Archives: Medical Student Finals

MSFinals-4148

A 6-year-old boy is admitted to the paediatric ward with a cough and lethargy. His dad is concerned as his breathing is fast and he has had a high temperature which hasn’t improved with paracetamol. He is normally healthy and up to date with all his vaccinations.

Upon examination, he is tachypnoeic with a temperature of 39.5ºC. He has crackles in the left lower zone on auscultation. Blood tests reveal the following results:

– Hb 132 g/L (Male: 135-180, Female: 115-160)
– Platelets 290* 109/L (150-400)
– WBC 18.5* 109/L (4.0-11.0)
– Na+ 140 mmol/L (135-145)
– K+ 4.2 mmol/L (3.5-5.0)
– Urea 5.5 mmol/L (2.0-7.0)
– Creatinine 90 µmol/L (55-120)
– CRP 85 mg/L (<5) A chest radiograph shows a left lower lobe consolidation. What is the most likely causative agent of his pneumonia?

MSFinals-4117

A 4-year-old boy, with a history of acute lymphoblastic leukaemia (ALL), is admitted to the Paediatric Ward due to a fever of 38.9 °C at home. He received his last treatment 1 week ago. His parents report that he has been feeling well, without cough, cold, rash, or vomiting.
Upon examination, his vital signs are stable except for a temperature of 38.4 °C. Physical examination is unremarkable. Blood tests and blood culture are taken from the portacath, revealing a haemoglobin (Hb) level of 11.5, a white cell count (WCC) of 1.1, neutrophils of 0.2, and a C-reactive protein (CRP) level of 85.
What is the most crucial next step in managing this patient?

MSFinals-4118

A 10 week old male infant is presented to the GP by his mother with concerns about an undescended testis on the right side since birth. The mother was advised to seek medical attention if the issue persisted after 6 to 8 weeks of age. Upon examination, the GP confirms the presence of a unilateral undescended testis on the right side, with a normal appearing penis. What would be the next step in management?

MSFinals-4119

A 7-year-old girl is brought to the pediatrician by her father. For the past few days, she has been experiencing pain while walking. Her father is concerned as this has never happened before and he cannot think of any reason for it.
During the examination, the girl refuses to walk. Her vital signs are stable, except for a temperature of 38ºC. On examining her legs, there is no visible inflammation, but the left hip is tender. When attempting to move the left leg, the child screams in pain. The right leg appears to be normal. She has no medical history and is not taking any medications.
What is the most appropriate management for the most likely diagnosis?

MSFinals-4120

A 5-year-old girl is brought in by ambulance after her parents awoke in the middle of the night to a harsh coughing episode and noted she had difficulty breathing. She has been coryzal over the last 2 days but has never had any episodes like this before. The paramedics have given a salbutamol nebuliser, to some effect, but she continues to have very noisy breathing. Oxygen saturations are 94% on air, with a respiratory rate of 50.
What is the most likely diagnosis?

MSFinals-4121

A 36-month-old girl is brought to the paediatric clinic. She is an orphaned refugee who recently arrived in the United Kingdom and has no medical history.

Her foster parents have brought her to the clinic as they have noticed that she becomes easily breathless on exertion or after a bath and squats down to catch her breath. During these times, they notice that her lips turn blue.

Upon examination, you find that she is on the 10th centile for height and weight, her lips are slightly dusky, she has good air entry bilaterally in her chest, and she has a normal heart rate at rest with a loud ejection systolic murmur at the upper left sternal edge with an associated thrill.

A chest x-ray reveals decreased vascular markings and a normal-sized heart. Electrocardiography (ECG) shows sinus rhythm with right axis deviation and deep S waves in V5 and V6.

What is the most likely diagnosis?

MSFinals-4122

You are on duty in the paediatric acute admissions unit during winter when you are called to assess a 16-month-old toddler presenting with a runny nose, dry cough, increased respiratory effort, and an elevated respiratory rate. Upon examination, you note a mild generalised wheeze, along with fever and feeding difficulties. What is the probable diagnosis?

MSFinals-4123

A 35-year-old woman comes in for a postnatal check-up after an emergency C-section 10 weeks ago. She has also scheduled her baby’s first set of routine immunizations for today. She inquires about the MenB vaccine and when it is typically administered. Can you provide this information?

MSFinals-4124

You are conducting an 8-month well-baby visit for a boy and his mother. The physical examination is normal, and you proceed to discuss the child’s immunizations. The mother expresses concern about recent measles outbreaks and asks when her son should receive the first dose of the MMR vaccine.

When is the MMR vaccine typically administered as part of routine immunizations?

MSFinals-4125

A 13-year-old girl comes in with a swollen left knee. Her parents mention that she has haemophilia and has received treatment for a haemarthrosis on her right side before. What is the most probable additional condition she may have?