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Case # 2 (4 marks) 18 hours ago a pregnant lady had delivered a 36 weeks old girl weighting 2.650 kg. She was completely healthy woman with appropriate antenatal care. The baby is healthy as well and didnt require any resuscitation post delivery and started breast feeding with good suction. Apart from abnormally looked genitalia the baby is normal by quick inspection. This is the second child for this mother; her first son had died at the age of 2 weeks secondary to sever gastroenteritis and dehydration.
1. What is the initial action you do now? (Select TWO answers only) A. Stop breast feeding B. Give IV Saline bolus C. Check blood glucose D. Consult the parents to avoid giving a name now. E. Check serum electrolytes F. Complete you clinical examination G. Urgent pelvic ultrasound H. Buccal smear I. Talk to obstetrician J. Check cord blood gas K. Check the placenta and umbilical cord 2. What are the most two important signs helping in diagnosis? (Select TWO answer only) A. OFC B. Blood pressure C. Feeling the testis D. Dehydration status E. Hypopigmentation F. Urine volume G. Patent anus H. Sacral agenesis I. Temprature J. Eye examination K. Primative reflexes L. Abnormal ear M. Palpable kidney N. Bulging fontanels O. Dysmorphic face P. Polydactyly Q. Cardiac murmur R. Hand anomaly S. Cleft palate T. Lethargy U. Urine specific gravity V. Palpable bladder W. Hepatomegaly X. Height
_____________________________________________________________________________________ 3 July 2009
Case # 7 (2 marks) 10-year-old girl presented with a history of progressive loss of vision and painful eyes. She has an area of numbness over her left side of the face. She is fully conscious but has developed progressive ataxia over the last few weeks. She is a completely healthy girl before that and achieving well in school until this year. Pregnancy and delivery were uneventful. Brain MRI shows scattered areas of demyelination in white matter over both hemispheres.
1. What is the main lines of treatment? (Select TWO answers only) A. Reassurance B. Behavioral therapy C. IV Antibiotics D. IV Acyclovir E. Steroid F. IVIG G. Plasmaphoresis H. Carbamazepine I. Interferon J. Bone marrow transplantation K. Haloperidol L. NSAIDs M. Pyridoxine N. Biotin O. Thiamine P. Refer to Psychiatrist Q. Radiotherapy R. Immunosupprion
Case # 8 (1 marks) Alex is 14 years old girl. Currently she is inpatient for the last 4 days following an appendicectomy. She is otherwise fit and well. You have just finished the ward round, during which said that she could be discharged. Alex has asked to speak to you alone before she goes home. She want you to prescribe an oral contraceptive pills for her. 1. What is your response and action? (Select ONE answer only) A. I will tell her parents to take the appropriate action B. I will prescribe that without any problem to avoid teenage pregnancy C. I will prescribe for her the pills after checking her competence D. I will advice her to avoid discussing this matter with her parents E. I will refuse that and will not prescribe anything like that F. I will not warn her about sexually transmitted diseases G. I will prescribe that according to the background social circumstances H. I will call my senior and nurses to discuss with her I. I will contact the social worker to be involved in her management J. I will advice her to bring the partner for counseling K. I will recommend the mechanical barrier which is more protective
_____________________________________________________________________________________ 3 July 2009
Case # 9 (2 marks) 6 years old boy had a past history of medulloblastoma. It was operated 4 years ago. He is presented to you clinic with the following result of Insulin stimulation test: Time / min 0 20 30 60 90 120 Glucose (mmol/l) 4.5 1.8 1.6 6.3 7.5 8.1 Cortisol (nmol/l) 507 581 992 741 582 GH (mU/l) 0.9 0.7 1.7 4.2 4.6 TSH (mU/l) 41 > 60 > 60 FSH (u/l) 1.6 > 30 > 30 LH (u/l) 1.2 2.8 3.2 1. What does the test show? (Select ONE answer only) A. Normal test result B. Growth hormone deficiency C. Panhypopituitarism D. Primary hypothyroidism E. Secondery hypothyroidism F. Isolated hyperthyroidism G. Isolated deficiency of cortisol H. GnRH deficiency I. GnRH excess J. Both B & D K. Both E & G L. All B,D & H M. All B, E, G & H Case # 10 (1 marks)
A baby born at 28 weeks gestation is now 3 months old with chronic lung disease. He is on nasal cannula Oxygen at home. 2 days ago he developed cough and respiratory distress with increasing Oxygen requirement. You have asked for arterial blood gas which shows the result below: PH 7.20 PO2 11.2 kPa 13 kPa PCO2 28 kPa HCO3 Be +9.3 1. How do you interpret this result (Select ONE answer only) A. Respiratory acidosis B. Metabolic acidosis C. Compensated Metabolic acidosis D. Compensated Respiratory acidosis E. Partially Compensated Respiratory acidosis F. Partially Compensated Metabolic acidosis G. Normal gas for chronic lung disease child