MEQ I

8/16/2019 MEQ I

1/6

Medical MEQ 1999/2000

MEDICALQuestion 13 years old boy brought to A&E with signs of dehydration.1. Patient has been vomiting with high-grade fever.

a. Give 5 questions to as his mother

i. Fever: duration, nature, cills/ri!ors"ii. #o$itin!: duration, %re&uenc', content o% vo$itus"iii. An' associated s'$(to$s li)e a*do$inal (ain, urinar'

s'$(to$s"iv. An' rases note on te *od'"v. An' %a$il' $e$*ers +it si$ilar illness"

b. !ign that you e"#e$ted i. i!ns o% de'dration suc as dr' $ucosa, decreased

s)in tur!or and sun)en e'e*all.

ii. Fever $ore tan -°C

iii. ac'cardia and tac'(noeaiv. ases on te *od' and etre$itiesv. A*do$inal distension or a*do$inal (ain

$. %ist the investigation that you would lie to do at thisstagei. Full *lood count to loo) %or increased +ite *lood cellii. lood urea and electrol'te to loo) %or i$*alance sodiu$

and (otassiu$.iii. lood culture and sensitivit' to loo) %or t'(e o% in%ective

or!anis$iv. 3rine FEME, culture and sensitivit' to loo) %or urinar'

tract in%ection. After mu$h #ersuasion' #arents agreed for %umbar

#un$ture. %umbar #un$ture showed in$rease #rotein andde$rease glu$ose.a. Give 3 organism with their gram stain and appearance

which can cause meningitisi. Haemophilus infuenzaeii. Streptococcus pneumoniaeiii. Neisseria meningitidis

b. (hat will you tell the #arent)s about lumbar #un$ture*i. ell te 4ndin! o% lu$*ar (unctureii. Ma' *e caused *' $enin!itisiii. ell te$ $ore a*out $enin!itisiv. ell te$ te treat$ent, (ro!nosis and co$(licationv. ell te$ not to +orr'.

$. (hat are the a##ro#riate antibioti$ for this #atient i. A$(icillin 5 !enta$icin

d. (hy do you thin most of the #arent will refused%umbar #un$ture*i. ecause o% teir %alse *elieved tat Lu$*ar (uncture

+ill (aral'sed teir cild or cause convulsion

3. +!, showed E. $oli whi$h sensitive to netilmy$in. ut #atient failed to im#rove his $ondition after days of

6200- 78 78; 8E 1

8/16/2019 MEQ I

2/6


treatment. +urrently #resented with ar$hed ba$' stine$ and high fever.a. (hat will $ause the failure of treatment*

i. Failure o% netil$'cin to reac te intratecal s(ace.ii. e dosa!e o% te dru! is not enou!

iii. Dru! resistantiv. ere $a' *e oter or!anis$ as +ellv. ere $a' *e source o% in%ection else +ere

b. (hat further investigation you want to do*i. e(eat CF and *lood culture and sensitivit' a!ain.ii. e(eat %ull *lood countiii. Do urine FEME and culture and sensitivit'

/. 0other was worried that #atient sibling will have thesame #roblema. ow do you res#onse to this situation*

i. As) te$ to co$e to os(ital i$$ediatel' i% te' ave%ever and si!ns o% $enin!itis.

ii. ell te $oter to !ive vaccine to teir oter cildrenb. Give s#e$i2$ ways of #reventing . inuen4a

infe$tioni. I$$uniro('lais anti*iotic

uestion 1. 3 years old with 1 wee history of swollen fa$e and

hands. Patients have normal develo#ment. 6he #arent

was well.a. 3 $auses of fa$ial #u7ness

i. enal (ro*le$: ne(rotic s'ndro$e, ne(ritic s'ndro$eii. Liver (ro*le$: '(oal*u$ine$iaiii. =eart (ro*le$: con!estive eart %ailure

b. 5 question you would lie as #atient i. =ave 'ou (assin! %rot' urine"ii. Do 'ou ave soretroat %or te (ast %e+ +ee)s"iii. Do 'ou ave an' s)in in%ection %or te (ast %e+ +ee)s"iv. Do 'ou ave an' con!enital eart disease"v. Do 'ou (assin! *lood durin! $icturition"

. Patient had history of #assing frothy urine. 8nvestigationresult given.a. 8nter#rete the investigation result

i. %,69 hy#oalbuminemiaii. :rine9 #roteinuria' no hematuria

b. 0ost liely diagnosisi. e(rotic s'ndro$e

$. 0anagement i. 8n ne(rotic cartii. trict In(ut/out(ut cart

iii. Do dail' urine di(sti: to cec) (roteinuriaiv. ive steroid tera('

6200- 78 78; 8E 2

8/16/2019 MEQ I

3/6


?1@0$!/$2/da', in divided dose %or B +ee)s?2@B0$!/$2/da', Ever' 8ter Da', %or B +ee)s

3. Patient has had one rela#se and $urrently $ome with$om#laint of abdominal #ain and high grade fever.a. !tate your #rovisional diagnosis at this time

i. >eritonitis secondar' to ne(rotic s'ndro$eb. ow do you $on2rm your diagnosis

i. As(irate (eritoneal uidii. Full *lood countiii. Cec) urine %or (roteinuria

/. Patient is now ; years old. e #resented with rela#se. ehas had 1 rela#ses in the #ast 5 years.a. (hat are #sy$hologi$al burden of $hroni$ illness on

#atient and family*i. >atient

?1@=e as to a*sence %or scool?2@=is scool (er%or$ance $a' reduced

ii. Fa$il'?1@e $oter as to ta)e care o% te (atient and $a'

ne!lect te oter cildren.?2@e $oter as to *rin! te (atient to te os(ital %or

ever' rela(se.?-@e treat$ent cost is a *urden to te %a$il'.

b. ow do you managei. ive c'clo(os(o$ide

Question -1. 5 years old male brought by mother to A&E with history

of abdominal #ain and vomiting for 3 days #rior toadmission.a. Give 3 dierential diagnosis

i. Acute !astroenteritisii. Acute a((endicitisiii. >e(tic ulcer disease

b. 2 %urter &uestion 'ou +ould li)e to as) %or eac o% 'ourdia!nosis a*ove.i. Acute !astroenteritis

?1@=ave 'ou eatin! outside %or te (ast %e+ da's"?2@Do 'ou ave diarroea"

ii. Acute a((endicitis?1@Does te (ain start around te u$*ilicus and ten

radiated to te ri!t iliac %ossa"?2@Do 'ou ave %ever"

iii. >e(tic ulcer disease?1@Do 'ou ave !astritis *e%ore"?2@Does te a*do$inal (ain relieved *' eatin!"

. ,urther questioning' no history of

8/16/2019 MEQ I

4/6


$re#itation' de$reased breath sound and in$reased vo$alresonan$e.a. / investigation and reason.

i. Cest ra': to loo) %or consolidation, (leural eusionii. Liver %unction test: to loo) %or liver i$(air$ent, *iliru*in

iii. =e(atitis A, and C screenin!iv. Full *lood count: to loo) %or increased +ite *lood cell

b. 8nvestigation result

i. AG9 #

ii. =!9iii. :rine9 etoneiv. +>=9 showed #leural eusion in left lung

$. 8nter#ret the result i. A: (atient as $eta*olic acidosisii. : (atient as '(er!l'cae$ia

iii. 3rine: te is )etonuriaiv. C: te is (leural eusion in le%t lun!v. Conclusion: (atient as dia*etic )etoacidosis

d. (hat would you lie to do this #atient i. tart DGA re!i$enii. o re'drate te (atient

?1@ive nor$al saline 0.9H 4rst?2@Cec) to *lood !lucose level, i% 1J$$ol/L, can!e

nor$al saline 0.9H to detrose JH.iii. ive (otassiu$iv. ive insulin tera('

3. Patient was rehydrated and given

8/16/2019 MEQ I

5/6


i. Full *lood (icture to loo) %or leucoc'tosis, ane$ia,tro$*oc'to(enia

ii. lood s$eariii. (utu$, lood culture and sensitivit' to loo) %or

in%ective or!anis$

iv. Cest ra' to loo) %or consolidation, cardio$e!al',(leural eusion

$. lood 2lm revealed Ci. (hat further investigationii. (hat are the mostly liely diagnosisiii. ow to $on2rm it

?1@one $arro+ as(iration3. one marrow shows myelo2brosis. Patient was treated

with regular blood transfusion. years later he #resented with history of bleeding and #ete$hiae.a. Possible $ause of this

i. ro$*oc'to(enia due to $'elo4*rosisii. Den!ue e$orra!ic %everiii. Idio(atic tro$*oc'to(enia (ur(ura

b. ow do you treat i. rans%use %res %ro

8/16/2019 MEQ I

6/6


iii. al)ative3. 0!E revealed gradiose ideation' #ressure of s#ee$h

a. (hat is your management of this #atient*i. Ad$it tis (atientii. ive $ood sta*ili

Documents

MEQ I