Undergraduate drill

1.The following are secondary causes of nephrotic syndrome
a) Minimal change disease
b) Nail-patella syndrome
c) Falciparum malaria
d) Focal segmental glomerulosclerosis
e) Bee sting

2.Congenital nephrotic syndrome
a) Occurs in an infant less than a month of life
b) Occurs in an infant less than 3 month of life
C) It is a differential of hydrop fetalis
d) It has a good prognosis
e) Renal transplant may be needed

3.The following characterized nephrotic syndrome
A) Massive proteinuria of greater than 25mg/hr /m2
a) Hypoalbuminuria
b) Haematuria
c) Hypercholesterolaemia
d) Massive oedema
E) Oliguria

4.Hyperlipidemia in nephrotic syndrome
A) May be due to increase consumption of fat
b) Increase fat catabolism
C) Increase production in the liver
TheD)decrease albumin in the serum
e) Reduce catabolism of fat
F) Reduce oncotic pressure

5)Effective serum potassium may be reduced by the following treatment modalities
a) Administration of keyaxelate
B) Intravenous calcium gluconate
C) Intravenous sodium bicarbonate
D) Dialysis
E) Nebulized salbutamol

6.Minimal change disease
A) Occurs in ages 1to 8yrs
B) Has good prognosis i.e respond to steroid use
C) Hypertension is prominent
D) Relapse occur in up to 90% of cases
E) Hematuria is rare.

7.Terminologies describing nephrotic syndrome
A) Remission is when there is reduced urinary protein of trace or negative on at least  three consecutive days.
B) Relapse is proteinuria of greater than 2+ after an initial remission
C) Steroid resitance is when there is at least 2+ of proteins after at least 6 weeks of adequate steroid use
D) Frequent relapser is a patients with 2 or more relapses in a year period
E) Steroid dependence occurs when a patient relapses while on alternate day course or within 28days of completing steroid use.

8.Patients with nephrotic syndrome are at increased risk of developing
A) Spontaneous bacterial peritonitis
 Stroke
B) Pulmonary oedema
C) Hypertension
D) Bleeding per rectum

9 Steroid sparing agents
A) levamisole
B) methicillin
C) azathioprine
D) cyclophosphamide
E) mycophenolate

10. Acute glomerulonephritis
A) Occurs in school age group in Nigeria
b) haemoglobinuria is a common presentation
c) post streptococcal type may follow throat infection usually with serotype 49
d) may be complicated by encephalopathy
e )haematuria may last beyond a year

FEMALE GENITAL MUTILATION

I grew up believing that is normal and beneficial to have a female child circumcised like a male child until, i saw a woman whose vaginal orifice is smaller than a pin head!
The circumcision of a female child has no benefit to the child and the community , it constitutes a lot of hazard and must stop in every part of the world where it is still being practised.
 I have decided to play my  part in the campaign to END Female genital mutilation by presenting in today's blog some of the world health organization assertions.

What is female genital Mutilation?
Female circumcision also known as female genital mutilation (FGM) is the total or partial cutting/removal of the external female genitalia or injury to the female genital organ for non-medical reason.
It alters the female genitalia(sexual organs), may disfigure it and cause a lot of untoward effects.
It is a criminal action, considered as violence towards women, a violation of women(human) right, and should not be allowed.

Types:
All of the types below are forms of Females genital mutilation  and are written as explained by world Health Organization.
Type 1: Often referred to as clitoridectomy, this is the partial or total removal of the clitoris (a small, sensitive and erectile part of the female genitals), and in very rare cases, only the prepuce (the fold of skin surrounding the clitoris).
Type 2: Often referred to as excision, this is the partial or total removal of the clitoris and the labia minora (the inner folds of the vulva), with or without excision of the labia majora (the outer folds of skin of the vulva ).
Type 3: Often referred to as infibulation, this is the narrowing of the vaginal opening through the creation of a covering seal. The seal is formed by cutting and repositioning the labia minora, or labia majora, sometimes through stitching, with or without removal of the clitoris (clitoridectomy).
Type 4: This includes all other harmful procedures to the female genitalia for non-medical purposes, e.g. pricking, piercing, incising, scraping and cauterizing the genital area.
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Why do people do it?
In most societies, where FGM is practised, it is considered a cultural tradition, which is often used as an argument for its continuation.
In some societies, recent adoption of the practice is linked to copying the traditions of neighbouring groups. Sometimes it has started as part of a wider religious or traditional revival movement.

FGM is associated with cultural ideals of femininity and modesty, which include the notion that girls are clean and beautiful after removal of body parts that are considered unclean, unfeminine or male.
FGM is often motivated by beliefs about what is considered acceptable sexual behaviour. It aims to ensure premarital virginity and marital fidelity. FGM is in many communities believed to reduce a woman's libido and therefore believed to help her resist extramarital sexual acts. When a vaginal opening is covered or narrowed (type 3), the fear of the pain of opening it, and the fear that this will be found out, is expected to further discourage extramarital sexual intercourse among women with this type of FGM.

Health implications
 1.severe pain
 2. Excessive bleeding (haemorrhage)
3. Genital tissue swelling
 4. Fever
5.  infections e.g., tetanus
6. Urinary problems
7.  Wound healing problems
8. injury to surrounding genital tissue
9. Urinary problems (painful urination, urinary tract infections);
10. Vaginal problems (discharge, itching, bacterial vaginosis and other infections);
11. Menstrual problems (painful menstruations, difficulty in passing menstrual blood, etc.);
scar tissue and keloid;
12. Sexual problems (pain during intercourse, decreased satisfaction, etc.);
13. Increased risk of childbirth complications (difficult delivery, excessive bleeding, caesarean   section, need to resuscitate the baby, etc.) and newborn deaths;
14. Need for later surgeries: for example, the FGM procedure that seals or narrows a vaginal opening (type 3) needs to be cut open later to allow for sexual intercourse and childbirth (deinfibulation). Sometimes genital tissue is stitched again several times, including after childbirth, hence the woman goes through repeated opening and closing procedures, further increasing both immediate and long-term risks;
15. Psychological problems (depression, anxiety, post-traumatic stress disorder, low self-esteem, etc.);
Benefits
IT HAS NO BENEFIT.
Eradicating Female genital mutilation is a challenge that we all must take part in, we must join hands with several organisations that are campaigning against it already.
Play your part , preach against it in your neighborhood, forward this piece to friends and family members.

29082017

A 10 /yr old girl presented in outpatient department with left flank pain of 2weeks duration,  progressive abdominal mass of a week duration and weight loss of a week duration.
Notable on examination are  evidences of weight loss and a tender,  nodular mass on the right flank,

a)  mention three diffential diagnosis for her condition.

B)  the girl was noticed to be unable  to use are lower limbs while being investigated  and the Abdominal Ultrasonography showed the mass to originate from the left kidney, what is your most likely diagnosis at this point?

C) Discuss four investigations  relevant to this diagnosis.

D) What are the risk factors to this condition?

E) Mention 5 prognostic factors in this condition.

F) What four complications may occur?

G) highlight  the stages of this condition.


A four year old girl was referred to you from a peripheral hospital  with history of Fever of ten days duration, vomiting and diarrhoea of week duration,  he was said to have had reduced urine output for two days though urine color was Amber, there was also facial and pedal edema.
Examination  revealed  an acutely ill looking child, Febrile (temperature  is 38.7centigrade) in mild respiratory distress, has pedal edema and facial puffiness, weight is 14kg.
Urine output is 0.3mls/kg/hr in the first 24hrs of admission
Serum  creatinine is is 6mg/dl.
Potassium  5.4mmol/l.
Urea 20mg/dl.

a)  What is your diagnosis?

b ) explain your initial fluid  regimen to your nurses.

c)  list ten causes of this condition.

d) Explain the pathophysiology of any three complications that may develop in this patient.

E)  what is the place dopamine in the management of this patient?

F)  Explain the term disequilibrum syndrome to your registrars.

MCQ 08/09/2017

1. A three -year old was brought to your specialist clinic with history to suggest severe mental retardation, special interest in water,  and always laughing, he has had several episodes of seizure.
Notable on examination include facial hypolasia,severe hypotonia and tremor.
The following are likely to be true about this patient.
a) This patient has a microdeletion on a  paternity derived  chromosome.
b) This patient has paternal uniparental disomy.
c) The prognosis is good.
d) this patient speech is expected to be affected.
e)  The patient has Down syndrome.

2. A twenty-day old baby was rushed into the special care baby unit unconscious,  he has being vomiting for three days,  has not being thriving since birth,  examination revealed a child who appeared small for age,  with sunken eye balls.
Random blood sugar was elevated with a value of 26mmol/l, urinalysis yielded ketonuria of +
The following are correct about this patient.
a).   He has a chance of spontaneous cure.
b). Abnormality of this type is mostly associated with mutation on chromosome  6p24.
c. Permanent diabetes may result in up to 60 percent of patients with this condition
d). Ketonuria is the hallmark of diagnosis
e) soluble insulin is of choice in active phase.

3. A 6yr old boy presented in OPD with history of progressive generalised body swelling of a month duration, urine output has reduced, bedside urinalysis yielded 4+ of protein, serum albumin was 1.8mg/dl
The following are likely to be correct of this patient and his condition.
A) Most patient with steroid responsive type have repeated relapses
B) A relapse is defined as proteinuria 3+ or 4+ for 3 consecutive days after initial remission.
c)immunenoflorescence microscopy is typically negative
D)children who continue to have proteinuria after 4 weeks of steroid therapy are considered steroid resistant.
E) in congenital type ,  cure rate is hundred percent after transplantation.

4. Concerning Proteinuria
A) Glomerular proteinuria should be suspected in any patient with a first morning urine protein : creatinine ratio >1.0.
B) microalbuminuria in children has been found to be associated with obesity and to predict, with reasonable specificity, the development of diabetic nephropathy in type 1 dmicroalbuminuria in children has been found to be associated with obesity and to predict, with reasonable specificity, the development of diabetic nephropathy in type 2 diabetes mellitus.
C. The dipstick may  be falsely positive in patients with highly concentrated urine.
d) orthostatic proteinuria occurs in less than 60% of patient with persistent proteinuria
E)Nephrotic range if greater than 960mg/metre square/ day.

5. Anti neutrophilic cytoplasmic antibody associated vasculitis include the following :
A). Kawasaki disease.
B) henoch schonlein purpura.
C.Takayasu disease.
D) churg Strauss syndrome.
E). Microscopic polyangitis.

Can it be diabetes?

I remember moving through the adult wards  in medical school and the sight of the interns checking the blood sugar of their patients,  from one bed to another without missing any ! Such is the place of diabetes in adult medicine, a very common condition among adults.
In children however, diabetes is not a very common occurrence such that doctors often miss the diagnosis when it occurs in children of resource poor countries. Diabetes in children may disguise as appendicitis, cerebral malaria,urinary tract infections, pneumonia or even typhoid enteritis.
A high index of suspicion is required for diagnosis of diabetes in children.One may need to routinely check the blood sugar of every child that present in the hospital for early diagnosis, treatment and prevention of complications of childhood diabetes.
I have made it a point of duty to bring this to the fore for this week because, it appears there is an increase in its occurrence amongst children seen in my facility in the last few years. This increase is such that in the last one year we have seen three cases, two of whom were initially managed as typhoid enteritis.
I hope to use this medium to educate us about this condition

What is Diabetes? 
Diabetes simply means high blood sugar. It occurs when the sugar in the body (sugar is the end product of almost every thing we eat) is not available for energy generation and also not converted to the storage form, usually the insulin in such a person is not available or insufficient for this conversion, making lack of insulin or insufficient insulin the reason for this excess blood sugar.

Why do people have diabetes? 
The reasons why people have diabetes is not entirely clear;  however, some of the reasons may include:
Genetic abnormalities, infection, and diet.

Family history: children of diabetic parents should be routinely checked as they are often at higher risk.

Infections: some infections are capable of destroying pancreas,  the insulin producing organ in the body, such infections include Mumps,  tuberculosis,  measles, other viral infections

Diet: western diet that predispose to Obesity may in turn predispose to a type of diabetes. Early exposure to "Canned" food with preservatives can trigger allergy/autoimmune reactions that may destroy insulin producing organ (this is hypothetical).

Here is a good news ;  Human breastmilk is protective, it is cheap and unadulterated. Vitamins such as C, D and E vitamins are also protective.
Minerals like zinc ,selenium are also protective .

What are the signs of diabetes in children?
Weight loss: This though not universal and may be subtle is a very common sign,  any unexplained weight loss in childhood must be investigated and the investigation  panel must include blood sugar,  please see your doctor or seek his or her opinion if your child is losing weight, you may even politely request for blood sugar check.

Frequent urination: if you notice that your child is urinating more frequently or too frequently please beckon  on your doctor,. Some of these children may even start to bed wet newly.

 Some children may start to drink water more often.

Some will eat more than before. !

Wounds on their body may not heal on time.

Some may have boil more often .

What to do if any of the above signs is seen?
See your doctor,  preferably  a paediatrician.,
 the complications( stroke,  blindness,  kidney damage to mention a few) of diabetes are serious and may be life long,  these complications are avoidable if diabetes is treated promptly.


To learn more..... Stay tuned.

Leave your questions,  comments or suggestions in the comments  box.

Daily assesment 18/08/17

1)  A mother presented with her 2 year old son who was left in care of her neighbour and was met watching television , he however has rash on the trunk, which was not there before leaving home.
Your registrar suspected physical Abuse and requested that you review before further plan.
Your examination shows widespread petechiae haemorrhage.

1. What four history will help you make diagnosis?
2. Mention Five of your differential diagnosis.
3. Mention three investigations that will help you make diagnosis.
4. The result of some of the investigations  are as shown below:
       WBC: 9000cells/ul.
       PCV: 34 Percent
       Platelet :52000cells/ul.
       Bleeding time : 17minutes.
       Prothrombin time: 12s.
       Activated plasma thromboplastin time: 40s.
a) what is the most likely diagnosis?
b)  Mention five causative agents.
C)  mention four treatment modalities.

2. Your Houseofficer has seen a 4year old boy with history of abdominal distention  of  a year duration,notable findings on  his examination include an abdominal mass extending from the right flank to the midline with smooth surface,   he could get above and below the mass, the child weighs 20kg and has a length of 78cm.

1) Mention four likely diagnosis.
2. Mention two investigations that are of outmost relevance in making diagnosis.
3. The chest radiograph reveal multiple well circumscribed opacities on the lung fields.
a).  What is your most likely diagnosis?
b). Mention four associations that may be expected.
c). What are the likely haematologic findings?
d).  Mention five clinical features expected?
e. Mention four prognostic factors in this patient.


     
   

14/08/17, Daily assessment.

1. You have been managing a twelve year old boy since age seven month, when he presented with history of progressive abdominal  distention , passage of large bulky stool and low weight of four kilograms, he developed  inability to make smooth coordinated movements at age ten.
Parents have no such history.
The peripheral blood film of this boy revealed numerous Acanthocytes.
Which of the following conclusions is/are correct?

(a) The boy may have retinal degeneration.
(B)  This condition is inherited as autosomal dominant.
(C) ricket is an early finding in this condition.
(d) Supplementation  with vitamin E may cure this condition.
(e)  This boy has hypobetalipoproteinaemia.

2. A  4 week old boy being managed by your resident doctors on outpatient basis for an extensive macular rash involving the scalp,  face and the trunk,was noticed to have irregular heart rate, the maternal immunoglobin profile obtained during pregnancy showed elevated anti la antibodies.
Which of the following  conclusions may be right?

(a)  This rash typically last three to four months.
(b) majority of patients with this condition develop progressive cardiomyopathy.
(c) The cardiac arrythmias  in this condition are permanent.
d) This rash is photosensitive.
(e) most feared complication of this condition is hepatitis.

3. expected findings in kwashiorkor include the following:

(a) increase cortisol and growth hormones level.
b)  increase thyroid stimulating hormone level.
(c) high plasma ferritin level.
(d) blood transfusion is indicated for persistent lack of appetite.
(e)  Apathy.

4. A 12yr old boy with recurrent passage of bloody urine since age four has now developed deafness, opthalmogical examination shows extrusion of the lens,  you make the following conclusions :

a)  anterior lenticonus is a pathognomonic feature of this condition.
b)  This patient is at risk of nephrotic syndrome.
C)  This condition can be inherited as autosomal dominant.
D)  The deafness in this condition is acquired.
E)  This condition  occurs as a result of defect in Type one collagen.

5. A two  year old girl whose mother is a vegan present with recurrent ulcer on the lips and tongue, you suspect the patient condition is due to :

a)  lack of enough calorie intake.
b) vitamin B1 deficiency.
c)  vitamin B5 deficiency.
d)  vitamin C deficiency.
e)  vitamin B12 deficiency.

Oral question:

A two year old boy who left the hospital  against medical advice while on chemotherapy  for retinoblastoma because the parent believed the eye swelling was due to spiritual attack,  presented last night with several episodes of convulsions and loss of consciousness  of about forty-five hours, the Glasgow coma score of three,  absent cornea reflex and  dilated and fixed pupils.

 1) what is your diagnosis?
ii) list Five confounders in making this diagnosis.
iii) mention three other reflexes that are likely to be absent.
iv ) mention two investigations that will enable a definitive diagnosis.
v)  describe  apnea  test?