1.3 What is the mechanism of action of adrenaline in anaphylactic shock? (20 marks)

Transcription

1 DCH Examination -Short Answer Questions Time - Two and half hours Model paper 1.1 A 10 month old child presented with urticaria within one hour following ingestion of an egg. Mother claims that a week ago, she had a similar rash following ingestion of an egg and it resolved spontaneously. a. What is the pathogenesis of the above condition? (30 marks) b. List three other manifestations of the above condition. (30) 1.2 What is the immunological reaction to BCG vaccine? (20 marks) 1.3 What is the mechanism of action of adrenaline in anaphylactic shock? (20 marks) Name five important investigations you will perform in a 5 year old child detected with microscopic haematuria during a routine check (30 marks) 2.2 Name five common causes for the above presentation (40 marks)

2 2.3 Name 3 situations, where you will make an urgent paediatric nephrology referral (30 Marks) Enumerate three (3) Neonatal surgical conditions that Do not need early surgery (15) That need early surgery (15) 3.2 List 5 clinical features pyloric stenosis in a 5 week old baby. (25) Mention 5 causes of unconjugated hyperbillirubinaemia in 30- day old neonate. (25)

3 3.3.2 What is the mechanism of action of phototherapy in early jaundice. (20 marks) Name 5 most venomous snakes in Sri Lanka (30 marks) 4,2 Name four indications to use antevenoum (40 marks) 4.3 Name 3 life threatening complications of Russell's viper bite (30 marks) Outline the current immunization schedule for children in Sri Lanka (30 marks) 5.2 Name the live attenuated vaccines mentioned in 5.1 (20 marks)

4 5.3 Name 3 contraindications for administration of standard penta-valent vaccine (30 marks) 5.4 Name 4 Non EPI vaccines which are useful and available in Sri Lanka (20 Marks) Name five advantages of exclusive breast feeding during first six months of life (50 marks) 6.2 Name five disadvantages of formula feeding from birth (50 Marks) 7. Four year old preschool child was brought the emergency department with difficulty in breathing. The child has been suffering with cough for last one week and has been treated with oral amoxicillin. The chest X ray revealed right middle lobe consolidation 7.1 Name 3 possible organisms responsible for the above condition (30 marks)

5 7,2 What is the most likely organism (20 marks) 7.3 Name 3 further investigations that you will perform (30 marks) 7.3 What is the most appropriate initial antibiotic therapy (20 marks) 8. A 5 week old baby was brought for routine review to the MOH clinic. The baby is mildly icteric but the mother was reassured by the midwife. Both mother and baby are 0 positive. On direct questioning mother revealed that the baby is passing dark colour urine. TSH - Normal 8.1 Write 2 steps in initial clinical evaluation (50 marks) 8.2 Write the next investigation you will arrange(10 marks) 8.3 Explain briefly why this baby should be referred to hospital early. (40 marks) 9 A 4 year old boy is followed up at pediatric clinic for iron deficiency anemia during the last 4 months. He is having a good compliance with the treatment. He is not pale, no lymphadenopathy or hepatosplenomegaly. His growth parameters are normal. Hb- 8.5g/dL, WBC (Neutrophils - 57%, Lymphocyte -37%, Eosinophil -7%)

6 PLT- 450,000 Blood picture- Microcytic hypochromic anaemia 9.1 Write 3 differential diagnoses for this clinical scenario. (30 marks) 9.2 Mention 3 appropriate investigations to arrive at a diagnosis. (30 marks) 9.3 Write 2 other abnormalities you will see in a complete blood count in a child with nutritional iron deficiency. (40 marks) 10. A 9 month old girl presented with the history of watery diarrhea and fever for three days duration. Mother noticed that she was less active and has reduced urine output for last 8 hours. On admission she was irritable, not pale, anterior fontanell is full with normal skin turgor. Capillary refilling time is 3 seconds. Pulse rate- 160/min. Just after admission she developed a seizure Mention 2 differential diagnoses for above presentation (20 marks) 10.2 Mention 4 investigations required for initial management (40 marks) Write the composition of reduced osmolarity ORS (40 marks)

7