Thursday, May 09, 2013

Of Paediatric Exams

Theory exam on 3/5/13 was a bit chaotic since I didnt have enough time to answer a few PMP sub-questions.

The Cases were:

1. A child presented with generalized tonic clonic seizures 4 times in a day, less than 5 minutes with post-ictal drowsiness. On examination, afebrile.

2. A child with dyspnea and cyanosis. On examination, pansystolic murmur heard with displaced apex beat.

3. A child came with high grade fever, retroorbital pain and joint pain. On examination, tachycardia and hypotension.

ps. There were questions asked on pathophysiology of VSD and the mechanisms of left-to-right shunt (ASD and PDA)! 

And I was like, SERIOUSLY??

On the MCQ/OBA questions, there were few difficult questions too. Some of them were repeating questions from years before.

So, please make sure you do your compilations! :D

Clinical exam today was okay, I think. 

I suck in Short Case. Haha

LONG CASE (Dr. Ghaffar Nagi)

Case: Viral Croup

1 year 4 month old Malay boy presented with:
fever for 2/7
cough for 2/7
fast and noisy breathing for 1/7
reduced oral intake 1/7

child alert, conscious, comfortable, not in pain or respiratory distress
not on nasal prong/oxygen mask
inspiratory stridor, hoarseness of voice and barking cough heard
on auscultation, bronchial breathing heard over both lungs
inspiratory rhonchi heard but no crepitations

1. Can this be a case of TB? Why do you ask contact of TB in this child then?
No because the fever is only for 2 days duration 

2. How do you know this is VIRAL croup?
Because it is common among child this age, and there was history of URTI in the family (his sister) before the child got the symptoms

3. Ddx of Stridor
Laryngomalacia, Laryngeal atresia, Subglottic stenosis, Epiglottitis, Tonsils/Adenoid hypertrophy, Foreign body insertion

4. Investigations
Lateral neck X-Ray, CXR, FBC

5. Prognosis
Good because it is self-limiting. Antibiotics as prophylaxis.

SHORT CASE (Dr. Aye Aye)

12 year old Malay child, alert, conscious, not in pain or respiratory distress

1. Inspect the child's face. What do you see?
Facial puffiness, periorbital swelling and almost fused eyebrows (hirsutism?)

2. Do general examination

3. Do systemic examination (shifting dullness and fluid thrill only)
They were all negative

4. Diagnosis
Post-streptococcal AGN because there were signs of skin infection (scars) on her abdomen, hands and legs, plus the facial puffiness and periorbital and mild pedal edema up to mid-shin.

ps. Got scolded by Dr because I didnt recognize the marked facial puffiness. She asked me several times about what was wrong in the child'd face. She even grabbed another patient, asking me to compare their faces.

At first I kept silent because I couldnt see anything on her face. Then I said flat nasal bridge (which was stupid, I know. the kid was not Down Syndrome). Dr rolled her eyes at me. Flat nasal bridge? See again!

Then I said, she looked pale? Dr.Aye Aye shook her head and muttered something to herself. Id rather not know what she said.

Seeing that I still couldnt answer her question, she asked me to do general inspection. While I introduced myself to the child, I asked her quietly.

'Dik, adik masuk ni sebab apa?'
'Sebab buah pinggang, dengan darah tinggi'

Ahaaaa AGN! At the same time, Dr. asked me again. I confidently said, hirsutism. She said, HIRSUTISM? How can you say hirsutism? Because of the eyebrows fuse together? She said something which I couldnt hear.

How can you not see? Dont you have eyes? What was wrong in the child's face?


Yes, facial puffiness! She sighed.

I breathed a sigh of relief too.

What a day. I am really really bad in Short Case *sigh*

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