PAEDIATRIC AND CHILD HEALTH BANK OF QUESTIONS | CMT NTA LEVEL 5 | DOWNLOAD

 PAEDIATRIC AND CHILD HEALTH BANK OF QUESTIONS | CMT NTA LEVEL 5 | DOWNLOAD

1. A 4 year old child was brought to the dispensary by his mother complaining that the baby is coughing for long time now with excessive night sweats. Has used several antibiotics without any improvement.  The cough is associated with fevers of on and off for more than 2 weeks now. She recently noted that her child is not gaining weight. On examination the baby is wasted.

A. What is the most likely diagnosis for the child   (1 )

              Pulmonary tuberculosis                

B. List two (2)  investigations which you are going to perform at dispensary level (2 )

· Sputum for AFB

· Rapid test for HIV

· Chest X-ray

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C. Mention two drugs in  the plan of treatment of this child (2 )

Isoniazid, rifampicin, ethambutol, pyerinamide

 

2. A 3 year old child is brought to your dispensary with history of convulsions; tonic clonic in nature and occurred for less than 15 minutes. No history of head trauma prior to onset of this convulsion. On examination; the child was having a temperature of 38.5oC, no signs of meningeal irritations and had no neurological deficits. Serum electrolytes and random blood glucose are normal, CSF analysis, MRDT, FBP were all normal.

 

a. What  is the most likely diagnosis ( 2 )

Febrile convulsion

 

b. Mention three other diseases or conditions that can cause convulsion ( 3 )

Meningitis

Malaria

Septicemia

Epilepsy

Hypoglycemia

Electrolyte imbalance

Acidosis

Head trauma

 

 

 

1. A four year old female child presents with cough stridor for five days, physical examination reveals a bull neck appearance and a pseudo membrane covering the pharynx and larynx.

a. What is the most likely diagnosis of this child? ( 2 )

Diphtheria

b. Mention is the causative organism of the above condition ( 1 )

Corynebacteria diphteriae

c. Mention two forms of this disease (2 )

i. Pharyngotonsillar diphtheria

ii. Laryngotracheal diphtheria

iii. Nasal diphtheria

iv. Cutaneous diphtheria

 

4. Mention five complications of pneumonia ( 5 )

i. Lung abscess

ii. Empyema- puss in the pleural cavity

iii. Lung collapse (atelectasis)

iv.  Pneumothorax

v. Bronchiectasis

vi. Cardiac failure

vii. Septicemia

viii. Meningitis

 

5. Mention five (5) Priority Signs that you know (05)

i. Referral

ii. Respiratory distress

iii. Restless, continuously irritable

iv. Malnutrition

v. Edema of both feet

vi. Burns (major)

vii. Poisoning (history of)

viii. Pallor (severe)

ix. Pain (severe)

x. Tiny infant; any sick child <2 months old

xi. Trauma

xii. Temperature

 

6. 4 years old child is brought at the clinic with history of poor feeding and illness in the past six months. Physical examination reveals a weight for height below -3 standard deviation and mid upper circumference of 10 cm.

a. What is the most likely diagnosis? ( 1 )

Severe acute malnutrition

b. Mention four (4) complications of the above condition ( 4 )

i. Infections

ii. Hypoglycemia

iii. Hypothermia

iv. Electrolyte imbalance

v. Dehydration

vi. Anemia

vii. Micronutrient deficiency

 

7.  (a) Mention three clinical features of severe dehydration ( 3 )

· Lethargic or unconscious

· Unable to drink or drinks poorly

· Very slow skin pinch

· Sunken eyes

           (b) Mention two clinical features of some dehydration (2 )

· Irritability or restless

· Thirsty drinks eagerly

· Slow skin pinch

· Sunken eyes

 

8. A 6 years old boy presents to hospital with a history of fever, vomiting and headache. He is unable to sit without support jaundiced with massive splenomegaly. MRDT was done and it was positive.

 

a. What is the most likely diagnosis?    ( 1 )

Severe malaria

 

b. Mention four (4) species causing the above disease ( 4 )

Plasmodium vivax

Plasmodium falciparum

Plasmodium ovale

Plasmodium malariae

 

SECTION E: GUIDED ESSAY QUESTIONS (30 )

1. A 4 years old baby is brought at the health facility with history of vomiting, fever, joint pain and general body malaise. On examination the child is alert, not pale, not jaundiced, and febrile, with normal pulse rate and respiratory rate and able to sit without any help. MRDT was done and was positive. Discuss the management of this patient in terms of diagnosis, differential diagnosis, investigations, treatment and complications. ( 15 )

Answer

           Provisional diagnosis (2 - for correct and well-defended provisional diagnosis)

            Uncomplicated malaria- because of supportive features such as fever, joint pain, vomiting, body malaise and MRDT -positive

              

         Differential diagnosis (3 ) -  any 3

· Urinary tract infection- because of fever, vomiting and body malaise

· Septicemia- because of fever, vomiting and body malaise

· Enteric( typhoid) fever- because of fever, vomiting

· Meningitis

· Dengue fever

 

Investigations ( 3 )  any 3 investigations – 1 full  for each correct and well-defended investigation

· Malaria rapid test

· Blood smear for malaria parasites

· Full blood picture- may show raise of white blood cells or fall of hemoglobin and platelets

· Serum electrolytes- to detect electrolyte imbalance- potassium, sodium, chloride

· Random blood glucose- to detect and treat hypoglycemia

· Renal function test-serum creatinine and blood urea nitrogen and if there are signs of renal failure

· Erythrocyte sedimentation rate and C reactive protein


Treatment (4 )

· Tablets Artemether-Lumefantrine (ALu) (strength 20/120mg) at 0hour, 8th hour, 24th hour, 36th hour, 48th hour and 60th hour. ( 2 )

· Tablets paracetamol 15mg/kg 6-8hourly until fever subsidizes ( 1 )

· Continue feeding the child ( 1 )

 

Complications (3 )

· Coma, convulsions

· Progression to severe malaria

· Hypoglycemia

· Metabolic acidosis

· Electrolyte imbalance

· Acute renal failure

· Anemia

· Pulmonary edema

· Disseminated intravascular coagulopathy

 

2. An 8 years old presents at the hospital with history of painful swallowing and fever and headache, on physical examination she is febrile 380C, examination reveals swollen tonsils with areas of erythema, and white filled spots on the tonsils. Discuss the management of this patient in terms of provisional diagnosis, differential diagnosis, investigations, treatment and complications. ( 15 )

Provisional diagnosis (2 - for correct and well-defended provisional diagnosis)

Acute tonsilitis- because of painful swallowing, fever, erythema and white spots on the tonsils.

 

Differential diagnosis (3 ) -  any 3

· Pharyngitis-painful swallowing, fever

· Peritonsilar abscess

· Malaria- fever, headache

· Diphtheria- fever

· Esophageal candidiasis- painful swallowing

 

Investigations- 2 ,  any 2

· Throat swab for culture and sensitivity

· Maralia rapid test to rule out malaria

· Full blood picture- may show signs of infection such as elevated white blood cells

   Treatment (3 )

· Warm salt water gargle can be used to relief pain.

· If streptococcus tonsillitis is found give antibiotic Children: Amoxiclav 375mg (250mg amoxicillin, 125 Clavulanic acid) 12 hourly for 7 days OR Azithromycin 10mg/kg once daily for 3 days.

· Paracetamol (PO) 15 mg/kg body weight 6- 8 hourly until the fever is controlled

   Complications 5 -  any 5

• Pharyngitis

• Peritonsillar abscess (quinsy abscess)

• Chronic tonsillitis

• Recurrent tonsillitis

• Post streptococcal phenomena: rheumatic fever, post streptococcal glomerulonephritis

• Otitis media

• Meningitis, pneumonia

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