DATA 1

Interpret this lab report and answer the questions.

Hb 9.5 Red cell count 2.44

HCT 32

MCV 58

MCH 23

MCHC 26

RDW 21

WBC 10.3 Neutrophils 45

Lymphocytes 55
Monocytes 01
Eosinophils 01
Basophils 01
Platelets 203

1. What abnormal findings do you detect in the lab report?

2. Mention 3 differential diagnosis and justify each.
3. How will you differentiate between your differentials based on this report?
4. What confirmatory tests will you order for each of your differential diagnosis?
5. How will you manage the child?
DATA 2
A 5-year-old child brought to the OPD with failure to thrive. On inquiry mother gave the history
of recurrent loose motions for the last 2 years.
His lab data is as follows:
Anti tissue-transglutaminase IgA (TTG)= 82
(TTG antibody: <4 negative, 4-10 weak positive, >10 positive.)

Sweat chloride 20 mEq/L (10-35 meq/l)

1. What is the likely diagnosis?

2. What relevant questions in the history will you ask to reach to the diagnosis?
3. How will you confirm the diagnosis?
4. How will you counsel the mother regarding this problem?
DATA 3

A 9-months-old boy presented with complaints of progressive pallor from last 2 months. The
mother told that her 2.5 years old daughter had similar problem at the age of 7 months and
since then she requires blood transfusion almost every month. On examination this boy was
anemic and jaundiced. He also had hepato-spleenomgaly.
His labs showed Hb 6.4 mg/dL, MCV 60fL, MCH 27 pg and MCHC 30 gm/dL.
The other report is shown in the image.

1. What is the diagnosis?

2. What is the mode of inheritence?
3. What are the available treatment options that can be offered to this child?
4. How will you council the parents regarding this problem?
DATA 4

2 week after a viral illness, 2 year old child develop bruising and generalized petechie more
prominent on legs. His examination is unremarkable for hepatosplenomegaly and lymph node
enlargement.

Hb 10 gm/dl
WBC 7x109/l
Neutrophils 30%
Lymphocytes 70%
Platelets 25x109/l
Laboratory test are as follows

1. What is your most likely diagnosis? Give justification

2. What further test is required to reach the diagnosis?
3. How would you manage this child?
4. Give 3 differential diagnosis?
DATA 5

A 6 weeks old male child presented with history of vomiting and failure to gain weight.

His laboratory findings are as follows:

Hb: 12gm/dl Na: 126mEq/l ABG’s:

PCV: 40 % K: 2.4mEq/l PH: 7.56

TLC: 8,000/cu.mm HCO3: 28mEq/l PaO2: 118 mmHg

With normal differential Cl: 89mEq/l PaCO2: 42 mmHg

Platelets: 275,000/cu.mm Urea: 50mg/dl HCO3:30mEq/l

Creatinine: 0.6 mg/dl

Q.1 What are the biochemical abnormalities detected in the above data?

Q.2 What is the likely diagnosis?

Q.3 How will you confirm the diagnosis?

Q.4 How will you manage this case?

DATA 6

This is the report of a 3 month old baby boy.

Q1) Interpret the above report.

Q2) What is the likely dignosis?
Q3 ) Mention any 4 clinical features.
Q4) Name 4 associated conditions with this problem.
DATA 7

A 2 months old male child presented with c/o fever for 3 days followed by 2 episodes of fits. On
examination his anterior fontanelle was bulging and had neck retractions. LP was done and CSF
analysis showed the following picture:

Glucose= 30mg/dl
Protein= 101
Wbc= 2500
Rbc=5
Neutrophils= 75%
Lymphocytes=20%
Monocytes=5%

1. What is the interpretation of the report?

2. Mention the causative organisms (any 3).
3. Describe the management plan.
4. Name any 4 complications.
DATA 8
This is the pleural fluids aspirate of the patient.
PH 7.0
Glucose 35mg/dl
Protein 4.5gm
LDH 550 IU/L
Sp. Gravity 1.25
WBC 2000
Neutrophils 80%
Lymphocytes 20%

1. What is the interpretation of the report? Justify.

2. Name 3 possible causes?
3. How will you manage this case?
DATA 9

1. Interpret the report.

2. What is the likely diagnosis?
3. Mention any 4 clinical features.
4. Name any 4 complications.
DATA 10
5 years old male child weighing 13kgs, presented in ER with c/o low grade fever for 1 month.
There is history of weight loss for past 6 months. On examination signs of meningeal irritation
are positive. CSF analysis revealed:
Appearance straw color
Glucose 35
Proteins 550
WBC 220
Neutrophils 25%
Lymphocytes 73%
Monocytes 2%

1. What is the likely diagnosis?

2. What possible clinical findings you will look for?
3. How will you investigate further?
4. Name any 3 complications.
DATA 11

A baby born at term who is one week old is brought to the casualty department
with grunting and poor peripheral perfusion.
His ABG’s and electrolytes are as follows:
PH – 7.08 Na- 142mEq/l
PCO2- 15mmHg K- 4.8mEq/l
Pa02-100mmHg Cl- 110 mEq/l
HCO3- 11mEq/l HCO3- 09mEq/l
BE- -18

Q.1 Interpret the ABG’s report?

Q.2 Calculate the anion gap?
Q.3 What is the normal anion gap.
Q.4 Give 3 possible differential diagnoses for this case?
DATA 12

A 6 year old boy is suffering from fever for last 1 month. He received multiple
antibiotics for his fever but fever did not sub side.
On examination he is pale looking with cervical lymph adenopathy. His liver is 3
cm palpable and spleen is 1 cm palpable.
His CBC report is enclosed.

Hb - 5.5 gm/dl
TLC - 40,000/CC3
Platelets - 20,000/ CC3
1. What are the abnormal finding on CBC?
2. Mention 3 differential diagnoses
3. Which test can confirm the diagnosis?
DATA 13
A 5 year old child came with the complaint of fever, vomiting and decreased oral
intake for three days. On examination he is jaundiced and has mild hepatomegaly.
His LFT revealed

Total bilirubin : 7.39 mg/dl

Direct bilirubin : 3.35 mg/dl
SGPT : 1122 IU/L
ALK PO4 : 172 IU/L
Gamma GT : 60 IU/L

1 What is the likely cause of this illness?

2 How would you confirm the diagnosis?
3 How would you manage this child?
4 How would you prevent this condition?
DATA 14
6 year old Nadia is brought to ER with fits and fever for 2 days. On examination
she is drowsy with GCS 8/15, her CNS examination reveal brisk deep tender
reflexes, rest of examination is within normal limits. Her CSF picture is as follows

Colour : Clear
Protein : 45 mg/dl
Glucose : 80 mg/dl
RBCs : 2/cumm
WBCs : 100/cumm
Neutrophil : 5%
Lymphocytes : 95%

a) What is your likely diagnosis

b) How would you investigate the child
c) Broadly outline the steps of management
DATA 15
10 month old child whose previous weight is 9 kg admitted through ER with
complain of diarrhea and vomiting for 3 days, single episode of fits 2 hrs ago prior
to admission. On examination he is drowsy and tachypanic with current wt of 7 kg.
investigation done showed
Hb : 12 gm/dl PCV : 30

WBC : 9500/cu (N= 45%, L=60%)

BUN : 96 mg/dl Cr : 2.1 mg/dl

Na : 116 meq/l K : 2.5 meq/l

Cl : 100 meq/l HCO3 : 10 meq/l

Blood gases
PH : 7.2

PO2 : 95 mmhg

PCO2 : 20 mmhg

HCO3 : 9

BE : - 18

1) What is the most likely diagnosis

2) What is the cause of seizures
3) List all the biochemical abnormalities in the above mentioned data.
DATA 16
An 8 years old boy presented with the history of recurrent high grade fever for the last 4 months.
His urine DR showed

Color Pale yellow Specific gravity 1.015

PH 6.5 Albumin 1+

WBC 25-30/HPF RBC 10-15/HPF

1. What is your diagnosis?

2. What further investigations would you order to find out the cause?
3. What are possible underlying causes?
4. How would you manage this child?
STATION 17

Instruction for candidate;

Read the scenario and reply to examiner;

2 year old child brought in outpatient with complain of recurrent diarrhea for last 6 months, His
anthropometry reveal weight 7 kg,height 80cm,SD score <-4SD,MUAC=10CM.

Question for examiner;

Q1; What is your diagnosis?

Q2; What questions will you ask to identify the cause of primary malnutrition?

Q3; How will you manage this child?

Q4; What are the discharge criteria from nutritional rehabilitation programme?
STATION 18

A 30 month old child came in ER with complain of loose motion and vomiting for last 5 days. On
examination he is lethargic but refusal to drink with skin pinch goes back very slowly. He was kept on IV
fluids ringer lactate. His investigation reveal following results

Urea = 74 (10-50) mg/dl

Creatinine= 1.4(0.6-1.5) mg/dl

Sodium=136 (135-149) meq/l

Potassium=1.4 (3.8-5.2)meq/l

Chloride=101 (98-106) meq/l

Bicarbonate=18 (22-29) meq/l

Q1; What are abnormal finding?

Q2; What is likely diagnosis?

Q3; What are the complications of this condition?

Q4; What are management steps?

STATION 19

Q4; 5 year old child brought in ER with altered state of consciousness for last 12 hours. He is stuporous
with GCS 9/15 with hepatomegaly and jaundice +ve. On further inquiry it was found that he had yellow
discoloration of conjunctiva for last 10 days. Lab investigation are as follows

S.biuribin=15(0.1-1.0) mg/dl

Direct bilirubin = 13(<0.2) mg/dl

SGPT = 350 (5-35) IU/L

Gamma GT = 35(25-112) IU/L

Alkaline phosphatase = 400(25-112) IU/L

PT = 50 (12-16) sec

CSF DR = normal

Malarial parasite = not seen

Q1; What abnormality shown in this lab report?

Q2; What is your diagnosis?

Q3; What other history /examination point you will look for to reach at etiology?

Q4; What investigations will you advise in order to reach diagnosis?

STATION 20

This is an ECG strip of a 4-year-old child.

Q.1 What is the ECG findings in this rhythm strip?

Q.2 What underlying conditions can cause this finding? Name any four.

Q.3 What is the treatment of this condition?

Q4. What physical examination should you do in this child?

STATION NO.21

At what age would you expect a child to copy the given shapes
correctly and can achieve following mile stones? Give the
appropriate age under each picture.

a)

b)

c)

d)

e)
STATION NO.22

A 2 year old girl weighing 10 kg was admitted with 2 days history of

profuse rice watery diarrhea and severe dehydration. Her serum
electrolyte report is enclosed.
S.Na - 120 meq/l
S.K. - 2 meq/l
Cl - 108 meq/l
HCO3 - 10 meq/l

Q.1 How will you rehydrate the patient?

Q.2After reviewing her laboratory results what are the
complications of gastroenteritis she is suffering from?
Q.3 What further investigations you will perform to confirm the
diagnosis?
Q.4 Briefly outline the steps of management?
STATION NO 23

A 6 year old boy presented with complains of fever with rigors and chills and
vomiting for 5 days. On general physical examination he was pale and his
temperature was 103°F. On systemic examination his spleen was palpable.
His Laboratory data revealed;
Hb: 8 g/dl
MCV: 79 fl
Platelet count: 75,000/mm3
TLC count: 4,500/mm3 with predominate lymphocyte
Urinalysis: unremarkable

1) Give three differential diagnosis.

2) What investigations will you carry out to reach to the diagnosis?
(Justify each)
3) What is the most likely diagnosis?
4) What are the available treatment options?
5) What are the complications of this disease? Mention 3
STATION 24

A 3 year old boy resident of Malir presented with fever for 3 days. On
examination he is febrile with temperature of 102 F. He has no neck stiffness.

1. Classify his illness according to IMCI.

2. What questions will you ask according to IMCI?
3. What other signs will you look for in this case?
4. How will you manage this case?
STATION 25

READ THE SCENARIO AND ANSWER THE QUESTIONS;

A 6 years old boy presents with 3 days h/o high grade fever, vomiting, severe body ache and
headache. On examination he has transient maculopapular rash and few petechiae over lower
limbs. There is no visceromegaly and signs of meningeal irritation. Ultrasound shows mild
ascites and bilateral pleural effusion.

Q1. What is your differential diagnosis?

Q2. What qwill be your initial investigations?

Q3. What is the diagnosis (justify)?

Q4. What other investigations you will like to do to manage your patient?

Q5. How will you treat the patient?

Q6. What are the different clinical presentations of this disease?

Q7. What measure will you take to prevent this disease?

STATION NO.26

Interpret this lab report and answer the questions

Hb 9.5 WBC 10.3

Red cell count 2.44 Neutrophils 45

HCT 32 lymphocytes 55

MCV 58 monocytes 01

MCH 23 eosinophils 01

MCHC 26 basophils 01

RDW 21 Platelets 203

1. What abnormal findings do you detect in the lab report shown above?
2. What is your differential diagnosis
3. How will you differentiate between your differentials based on this report?
4. What confirmatory tests you will order to confirm your differential diagnosis?
STATION 27

A 6 year old boy is brought to the OPD with the complaint of fever for last 1
month. He received multiple antibiotics for his fever but fever did not sub side.
On examination he is pale looking with cervical lymph adenopathy. His liver is 3
cm palpable and spleen is 1 cm palpable.

His CBC report is enclosed.

Hb - 5.5 gm %
TLC - 40,000/CC2
Plalats - 20,000/ CC2

1. What are the abnormal finding on CBC?

2. Mention 2 differential diagnosis.
3. What test can confirm the diagnosis?
STATION 28

An 8 years old boy presented with the history of recurrent high grade fever for the last 4
months. His urine DR showed

Color Pale yellow Specific gravity 1.015

PH 6.5 Albumin 1+

WBC 25-30/HPF RBC 10-15/HPF

1. What is your diagnosis?

2. What further investigations would you order to find out the cause?
3. What are possible underlying causes?
4. How would you manage this child?
DATA 29

A 5-year-old boy presented to the Emergency Department with a history of bone pains,
bleeding from gums, fever and easy bruising for the past two weeks. On clinical examination
he is pale with cervical and axillary lymphadenopathy. Abdominal examination reveals
significant hepatosplenomegaly. CBC reveals Total leukocyte count 30,000/mm 3; Hemoglobin
7g/dl and platelet count 19,000/mm3.

Q 1. What is the most likely diagnosis?

Q 2. What are the differential diagnoses? Mention two

Q 3. What further investigations should be done in this child?

Q 4. What complications do you anticipate in this child? Mention any three

DATA 30

A 5 years old boy is brought to the clinic with periorbital swelling and oliguria
for last three days. His Blood pressure is 130/90mmHg.
His urine analysis shown below:
 Color Reddish
 Specific gravity 1020
 Nitrite Nil
 Albumin ++
 RBC’s Numerous / HPF
 WBC’s 4/HPF
 Bacteria Nil
 Cast RBC’s cast

Candidate Task: Read the Case Scenario and Answer the examiner questions?
DATA 31

A 10 month old child whose previous weight is 9 kg admitted through ER with

complain of diarrhea and vomiting for 3 days, single episode of fits 2 hrs ago prior
to admission. On examination he is drowsy and tachypanic with current wt of 7 kg.
investigation done showed

Hb : 12 gm/dl
PCV : 30
WBC : 9500/cu (N= 45%, L=60%)
BUN : 96 mg/dl
Cr : 2.1 mg/dl
Na : 116 meq/l
K : 2.5 meq/l
Cl : 100 meq/l
HCO3 : 10 meq/l
Blood gases
PH : 7.2
PO2 : 95 mmhg
PCO2 : 20 mmhg
HCO3 : 9
BE : - 18
1) What is the most likely diagnosis
2) What is the cause of seizures?
3) What are the biochemical abnormalities in the above mentioned
data?
DATA 32
2 weeks old baby came with gastroenteritis; on examination he is mildly
dehydrated and has prominent clitoris with bifid scrotum. His laboratory reports
are awaited. His ECG tracing is as follows:

Q.1 Identify 3 abnormal findings in the above ECG?

Q.2 What is the likely diagnosis and associated complication?
Q.3 Briefly outline the steps of immediate management?
DATA 33
A 12 years old boy presents in the emergency department with fits and unresponsiveness. He
has a history of fever and headache for the last 15 days. On examination his GCS is 8/15 with
left sided hemiparesis and positive sign of meningeal irritation. CSF DR reveals; appearance
cloudy, protein 300mg/dl, Glucose 20 mg/dl and WBC, 200 /mm 3 with 70% lymphocytes.

1. What is the likely diagnosis? Give justification

2. How will you investigate the child to reach the diagnosis? List 5
3. How will you manage the patient?
4. Name 3 complications associated with this condition?
DATA 34

A 16 month old child presents to the OPD with diarrhea for the last 3
days. He didn’t pass urine for last 6 hours. His electrolyte report is
shown below.

Na - 128 mEq/L
K - 2.5 mEq/L
Cl - 110 mEq/L
HCO3 - 10 mEq/L

1) Mention clinical signs and symptoms for the assessment of

dehydration according to IMNCI.
2) How will you classify severe dehydration?
3) Write the abnormalities detected in the above biochemical
report?
4) How will you calculate anion gap?
5) How will you manage the child?
DATA 35
A 15 month old girl, weighing 10 kg was admitted with viral
gastroenteritis and severe dehydration. Her serum electrolyte report
is enclosed.
S.Na - 130 meq/l
S.K. - 2 meq/l
Cl - 108 meq/l
HCO3 - 10 meq/l

1) How will you rehydrate the patient?

2) After reviewing her laboratory results what are the
complications of gastroenteritis she is suffering from
3) How would you like to treat them?
DATA 36
A 10 month old child whose previous weight is 10 kg admitted through ER with
complain of diarrhea and vomiting for 3 days he also had single episode of fits 2
hours ago prior to admission. On examination he is drowsy and tachypneic with
weak pulses. His current weight is 7 kg.
Investigation done showed

Hb : 12 gm/dl
PCV : 30
WBC : 9500/cu (N= 45%, L=60%)
BUN : 96 mg/dl
Cr : 2.1 mg/dl
Na : 116 meq/l
K : 2.5 meq/l
Cl : 100 meq/l
HCO3 : 10 meq/l

Blood gases
PH : 7.2
PO2 : 95 mmhg
PCO2 : 20 mmhg
HCO3 : 9
BE : - 18

Questions

1) What is the most likely diagnosis?

2) What is the cause of seizures?
3) List all the biochemical abnormalities in the above mentioned data.
4) How will you manage the child?