UNIVERSITY OF JAFFNA SRILANKA
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FINAL EXΑΜΙΝΑΤΙON FOR MEDICAL DEGREES — JULY 2021
PAEDIATRICS PAPER II
Date 28.07.2021 Time 03 hours
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ANSWER ALL THE SIX (6) QUESTIONS
Answer the questions in the space provided.
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INDEX NO
Question No 1
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A baby is delivered by LSCS due to lack of progress and mother had gestational diabetes. The birth weight of the baby was 3.7kg. At 6 hours the blood sugar was checked on the baby and it was 2.1mmol/l.
1.1 Mention the immediate management of the baby (15 Marks)
1.2. The following day the baby develops poor feeding and lethargy.
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What is the most likely diagnosis? (05 Marks)
1.3. List three (3) other possible causes for this presentation (15 Marks)
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1.4. Mention five (5) investigations you will order in this baby giving reasons (30 Marks)
1.5. List three (3) complications that you will look in this baby in relation to the underlying diagnosis (15 marks)
1.6. The baby is discharged on day 5 and the mother wants to know regarding breast feeding.
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Mention five (5) advantages of breast feeding to the baby. (20 Marks)
Question No 2
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An 18-month-old is seen at the clinic for not walking. He sits with support, reaches for objects and transfers them. He is unable to put small beads into a cup. He recognizes the mother and says monosyllable words.
2. 1. What is the developmental age of the child? (10 Marks)
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2.2. What information will you obtain in the birth history to arrive at a possible aetiology (20 Marks)
2.3. List five (5) examination findings you will look in this child (20 Marks)
During the clinic visit you notice the child's eyes deviated to one side and drooling of saliva lasted nearly 30 seconds.
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2.4. List three (3) specific investigations you will order giving reasons (15 Marks)
2.5 List five (5) steps in the long term management (20 Marks)
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2.6. Mention three (3) support systems that are available to manage this child in the community. (15 marks)
Question No 3
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A 5 month old diagnosed with ventricular septal defect is admitted to the emergency department with a history of fever and cough of 3 days duration. On further questioning mother says he is having head sweating while feeding for the last one month. His birth weight was 3 Kg and the current weight is 4.2 Kg. On examination respiratory rate is 68 breaths/minutes and the heart rate is 168/minute.
3. 1. What is the most likely diagnosis? (10 marks)
3.2. List the clinical features that you will look other that that is mentioned above to arrive at the diagnosis? (15 marks)
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3.3. Outline the initial stabilization of this baby (20 marks)
3.4.List Five (5) Investigation that you will request in this child. Give the expected findings in each. (20 marks)
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3.5. Outline the specific management of this child (25 marks)
3.6. Mention the long term management of this baby (10 marks)
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Question No 4
An 8 year old girl presented with periorbital swelling of 3 days duration.
4.1. List 5 possible causes for the above presentation. (15 marks)
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On examination the Blood pressure is 118/78 (95th centile is 112/72).
The UFR showed
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- Protein 3+
- Pus cell 4-5
- Red cell field full
- Granular cast +
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4.2.What is the most likely diagnosis? (4 Marks)
4.3.List three (3) other conditions that can present in the similar manner (9 Marks)
4.4.Indicate two (2) salient clinical features that are associated for each condition mention in 4.3 (12 marks)
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4.5.List five (5) investigation that you will request in this child, to support your diagnosis. Indicate the expected finding (20 marks)
4.6 Outline the principles of management of the most likely diagnosis (20 marks)
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4.7.Indicate three (3)key messages that you will provide
4.7.1 While in the ward during acute stage (10 marks)
4.7.2, At discharge (10 marks)
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Question No 5
An 8 year old girl is admitted with fever of 4 days, vomiting and abdominal pain of 1 day.
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On examination her peripheries are cold and the pulse rate is 180 beats per minute with low volume and the blood pressure is 60/10. The mother shows a Full blood count which was done on the previous day morning which shows Hb 120, WBC 2.1 x 109/l, Platelet 112 x 109/L.
5.1. Outline the immediate management of this child? (30 Marks)
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5.2.List five (5) investigation you will request in this child? Give your expected findings (15 marks)
5.3.List five (5) parameters that you will monitor in this child? Indicate the frequency of monitoring of each parameter (15 marks)
5.4.List five (5) complication that will anticipate in this child? (15 marks)
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5.5.The child did not improve with initial management. Outline the ongoing management of this child. (25 marks)
Question No 6
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6.1. Mention the advice you will give regarding vaccination in the following clinical scenarios
6.1.1. A 3-year-old on steroids for nephrotic syndrome is due to get the routine MMR (15 Marks)
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6.1.2. A 12-month-old with a febrile convulsion at the age of 9 months awaiting the JE vaccine. (15 Marks)
6.1.3. A 2-month-old with a cyanotic congenital heart disease is due her second month vaccine. (15 Marks)
6.2. Mention key points regarding dietary advice in the following clinical scenarios
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6.2.1. An 8-year-old boy with simple obesity (25 Marks)
6.2.2. An 18-month-old with wasting with no other organic cause (30 Marks)
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