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.

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?

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?