08.ELBABA M.A. Answers SAT8 for MRCPCH,2009.pdf

SAT for MRCPCH Part 1& 2 ELBABA M.A. ______________________________________________________________________________________

SAT FOR

MRCPCH Part 1&2 Series # 8 Question number: Total is 10 cases Question Format: Best of many & Extended match Time allowed: 20 Minutes Total Marks: 20

Set your time & write in the answer sheet Answer is available on request & your score is confidential

Please, do not turn this page until you asked to start Visit MRCPCH 2009 Website for all educational materials http://sites.google.com/site/mrcpch2009/

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SAT for MRCPCH Part 1& 2 ELBABA M.A. ______________________________________________________________________________________

Self-Assessment Test for MRCPCH / Series # 8 Case # 1 (2 marks) 12 years old girl is admitted to the hospital with burns on her legs which she obtained while playing near a bonfire. The burn was treated and starts to heal. While in hospital, it was noted that her behavior was “odd”. Her concentration span was very poor. She was suddenly changing her attention from one conversation and shouts something to another patient. On one occasion, she had been walking a little unsteady across the ward when she fell for no apparent reason. Another time she had fallen out of bed. Apart from parents divorce at age of 18 months, there was nothing significant in family or social history. For the last few months her behavior had been unpredictable and in view of this she had been sent to stay with an aunt for some weeks during the holiday. Since that time, the teachers in school had been observed deterioration in her performance. There was a past history of tonsillectomy at age of 6 years and the usual childhood infections as coryza, measles and recently chicken pox. Her cranial nerves and fundus exam are intact. She had sudden grimaces and jerky movements of her arms, and occasional abnormal posture of her limbs. Her gait is unsteady. There was an increased tone and reflexes mainly over both lower limbs with positive planter reflexes. Romberg’s test couldn’t be done. Her FBC, ESR and skull X-ray are within normal. 1. What is the most likely diagnosis? (Select ONE answer only) A. Drug poisoning B. SLE C. Hyperthyroidism D. Chorea E. Conduct disorder F. Schizophrenia G. Anxiety neurosis H. Hepatic encephalopathy I. Uremic syndrome J. Subacute sclerosing panencepalitis K. Psychomotor epilepsy L. Myoclonic epilepsy M. Frontal lobe tumor N. Lundau Kleffner syndrome O. Rett syndrome P. Autism Q. Chronic fatigue syndrome R. Encephalitis S. Cow mad disease T. Alzheimer disease U. Dementia V. Vitamin B12 deficiency W. Vitamin B6 deficency _____________________________________________________________________________________ 3 July 2009

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SAT for MRCPCH Part 1& 2 ELBABA M.A. ______________________________________________________________________________________

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 didn’t 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

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SAT for MRCPCH Part 1& 2 ELBABA M.A. ______________________________________________________________________________________

Case # 3,4,5 & 6 (Extended Match) ( 2 mark for each, total 8) Choose the one most likely diagnosis from the list below which best matches each of the following cases. Note: Each option may be used once, more than once or not at all. SELECT ONE ANSWER ONLY FOR EACH QUESTION 3. 5 weeks newborn presented to OPD with difficulty in feeding, sweating and poor weight gain. Baby is full term with uneventful pregnancy and delivery. The baby had discharged on second day of life completely healthy. On examination he has, mild tachypnea 50/m, tachycardia 180 b/m, normal temp. & blood pressure. Lungs are clear and normal cardiac examination. Chest X-ray shows only mild cardiomegaly, ECG is normal. G 4. 5 weeks newborn presented to OPD with difficulty in feeding, sweating and poor weight gain. Baby is full term with uneventful pregnancy and delivery. The baby had discharged on second day of life completely healthy. On examination he has, mild tachypnea 50/m, tachycardia 180 b/m, normal temp. & blood pressure. Lungs are clear and normal cardiac examination. Chest X-ray shows only mild cardiomegaly, ECG shows only deep Q wave. F 5. 5 weeks newborn presented to OPD with difficulty in feeding, sweating and poor weight gain. Baby is full term with uneventful pregnancy and delivery. The baby had discharged on second day of life completely healthy. The baby has Flu for the last 3 days. On examination he has, mild tachypnea 50/m, tachycardia 180 b/m, and normal temp. & blood pressure. Lungs show bilateral crackles and normal cardiac examination. Chest X-ray shows moderate cardiomegaly, ECG shows biventricular enlargement. I 6. 5 weeks newborn presented to OPD with difficulty in feeding, sweating and poor weight gain. Baby is full term with uneventful pregnancy and delivery. The baby had discharged on second day of life completely healthy with soft systolic murmur. On examination he has, mild tachypnea 50/m, tachycardia 180 b/m, and normal temp. & blood pressure. Lungs show bilateral crackles. There was a systolic murmur and loud 2nd sound on cardiac examination. Chest X-ray shows moderate cardiomegaly, ECG shows biventricular enlargement. B Select your answers from the following list: A. Small VSD B. Large VSD C. Aortic stenosis D. Coarctation of the Aorta E. Total anomalous pulmonary venous drainage F. Anomalous left coronary artery G. Arterio-venous malformation H. Ebstein anomaly I. Myocarditis J. Pericarditis K. Protein C deficiency L. Suprventricular tachycardia _____________________________________________________________________________________ 3 July 2009

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SAT for MRCPCH Part 1& 2 ELBABA M.A. ______________________________________________________________________________________

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

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SAT for MRCPCH Part 1& 2 ELBABA M.A. ______________________________________________________________________________________

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

End of the test ELBABA M.A. M.A. _____________________________________________________________________________________ 3 July 2009

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