Qs

Question 1

A 5 year old boy has 2 days of fever, runny nose, cough and sore throat. He has developed a rash over the past 24 hours. His temperature is 39.2°C, pulse rate 160 bpm, respiratory rate 30 breaths per minute, capillary refill <2 seconds and oxygen saturation 98% in air. He has cervical lymphadenopathy, a red tongue, cracked lips and a fine erythematous macular rash all over his body.

What is this and how is it managed?

Answer 1

this is scarlet fever

pheoxymethylpenicillin

Question 2

A 3 year old boy has not been using his left arm since fighting with his older siblings 2 hours previously.His left elbow is in the flexed position and pronated. He permits all passive movements except supination.

Which is the most likely diagnosis? 
A. Distal triceps tendon tear  
B. Olecranon bursitis  
C. Olecranon fracture 
D. Subluxation of the radial head 
E. Supracondylar fracture of the humerus

Answer 2

D.

Question 3

A 6 year old boy has mild abdominal pain, non blanching rash on his lower extremities and arthralgia. He had an upper respiratory tract infection two weeks ago and has now recovered.His temperature is 36.8ºC, pulse rate 95 (80–120) bpm, BP 110/72 (97–115/57–76) mmHg, respiratory rate 23 (20–25) breaths per minute and oxygen saturation 96% breathing air.Urinalysis: protein 2+

What is the most likely diagnosis? 
A. Acute lymphoblastic leukaemia 
B. IgA vasculitis 
C. Immune thrombocytopaenic purpura  
D. Meningococcal septicaemia 
E. Post streptococcal glomerulonephritis

Answer 3

B. IgA vasculitis = henoch schonlein purpura

triad of abdominal pain + purpura + arthralgia

Question 4

A one week old fully breastfed baby girl has pale stools in her nappy, with streaks of dark urine. She has lost 8.2% of her birth weight. She was born at term.She is apyrexial. She is alert and appears to have jaundice.

How should she be investigated?
A. Coombs (direct antiglobulin) test 
B. Full blood count and film 
C. Plasma glucose 
D. Split bilirubin 
E. Urea and electrolytes

Answer 4

D. split bilirubin

? conjugated bilirubinaemia

Question 5

A six month old infant who was previously well, developed red patches over the cheeks spreading to the face, neck and the trunk over the past few days. His four year old brother is under regular follow-up in the asthma clinic.

What is the most likely diagnosis? 
A. Chickenpox 
B. Lymphoblastic leukaemia (acute) 
C. Infantile eczema 
D. Roseola infantum 
E. Rubella

Answer 5

C. eczema

on infants eczema distribution = face + trunk

Question 6

A 4 month old girl has had eczema for 2 months. She has a non-infective flare-up on her face, despite frequent use of aqueous cream.

Which is the most appropriate treatment? 
A. Betamethasone (Betnovate ® )  
B. Dithranol 
C. Emollient ointment 
D. Topical hydrocortisone  
E. Topical tacrolimus

Answer 6

D. topical hydrocortisone

• lower strength steroid for use on face