PEDIATRICS LONG & SHORT CASE QUESTIONS
CASE 1
Yolam Banda, a 3-week-old infant, youngest of two siblings, presented with jaundice
which started on the first day after birth. His older sibling is healthy with an
uneventful past medical history. On examination he has mild pallor and displays some
abnormal movements.
A. List down what more you would want to know to establish your diagnosis. (3
marks)
B. What is the most likely cause of the abnormal movements? (2 marks)
C. What measure should have been taken on day one to avoid the current
situation? (3 marks)
D. Write down two complications due to the current condition. (2 marks)
CASE 2
Grace Chileshe, an infant weighing 3kg, was born to a teenage mother. Labor was
rather prolonged lasting about 14 hours and was associated with premature rupture of
membranes. Apgar’s score at birth was 6/10, 7/10 at 1 minute and 9/10 at 5 minutes.
Two days later after birth the child developed failure to feed, lethargy, tinge of
jaundice and hypotonia.
A. What is your differential diagnosis? (1 mark)
B. List three investigations other than FBC/DC that must be done in this child. (3
marks)
CASE 3
Arnold Sikama, a 5 year old boy presents to the hospital with a history of chocking
while feeding since 6 months of age. He has a history of having convulsions since 9
months of age. He is unable to sit or talk. On examination, he is underweight,
microcephalic and is spastic in all 4 limbs.
A. What is the full diagnosis of this childs condition? What is Arnolds full
diagnosis? (3 marks)
B. List two possible causes of this condition? (2 marks)
C. List the complication of this condition. (5 marks)
CASE 4
Tevin Phiri, aged 2 years, has had acute diarrhea for the past 4 days. He is severely
dehydrated.
A. Write down 4 clinical signs you would elicit on your physical examination (4
marks)
B. He weighs 13kg, what fluid, how much and how long would you give him to
treat the shock? (6 marks)
CASE 5
Ella, a 6-month-old infant, is admitted with pneumonia (first occurrence) and is able
to feed well. Her mother tested positive for HIV.
A. Write down 5 questions you would ask the mother to assess the risk of HIV
Infection in Ella. (10 marks)
CASE 6
Martha Lutangu, a 9-year-old girl is brought to the Peds Emergency with continuous
generalized tonic clonic seizures for the past half hour. On examination, she is febrile
with no signs of meningeal infection. She has scars of sores she developed as a result
of the thorny bushed while setting up rat traps in Mongu, other systems are
unyielding.
A. What is your differential diagnosis? (3 marks)
B. Give 2 bedside assessments that would help your diagnosis? (2 marks)
C. What is your most likely diagnosis? (2 marks)
D. List down your management principles of this child. (3 marks)
CASE 7
Frenchus, a healthy toddler, is brought to OPD in the middle of the night with
difficulties in breathing which gradually worsened since the early hours of the evening,
he developed a cough and a low-grade fever 2 days ago but has now lost his voice and
is refusing to feed. He missed week 6 and 10 immunizations.
A. What is your most likely diagnosis? (2 marks)
B. Which immunization would have prevented this condition? (1 mark)
C. Write down 3 investigations you would carry out to ascertain your diagnosis. (3
marks)
D. How would you manage his current condition? (4 marks)
CASE 8
A baby girl weighing 3.2kg was admitted to NICU when she was a day old, passing
melaena stools. She breastfed well. The Apt test showed this not to be of maternal
origin. On examination, she was stable hemodynamically with no petechia or
dysmorphic features. Her capillary refill time was 3 seconds. Investigations carried out
are as follows.
Hb: 17.5g/dl, WBC: 10,100/mm3, Platelet count: 207,000/mm3, Thrombin time: 22
seconds (control 3 seconds), PTT: 58 seconds (control 13 seconds), PT: 60 (control
13 seconds).
A. What is your differential diagnosis? (4 marks)
B. Write down the findings in favor of your diagnosis. (4 marks for 2 correct
answers)
C. Line up your management. (2 marks)
CASE 9
Lwito has had rheumatic heart disease for the past 5 years. He has been taking his
daily medication religiously and has enjoyed good health. During Christmas he visited
his grandmother in the village and was happy to reunite with 7 of his cousins. Upon
his return to Lusaka, he developed fever and breathlessness, he looks pale and
complains of pain in the muscles.
A. What is your differential diagnosis? (2 marks)
B. Write two leading causative agents (2 marks)
C. Mention 4 common clinical findings in this condition. (4 marks)
D. Write down investigations you would carry out to support your diagnosis. (2
marks for 4)
CASE 10
You walk into a mall with your 3-year-old toddler and she picks a pack of food with
the following nutritional information per 100g.
Protein: 12g, Maize: 35g, Wheat flour: 70g, Olive oil:3g, Palm oil: 5g, Zinc: 11g
Potassium: 110mg, Vitamin A: 800mcg and Folate: 230mcg.
A. Work out the energy content of this pack. (5 marks)
B. Considering your childs daily caloric requirement is about 1,800Kcal, how
many packs would she require to cover this need. Please show how you solve
for this. (5 marks)
CASE 11
A boy brought into the hospital with difficulties in breathing and swelling of the legs.
The patient indicates that he is unable to sleep supine on the bed as he runs out of
breath. He also indicates that he develops breathlessness after walking for only a few
steps. On examination, the boy has a pan systolic murmur in the mitral area radiating
to the left axilla. He also has anemia and fever as well as splenomegaly.
A. Give your differential diagnosis. (2 marks)
B. Line up investigations based on your differential diagnosis. (0.5 marks per
answer)
C. Which organisms are usually associated with this condition? (1 mark)
D. Which is the most affected age group and why? (1 mark)
E. What is the fill diagnosis of this child? (2 marks)
F. List the heart valve structural problems that this child has. (1 mark per answer)
G. List the investigations you would carry out in this patient. (0.5 marks per
answer)
CASE 12
A 7-year-old girl is brought to LMUTH with a history of increases thirst, passing a lot
of urine, increased appetite and vomiting. She however has lost a lot of weight in the
last 2 weeks. On examination she is severely dehydrated and lethargic with labored
deep breathing. Her investigation results are as follows.
RBS: 16 mmols
PH: 7.25
Urinalysis: Leucocytes trace, protein negative, ketones 2+, glucose 3+.
A. What is your diagnosis? (2 marks)
B. What are the principles of management of this condition? (3 marks)
C. What are the short term and long-term complications of this condition? (5
marks for any 5)
CASE 13
Martha, a 4-year-old girl, has a history of bony pains on and off for 2 weeks. On
examination she is febrile, underweight, pale and in respiratory distress. She has
cervical and axillary lymphadenopathy, sternal tenderness and bony tenderness on her
lower limbs. Her results are as follows.
WBC: 80.6 ×10
Hb: 6g/dl
Platelets: 60×10
A. What further questions would you ask to help determine the diagnosis? (4
marks for any 4)
B. Give 2 differential diagnoses. (2 marks)
C. What investigations would you do to help ascertain your diagnosis? (4 marks
for any 4)
CASE 14
Allan, a 6-year-old boy is referred from Kasisi for convulsions. He has had few
episodes of vomiting, fever and weakness. On examination he is comatose with a
GCS 8/15, pale and jaundiced.
A. Write down 3 possible diagnosis. (5 marks)
B. List down specific investigations to ascertain your diagnoses. (5 marks for any
5)
CASE 15
Arnold, a school going boy, is complaining of headaches for the past few days and
does not concentrate in class. The mother said that she observed some blood stains
on the pillow as she woke him up in the morning of the visit to the clinic. She then
suspected that he might have bitten his tongue at night. On examination, he has mild
periorbital oedema and scars on both legs. He is well nourished and has difficulty
breathing.
A. Write down 2 differential diagnoses. (2 marks)
B. Mention 2 important beside acts you would carry out to ascertain your
diagnosis. (1 mark for 2)
C. List down 4 complementary investigations to help with management. (2 marks)
D. Give 4 principles of management. (4 marks)
CASE 16
Alex, a 13-year-old self-referral, is found seated on the OPD bench. He looks weak
with sunken eyes. He can barely answer questions. He denies any history of diarrhea
and vomiting. On examination he has signs of some to severe dehydration. His
breathing is marked by deep and slow sequences of inspiration-expiration.
A. Write down your most likely diagnosis.
B. List down 3 important investigations you would carry out on him to ascertain
your diagnosis.
C. Give principles of how you manage Alex condition.
CASE 17
Dumisani, a 10-year-old boy of Chazanga, presents with bilateral painless neck
swelling for the last 3 months. On examination there is bilateral cervical and axillary
lymph node enlargement. These lymph nodes are 2-3cm in size, discrete, non-tender
and rubbery. Chest X-Ray shows mediastinal mass.
A. What is the most likely diagnosis? (3 marks)
B. How will you investigate? (4 marks)
C. Outline modes of treatment. (3 marks)
CASE 18
Grace, a healthy 2-year-old toddler, is brough to the OPD in the middle of the night
with difficulties in breathing which gradually worsened since the early hours of the
evening. She developed a cough and a low-grade fever 2 days ago, but has now lost
her voice and is refusing to feed. She missed week 6 and 10 immunizations.
A. What is the most likely diagnosis? (2 marks)
B. Which immunization would have prevented her condition? (1 mark)
C. Write down 3 investigations you would carry out to ascertain your diagnosis. (3
marks for 3)
D. How would you manage her current condition? (4 marks for 4)
CASE 19
Liseli, a 9-year-old school going child has complained of body hotness, generalized
body weakness and loss of weight over the past 6 weeks. On examination he is found
with cervical lymphadenopathy and a slightly distended abdomen. The mother
complained that Liseli always soaked in sweat even when the room is cool.
A. Write down your differential diagnosis. (2 marks per answer)
B. List down all possible investigations you would carry out in this patient. (1
mark per answer)
C. Without going into details of management, give principles of treatment of your
possible diagnoses. (1 marks per answer)
CASE 20
Bwalya, a 6-month-old infant, is brought to you with profuse oral bleeding. He is well
nourished, afebrile and is said to have been well prior to this incident. The informant,
the grandmother, reports that the bleeding was as a result of an accidental laceration
under the tongue caused by a spoon as she tried to feed him. All the attempts to stop
the bleeding proved futile and a surgeon is called to see the child.
His platelet count is 250×103/mm3, Hb 6g/dl.
A. Write down 2 differential diagnoses.
B. If any of your diagnoses is hereditary, specify the mode of inheritance.
C. What is the drug of choice?
CASE 21
A 3-day old infant presents with jaundice which in noted to have started on the first
day of birth. There is a history of 2 prior siblings also suffering from jaundice within
the first few days of life. The first sibling did not suffer from jaundice shortly after
birth. On examination the baby is pale and has a retracted neck.
A. What is the most likely diagnosis? (5 marks)
B. What is the blood group of the mother likely to be and the blood group of the
neonate?
C. A urinalysis is done in order to help with the diagnosis. Indicate the expected
findings.
CASE 22
Esther Mubiana, a 4-month old baby is brough to OPD for not gaining weight. She is
exclusively breastfed and the mother says she sweats profusely while taking feeds. She
was treated for bronchopneumonia at 2 months of age. On examination her weight is
4kg, irritable child with respiratory rate of 45/min and heart rate 140 bpm
A. What is the diagnosis? (3 marks)
B. How will you investigate? (4 marks)
C. List 3 complications of this condition? (3 marks)
CASE 23
Miriam, a 10-year-old girl is brought to the emergency room with a history of
difficulty breathing sine the previous night. She is a known sickle cell disease patient
who has been receiving monthly blood transfusions due to cerebral vascular accident.
She is in severe respiratory distress with a respiratory rate of 70/min, associated with
Sub costal and intercostal recession. Her temperature is 38.7 degrees Celsius. Her Hb
is 7gm/dl and her oxygen saturation is 76% on room air.
A. What are the 2 key differential diagnoses for the condition that the patient is
presenting with? (3 marks)
B. Bedside blood, list 2 further investigations you would carry out. (2 marks)
C. Comment on her hemogram: WBC:22,300 cells/mm3, MCV: 67fL. RDW-CV
25%. (2 marks)
D. How would you manage this child?
TO BE CONTINUED
