08.ELBABA M.A. Answers SAT8 for MRCPCH,2009.pdf

7/22/2019 08.ELBABA M.A. Answers SAT8 for MRCPCH,2009.pdf

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SAT for MRCPCH Part 1& 2 ELBABA M.A.ELBABA M.A.ELBABA M.A.ELBABA M.A.

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3 July 2009

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SAT FOR

MRCPCH

Part 1&2Series #Series #Series #Series # 8888Question number: Total is 10 cases

Question Format: Best of many & Extended match

Time allowed: 20 MinutesTotal Marks: 20

Set your time & write in the answer sheet

Answer is available on request & your score is confidential

Please, do not turn this page until you asked to start

Visit MRCPCH 2009 Website for all educational materials

http://sites.google.com/site/mrcpch2009/
http://sites.google.com/site/mrcpch2009/http://sites.google.com/site/mrcpch2009/http://sites.google.com/site/mrcpch2009/


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3 July 2009

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Self-Assessment Test for MRCPCH / Series # 8

Case # 1 (2 marks)12 years old girl is admitted to the hospital with burns on her legs which she

obtained while playing near a bonfire. The burn was treated and starts to heal.While in hospital, it was noted that her behavior was odd. Her concentration span

was very poor. She was suddenly changing her attention from one conversation and

shouts something to another patient. On one occasion, she had been walking a little

unsteady across the ward when she fell for no apparent reason. Another time she

had fallen out of bed. Apart from parents divorce at age of 18 months, there was

nothing significant in family or social history. For the last few months her behavior

had been unpredictable and in view of this she had been sent to stay with an aunt

for some weeks during the holiday. Since that time, the teachers in school had been

observed deterioration in her performance. There was a past history of

tonsillectomy at age of 6 years and the usual childhood infections as coryza, measles

and recently chicken pox. Her cranial nerves and fundus exam are intact. She hadsudden grimaces and jerky movements of her arms, and occasional abnormal

posture of her limbs. Her gait is unsteady. There was an increased tone and reflexes

mainly over both lower limbs with positive planter reflexes. Rombergs test couldnt

be done. Her FBC, ESR and skull X-ray are within normal.

1. What is the most likely diagnosis? (Select ONE answer only)A. Drug poisoningB. SLEC. HyperthyroidismD. ChoreaE. Conduct disorderF. SchizophreniaG. Anxiety neurosisH. Hepatic encephalopathyI. Uremic syndromeJ. Subacute sclerosing panencepalitisK. Psychomotor epilepsyL. Myoclonic epilepsyM.Frontal lobe tumorN. Lundau Kleffner syndromeO. Rett syndromeP. AutismQ. Chronic fatigue syndromeR. EncephalitisS. Cow mad diseaseT. Alzheimer diseaseU. DementiaV. Vitamin B12 deficiencyW.Vitamin B6 deficency


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Case # 2 (4 marks)18 hours ago a pregnant lady had delivered a 36 weeks old girl weighting 2.650 kg.

She was completely healthy woman with appropriate antenatal care. The baby is

healthy as well and didnt require any resuscitation post delivery and started breast

feeding with good suction. Apart from abnormally looked genitalia the baby is

normal by quick inspection. This is the second child for this mother; her first sonhad died at the age of 2 weeks secondary to sever gastroenteritis and dehydration.

1. What is the initial action you do now? (Select TWO answers only)A. Stop breast feedingB. Give IV Saline bolusC. Check blood glucoseD. Consult the parents to avoid giving a name now.E. Check serum electrolytesF. Complete you clinical examinationG. Urgent pelvic ultrasoundH. Buccal smearI. Talk to obstetricianJ. Check cord blood gasK. Check the placenta and umbilical cord

2. What are the most two important signs helping in diagnosis? (Select TWO

answer only)A. OFCB. Blood pressureC. Feeling the testisD. Dehydration statusE. HypopigmentationF.

Urine volumeG. Patent anus

H. Sacral agenesisI. TempratureJ. Eye examinationK. Primative reflexesL. Abnormal earM.Palpable kidneyN. Bulging fontanelsO. Dysmorphic faceP. PolydactylyQ.

Cardiac murmurR. Hand anomaly

S. Cleft palateT. LethargyU. Urine specific gravityV. Palpable bladderW.HepatomegalyX. Height


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Case # 3,4,5 & 6 (Extended Match) ( 2 mark for each, total 8)Choose the one most likely diagnosis from the list below which best matches each of thefollowing cases.Note:Each option may be used once, more than once or not at all.

SELECT ONE ANSWER ONLY FOR EACH QUESTION

3. 5 weeks newborn presented to OPD with difficulty in feeding, sweating andpoor weight gain. Baby is full term with uneventful pregnancy and delivery.

The baby had discharged on second day of life completely healthy. On

examination he has, mild tachypnea 50/m, tachycardia 180 b/m, normal

temp. & blood pressure. Lungs are clear and normal cardiac examination.

Chest X-ray shows only mild cardiomegaly, ECG is normal. G

4. 5 weeks newborn presented to OPD with difficulty in feeding, sweating and

poor weight gain. Baby is full term with uneventful pregnancy and delivery.

The baby had discharged on second day of life completely healthy. On

examination he has, mild tachypnea 50/m, tachycardia 180 b/m, normal

temp. & blood pressure. Lungs are clear and normal cardiac examination.

Chest X-ray shows only mild cardiomegaly, ECG shows only deep Q wave. F5. 5 weeks newborn presented to OPD with difficulty in feeding, sweating and


The baby had discharged on second day of life completely healthy. The baby

has Flu for the last 3 days. On examination he has, mild tachypnea 50/m,

tachycardia 180 b/m, and normal temp. & blood pressure. Lungs show

bilateral crackles and normal cardiac examination. Chest X-ray shows

moderate cardiomegaly, ECG shows biventricular enlargement. I

6. 5 weeks newborn presented to OPD with difficulty in feeding, sweating and


The baby had discharged on second day of life completely healthy with soft

systolic murmur. On examination he has, mild tachypnea 50/m, tachycardia180 b/m, and normal temp. & blood pressure. Lungs show bilateral crackles.

There was a systolic murmur and loud 2nd

sound on cardiac examination.

Chest X-ray shows moderate cardiomegaly, ECG shows biventricular

enlargement. B

Select your answers from the following list:A. Small VSDB. Large VSDC. Aortic stenosisD. Coarctation of the AortaE.

Total anomalous pulmonary venous drainageF. Anomalous left coronary artery

G. Arterio-venous malformationH. Ebstein anomalyI. MyocarditisJ. PericarditisK. Protein C deficiencyL. Suprventricular tachycardia


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Case # 7 (2 marks)10-year-old girl presented with a history of progressive loss of vision and painful

eyes. She has an area of numbness over her left side of the face. She is fully

conscious but has developed progressive ataxia over the last few weeks. She is a

completely healthy girl before that and achieving well in school until this year.

Pregnancy and delivery were uneventful. Brain MRI shows scattered areas ofdemyelination in white matter over both hemispheres.

1. What is the main lines of treatment? (Select TWO answers only)A. ReassuranceB. Behavioral therapyC. IV AntibioticsD. IV AcyclovirE. SteroidF. IVIGG. PlasmaphoresisH. CarbamazepineI. InterferonJ. Bone marrow transplantationK. HaloperidolL. NSAIDsM.PyridoxineN. BiotinO. ThiamineP. Refer to PsychiatristQ. RadiotherapyR. Immunosupprion

Case # 8 (1 marks)Alex is 14 years old girl. Currently she is inpatient for the last 4 days following an

appendicectomy. She is otherwise fit and well. You have just finished the ward

round, during which said that she could be discharged. Alex has asked to speak to

you alone before she goes home. She want you to prescribe an oral contraceptive

pills for her.

1. What is your response and action? (Select ONE answer only)

A. I will tell her parents to take the appropriate actionB. I will prescribe that without any problem to avoid teenage pregnancyC. I will prescribe for her the pills after checking her competenceD. I will advice her to avoid discussing this matter with her parentsE. I will refuse that and will not prescribe anything like thatF. I will not warn her about sexually transmitted diseasesG. I will prescribe that according to the background social circumstancesH. I will call my senior and nurses to discuss with herI. I will contact the social worker to be involved in her managementJ. I will advice her to bring the partner for counselingK. I will recommend the mechanical barrier which is more protective


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Case # 9 (2 marks)6 years old boy had a past history of medulloblastoma. It was operated 4 years ago.

He is presented to you clinic with the following result of Insulin stimulation test:

Time / min 0 20 30 60 90 120

Glucose (mmol/l) 4.5 1.8 1.6 6.3 7.5 8.1

Cortisol (nmol/l) 507 - 581 992 741 582GH (mU/l) 0.9 - 0.7 1.7 4.2 4.6

TSH (mU/l) 41 > 60 - > 60 - -

FSH (u/l) 1.6 > 30 - > 30 - -

LH (u/l) 1.2 2.8 - 3.2 - -

1. What does the test show? (Select ONE answer only)

A.Normal test resultB. Growth hormone deficiencyC. PanhypopituitarismD. Primary hypothyroidismE. Secondery hypothyroidismF. Isolated hyperthyroidismG. Isolated deficiency of cortisolH. GnRH deficiencyI. GnRH excessJ. Both B & DK. Both E & GL. All B,D & HM.All B, E, G & H

Case # 10 (1 marks)A baby born at 28 weeks gestation is now 3 months old with chronic lung disease.

He is on nasal cannula Oxygen at home. 2 days ago he developed cough and

respiratory distress with increasing Oxygen requirement. You have asked for

arterial blood gas which shows the result below:PH 7.20

PO2 11.2 kPa

PCO2 13 kPaHCO3 28 kPaBe +9.3

1. How do you interpret this result (Select ONE answer only)

A. Respiratory acidosisB. Metabolic acidosisC. Compensated Metabolic acidosisD. Compensated Respiratory acidosisE. Partially Compensated Respiratory acidosisF. Partially Compensated Metabolic acidosisG.Normal gas for chronic lung disease child

End of the testELBABA M.ELBABA M.ELBABA M.ELBABA M.A.A.A.A.

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08.ELBABA M.A. Answers SAT8 for MRCPCH,2009.pdf