Archives: Medical Student Finals

MSFinals-4138

A 4-year-old boy is brought to the emergency department with symptoms of lethargy, cough and breathlessness that have been present for the past 2 weeks. The mother reports that the cough has been progressively worsening, but there is no production of sputum. Upon examination, the child has a fever, tachycardia and tachypnoea. Given the age and worsening cough, the suspected infecting organism is Mycoplasma pneumonia. A chest x-ray confirms right lower zone consolidation. What is the most appropriate oral therapy for this patient?

MSFinals-4139

A 6-year-old male is brought to the emergency department by his mother due to increasing lethargy over the past few days. The child has a temperature of 38.6ºC and appears more pale than usual. Upon physical examination, petechiae and bruising are noted on the lower extremities. The following blood results are obtained: Hb 94 g/L (135-180), Platelets 86 * 109/L (150 – 400), WBC 26 * 109/L (4.0 – 11.0), Neutrophils 1.0 * 109/L (2.0 – 7.0).

What is the most likely diagnosis?

MSFinals-4140

A 4-day-old neonate born prematurely at 33 weeks’ gestation has been experiencing difficulty in weaning off the ventilator. During a physical examination, a continuous heart murmur was detected. An echocardiogram revealed the presence of a patent ductus arteriosus, while no other structural heart abnormalities were found. Additionally, a chest x-ray showed cardiomegaly and mildly congested lung fields. What is the recommended initial treatment for managing this condition?

MSFinals-4141

Beta-human chorionic gonadotrophin (beta-hCG) and alfa-fetoprotein (AFP)

MSFinals-4142

An infant born with trisomy 21 begins to vomit shortly after his first feed. The emesis is green and occurs after each subsequent feeding. His abdomen is also distended, most noticeably in the epigastrum. A baby-gram demonstrates a ‘double bubble’ in the abdomen.
What is the most likely diagnosis?

MSFinals-4143

A 4-week-old girl who previously had no issues with feeding is now experiencing forceful, non-bilious vomiting after feeds. The following blood and blood gas results have been obtained:

Investigation Result Normal Range
Haemoglobin 170 g/l 130–200 g/l
White cell count (WCC) 8 × 103/mm3 6–18 × 103/mm3
Sodium (Na+) 142 mmol/l 135–145 mmol/l
Potassium (K+) 3.2 mmol/l 3.5–6 mmol/l
Chloride (Cl-) 80 mmol/l 95–105 mmol/l
Bilirubin 12 mmol/l 3–17 mmol/l
Urea 9 mmol/l 1–5 mmol/l
Creatinine 55 μmol/l 20–65 μmol/l
pH 7.4 7.35–7.45
pO2 31 kPa 11–14 kPa
pCO2 3.2 kPa 4.5–6 kPa
HCO3- 28 mmol/l 18–25 mmol/l

What is the most likely diagnosis?

MSFinals-4144

You assess an 11-year-old girl who has been experiencing worsening constipation for the past 3 years, despite previously having regular bowel movements. All other aspects of her medical history and physical examination are unremarkable. She is not currently taking any medications.

What would be the appropriate next course of action in managing her constipation?

MSFinals-4145

A 12-year-old girl comes to the emergency department with a headache. During the examination, she mentions that the lights are bothering her eyes and the doctor observes a purpuric rash on her chest. Her respiratory rate is 22/min, heart rate is 140/min, and blood pressure is 80/60 mmHg. Which of the following tests should be avoided in this patient?

MSFinals-4146

A 4-year-old girl is admitted to the paediatric ward with suspected Kawasaki disease. Upon arrival at the emergency department, she had a fever lasting for 8 days, dry cracked lips, bilateral conjunctivitis, and peeling of her fingers and toes. What additional symptom would support the diagnosis?

MSFinals-4147

Which of the following symptoms is not associated with acute or subacute lead poisoning in infants?