SBA

Question 1

A 7 year old brought by his mother who says he was well at birth but has been suffering from repeated chest and GI infections since then. He is not growing well for this age. What is the likely condition of this child?

A. CF
B. SCID
C. Primary T cell immunodeficiency
D. Primary B cell immunodeficiency
E. Malabsorption

Answer 1

Cystic Fibrosis –> secretions in sweat and GI tract become much thicker and traps bacteria!

Question 2

3 year old child has a high temperature for 4 days and he has not seen a doctor. The mother notices rashes on buccal mucosa and some around the mouth. What is the most appropriate Mx?

A. Measles
B. Roseola Infectiosum
C. Rubella
D. Chickenpox
E. Impetigo

Answer 2

A. Measles

This is Koplik’s spots –> pathognomic of measles

Question 3

A 6-year-old girl has had vomiting and central abdominal pain for
3 days. She has eczema and poorly controlled asthma. She looks
pale and has a Glasgow Coma Scale score of 11/15. Her abdomen is generally tender, but there is no rigidity, rebound, or guarding. Bowel sounds
are present and normal. Her respiratory rate is 36 breaths/minute, with
no recession. Her heart rate is 160 bpm and her capillary refill time is 4
seconds. She is given a 20 mL/kg bolus of fluid. Blood tests show:
● haemoglobin 13 g/dL
● white cell count 22 × 109/L
● C-reactive protein 25 mg/L
● sodium 120 mmol/L
● potassium 6.8 mmol/L
● urea 9.3 mmol/L
● creatinine 110 μmol/L

Which is the single most important next investigation? 
A Abdominal ultrasound scan
B Blood glucose
C CT scan of the head
D Serum ammonia
E Urine osmolality

Answer 3

B - blood glucose

This is hyperglycaemia causing hyponatraemia and hyperkalaemia, plus ABCDE pathway is important

Question 4

A 5-month-old baby boy is brought into the GP by his parents, as they are concerned that his urine has a strong smell.

Urine dipstick is positive for leucocytes and nitrites and the GP prescribes a course of antibiotics to clear the infection. This is the third urinary tract infection that has been diagnosed since birth. An ultrasound scan is ordered which shows dilatation of the ureters. His doctor suspects vesicoureteric reflux.

Which of the following is the next best step in this patients management?

A. Repeat USS in 6 weeks times
B. Refer for MCUG
C. Prescribe antibiotic prophylaxis for recurrent UTI
D. Refer to paediatric surgeons
E. Reassure parents and provide info on UTIs

Answer 4

B. Refer for MCUG

Definitive diagnosis of VUR is needed before giving antibiotics for recurrent UTI