Use 7.5min for the questions.
Answer true for correct statement and false for incorrect statement
Incorrect answer attract 0.5 mark deduction.
Pass mark is 13/and above.
1. A 2 -day old girl noticed to have bled per rectum, the following may hold true of this patient
A). He may have vitamin k dependent bleeding.
B). He may have swallowed her mother's blood during delivery.
C.)bet-ke test may be important in making diagnosis
D).haemophilia is not a possible diagnosis since the baby is a girl
E). She has necrotizing enterocolitis
2. The following investigation result were obtained for the above child
i prothrobin time ( 20s)
ii plasma thromboplastin time (80s)
iii platelet counts (250000/ul)
iv cloting factors 5 and8 (normal)
Which of the following is /are true statement(s)
A).protein induced in vitamin K absence is a sensitive marker in this condition
B). The level of cloting factors 2,7,9, and 10 may be normal in this condition
C). The patient may have hemophilia A
D. There is impaired post translational decarboxylation of vitamin k dependent clothing factors.
E.Oral vitamin K may be used for prevention of this condition
3. A 4-week old boy has being vomiting, failing to thrive and he is severely dehydrated, the following are some of the differentials to consider
A.) Cystic fibrosis
B.) Galactosemia
(C).Neonatal diabetes
D). pyloric Stenosis
E). Sepsis
4. The above patient (3) was noticed to have cataract and jaundice on examination, blood culture done for the patient yielded Klebsiella sp.
The following are some of your conclusions
A).The boy most likely has Cystic fibrosis
B). Exclusion of glucose from the diet of this boy should be considered
C).The deficient enzyme may be Galactose-1-phosphate uridyl transferase.
D).Symptoms are due to accumulation of galactose in the blood
E.)This boy may suffer mental retardation.
5. The following conditions are commoner in females
A).Patent ductus arteriosus
B). Atrial septal defect
C).Ventricular Septal defect
D). Coaractation of aorta
(E).Pulmonary stenosis
Sunday 30 July 2017
Friday 28 July 2017
Newborn Cord Care
I have chosen to speak out to the public through this medium having kept quiet for so long .
The last straw of events happened this weekend, another baby lost to a very preventable death, through needless hot formentation of the remnant of the baby's cord a means through which, though rare, an infection, a kind that sort of eat up the flesh around the cord occurs , This I must agree is rare occurrence but usually a fatal one.
Before I continue with my rant, may I be permitted to educate us on the universally acceptable means of caring for a newborn umbilical cord remnant.
What is an umbilical cord?
It is a thin rope of fleshy white gelatin that attach a baby to the placenta. It serves as a means of communication between the baby and the placenta (the mother).
It is a passage through which digested food from the mother, oxygen and other essentials of life are passed to the baby. Some of the baby's wastes are also passed through it to the mother for removal.
A baby is delivered of the mother only when the cord is severed after expulsion of the baby through whatever means Vaginal or abdomen (in case of caesarian cut).
The remnant of the severed cord is clamped (tied) as it contained blood vessels and will bleed out all the baby's blood if left unclamped (not tied). This remnant will naturally degenerate and drop off the baby, usually between day 4 and 7 though may rarely remain intact for longer time (maximum 28days), after which it is considered prolonged (Seek medical attention if it has not dropped after 2 weeks).
It usually will drop without leaving any appreciable wound, but may rarely leave an innocous fleshy outgrowth (Seek medical care if you see this).
 |
| Picture of a newborn showing the cord immediately after severance |
Why is the need for special care of the cord?
The process that leads to eventual dropping of the cord produces dead tissue that is slightly foul smelling and must be cleansed off.
The dead tissue is a good medium for bacteria infection and other disease causing agents to grow and multiply so we must clean to prevent this.
What are the ways by which we can care for the cord?
1. Normal baby bath twice daily (where necessary) with warm water containing one to two drops of savlon , towel dry after.
2. The remnant of the cord should not be tucked in to the diaper as it may be readily contaminated with baby's urine and stool.
3. The cord can be swabbed with methylated spirit (alcohol swab) 3 to 6 times daily at regular interval, triple dye or bacitracin, if available, may be applied daily.
4. WHO ( World Health Organisation ) recommends application of chlorhexidine gel (Available in health centres and some pharmacy shops) or savlon cleaning)
5. After the umbilical cord has dropped off, cleaning with methylated spirit should continue for one or two days after which no special care is needed.
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What is fobbiden?
1. Application of cow dung, yes I said cow poo, it is rather a common practice (though has reduced drastically) to see people apply this mess on their baby's cord. This is a dangerous practice as many of such children die of infection and/or tetanus.
2. Hot formentation... This is the cause of my early rant , it is a rampant practise in this part of the world and rather unfortunate as both the very educated and the uneducated are involved.
What is more disheartening is that this is like a tradition passing from one generation to the other.
We have to stand right and stop this right away( Say no to Cord formentation)
It is cruel as many of these children cry ceaselessly and helplessly while going through this torture
The baby is a well formed human , no internal wound of any sort that will be healed with your hot formentation, so stop it.
 |
| Picture of one of the scores of affected children |
 |
| Another victim of our gruesome traditional practice |
4.Application of mentholatum, Robb or Dustin powder is also very dangerous.
Anything other than the above mentioned methods of care can be potentially dangerous , ask from babies doctor before you do them.
Yes that you did it for your baby and you got away with it does not make it right.
I may have been hot formented but I (we) am(are) here to stop these barbaric practises .
We care , God heals.
Leave your comments or questions in the box below
Oral Question 28/7/17.
A 12 year old boy presented in a peripheral hospital with history of abdominal pain, several episodes of vomiting and Loss of consciousness.
He was managed as a case of typhoid sepsis to no avail necessitating referral to you.
You obtained an history of recent weight loss and secondary enuresis that begins about a month prior presentation, he is also dyspnoic with fast deep breathing.
(a) What is Your likely assessment ?
b) Mention two bedside investigations that will help you clinch the diagnosis and your likely findings.
c) Mention 5 risk factors for this type of presentation.
c) Outline 5 principles of managent.
d)What 4 complications can occur acutely in this pateint and explain briefly the pathophysiology of any two.
A 15yr old girl presented in accident and emergency unit with two weeks history of fatigue, headache , joint and chest pain and great discomfort whenever she is expose to sunlight. You noticed that she also has macular rash on the face , pale and has pedal edema.
a) .what is the most likely diagnosis ?
b) Mention two differentials.
c) State 5 of the criteria needed for making diagnosis.
d) Mention five relevant investigations.
e) mention Four drugs that can induce the above condition.
f) mention three medications that may help in treatment of this condition.
A 3 week old boy is brought to your clinic for evaluation , he has
an episode of gross hematuria. , severe respiratory distress, mother volunteer an history of small volume liqour in pregnancy, he appears to have an abnormal facie,
abdominal examination shows a mass palpable to both flanks.
Amongst other abnormal result of investigations is a markedly deranged liver function test
A) What is the most likely diagnosis?
B) list two differential diagnosis
C) Mention four other investigations that may be relevant
D) what two prominent associations are expected
E.mention 5 complications that may arise
F.what will be your treatment plan?
A 10yr old girl present in out patient department with history of pain in the ankles , and the wrists, the joints appear stiff on awakening in the morning.The involved joints are swollen , warm and tender.,
a. What is your diagnosis?
b. Give two differential diagnosis
C.list four investigations you will like to do.
D.Give five classes of this condition according to the international league
E. Mention three complications that may arise
F. Mention four drugs that may be beneficial
What is Macrophages activation syndrome(MAS)?
b. How is the diagnosis of MAS confirmed?
He was managed as a case of typhoid sepsis to no avail necessitating referral to you.
You obtained an history of recent weight loss and secondary enuresis that begins about a month prior presentation, he is also dyspnoic with fast deep breathing.
(a) What is Your likely assessment ?
b) Mention two bedside investigations that will help you clinch the diagnosis and your likely findings.
c) Mention 5 risk factors for this type of presentation.
c) Outline 5 principles of managent.
d)What 4 complications can occur acutely in this pateint and explain briefly the pathophysiology of any two.
A 15yr old girl presented in accident and emergency unit with two weeks history of fatigue, headache , joint and chest pain and great discomfort whenever she is expose to sunlight. You noticed that she also has macular rash on the face , pale and has pedal edema.
a) .what is the most likely diagnosis ?
b) Mention two differentials.
c) State 5 of the criteria needed for making diagnosis.
d) Mention five relevant investigations.
e) mention Four drugs that can induce the above condition.
f) mention three medications that may help in treatment of this condition.
A 3 week old boy is brought to your clinic for evaluation , he has
an episode of gross hematuria. , severe respiratory distress, mother volunteer an history of small volume liqour in pregnancy, he appears to have an abnormal facie,
abdominal examination shows a mass palpable to both flanks.
Amongst other abnormal result of investigations is a markedly deranged liver function test
A) What is the most likely diagnosis?
B) list two differential diagnosis
C) Mention four other investigations that may be relevant
D) what two prominent associations are expected
E.mention 5 complications that may arise
F.what will be your treatment plan?
A 10yr old girl present in out patient department with history of pain in the ankles , and the wrists, the joints appear stiff on awakening in the morning.The involved joints are swollen , warm and tender.,
a. What is your diagnosis?
b. Give two differential diagnosis
C.list four investigations you will like to do.
D.Give five classes of this condition according to the international league
E. Mention three complications that may arise
F. Mention four drugs that may be beneficial
What is Macrophages activation syndrome(MAS)?
b. How is the diagnosis of MAS confirmed?
Thursday 27 July 2017
MCQ: 28/07/17
1. A 4yr old BOY with severe infectious mononucleosis was investigated for immune deficiency , the result shows deficiency in certain adhesive proteins on b and t lymphocytes.
The following is true of this patient immune deficiency.
a). It is an X linked reccesive condition
b). Affected patient may develop acquired hypogamaglobinaemia
c.) This is Duncan disease
d.) Stem cell transplant offers no benefit
e.) Prognosis is very poor.
2. A 5yr old boy rushed into CEW with history of repeated episodes of convulsion of an hour duration, he has had red urine that has being progressively reduce in quantity in the last 12hrs
Examinations reveal an unconscious child , with periorbital fullness and severely elevated blood pressure.
The following are true of this patient
a). C3 hypo complementemia is an expected finding
b) ricketsial is a known cause
c) group B hemolytic streptococcus serotype 12 is a known cause
d.). congestive heart failure is a feature
e) lumpy bumpy deposit of immune complex is seen on light microscopy
3. The serology result of a 7yr old boy is as shown below :
Anti HbC IgG positive
Anti HbS positive
The following are true of this patient
a. He has an acute infection
b. He is a chronic carrier of the infection
C. He is highly infective at this stage
d. He is safe throgh immunization against hepatitis b
e. He is previously infected but has recovered.
4. Molluscum contagiosum
a. A self limited condition
b. Caused by Pox virus
c. Curettage is the treatment of choice
d. Infection is life long
e. Coccidiomycosis is a differential
5. A 2 yr old boy was found with the container of red pills that belongs to his pregnant mother, he has swallowed some of the pills, if the toxic dose is exceeded the following will be True
a) hematemesis within 6hrs of ingestion is expected
b. This patient will benefits from administration of activated charcoal
c. The boy will benefit from whole bowel irrigation
d. penicillamine is the antidote for the ingested pill
e) the antidote is preferably given subcutaneously.
7.5min time allowed
0.5 mark deducted as penalty for wrong options
Score above 20 is excellent
15 to 20 good
10 to 15 is average
The following is true of this patient immune deficiency.
a). It is an X linked reccesive condition
b). Affected patient may develop acquired hypogamaglobinaemia
c.) This is Duncan disease
d.) Stem cell transplant offers no benefit
e.) Prognosis is very poor.
2. A 5yr old boy rushed into CEW with history of repeated episodes of convulsion of an hour duration, he has had red urine that has being progressively reduce in quantity in the last 12hrs
Examinations reveal an unconscious child , with periorbital fullness and severely elevated blood pressure.
The following are true of this patient
a). C3 hypo complementemia is an expected finding
b) ricketsial is a known cause
c) group B hemolytic streptococcus serotype 12 is a known cause
d.). congestive heart failure is a feature
e) lumpy bumpy deposit of immune complex is seen on light microscopy
3. The serology result of a 7yr old boy is as shown below :
Anti HbC IgG positive
Anti HbS positive
The following are true of this patient
a. He has an acute infection
b. He is a chronic carrier of the infection
C. He is highly infective at this stage
d. He is safe throgh immunization against hepatitis b
e. He is previously infected but has recovered.
4. Molluscum contagiosum
a. A self limited condition
b. Caused by Pox virus
c. Curettage is the treatment of choice
d. Infection is life long
e. Coccidiomycosis is a differential
5. A 2 yr old boy was found with the container of red pills that belongs to his pregnant mother, he has swallowed some of the pills, if the toxic dose is exceeded the following will be True
a) hematemesis within 6hrs of ingestion is expected
b. This patient will benefits from administration of activated charcoal
c. The boy will benefit from whole bowel irrigation
d. penicillamine is the antidote for the ingested pill
e) the antidote is preferably given subcutaneously.
7.5min time allowed
0.5 mark deducted as penalty for wrong options
Score above 20 is excellent
15 to 20 good
10 to 15 is average
Wednesday 26 July 2017
Daily mcq
MCQ: Indicate True or False for ALL the options in the questions below.
1. A 28 day old boy with a birth weight of 4.5kg has been having recurrent hypoglycemia. He also has pits in the ear helix bilaterally. The parent request an audience with you to explain their child's condition. You mentioned that the child is at increased risk of having the following tumors
(A) Hepatoblastoma
(B) Neuroblastoma
(C) Wilma tumour
(D) Rhabdomyosarcoma
(E) Gonadoblastoma
2. A 5yr old boy with chief complaint of excessive urination, voiding of large volume urine, failure to thrive, has normal blood sugar.
You make some of the following conclusions
(A) His condition can be caused by hypokalaemia
(B) Hypokalaemia may result from this condition
(C) Diabetes mellitus is a likely cause
(D) The likely deficient hormone has 9-amino acids
(E) C-peptide assay is neccesary for diagnosis
3. A 15year old girl with chief complaint of amenorrhea was observed to have a low posterior hairline, red green colour blindness and a height below two standard deviations from the mean.
The following hold true for this patient
(A) Parental age is a risk factor for this concondition (B) The lost chromosome is of paternal origin in most cases
(C) 99% of fetus with this condition end up in spontaneous abortion
D.This patient may have blood pressure that is higher in upper limbs that in the lower limbs
(E) lyphedema of the extremities is an expected finding
4. A newborn was noticed shortly after birth to have a an erythematous plaque on the left side of the face, the plaque persists on blanching, not tender though warm,an assesment of facial hemangioma is made.
The following hold true
(A) 50% of cases reach maximal involution by age of one
(B)This condition is commoner in boys than girls
(C)the lesion is more likely to get bigger in the next few days
(D)Occurrence is higher in preterms
(E)sodium bicarbonate is useful in the management of this patient.
(5) polydactyly
(A) bilateral involvement in 50% of cases
(B) Mostly pre axial
(C) repair is best at 3rd month of life
(D) may be tied off
(E) Seen in Ellis van creveld syndrome
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1. A 28 day old boy with a birth weight of 4.5kg has been having recurrent hypoglycemia. He also has pits in the ear helix bilaterally. The parent request an audience with you to explain their child's condition. You mentioned that the child is at increased risk of having the following tumors
(A) Hepatoblastoma
(B) Neuroblastoma
(C) Wilma tumour
(D) Rhabdomyosarcoma
(E) Gonadoblastoma
2. A 5yr old boy with chief complaint of excessive urination, voiding of large volume urine, failure to thrive, has normal blood sugar.
You make some of the following conclusions
(A) His condition can be caused by hypokalaemia
(B) Hypokalaemia may result from this condition
(C) Diabetes mellitus is a likely cause
(D) The likely deficient hormone has 9-amino acids
(E) C-peptide assay is neccesary for diagnosis
3. A 15year old girl with chief complaint of amenorrhea was observed to have a low posterior hairline, red green colour blindness and a height below two standard deviations from the mean.
The following hold true for this patient
(A) Parental age is a risk factor for this concondition (B) The lost chromosome is of paternal origin in most cases
(C) 99% of fetus with this condition end up in spontaneous abortion
D.This patient may have blood pressure that is higher in upper limbs that in the lower limbs
(E) lyphedema of the extremities is an expected finding
4. A newborn was noticed shortly after birth to have a an erythematous plaque on the left side of the face, the plaque persists on blanching, not tender though warm,an assesment of facial hemangioma is made.
The following hold true
(A) 50% of cases reach maximal involution by age of one
(B)This condition is commoner in boys than girls
(C)the lesion is more likely to get bigger in the next few days
(D)Occurrence is higher in preterms
(E)sodium bicarbonate is useful in the management of this patient.
(5) polydactyly
(A) bilateral involvement in 50% of cases
(B) Mostly pre axial
(C) repair is best at 3rd month of life
(D) may be tied off
(E) Seen in Ellis van creveld syndrome
Check out for the blogger's view in the evening (7:00pm)
Drop your view in the comment box below.
Share to other group using the share icons below.
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