Archives: Medical Student Finals

MSFinals-4625

As a junior doctor on the neonatal ward, you are asked to assess a premature baby born at 34 weeks gestation who is experiencing respiratory distress. The delivery was uneventful. The baby’s vital signs are as follows:

– Heart rate: 180 bpm (normal range: 100-180 bpm)
– Oxygen saturation: 95% (normal range: ≥ 96%)
– Respiratory rate: 68/min (normal range: 25-65/min)
– Temperature: 36.9°C (normal range: 36.0°C-38.0°C)

The baby is currently receiving 2 liters of oxygen to maintain their oxygen saturation. Upon examination, you notice that the baby is not cyanotic, but there are subcostal recessions and respiratory grunts. There are no added breath sounds on auscultation, but bowel sounds can be heard in the right lung field.

What is the most likely cause of the baby’s symptoms?

MSFinals-4626

A 6-month-old Caucasian baby girl is brought to her general practitioner, as her parents are concerned about a skin lump that has appeared on the left side of her neck. It is non-tender and does not seem to bother her, but it is growing in size. She is feeding well and is otherwise healthy. On examination, there is a 2 x 2 cm, firm and well-demarcated lesion in the left posterior triangle of the neck, with visible telangiectasia. There are no other skin lesions. The abdomen is soft, without masses.
What would be the next step in management?

MSFinals-4627

A mother brings her 18-day old baby to the emergency department with visible jaundice and distress. The baby has been feeding poorly since yesterday. Upon examination, hepatomegaly and splenomegaly are observed. The newborn jaundice screen shows no infection, normal thyroid function tests, raised conjugated bilirubin, liver transaminases, and bile acids. Reducing substances are absent in the urine. What is the initial management option for the most probable diagnosis?

MSFinals-4628

A newborn delivered 12 hours ago without any complications is showing signs of jaundice. The mother gave birth at home and has been breastfeeding, but is concerned about the baby’s skin color. The baby was born at 38 weeks gestation. What is the recommended course of action for management?

MSFinals-4629

You are requested to assess a neonate who is 2 hours old in the delivery suite. The baby was delivered through an elective Caesarean section. The mother’s antenatal history reveals gestational diabetes. During a heel prick test, the baby’s blood glucose level was found to be 2.2 mmol/L. What should be the subsequent course of action in managing the baby?

MSFinals-4630

You are consulting with a family whose daughter has been referred due to suspected learning difficulties. Whilst talking to her parents, you notice that she has a friendly and sociable personality. You begin to wonder if she might have William’s syndrome.

What physical characteristic would be the strongest indicator of this diagnosis?

MSFinals-4631

A 9-month-old girl is brought to the Emergency Department with a fever, cough, and difficulty breathing. Her vital signs are as follows: temperature 38.5˚C, heart rate 170 bpm, respiratory rate 60/min, oxygen saturation 92% on room air, blood pressure 100/65 mmHg, capillary refill time is 3 seconds. Her parents report that she has been eating poorly for the past few days and has had a high temperature for the past 24 hours. A senior clinician has admitted her and started IV antibiotics, IV fluids, and supplemental oxygen. The patient is currently awake and alert.

According to the NICE pediatric traffic light system, which of the following in her presentation is a red flag?

MSFinals-4632

A 6-year-old girl presents to your clinic with her parents for a follow-up appointment. She has been experiencing nocturnal enuresis for the past eight months. During her last visit four months ago, she was wetting the bed six to seven nights a week. You advised her parents to limit her fluid intake before bedtime, establish a toileting routine before bed, and implement a reward system for positive behavior. Despite following these recommendations, she continues to wet the bed six to seven nights a week. What would be the most appropriate next step in managing her nocturnal enuresis?

MSFinals-4602

A 6-year-old male is brought to his pediatrician by his father who is worried that he may have an infection. He reports that for the past 5 days his son has been scratching his anal and genital area, especially at night. He has also noticed some ‘white threads’ in his son’s stool which he is very concerned about.

What is the most suitable course of action based on the probable diagnosis?

MSFinals-4603

A 24-month-old child is brought to see you with concerns about his development.
Which of the following sets of findings on history and examination reflects age-appropriate development for this child?