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‫جامعة الجبل الغربي ‪ -‬كلية الطب البشرى ‪ -‬غريان‬

‫قسم طأب الطأفال‬


‫‪7/9/2014‬‬ ‫دور شهر سبتمبر ‪2014‬‬

‫الورقة الثانية ‪ :‬أسئلة تحليل البياناتا و الحالتا السريرية‬

‫الزمن المحدد ‪ 90 :‬دقيقة‬

‫عدد السئلة ‪-:‬‬


‫‪ 3‬بياناتا ‪ 15 :‬درجة‬ ‫‪+‬‬ ‫‪ 3‬حالتا ‪ 15 :‬درجة‬

‫الرقم السري‪....................................:‬الدرجة‪.......................................‬‬

‫‪x ............................................................................................x‬‬

‫السم‪......................................................................................... :‬‬

‫رقم الجلوس )القيد( ‪...................................... :‬‬

‫الرقم السري‪.............................................. :‬‬

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CASE (1)
3 years old girl awakens at night with fever of 39°C, severe sore throat and mild cough. The
child was unwell, drooling of saliva, muffled voice and has inspiratory stridor. The patient
prefers to sit leaning forward on her hands with her neck hyperextended. Chest, heart &
abdominal examinations are normal.

Questions:

(1)- What is the most likely diagnosis?

(2)- Mention the differential diagnosis for this case?

(3)- Describe the Management of this case?

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CASE (2)
After playing football match a 10 years old boy complained of a painful swollen knee, on
examination no hepatosplenomegaly or lymphadenopathy. There is a past history of previous
post circumcision bleeding and recurrent attacks of epistaxis. investigations showed normal
bleeding time, prolonged both clotting time and partial thromboplastin time.

Questions:

(1) -What is the most likely diagnosis?

(2) -What are further investigations needed to confirm the diagnosis?

(3) -What are the lines of treatment in such condition?

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CASE (3)
A full term newborn delivered by non complicated normal vaginal delivery. Immediately after
birth the patient develops respiratory distress. His abdomen is scaphoid. Auscultation of the
chest reveals absent breath sound on the left side but clearly audible on the right side. Ambu
bag resuscitation is done for the baby but the condition is deteriorated. Emergency X ray
shows: mediastinal shift to the right side.

Questions:

(1) What is the most likely diagnosis?

(2) What are the differential diagnoses of respiratory distress in newborn?

(3) Mention the emergency treatment needed for such case?

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Data interpretation (1)

2 months old male infant presented with cough and poor feeding .Examination showed :
respiratory rate 80 cycles /minute, heart rate 190 beats /minute, his weight is 3.25 kg and his
birth weight was 3 kg, Auscultation showed diffuse crepitation all over both lung fields and a
pansystolic murmur on the left third and fourth intercostal spaces, the liver is 4 cm below the
right costal margin and tender.

Questions:

1- What is the most likely congenital heart lesion the patient has?

2-Mention the abnormal clinical findings in such case?

3- Is this patient has heart failure or not and why?

4- What are the proper lines of treatment needed for this patient?

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Data interpretation (2)

8 years old Gharian boy presented to the hospital with dark colored urine. The patient had
previous history of URTI 3 weeks ago. On examination: BP: 160/100 mmHg, puffiness of
upper eye lids, Temp 37 C0, CBC: Hb%:12gm%, WBC: 15,000/mm3, neutrophils 75%,
platelets: 200,000/ mm3 , urine examination shows: numerous RBC with albumin+++, Throat
swab show streptococci.

Questions:

(1) Mention the abnormal clinical and laboratory findings for this child?

(2) What is the most possible diagnosis?

(3)What are the further investigations required for this patient?

(4) Mention the lines of treatment for such patient

Data interpretation (3)


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A previously healthy 8 months old girl is admitted to the hospital with fever
(temperature: 39.4 C0), vomiting, irritability, high pitched cry and tense bulged
anterior fontanel. Lumbar puncture was done and cerebrospinal fluid shows the
following results: WBC: 3500 cells/mm 3 with 98% polymorphonuclear cells,
glucose: 20mg% while blood glucose 100mg%, and protein: 600 mg/dl, gram
stain shows gram –ve bacilli.

Questions:

1- What are the abnormal laboratory findings mentioned in this case?

2- What is your diagnosis?

3- Would you suspect which organism infected this patient?

4- Mention treatment required for this baby?

Answer of case (1)

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1-The most likely diagnosis is: Acute epiglottitis (2 marks)

2-Differential diagnosis (1.5 marks)


a.Foreign body aspiration.
b.Retropharyngeal abscess.
c.Peritonsillar abscess.
d.Acute laryngitis.
e.Acute laryngeotracheobronchitis

3-Management should include: (1.5 marks)


- Avoid excessive stimulation specially pharyngeal examination by tongue depressor
- Humidified oxygen
- Nasopharyngeal or endotracheal intubation under general anaesthesia
- Antibiotics: third generation cephalosporins or combined ampicillin chloramphenicol

Answer of case (2)

1-The most likely diagnosis is Haemophilia (1 mark)

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2-Further investigations needed to confirm the diagnosis; (2 marks)

-Thromboplatin generation time


- Factor VIII or IX or XI assay

3-Treatment includes:
(2 marks)
a- Immobilization of the joint

b- Replacement therapy:
-Factor VIII or IX
- Cryoprecipitate
- Fresh frozen plasma.

c- Desmopressin DDAVP that stimulate transient increase in factor VIII levels

Answers of Case (3)

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Answer (1) The most likely diagnosis is Left sided Diaphragmatic hernia.
(1 mark)

Answer (2) The differential diagnosis respiratory distress in newborn are:


(2 marks)
- Hyaline membrane disease
- Transient tachypnea of newborn
- Meconium aspiration
- Neonatal pneumonia
- Pneumothorax
- Congenital lobar emphysema
- Bronchopulmonary dysplasia
- Congenital heart disease

Answer (3) the emergency treatment needed for such case is:
- Emergency intubation and artificial ventilation.
- surgical reduction of the hernia and closure of the diaphragmatic defect.

(2 marks)

Answer of Data Interpretation (1):

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Answer(1): the most likely congenital heart lesion the patient has is ventricular
septal defect. (1 Mark)

Answer(2): the abnormal clinical findings in such patient are:- (2Marks)

- Tachypnea (Respiratory rate > 40/minute).


- Tachycardia (heart rate >160 beats / minute)
- Failure to gain the proper weight (Normal weight gain is 250 gm /week)
- Diffuse crepitation all over both lung fields could be pulmonary
oedema secondary to heart failure or chest infection predisposed by VSD.
- Enlarged tender liver due to heart failure

Answer(3): the patient has heart failure since he has (Tachypnea, Tachycardia, Enlarged
tender liver, pulmonary edema)
(1 Mark)

Answer(4): the proper lines of treatment needed for such patient are:
A)-Medical treatment including : hospitalization, oxygen therapy,
anti failure drugs(digitalis, diuretics, ACE inhibitors).

B)-Surgical treatment :Patch closure of VSD after control of heart


failure, the proper time of the operation is determined according to
P/S ratio of this patient. (1Mark)

Answers of Data interpretation ( 2 )

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(1):the abnormal clinical and laboratory findings for this child are: (1mark)
-Hypertension
-Renal oedema
-Leukocytosis
-Neutrophilia
-Hematuria
-Albuminuria

(2)The most possible diagnosis is acute post streptococcal glomerulonephritis (1mark)

(3)Further investigations required for this patient : (1mark)


 BUN
 ASO titre
 Serum complement
 Serum albumin & cholesterol
 Abdominal ultrasound
(4)Treatment: (2marks)
 Treatment of hypertensive encephalopathy by using
antihypertensive drugs( diazoxide, B blocker, methyl dopa)
 Fluid restriction
 Na, protein, k and P restriction
 Penicillin for 10 days

Answer of Data interpretation ( 3 )

Answer (1): the abnormal laboratory findings in this patient:

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-High CSF WBCs, mainly polymorphonuclear cells.
-High protein content
-Low CSF sugar (hypoglycorrhachia)
-Positive gram stain

(1.5- mark)

Answer (2) : the most possible diagnosis is :


- Acute bacterial meningitis

(1- mark)

Answer (3): Organism infected this patient is haemophillus influenza.

(1 mark)

Answer (4): the main lines of treatment :


-Antibiotics: combined with mainly third generation cephalosporin
until culture and sensitivity done.

-Corticosteroid therapy

-Supportive measures
(1.5- marks)

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