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1. A 4-year-old-girl was brought to the dispensary after sudden onset of chest tightness, cough and difficult breathing. O/E: RR=56b/min, PR=125b/min, BT=35.8 0 C, central cyanosis and rhonchi were heard throughout the chest:
a) What is the most likely diagnosis? (1mark)
Severe acute bronchial asthma (1mark)
b) Outline important management plans within an hour of admission. (4marks)
ANSWERS: any four points @ 1mark (4marks)
i. Proper position/cardiac position
ii. Oxygen therapy 2-4L/min or via an amb bag.
iii. IV Hydrocortisone
iv. IV aminophyline
v. Then 2-6 puffs of salbutamol inhaler
vi. Health education on risks exposure, drug and likely complications
vii. Refer for FBP, Chest X-ray
2. Outline five (5) tools that can be used when assessing the infant growth at the reproductive and child health clinic: (5marks)
ANSWERS: @point 1mark (5marks)
i. Weighing scales
ii. Length/Height boards
iii. Tape measures
iv. Standardized growth charts for interpretation
v. RCH card
vi. Pen
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3. A child aged 2years presents with history of wet cough and fevers that do not improve with penicillin and anti-malarials for 4weeks. O/E: the patient had no BCG scar, RR=58b/min, BT=37.8 0C.
a) What is the most likely diagnosis (1mark)
Pulmonary tuberculosis (1mark)
b) Outline four (4) complications of the diagnosis: (4marrks)
ANSWERS: any four points @ 1mark (4marks)
i. Thoracis empyema
ii. Pneumothorax
iii. Pleural effusion
iv. Respiratory failure
v. Adverse drug reactions
vi. Brochiectasis
vii. Pott’s disease
viii. TB meningitis
ix. TB pericarditis
x. Miliary TB
xi. TB enteritis
4. Outline five (5) emergency signs from the patient: (5marks)
ANSWERS: any five points @ 1mark (5marks)
i. Obstructed airway
ii. Cyanosis
iii. Convulsion
iv. Shock
v. Severe dehydration
vi. Severe respiratory distress
vii. Major burn
viii. Prolonged state of unconsciousness/Coma
5. A 6-year-old boy presents with history of septic wound on left leg that he gets 16days ago when milking and today presents with several episodes of generalized body fits.
O/E: opisthotonus posture, BT=39.5 0 C, RR=43b/min and stridor.
a) What is the most likely diagnosis: (1mark)
Tetanus with septicaemia (1mark)
b) Outline four (4) important management plans at the dispensary (4marks)
ANSWERS: any four points @ 1mark (4marks)
i. Anti-convulsant such as diazepam, phenobartitone and CPZ
ii. Antipyretic: Paracetamol 15mg/kg QID for 7/7 the PRN
iii. Clear airway with suction machine apparati (PRN)
iv. Oxygen therapy
v. Wound cleaning and dressing
vi. IV amoxyclavulunic acid + Metronidazole for 7/7
vii. Monitor: vital signs, level of consciousness
viii. Refer patient to hospital for; FBP, Blood culture & sensitivity, Chest X - ray
6. Outline five (5) characteristics of febrile convulsion. (5marks)
ANSWERS: any five points @ 1mark (5marks)
i. Common to males
ii. Occurs btn 6month to 6years
iii. Convulsion persist for <15minutes
iv. Pathological cause is outside the CNS
v. No neurological deficits
vi. Patient is conscious immediate after convulsion
7. A child reported to experience inability to use all limbs of acute onset and not associated to trauma. Currently denied history fever, headache and signs of meningeal irritation. O/E: painless deformed limbs with muscle power of 1/5.
a) What is the most likely diagnosis (1mark)
Poliomyelitis (1mark)
b) Outline four (4) differential diagnosis of the child (4marks)
ANSWERS: any four points @ 1mark (4marks)
i. Botulinism
ii. Guillain Bare Syndrome
iii. Strychnine poisoning
iv. Mythaenia gravis
v. Acute severe combined demyelization
8. Outline five (5) features of severe malaria in children. (5marks)
ANSWERS: any five points @ 1mark (5marks)
i. Prostration
ii. Vomiting everything
iii. Coma/Unconsciuosness
iv. Changed behavior
v. Jaundice
vi. Severe palmar pallor
vii. Glomerulonephritis: Haematuria (black water fever)
viii. Renal failure: Oligulia
ix. Pulmonary edema: dyspnoea
x. Hypoglycemia
xi. Hyper parasitemia
xii. Elevated liver enzymes
A 3-year-old-boy presents at the hospital with history of cough and fever for 6days and currently has difficulty breathing. O/E: restless, with nasal flaring, cyanosed, RR=51b/min, PR=113b/min, BT=38.90 C, Wt=13.8kg. RS: dull note to percussion with reduced sound diffusely.
Describe the child management based on the following: diagnosis, differential diagnosis, investigations, treatment, follow-up and prevention. (15marks)
Diagnosis and description: (2marks)
§ Very severe pneumonia.
Ø Reasons: cough, fever for 6days and difficulty breathing. O/E: restless, nasal flaring, cyanosed, RR=51b/min, PR=113b/min, BT=38.90 C, RS: dull note to percussion with reduced sound diffusely.
Differential diagnosis: any two points @ 0.5marks (1marks)
§ Pulmonary TB
§ PJP
§ Bronchitis
§ Pertussis
§ Septicaemia
§ Bronchial asthma
Investigations: Any four points @ 1mark (4marks)
§ Sputum for Gram & ZN smear and microscopy
§ Sputum for Culture & sensitivity
§ Chest X-ray, PA and Lateral views
§ Arterial blood gases: O2 & CO2
§ Full blood picture
§ Blood for culture and sensitivity.
§ CRP
§ ESR
Treatment plans: any five points @ 1mark (5marks)
§ Oxygen gas therapy 2 - 4 litres/min.
§ Maintain the airway by gentle suction of any thick secretions
§ Paracetamol 15mkg/kg for day the PRN
§ Antibiotics: Ampicillin IV 50mg/kg 6 hourly and Gentamicin IV 7.5mg/kg once a
day for at least 5 days;
Ø then complete treatment at home or at health facility with Amoxicillin PO 40mg/kg 12 hourly plus Gentamicin 7.5mg/kg IV/IM once daily for a further 5 days.
§ Encourage breastfeeding and ensure that the child receives daily maintenance fluids
§ Psychological counseling
Follow-up: any two points @ 0.5marks (1mark)
§ Cyanosis
§ Vital signs: RR, BT, PR, BP
§ Level of consciousness
Prevention modalities: Any two points, @1mark (2marks)
§ Primary: vaccination to younger infants, avoid over crowded area, parents should avoid passive smoking to children, control all risk factor and regular body check up
§ Tertiary: manage complications such as: Pleural effusion, pneumothorax, lung abscess via chest tube, medical gas.
An infant presents with history of fever, reduced activities, vomiting and diarrhea for 4days and 20minutes ago she convulsed twice. O/E: convulsing, bulged fontanelle, BT=38.60C, Wt=7kg, photophobic, with stiff neck.
Describe the management of this child and likely complications. (15marks)
ANSWERS: TOTAL MARKS 15MARKS
Diagnosis and description: (2marks)
§ Bacterial meningitis.
Ø Reasons: fever, reduced activities, vomiting and diarrhea for 4days, she convulsed twice. O/E: convulsing, bulged fontanelle, BT=38.60C, photophobic, with stiff neck.
Differential diagnosis: any two points @ 0.5marks (1mark)
§ Cerebral malaria
§ Encephalitis
§ Septicaemia
§ Febrile convulsion
§ UTI
§ Epilepsy
Investigations: Any four points @ 1mark (4marks)
§ LP for CSF analysis (Microbiology, Cytology, Biochemistry)
§ mRDT the BS for MPs if reacted Positive
§ Blood culture & sensitivity
§ Urinalysis
§ Full blood picture
§ Serum electrolytes
Treatment plans: any five points @1mark (5marks)
§ Ensure the airway is patent
§ Diazepam 0.1mls/kg rectal then assess
§ Paracetamol 15mg/kg
§ Give Oxygen 1-2L/min
§ Give Ampicillin 50mg/kg/dose IV 6 hourly and Gentamicin 7.5mg/kg OD for 14 days (For treatment of newborns refer section 3)
Ø OR Ceftriaxone 50mg/kg12 hourly or 100mg/kg once daily for 14 days
§ Encourage breastfeeding and ensure adequate fluid and calorie intake.
Follow – up: any two points @ 0.5marks (1mark)
§ Level of consciousness
§ Vital signs: BT, RR, PR
§ Danger signs: if improving
Complications of meningitis: Any four points, @ 0.5marks (2marks)
§ Brain abscess
§ Hydrocephalus
§ Epilepsy
§ Sensory-neural hearing loss
§ Blindness
§ Cerebral palsy
§ Speech problems
§ Septicaemia
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