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NATIONAL UNIVERSITY OF IRELAND, GALWAY
Ollscoil na hEireann, Gaillimh
4MB3 AUTUMN EXAMINATIONS 2010
P A E D I A T R I C S MD
Professor B.G. Loftus Dr. E. Moylett
Dr D. Gallagher Dr. R. Geoghegan
This written examination is in two parts: Paper 1 (2 X MEQS) 1 hour Paper 2 (4 X Short Answer Questions) 2 hours
Number of pages: 8
PAPER 1
INSTRUCTION TO CANDIDATES:
The following instructions apply to Paper 1 only:
TIME ALLOWED: 1 Hour
ANSWER BOTH MODIFIED ESSAY QUESTIONS (MEQ).
ANSWER IN THE SPACES PROVIDED ON THE QUESTION PAPER.
ENSURE TO ADD YOUR NAME AND ID NUMBER AT THE START OF BOTH QUESTIONS:
RETURN THE QUESTION PAPER TO INVIGILATOR ON COMPLETION.
Remember: The MEQ is structured in such a way that marks are awarded for specific points in each section All answers should refer to the particular case history If answering in a list where X answers are requested only the first X answers will be accepted. All subsequent answers will not be considered even if correct. Thus marks will be lost if the answer is badly organized or particularly if irrelevant or incorrect material is used. You will receive NO marks for an incorrect answer or a question which is not answered
PAPER 1
CANDIDATE NAME: …………………………………………………………..
CANDIDATE I.D………….……………………………………………………..
Question 1
A 3 year old child is referred to the Emergency Department with a 1-week history of cough, reduced appetite and intermittent fever. Chest examination revealed a toxic appearing child, (weight on 3rd^ centile, Height on 50 th^ centile) moderately dehydrated, increased work of breathing, temperature of 38.5°C, oxygen saturation, 90% in room air, diffuse crackles on chest exam with reduced air entry right lower zone. The child had been compliant with an oral course of Amoxicillin as prescribed by the GP for the previous 4 days.
Prioritise your initial investigations for this child? (4 marks)
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Outline your initial management plan for this child. (4 marks)
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Which antibiotic would you commence this child on? (2 marks)
Hospital Day 4: there has been no significant improvement, fever continues, oxygen requirement continues and the child still has moderate respiratory distress and has a productive cough.
CXR was consistent with right lower lobe pneumonia, no hilar adenopathy was noted. On review of the child’s medical record you note that he has had two prior admissions with lower respiratory tract infection, no history of atopic illnesses.
The patient’s mother reports that she is 12 weeks pregnant; this will be her second child.
What are the chances of the next child having a similar problem (1 mark) What likely screening procedure will the newborn undergo? (1 mark)
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Proceed to MEQ 2 on Page 5
CANDIDATE NAME: …………………………………………………………..
CANDIDATE I.D………….……………………………………………………………..
Question 2 A 16 year old single un-booked primagravida presents in labour at approximately 38 weeks by dates. The midwifery staff notes that she has extensive needle track marks on her arms and also on her feet. She herself denies that she has any substance abuse. One hour later she gives birth to a 2.8 kgs female infant. Baby initially appears to be in good condition with good colour and heart rate but has no respiratory effort.
What is the likely problem? (3 marks)
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Outline your management at this point (2 marks)
At 30 hours of age the baby is noted to have bilateral conjunctivitis with discharge. Name 2 likely organisms. (4 marks)
The conjunctivitis is treated appropriately.
On day 2 the baby is noted to be irritable with inconsolable crying, sneezing and hiccups.
What is the likely cause? (2 marks)
What is the management? (3 marks)
NATIONAL UNIVERSITY OF IRELAND, GALWAY
Ollscoil na hEireann, Gaillimh
4MB3 AUTUMN EXAMINATIONS 2010
P A E D I A T R I C S MD
Professor B.G. Loftus
Dr. E. Moylett
Dr D. Gallagher Dr R Geoghegan
PAPER 2
INSTRUCTIONS TO CANDIDATES (PAPER 2 ONLY).
TIME ALLOWED: 2 Hours
PLEASE ANSWER ALL QUESTIONS IN ANSWER BOOKS PROVIDED.
ANSWER ALL SECTIONS ON SEPARATE ANSWER BOOKS
SECTION A
Q. 1 Outline your acute management of:
a) A 6 year old with acute onset wheeze and breathlessness, background
history of atopy.
b) A 3 month old infant drowsy, with fever and high pitched cry.
c) A 9 year old with dysuria, back-pain, fever and persistent vomiting
d) A 3 year old with generalized oedema and proteinuria
Q. 2 List three differential diagnoses for the following:
a) An 8 year old boy with swollen ankles and a rash.
b) A 10 year old who collapses whilst standing with her class in school hall.
c) A 3 year old with bruises on arms and legs and painful right arm.
d) An 8 month old boy with 24hr history of intermittent screaming, pallor,
drawing up his legs and vomiting.
Proceed to Section B on page 8
SECTION B
Q. 1 Write short notes on the following:
a) Causes of unilateral neck swelling in a 2 year old child.
b) Typical features of migrainous headache in childhood.
c) Causes of delayed walking in a 20 month old.
d) Typical features of Duchenne’s Muscular Dystrophy.
Q. 2 Write short notes on the following:
a) Allergic rhinitis
b) Pyloric stenosis
c) Heel prick test
d) Innocent murmurs
End of paper 2.
