pediatrics test 2005,2006,2007,2008 clicking for practics (JSM)

A child from thefirst non-complicated pregnancy but complicated labor had
cephalhematoma. On the second day there developed jaundice. On the 3th day appeared
changes of neurologic status: nystagmus, Graefe’ssi-gn. Urea is yellow, feces- golden-yellow.
Mother’s blood group is (I I )Rh−, child-(I I )Rh+. On the third day child’s Hb is 200 g/L,
RBC- 6, 1 ∗ 1012/L, bilirubin in blood - 58 mkmol/L due to unconjugated bilirubin, Ht- 0,57.
Whatisthechild’sjaundiceexplanation?

A full-term new-born suffered ante-and intranatal hypoxia, was born in asphyxia (Apgar
score 2-5 points). After birth baby’s excitation is progressing, occurs vomiting, nystagmus,
spasms, squi-nt, spontaneous Babinski and Moro’s reflexes. What is the most probable locati-on
of the intracranial haemorrhage in this case?

A child was delivered severelypremature. After the birth the child has RI symptoms,
anasarca, fine bubbling moist rales over the lower lobe of the right lung. Multiple skin
extravasations, bloody foam from the mouth have occured after the 2 day. On chest X-ray:
atelectasis of the lower lobe of the right lung. In blood: Hb-100 g/L, Ht- 0,45. What is the most
probable diagnosis?

A child was born at 34 weeks ofgestation in bad condition. The cardi-nal symptoms show
respiratoty disorders: sound prolonged expiration, additional muscles taking part in breathing,
crepitati-on rales on the background of the rough breath sounds. Assesment according to
Silverman’s scale was 0, in 3 hours- 6 with presence of clinical data. What diagnostic method
can determine pneumopathy’s type in the child?

Full term newborn has developedjaundice at 10 hours of age. Hemolytic disease of newborn
due to Rh-incompatibility was diagnosed. 2 hours later the infant has indirect serum bili-rubin
level increasing up to 14 mmol/L. What is most appropriate for treatment of hyperbilirubinemia
in this infant?

A newborn aged 3 days with hyperbi-lirubinemia (428 mkmol/L) developed following
disorders. From beginning there were severe jaundice with poor suckling, hypotomia and
hypodynamia. Little bit later periodical excitation, neonatal convulsions and neonatal primi-tive
reflexes loss are noted. Now physi-cal examination reveals convergent squi-nt, rotatory
nystagmus and setting sun eye sign. Howto explain this condition?

A mother of a newborn child suffersfrom chronic pyelonephritis. She had acute respiratory
viral disease before the labor. Labor in time, with prolonged period without waters. A child had
erythematous eruption on the 2 day, then there were seropurulent vesicles about 1cm.
Nikolsky’s symptom is posi-tive. Erosions have occured after vesi-cle rupture. The child is
flabby. The temperature is subfebrile. What is the most probable diagnosis?

An unconscious patient presents wi-th moist skin, shallow breathing. There are signs of
previous injection on the shoulders and hips. BP- 110/70 mm Hg. Tonus of skeletal muscles and
reflexes are increased. Cramps of muscles of the extremities are seen. What is the most li-kely
disorder

A 6 y.o child complains of thirst,polyuria, increased appetite for 2 months with weight loss
for 3 kg. There has been nocturnal enuresis during last week. On examination: hyperglycemia 14
mol/L. The diagnosis is diabetis mellitus I type. Whatisthegenesisofthisdisease

A full-term new-born suffered fromante- and intranatal hypoxia, was born in asphyxia
(Apgar score 2-5 points). After birth baby’s excitation is progressi-ng, occurs vomiting,
nystagmus, spasms, squint, spontaneous Babinski and Moro’s reflexes. What is the most
probable locati-on of the intracranial hemorrhage in this case?

A baby boy was born in time, it was hismother’s 1st pregnancy. The jaundice was revealed
on the 2nd day of life, then it progressed. The adynamia, vomiting and hepatomegaly were
presented. The indi-rect bilirubin level was 275 mcmol/L, the direct bilirubin level - 5 mcmol/L,
Hb- 150 g/L. Mother’s blood group - 0(I ), Rh+, child’s blood group - A(I I ), Rh+. Make a
diagnosis.

A full-term newborn child has a di-agnosis Rh-factor hemolytic disease of newborn.
Bilirubin rate is critical. The chi-ld’s blood group is В(III), his mother’s blood group - А(II).
The child has indi-cation for hemotransfusion. What donor blood must be chosen?

A mother of a newborn child suffersfrom chronic pyelonephritis. She had acute respiratory
viral disease before the labor. Labor in time, with prolonged period without waters. A child had
erythematous eruption on the 2 day, then there were seropurulent vesicles for about 1cm large.
Nikolsky’s symptom is positive. Erosions have occured after vesicle rupture. The child is
flabby. The temperature is subfebrile. What is the most probable diagnosis?

A 15 y.o. patient has a developmentallag, occasionally he has skin yellowi-ng. Objectively:
spleen is 16х12х10 cm, cholecystolithiasis, skin ulcer of the
lower third of left crus. Blood count: RBC- 3, 0 ∗ 1012/L, Hb- 90 g/L, C.I.-
1,0; microspherocytosis, reticulocytosis. Total serum bilirubin is 56 mcmol/L, unconjugated - 38
mcmol/L. What therapy will be the most appropriate?

A 15 y.o. girl was examined. Her medical history registers gradual onset of fever, malaise,
loss of weight. There was nothing typical about the kind of fever which has been present for
more than 7-10 days and changed quickly. Physical examination di-dn’t give evident results.
What is the only most important examination for excluding miliary tuberculosis?

A 7 y.o. boy suddenly felt pain inhis right knee, it became edematic. The day before he took
part in a cross-country race. Family anamnesis has no data about hemophilia and bleeding sickness.
Objectively: body temperature is 37,50 . The knee is painful, hot to the touch, edematic
with local tissue tensi-on over it. Blood count: Нb- 123 g/L, leukocytes - 5,6 ∗ 109/L,
thrombocytes - 354 ∗109/L, prothrombin time - 12 seconds (normally 10-15 seconds), partly activatedthromboplastin
time - 72 seconds (normally 35-45 seconds). Hemorrhage ti-me is normal,
VIII:C factor is 5% of norm. Whatisthemostprobablediagnosis?

2 month old child who was born wi-th body weight 5100 g has jaundice, hoarse cry,
umbilical hernia, developmental lag. His liver is +2 cm, spleen isn’t enlarged. Stool and urine are
of normal color. In anamnesis: delayed falling-away of umbi-lical rest. Blood count: Hb- 120
g/L, RBC- 4, 5 ∗ 1012/L, ESR- 3 mm/h. General level of serum bilirubin - 28 mcmol/L,
unconjugated bilirubin - 20 mcmol/L, conjugated bilirubin - 8 mcmol/L. What disease would you
think about first of all?

A full-term child survived antenataland intranatal hypoxia, it was born in asphyxia (2-5
points on Apgar score).
Afterbirth the child has progressing
excitability, there are alsovomiting,
nystagmus, spasms, strabismus,
spontaneous Moro’s and Babinsky’s
reflexes. What localization of intracrani-al hemorrhage is the most probable?

A full-term newborn child has a diagnosis newborn’s Rh-factor hemolytic di-sease.
Bilirubin rate is critical. The child’s blood group is B(I II ), his mother’s blood group - A(I I ).
The child has indication for hemotransfusion. What donor blood must be chosen?

Mother of a newborn child suffersfrom chronoc pyelonephritis. Shesurvi-ved acute
respiratory viral infection di-rectly before labour. Delivery was at term, the period before
discharge of waters was prolonged. On the 2-nd day the child got erythematous rash, later on -
vesi-cles about 1 cm large with seropurulent content. Nikolsky’s symptom is positive.
Dissection of vesicles results in erosions. The child is inert, body temperature is subfebrile.
What is the most probable di-agnosis?

A newborn child has purulent discharges from the umbilical wound, skin around the
umbilicus is swollen. Objecti-vely: the child’s skin is pale, of yellow-greyish colour,
generalized hemorrhagic rash. Body temperature is of hectic nature. What is the most probable
diagnosis?

An infant is 2d.o. It was full-termborn with signs of intrauterine infection, that’s why it
was prescribed antibiotics. Specify, why the gap between antibiotic introductions to the newborn
children is longer and dosage is smaller compared to the older children and adults?

A 16 y.o. female presents with abdominal pain and purpuric spots on the skin. Laboratory
investigations reveals a normal platelet count, with haematuria and proteinuria.The most likely
diagnosis:

What of the mentioned anti-febrile medications are contraindicated to this patient?

A 13 y.o. teenager who suffers fromhemophilia A was taken to the hospi-tal after a fight at
school. His diagnosis is right-sided hemarthros of knee joint, retroperitoneal hematoma.
Whatshouldbeprimarilyprescribed?

A 2m.o. child with birth weight5100 g has jaundice, hoarse cry, umbi-lical hernia,
physical development lag. Liver is +2 cm enlarged, spleen is not enlarged. In anamnesis: delayed
falling-away of umbilical cord rest. In blood: Hb- 120 g/L, erythrocytes - 4, 5 · 10 12/L, ESR- 3
mm/h. Whole serum bilirubin is 28 mcmole/L, indirect - 20 mcmole/L, direct - 8 mcmole/L.
What is the most probable diagnosis?

A child is 1 day old. During deliverythere had been problems with extraction of shoulders.
Body weight is 4300,0. Right arm hangs down along the body, hand is pronated, movement in
the arm is absent. "Scarf"symptom is positive. What is the most probable diagnosis?

A woman born a child. It was herfithpregnancy but the first delivery. Mother’s blood group
is A(I I )Rh−, newborn’s - A(I I)Rh+. The level of indirect bilirubinin umbilical blood was 58
micromole/l, hemoglobin - 140 g/l, RBC- 3, 8·1012/l. In 2 hours the level of indirect bilirubin
turned 82 micromole/l. The hemolytic disease of newborn (icteric-anemic type, Rhincompatibility)
was diagnosed. Choosethetherapeutictactics:

A 28 year old woman had the secondlabour and born a girl with manifestati-ons of anemia
and progressing jaundice. The child’s weight was 3 400 g, the length was 52 cm. The woman’s
blood group is B (I II) Rh−, the father’s blood group is A (I II) Rh+, the child’s blood group is B
(I II ) Rh+. Whatisthecauseofanemia?

A full-term infant is 3 days old.On the different parts of skin there are erythemas, erosive
spots, cracks, areas of epidermis peeling. The infant has scalded skin syndrome.
Nikolsky’ssymptom is positive. General condition of the infant is grave. Anxiety,
hyperesthesia, febrile temperature are evident. Whatisthemostprobablediagnosis?

A 5 month old boy was bornprematurely, he didn’t suffer from any disease at the infant age
and later on. Examination at an outpatient’s hospi-tal revealed paleness of skin, sleepiness.
Blood count: Hb - 95 g/l, erythrocytes - 3, 5 · 1012/l, reticulocytes - 90/00, colour index - 0,7
osmotic stability of erythrocytes - 0,44-0,33%, serum iron - 4,9 micromole/l. What is the most
probable cause of anemia?

An 8 year old child has low-gradefever, arthritis, colicky abdominal pain and a purpuric
rash llocalized on the lower extremities. laboratory studies reveal a guaiac-positive stool,
urinalysis with red blood cell (RBC) casts and mild protei-nuria, and a normal platelet count.
Themostlikelydiagnosisis:

A 9 year old boy has been sufferi-ng from diabetes mellitus for a year. He gets insulin
injections (humulin R, NPH), the dose makes up 0,4 units per 1 kg of body weight a day.
Insulin is untroduced subcutaneously (into the shoulder) by means of a syringe. What measures
should be taken in order to prevent lipodystrophy?

Which of the following IS NOT TYPI-CAL for Addison’s disease?