Archives: Medical Student Finals

MSFinals-4160

A 3-year-old child is admitted with poor appetite. Over the last 24 hours, they have eaten only 25% of their usual amount and have had significantly fewer wet diapers than usual. The child has been particularly irritable over this time and is not settling. There is no past medical history, no known allergies, and there has been no travel outside of the UK.

On examination, the child appears unsettled and grouchy. There are no rashes on exposure and the fontanelles appear normal. The physical observations reveal tachycardia and a fever of 39ºC. When you attempt to manually flex the child’s neck you note that they also flex the hips and knees.

What is the most appropriate empirical intravenous treatment for this child?

MSFinals-4161

You are observing a doctor on the neonatal ward who is asked to assess a 3-hour-old baby delivered at 40+5 weeks by ventouse. The mother is concerned about the appearance of her baby’s head. Upon examination, you notice a soft, puffy swelling at the back of the head with some light bruising from the ventouse cup. The swelling seems to extend across the suture lines. However, the baby appears to be in good health otherwise, and the neonatal hearing screen conducted earlier that morning was normal. What could be the probable cause of this presentation?

MSFinals-4162

A 4-week-old baby boy is brought in by his concerned parents. Since two weeks of age, he has had a slowly expanding lump to the left side of his head. He is otherwise healthy, gaining weight, and breastfeeding well. He wakes to demand food and is starting to show signs of social smiling. He was delivered by unassisted normal vaginal delivery at 38 weeks’ gestation after an uncomplicated pregnancy. Birthweight was 3.2 kg. Other than a slightly prolonged second stage of labor, there is no significant perinatal history. He has no siblings and there is no family history of note.

During the examination, an alert and active baby is observed. Vital signs are normal. There is a smooth lump measuring 2 × 3 cm arising in the left parieto-occipital region. The lump is compressible and non-pulsatile and does not cross the suture lines. A head to toe examination of the baby reveals no other lumps, skin lesions, rashes, or marks. The anterior fontanelle is normal. The baby has good tone and a normal Moro reflex. There is no jaundice or pallor.

What is the most likely diagnosis?

MSFinals-4163

As a doctor working on the paediatric ward, you encounter a 5-year-old patient who has become unresponsive. You call for assistance from another doctor and proceed to open the patient’s airway, but the child is not breathing. After giving five rescue breaths, the other doctor checks for a femoral pulse, which is not present. You decide to initiate CPR while waiting for further help to arrive.

What is the appropriate ratio of chest compressions to rescue breaths and the recommended rate of chest compressions for this child?

MSFinals-4164

A 6 month old infant presents to the hospital with a fever. Upon examination, there are no respiratory symptoms or signs of diarrhea. What initial investigations would you include in your assessment?

MSFinals-4165

A 2-day-old baby has her heel prick test done, and it comes back that she has a raised level of immunoreactive trypsinogen (IRT).
What is the most suitable subsequent test for this infant?

MSFinals-4134

A 14-month-old boy is seen by his doctor. He has been experiencing fever and cold symptoms for the past 2 days. Recently, he has developed a harsh cough and his parents are concerned. During the examination, the doctor observes that the child has a temperature of 38ºC and is experiencing inspiratory stridor, but there are no signs of intercostal recession. What is the probable diagnosis?

MSFinals-4135

A 5-year-old child has a history of chronic constipation for the past two years and chronic abdominal distention with vomiting for six months. Hirschsprung’s disease is suspected. What investigation from the list below provides the most conclusive diagnosis for this condition?

MSFinals-4136

A 9-month-old infant is experiencing feeding difficulties accompanied by a cough and wheeze, leading to a diagnosis of bronchiolitis. What is a triggering factor that can cause a more severe episode of bronchiolitis, rather than just an increased likelihood of developing the condition?

MSFinals-4137

A 4-year-old girl comes to the doctor’s office complaining of nightly coughing fits over the past 2 weeks. She has an inspiratory whoop and noisy breathing, but no signs of cyanosis or other abnormalities during the physical exam. The doctor diagnoses her with whooping cough. What is the most appropriate initial treatment for this patient?