to be 2. Pt with T 4 12, TSH 13 what is inv
Thyroid Ab
T3
Thyroid US
Brain MRI
She started on thyroxin , what is best monitoring for ttt :
T4
TSH
Thyroid Ab
3.pt short stature with ph 0.8 normal ca and PTH and ALP :
X linked Hypophosphatimic Ricket
Nutritional ricket
4. Pic of Pt 19 mo with bilteral breast enlargement bone age 2 y no other abnormality what
inv :
A. Oestrogen level
B. LH FSH
C. Brain imaging
D TSH ?
plvic us
Neonate with poor feeding low glucose and micropenis, jaundice and leathargic with low BP
A. Hypothyroidsm
B. sepsis
C. Hypopituitarism
D CAH
Child with vomitting and darke skin creases on the palm Addison dis
Child known CAH on good treatment , parent ask what his ht will be:
A. Decrease growth and final ht as parents
B. Rapid growth and final ht below parents
C. Decrease growth and final ht above parents
NEURO:
4 questions of headache..1 with classic migraine one with cluster headaches..rest 2 I got wrong..people
saying tension headache/space occupying lesion..in one question headache with vomiting getting worse
but fundoscopy normal..rest neuro exam normal..dx?
one African child with 3weeks h/o headache malaise fever .now reduced
consciousness and generalzed hyper reflexia. Options for dx
TBM
Encephalitis..
chiari malformation ct scan.
_hx of rolandic epilepsy _clear, what treatment is needed ? No.
pt with absence epilepsy and Na valproate 25 mg /kg , was contolled now developed seziures ,action?
( increase the dose to 40 mg/dl# shift to other antiepileptic # refer to psychiatry ).
EMQ about ataxias , the only keyword i remember was pes cavus for fridrich,
Gail 12 y with weakness in her upper Rt limb since morning can't lift it with history of previous
intermittent episode in the lower limbs , inv all normal except k + 2.6 what diagnosis :
Periodic paralysis
Pic of child with Rt ptosis and big eye lid and history of skin mark what diagnosis :
A. Neurofibromatosis 1
B. Neurofibromatosis 2
C. Tuberus sclerosis
Extending matching q about headache Migrain Brain tumor Idiopathic ICP A. one scenario with
night vomiting papilledema and uncle died of brain tumor B. Headache intermittent BP high BMI
high normal eye exam C. Headache with confusion at the episode with photophobia
6 weeks old with RSV infection and calycic on ribs in hospital with drug addict mother n on
methadone,suddenly he deriorated
PICU admission
social services
call the consultant.
6 years old child with hx of odd behaviour,mother hears a loud thump and when she arrives she finds
him running,shouting around room,father is step father,even child has similar behaviour,dazed look
during day time
Night mares
night terrors
Fictious fits.
3yrs old girl with adopted parents having TC,afebrile fits eeg ok,choose the ttt,afte 6 months fits
controlled but on further probing child has hx of familiarity with strangers plus sexual behaiour as her
mother was prostitute,her fits are controlled now but her sexual behaiour is more perplex now as she
takes off her clothes in front of other children
foster care
change the adoptive parents
social services
multidisciplanary team involvement.
3 Scnarios of consent method.
15 years old with anorexia nervosa,need iv ttt,mother n stepfather accompanying her but she is
refusing,who can give consent
child came in An E accomnied by grandmother,parents on holidays need urgent ct under GA
3rd i dont rememeber
options were like pt,mother,stepfather,doctor in pt best interest etc.
Rules in prescribing medicine...
X ray of 11 y boy with cough and fever with O2 sat 92 % show Rt sided pleural effusion and
consolodation doct deside to give IV antibiotic but parent refuse and belive on homopathic ttt and
tell they will take him home
What is your action :
Let child consent for ttt
Call social worker
Inform pediatrition .. .
Early teenage has argue with her family b/c of her boy freind , she took many paracetamol tabs , st
ER she was fine and paracetamol level was low not need administration of N Acetyl cystine , she
deny pregnancy or any emotional problem what is next action :
NEONATOLOGY:
-there was 2 week old baby with distended bowels..options included NEC,mec ileus NEC, the same
photo was in OnExamination questions and called tram lining of pneumatosis coli as I think
a neonate with eye infection and later on developed sepsis..no risk factors for sepsis..options were
GBS,Herpes.
a child on CPAP of 5..deteriorated gas..what to do next..put back to SIMV,Inc CPAPA pressure..i went for
pressure..think right ans is SIMV a newborn with RDS and stable of mechanical ventilation, weaned
and put on CPAP but deteriorated within 2 hours of CPAP and gave the blood gases of the patient I
choosed to put again on mechanical ventilation.
3 weeks old with billious vomiting for 1 day---investigation
upper GI Barium study
pH study
USG
Rectal Biopsy.
32 weeks old preterm delivery expected,councelling regarding pork derived surfactant
Councell that in the best interest of child
refer them to hospital imaam regarding cx that Islamic council has permitted its use
offer synthetic surfactant.
24 hrs old breastfed baby mother having difficulty in establishing feed,health care checked Glucose
which is 2.2 now,what to do
Breast feed him now
Tell mother to express and gv in bottle
start IV glucose.
question about haemorrhgic disease of newborn with its 2 causes (only one dose of oral vit K and biliary atresia) 4-Q
about
Transient neonatal DM arch.
extended match scenario of neonate with poor feeding .floppy.without birth asphyxia
Diagnostic options .there were 3 scenarios.inverted v mouth one associated with
mother developed diplopia after delivery.another with mother having learning
difficulties.options were
Myesthenia gravis
SMA
Nemalin rod
Myotonic dystrophy
Central core.
necrotizing enterocolitis management ( 3 steps answers contain bolus _ referral to
sugery_antibiotics_CXR, AXR ).
hx of neonate with swelling and bleedind ,results of coagulation profile were there, diagnosis # vit K #
kazabech merit .
X ray -- pt 6 hr old with history of progressive distress and established feeding well Dx
congenital diaphragmatic hernia
. 8 weeks with fever and vomiting routine urine bag test normal what is action :
A. Obtain clear catch test
B. Start antibiotic
C Abd. US
D repeat urinalysis
Pic of recently delivered neonate with history of forceps delivery has bilateral lid ( light
ecchymosis /redness ) ask what management :
A. Discharge and reassure
B. Cranial USS.
C No action
.
....
5. Extending matching q
Intusseption, campelobacter gastroenteritis, cows milk protein intolerance
METABOLIC:
There was a data where with fasting glucose dropped and child developed hypoglycaemia and
acidosis..ketones +..?GSDa
question with child with features of galactosemia..investigation? GALPUT#
DERMATOLOGY:
A child with eczema herpeticum..asked abt management.
I choosed SUFE
An xray with large head and telephone handle deformity of femur..wrote thonophoric me also
.Photo ----> DDH,
15yrs old with 1 week h/o knee pain and limp.no trauma.no other symptoms XR was
given.on xray there was large cystic or lytic lasion at lower end of femur.they asked
dx.there was no sunburst or onion appearance. Options were
Osteosarcoma
Histiocytosis
Ewing sarcoma. .
Boy has bilateral knee pain , fever and rash ASOT ! , ANA +ve ! A. Rheumatic fever B. JIA
...
in hospital,do not give? I think it was about pertussis vaccine and give the next doses as usual.
a child with epiglottitis..?intubate in theratre,/give dexamethasone.
child with Neutropenic Hyperpyrexia,38.5F,Neutro count=< 0.5,initial or appropriate investigation
Culture and sensitivity
prophylaxis antibiotics
No antibiotics
wait and See
swabs.
Child ,microcephalic with petechiae and Hepatosplenomegaly with CMV Ig M positive at 2 weeks
Mother is infected
Intra uterine infection
acquired infection
Pt 9 y with diarrhea bloody and vomiting urine blood and protein inv Hb 9 , platelet low , urea 40
what 3 inv to confirm diagnosis :
A. Prephral blood film
B. Creatinine clearnce
C. Reticulocyte count
D. Stool culture
13 y girl with vomiting and fever start at night , morning she has profuse diarrhea and headache
on exm temp 41 negative kernig sign :
A. Meningitis !
B. Meningococcal septisemia C.
Same pic in sample paper of palatal hemorrhage tell he has fever and sore throat for two weeks
ask what is the diagnosis: A. Glandular fever. B. Leukemia
9 y girl with tender rash in the lower limb other with normal :( picture)
A. Erythema multiform
B. Erythema nodosum
C. Insect bite
D child abuse
Child with orbital cellulitis recieved ttt come later with the ( in pic ) reddish and mildly swollen lt eye
with smooth lt nasolabial fold
A. Cavernous sinus
B Sinusitis
C Neuroblastoma
HAEMATOLOGY:
a child shown with rash on buttocks asking about possible serious complication associated..some wrote
GI bleed,some wrote nephritis GI bleeding.
.5day old baby with hematoma over temporal area.initial 2 days irregular feeding.
Data was there regarding cagulation profile with normal CBC.pt and APTT
prolonged.how to treat.
Vit k
FFP
Blood .. _
results of hb electrophoresis asking for diagnosis
.pt with kawasaki treated with asprin and immunoglobuline blood test reveal Hb 9 , ferittin
300 (? -300 ) , Hb f 9 %
What inv for cause of anaemia :
A. Haemoglobinopathy
B. Bone marrow biobsy
sickler pt will undergo surgery Hb 8 what parameter will be given to prevent post op crises
:
A. Increase fluids
B. Top up blood transfusion to increase the Hb to 10
C prophylactic antibiotic
D maintain oxygenation.
Pt with history compatible with HSP ask what investigation for follow up.
2 y with pallor and irregular abdominal mass Hb 9 and ferritin 650 what 2 inv :
A. Urine catecholamine
B. Bone marrow biobsy
C. Abdominal US
D. HPO OR HPMO !!??
RENAL:
there was a child with haematuria and HTN..management? labetalol,fluid retriction This is a big
scenario as I remember for a child with APGN, hematuria, hypertension, and raised renal function
tests; the questions are three, what is the next option? follow-up in the nephrology clinic; what will
confirm the diagnosis serum C3; the patient started beta blocker therapy but developed severe
8yrs old Asian child with nephrotic syndrome.oedems and ascities. Choose 2
management options
Prednisolone60mg/m2 alternate day
Prednisolone 60mg/m2 od
Frusemide 1mg/kg od
Cyclosporin. .
scenarios related to DI RTA 3 to 4questions.
Picture of 4months?MCUG with markedly dilated system .Wat next to test
DMSA
Ivp
MAG scan
Girl 13 y old had road traffic accident and blunt trauma given fluids and blood transfution became
after that tachpnoec and anuric , K + 8 mmmol / l creatinine 200 , what 2 management :
A. Neublized salbutamol
B. Hemodialysis
C. Perotoneal dialysis
D. Diuretic challenge.
pharma:
Drugs combinations which have side effects
--Ketoconazole+Azithrocin
--Carbamazipine+ibuprofen
--Amoxil+Clavulanic acid
pt with meningitis, finished treatment ,developed red urine , the cause ? ( drug reaction # allergy
1. #....) Pt with burn for dressing in need for analgesia with prolong bleeding profile which of
the following contraindicate :
A. inhaled NO
B. Paracetamol
C. Pethidine
D. Morphine
E Ibuprofen
Pt on phenytoin traumatized his knee joint ca and ph normal only high ALP ask what
management :
A. Vit D supplement
B. Iso enzyme level . .
STATISTICS:
Four Stat questions all in all --->about relative risk and ODD ratios.
Relative risk
OPHTHALMA:
1.pic of a baby with question about findings
Aniridia
Bilateral glucoma