Archives: Medical Student Finals

MSFinals-4257

A 4-year-old girl is seen by the General Practitioner (GP). She has been unwell with coryzal symptoms for two days and has fever. She has been eating a little less than usual but drinking plenty of fluids and having her normal amount of wet nappies. Her mother reports that she had an episode of being unresponsive and her limbs were jerking while in the waiting room that lasted about 30 seconds. On examination, following the episode, she is alert, without signs of focal neurology. Her temperature is 38.9 °C, heart rate 120 bpm and capillary refill time < 2 seconds. She has moist mucous membranes. There is no sign of increased work of breathing. Her chest is clear. She has cervical lymphadenopathy; her throat is red, but no exudate is present on her tonsils. She has clear, thick nasal discharge, and both her tympanic membranes are inflamed, but not bulging.

Which of the following is most likely to indicate that the child can be managed safely at home?

MSFinals-4258

A 5-year-old boy is brought to the pediatrician by his concerned mother due to a fever that has lasted for 72 hours and has now developed a rash on his face and torso. The mother describes the rash as appearing in clusters. The boy is not eating much but is drinking well and has no changes to his bowel or urinary movements. He has no significant medical history and his immunizations are up to date. No one else in the family has been sick recently, but the mother does mention that her son has recently started attending school and a few of the other children have had a similar rash.

During the examination, the boy’s temperature is 38.8ºC, and he has scabbed lesions on his right cheek and erythematous vesicles on his trunk. What is the most appropriate management for this child?

MSFinals-4259

A father and his 6-year-old daughter visit your Child and Adolescent Mental Health Service (CAMHS) clinic, as she has recently been diagnosed with Attention Deficit Hyperactivity Disorder (ADHD). The father has already attended an educational program on ADHD and is feeling overwhelmed as his daughter’s behavior is difficult to manage at home. He has heard that medication may be helpful. Based on previous interventions, what would be the next most suitable treatment for her ADHD?

MSFinals-4260

A 6-year-old girl with Down syndrome is seen by her general practitioner (GP). She has been complaining of ear pain for a few days. She has not had any problems with her ears in the past, and her mother has no concerns about her hearing. On examination, she is found to have otitis media with effusion.
What is the most appropriate management plan for this patient?

MSFinals-4261

A 9-month-old girl is brought to your clinic by her parents, reporting an atypical sequence of movements observed in their daughter. They managed to record a video of the episode, and upon reviewing it, you observe mild bilateral flexion of her neck and legs, succeeded by extension of her arms. She repeats this pattern approximately 40 times before ceasing.
What is the probable diagnosis for this scenario?

MSFinals-4262

A 32-week neonate is brought to the neonatal intensive care unit. The baby was delivered via emergency Caesarean section to a 17-year-old mother who had not received adequate antenatal care. The mother had a history of significant tobacco and alcohol use. During examination, it was observed that the baby had intestinal loops protruding through a hole on the left side of the umbilicus. What is the probable diagnosis?

MSFinals-4263

A 24-hour old baby is evaluated in the neonatal intensive care unit due to tremors in his limbs, as observed by his nurse. He is also experiencing poor feeding, increased irritability, and excessive drowsiness. The baby was delivered via emergency caesarean section at 34 weeks due to reduced foetal movements and foetal bradycardia. The mother had an otherwise healthy pregnancy, but was taking lamotrigine for epilepsy. During the examination, the baby appeared larger than expected for his prematurity and exhibited visible arm tremors. Based on these symptoms, which aspect of the baby’s medical history is most likely responsible for his condition?

MSFinals-4264

A 2-year-old child is being evaluated by a neurologist due to delayed motor development. The child’s general practitioner referred them to the specialist. The child exhibits slow, twisting, and repetitive movements of the arms when attempting to move or walk. Additionally, the child experiences rapid involuntary and jerky movements of the legs, along with oro-motor difficulties. There is no significant family history of neurological conditions, and the child’s two siblings are healthy. What is the most probable diagnosis, and in which zone is the lesion likely located?

MSFinals-4229

A three-week old boy is brought to the emergency department by ambulance after losing consciousness. His mother reports that he often appears short of breath and has a bluish tint to his skin while feeding, which she assumed was normal. Imaging reveals the presence of right ventricular hypertrophy, a ventricular septal defect, and a displaced aorta. Additional imaging is requested. Based on the probable diagnosis, what type of murmur would be anticipated in this infant?

MSFinals-4230

A 3-year-old girl is brought to the emergency department with a 1 week history of fever, lethargy, and irritability. The symptoms appeared suddenly and have not improved despite the GP’s recommendation of antipyretics. The child has also experienced a loss of appetite and diarrhea during this time. This morning, a red rash appeared all over her body.

Upon examination, the child appears toxic, has a temperature of 39.2ºC, and is tachycardic. The doctor observes a widespread maculopapular rash, left-sided cervical lymph node enlargement, and a swollen, erythematosus tongue.

What is the most important investigation for this child, given the likely diagnosis?