Archives: Medical Student Finals

MSFinals-4103

A 2-year-old boy is admitted to the ward with difficulty breathing. His mother reports a 3-day illness with cough and cold symptoms, low-grade fever and increasing difficulty breathing this morning. He has had no similar episodes. The family are all non-smokers and there is no history of atopy. His immunisations are up-to-date and he is otherwise growing and developing normally.
In the Emergency Department, he was given burst therapy and is now on one-hourly salbutamol inhalers. On examination, he is alert and playing. Heart rate (HR) 150 bpm, respiratory rate (RR) 40 breaths per minute, oxygen saturation 94% on air. There is mild subcostal recession, and his chest shows good air entry bilaterally, with mild wheeze throughout.
What is the most appropriate next step in management?

MSFinals-4104

Which of the following is least commonly associated with constipation in toddlers?

MSFinals-4105

A 7-month-old girl has been referred to you by the out of hours GP. Her parents report a 24-hour history of increased work of breathing, coryzal symptoms, lethargy, and reduced oral intake. Upon examination, you observe fine inspiratory crackles and subcostal recessions. She has a fever of 38.1ºC and her oxygen saturations are 92% in air.

What would be the most suitable next step to take?

MSFinals-4106

A 6-month-old girl is brought to the emergency department by her worried father. He reports that she has had a low-grade fever and a runny nose for the past week, and in the last few days, she has been struggling to breathe and making grunting noises. He is concerned because she is not eating well and her diapers are not as wet as usual. Upon examination, you observe chest retractions, wheezing, and bilateral inspiratory crackles.
What is the most suitable treatment for the probable diagnosis?

MSFinals-4107

A 3-month-old girl is brought to the morning clinic by her father. Since last night she has been taking reduced feeds and has been ‘not her usual self’. On examination the baby appears well but has a temperature of 38.5ºC. What is the most suitable course of action?

MSFinals-4108

A 4-year-old girl, Lily, is taken to the pediatrician by her father. He is concerned about an umbilical hernia that Lily has had since birth. He was told that it would likely go away on its own, but it has not yet resolved. The pediatrician conducts an examination and finds a 1.5 cm umbilical hernia that is easily reducible. What is the most suitable course of action for managing this, according to the guidelines?

MSFinals-4109

You are a junior doctor in paediatrics. You are called to attend an emergency Caesarean section for a baby at 32 weeks’ gestation due to fetal distress. The baby is delivered and does not cry immediately. The cord is cut, and the baby is dried and placed on the Resuscitaire®. There is no spontaneous respiratory effort from the baby who is pale and floppy, with a heart rate of 30 bpm.
When would it be appropriate to start chest compressions in a premature neonate?

MSFinals-4110

A 6-month-old boy is brought to the paediatrics emergency department by his parents. His parents report that he has had a fever for 2 days with reduced activity and feeding. On examination, he is not smiling, his respiratory rate is 50 breaths/minute (normal range: 30-60 breaths/minute) and his heart rate is 155 beats/minute (100-160 beats/minute). He also has reduced skin turgor and looks pale. A nurse looks up the NICE traffic light system to identify his risk of serious illness.
What is the most concerning symptom in this patient?

MSFinals-4112

A 14-year-old girl from Germany comes to the clinic complaining of chronic diarrhoea that has been ongoing for the past 10 months. She also reports having foul smelling stools. Her medical history includes recurrent chest infections since childhood and a diagnosis of diabetes mellitus.
What is the probable diagnosis?