Archives: Medical Student Finals

MSFinals-4191

A 7-year-old girl is brought to the Emergency Department by her parents. They report that she has had an upper respiratory tract infection for the past few days. Upon arrival, she complains of an increased headache. Upon examination, she exhibits neck stiffness and a positive Kernig’s sign.

The following investigations were conducted:

Investigation Result Normal value
White cell count (WCC) 16.5 × 109/l 4–11 × 109/l
Sodium (Na+) 143 mmol/l 135–145 mmol/l
Creatinine 98 μmol/l 50–120 µmol/l
Lumbar puncture Gram-negative diplococci –

What is the next step in management?

MSFinals-4192

A newborn is admitted to the paediatric cardiology intensive care unit with congenital transposition of the great arteries (TGA) identified on pre-natal scans. The baby was delivered spontaneously at 38 weeks. What is the most crucial medication to administer until the neonate can undergo surgery in a few days?

MSFinals-4193

A 16-year-old boy visits the GP with his father. His father is worried as he has noticed scars on his son’s arms and after a lengthy conversation, his son has confessed to self-harming on multiple occasions. The GP has decided to refer the boy to CAMHS (Child and Adolescent Mental Health Services). What is the most appropriate approach to minimize the likelihood of future self-harm?

MSFinals-4194

A 14-year-old girl presents with increased urinary frequency and thirst. Her initial observations and clinical examination revealed no abnormalities. On initial blood tests, the only abnormalities found are a urea of 10.5 mmol/l (normal range 2.5–6.5 mmol/l) and a borderline serum osmolality of 270 mOsmol/kg (normal range 270–295 mOsmol/kg). She subsequently had water deprivation testing. Time Investigation Result Normal range 0 hours Serum osmolality 270 mOsmol/kg 270–295 mOsmol/kg 4 hours – testing stopped Serum osmolality Urine osmolality 300 mOsmol/kg 285 mOsmol/kg 270–295 mOsmol/kg 350–1000 mOsmol/kg After administration of desmopressin Urine osmolality 287 mOsmol/kg 350–1000 mOsmol/kg. What is the most likely diagnosis based on the investigative results?

MSFinals-4195

You are reviewing a 12-hour-old neonate on the Postnatal Ward. During your examination, you notice a swelling over the occipital region of the skull. It is soft and does not appear tender. On further examination, you feel that the swelling is crossing the cranial sutures. Neurologically, the child appears normal. She was born by forceps due to failure to progress. There is no family history of note.
What is the most appropriate initial investigation?

MSFinals-4196

A 4-month-old boy is brought to the emergency department with a fever, poor feeding, and cough. The infant has received all routine vaccinations. Upon examination, the baby is alert and responsive, but there is increased work of breathing. Coarse crackles and a wheeze can be heard throughout the chest. The infant’s heart sounds and ECG are normal, and a lumbar puncture is performed and reported as unremarkable. However, one hour later, the patient experiences a cardiac arrest. What is the most probable underlying cause of this arrest?

MSFinals-4197

A 12-year-old boy is brought into the Emergency Department by his mother. He is known to have haemophilia B and has fallen while playing basketball. His ankle is very swollen and bruised.
Which of the following would be the best treatment option for this patient?

MSFinals-4198

A 9-month-old infant is referred to the clinic by their GP due to asymmetrical hip creases. DDH is suspected. What is the primary investigation to be conducted in this scenario?

MSFinals-4199

Which one of the following conditions is not associated with obesity in adolescents?

MSFinals-4200

A father brings his 10-month-old daughter to the emergency department due to a rash that has developed. Upon further inquiry, the father explains that the rash started behind her ears two days ago and has since spread. Prior to the rash, the baby had a fever and cough. Although she is up to date with her vaccinations, the father has not yet scheduled her next appointment. During the examination, the baby appears irritable, has white spots in her mouth, and inflamed eyes. What is the most likely diagnosis, and what is the potential risk for the baby?