Exam Cases

Question 1

What is the most likely diagnosis:

2m old bottle fed baby vomiting milk x5 for the past 2days w/loose stools. Temp is normal and no signs of dehydration

Answer 1

Gastroenteritis

Question 2

What is the most likely diagnosis:
2m old bottle fed baby bilious vomiting for the past 24hrs. OE looks unwell, sunken fontanelle, tacky, Cap refill >5secs. Firm mass felt in his groin

Answer 2

Incarcerated inguinal hernia

Question 3

What is the most likely diagnosis:
2m old bottle fed baby small vomiting of milk into his mouth which he swallows. Problems with feeding since first weeks of life. Irritable after feeds, arching back, no signs of dehydration

Answer 3

Gastro-oesophageal reflux disease

Question 4

What is the most likely diagnosis:
2m old bottle fed ‘greedy baby’ vomiting large amounts of milk after feeds happening since birth. No signs of dehydration

Answer 4

Overfeeding

Question 5

What is the most likely diagnosis:
2m old bottle fed baby vomiting getting worse over last 5days. Eager for feeds but forceful vomits afterwards. OE tachy but no other signs of dehydration. He has lost weight since last weighed at 6weeks.

Answer 5

Pyloric Stenosis

Question 6

What is the most likely diagnosis:

18m girl w/recurrent cough that’s occasionally productive. She is small for her age. Mother reports episodes of wheeze.

Answer 6

Cystic Fibrosis

Question 7

What is the most likely diagnosis:

2yr old boy w/cough present for 3days. He was previously well. OE he has a temp of 38.9 & RR of 55 with NO wheeze.

Answer 7

Pneumonia

Question 8

What is the most likely diagnosis:
4yr old boy w/recurrent cough worse at night & small for his age. Cough has been present for last 12months & interrupts his sleep

Answer 8

Asthma

Question 9

What is the most likely diagnosis:
6m old boy w/illness for 4days- runny nose & mild fever. Over last 24hours he has developed a high pitched cough with wheeze. OE fine crepitations throughout both lung fields

Answer 9

Bronchiolitis

Question 10

What is the most likely diagnosis:
2yr old boy with cough starting suddenly this pm after a kid’s party. Otherwise well but reduced breath sounds on right side

Answer 10

Foreign body aspiration

Question 11

What is the most appropriate investigation:
Asked to see a 12hr old baby urgently on delivery suite. Stopped breathing for a few secs needed stimulation to terminate apnoea. OE jaundiced, irritable, not feeding well. Mothers waters broke >24hr before birth

Answer 11

Blood Culture

Question 12

What is the most appropriate investigation:
Baby check on a 12hr old baby. Clinically well but marked jaundice. Mother born in India & has 2 children before moving to the UK.

Answer 12

Group & Coomb’s test

Question 13

What is the most appropriate investigation:

GP refers a 5week old infant w/jaundice. Mother reports white chalky stools, he is clinically well

Answer 13

Abdominal USS

Question 14

What is the most appropriate investigation: Health visitor refers 10d old baby w/jaundice but clinically well. Jaundice noticed 3d post-natally but bilirubin below Tx level. Initially BF but mother given up & started bottle feeding after he failed to gain weight

Answer 14

No further tests required

Question 15

What is the most appropriate investigation: 24hr old baby small for dates born at 37w. OE he has a small head & is jaundiced, large liver palpated & he has a seizure whilst you are in the room.

Answer 15

TORCH Screen

Question 16

What is the most likely diagnosis: 7yo boy from India lethargic for past few days & mild sore throat which has suddenly become worse w/grey membrane covering his tonsils. OE Temp 39.6, no stridor. PMHx of asthma, no immunisations

Answer 16

Diptheria

Question 17

What is the most likely diagnosis: Lethargic, fever for 2days & sore throat. GP diagnosed tonsillitis & gives Amoxicillin. He has now developed a widespread rash.

Answer 17

Infectious mononucleosis

Question 18

What is the most likely diagnosis: Boy becomes unwell quickly, w/high fever, sore throat, drooling, very quiet, sat upright on the bed. He appears shocked & tachypnoeic w/faint stridor.

Answer 18

Acute epiglottitis

Question 19

What is the most likely diagnosis: Sore throat for 24hrs, drooling, dysphagia, systemically well & not shocked. OE inflamed tonsils, bulging R soft palate & uvula deviated to the L w/bad breath.

Answer 19

Peritonsillar abscess (quinsy)

Question 20

What is the most likely diagnosis: Sore throat for 2w, systemically well, not shocked, no stridor, non-inflamed tonsils w/white exudate. PMH of asthma

Answer 20

Candidial infection (immunosuppressed from his inhalers)

Question 21

What is the most likely diagnosis: 11yo girl returned from Africa w/6w Hx of fever worse at night & painful purple rash on lower limbs

Answer 21

TB

Question 22

What is the most likely diagnosis: 2yo girl from UK w/6d Hx of fever w/ itchy, red eyes, sore lips, bilateral cervical lymphadenopathy & widespread rash w/skin peeling on hands.

Answer 22

Kawasaki

Question 23

What is the most likely diagnosis: 11yo girl returned from Africa w/6w Hx of fever worse at night & more tired than usual. No dermatological features

Answer 23

Malaria

Question 24

What is the most likely diagnosis: 11yo girl w/6w Hx of fever & more tired than usual. OE widespread painless cervical & supraclavicular lymphadenopathy

Answer 24

Malignancy- Lymphoma

Question 25

What is the most likely diagnosis: 5yo boy w/ central abdo pain, slight fever for 24hrs. Mother says he has been lethargic for a few weeks. OE generalised abdo tenderness, pharyngitis, laboured breathing.

Answer 25

DKA

Question 26

What is the most likely diagnosis: 5yo boy w/ slight fever, sore throat for 24hrs & central abdo pain since this morning. OE tenderness throughout the abdomen, pharyngitis & temp of 39.

Answer 26

Mesenteric Adenitis