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Question 1
3 years old boy brought to A&E with signs of dehydration.
1. Patient has been vomiting with high-grade fever.
a. Give 5 questions to ask his mother
i.
Fever: duration, nature, chills/rigors?
ii.
Vomiting: duration, frequency, content of vomitus?
iii.
Any associated symptoms like abdominal pain, urinary
symptoms?
iv.
Any rashes note on the body?
v.
Any family members with similar illness?
b. Sign that you expected
i.
Signs of dehydration such as dry mucosa, decreased
skin turgor and sunken eyeball.
ii.
Fever more than 38C
iii.
Tachycardia and tachypnoea
iv.
Rashes on the body and extremities
v.
Abdominal distension or abdominal pain
c. List the investigation that you would like to do at this
stage
i.
Full blood count to look for increased white blood cell
ii.
Blood urea and electrolyte to look for imbalance sodium
and potassium.
iii.
Blood culture and sensitivity to look for type of infective
organism
iv.
Urine FEME, culture and sensitivity to look for urinary
tract infection
2. After much persuasion, parents agreed for Lumbar
puncture. Lumbar puncture showed increase protein and
decrease glucose.
a. Give 3 organism with their gram stain and appearance
which can cause meningitis
i.
Haemophilus influenzae
ii.
Streptococcus pneumoniae
iii.
Neisseria meningitidis
b. What will you tell the parents about lumbar puncture?
i.
Tell the finding of lumbar puncture
ii.
May be caused by meningitis
iii.
Tell them more about meningitis
iv.
Tell them the treatment, prognosis and complication
v.
Tell them not to worry.
c. What are the appropriate antibiotic for this patient
i.
Ampicillin + gentamicin
d. Why do you think most of the parent will refused
Lumbar puncture?
i.
Because of their false believed that Lumbar puncture
will paralysed their child or cause convulsion
3. CSF showed E. coli which sensitive to netilmycin. But
patient failed to improve his condition after 2 days of
2003 YONG YONGS NOTES
i.
iii.
Talkative
3. MSE revealed gradiose ideation, pressure of speech
a. What is your management of this patient?
i.
Admit this patient
ii.
Give mood stabilized: lithium. Monitor serum lithium
level
4. Patient was started on lithium.
a. What 2 initial investigation do you want to do to this
patient
i.
Thyroid function test
ii.
Renal function test
b. Give 4 side effect of lithium
i.
Hypothyroidism
ii.
Tremor
iii.
Weight gain
iv.
Nausea and vomiting
c. What do you think regarding this patient prognosis and
give your reasons
i.
Poor because
(1)Early onset
(2)Not married yet