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JANUARY 2000 EDITION
DATA |
1. A 8 month old Sudanese baby is admitted with stridor.
Na 138, K 3.7, Urea 5.6, Creatinine 68. Ca 1.67, corrected Ca 1.69, Phosphate 1.22, ALP 1299.
What is the cause for the stridor?
2. A 7 year old girl is seen for breast development Tanner stage 4. The following diagnoses are possible:
Premature thelarche
Constitutional precocious puberty
Adrenal tumour
Craniopharyngioma
Pituitary microadenoma
3. What is the most likely diagnosis in this 14 year old girl with short stature?
4. A 5 year old has an episode of severe diarrhoea and is oliguric.
Na 134, K 4.6, Urea 11.6, Creat 150 µmol/L, Total protein 50 g/L, albumin 36, Total bilirubin 13 µmol/L conjugated fraction 2, AST 26, ALP 463, GGT 35.
Ca 2.37, PO4 1.5. Urinary Na 10, K 35, Creatinine 1.5 mmol/L
Is fluid restriction indicated at this stage?
5. A 14 hour old asphyxiated neonate has fits and is ventilated. There is spontaneous respiratory effort. The long-term neurological prognosis is
good very poor excellent poor dismal
6. What is this investigation? Diagnosis.
7. The age of a child who can crawl but not walk, says mama, recognises strangers and picks up bread crumbs from the floor is
6 mon
11 mon
15 mon
7 mon
9 mon
8. Results from a 9 year old girl with lethargy, weight loss and poor school performance over the last 6 months:
Hb 8.7, WCC 12.5, Platelets 364, MCV 65. Ferritin 6 (20-200), red cell folate 4 nmol/L (11-34). Blood film: dimorphic picture with microcytes and megalocytes.
What is the likely diagnosis?
9. Lumbar puncture results from a 10 year old who has had fever, headaches, fits and is behaving abnormally for the past 1 week
CSF clear. Protein 1 g/L, glucose 3.4, cells 200 (90% mononuclear), blood sugar 5.6.
What is the likely cause?
10. A 10 year old boy is started on Carbamazepine for epilepsy and develops a petechial rash after 4 weeks of treatment. Results:
Hb 7.3 g/dL, WCC 4.5, Platelets 65
What is the cause for the rash?
1. Hypocalcaemia. Tetany and laryngospasm from a low Ca is common in severe rickets as in this case (note high ALP and low Ca).
2. The correct answers are marked with the check-boxes
Premature thelarche |
Constitutional precocious puberty |
Adrenal tumour |
Craniopharyngioma |
Pituitary microadenoma |
3. Constitutional short stature. Note bone age is marked with a 'x'.
4. The key to deciding that is in the FeNa (fractional Na excretion). This is calculated by {urine Na/serum Na x Serum creat/urine creat}x 100. Remember urinary creatinine is given to you in mmol/L. A value of < 2 is suggestive of prerenal failure and > 2 is renal in origin. In this case, extra fluids are warranted.
5. Poor. This corresponds to Stage II HIE (Sarnat and Sarnat) with a moderately high risk of long-term neurological damage.
6. This is a dynamic renal isotope scan to assess excretion (DTPA or MAG3). The diagnosis is a pelvi-ureteric junction obstruction on the left side with delayed excretion of the marker isotope.
7. 11 months.
8. Coeliac disease or Crohn's disease. Note the iron deficiency and megaloblastic anemia with a dimorphic blood film.
9. Viral encepahalitis. Viral meningitis usually does not cause changes in behaviour.
10. Pancytopenia from the carbamazepine.
© Copyright 2000. Ram's MRCP Teaching. All rights reserved.
