100 data Barakat

35 week old preterm infant. Born at 25 week’s gestation. Ventilated from day
1 to day 27 and on NCPAP of 3.9 cm water pressure on 40-55% O2 until day
66. Now on nasal canula with 0.1 l/min O2.
What does the capillary blood gas show?
What is the most likely diagnosis?
What other investigations would you perform?
• Capillary blood gas
• PO2 4.3Kpa
• PCO2 9.12 Kpa
• pH 7.33
• HCO3 22 Kpa
• BE 3.4
• AlK Ph 900 IU
• ALT 13 IU
• Albumin 31 gm/L
• Urea 2.5 mmol/L
• Creatinine 28 μmol/L
• Bilirubin 22 μmol/L
• Na 133 mmol/L
• K 4.5 mmol/L
• Ca 2.14 mmol/L
• PO4 1.19 mmol/L
• Mg 0.93 mmol/L
Cardiac catheterization was performed in a 6 yr old girl and a heart
murmur was noted
What is the diagnosis?
Should the Child be excluded from exercise at school?
How should this child be follow up?

Pressure Saturation %
SVC 5 70
RA 5 73
RV 60/5 86
PA 60/20 85
LA 11 93
LV 103/60 91
AO 103/60 92
An 8 month old girl presented with history of lethargy, cough and fever for 24
hr. she visited her GP and was diagnosed as having an URTI. Oral amoxycillin
was commenced for 5 days. There was no improvement in condition. She
became more lethargic and unwell. At this point, her GP referred to hospital
for further opinion. She had also developed bruises.

• On examination, pallor, cervicle lymphadenopathy and

hepatosplenomegaly were found.
• Hb 5.5 gm%
• WCC 16.4 (90%) blasts cells
• Plt 66
• INR 0.94
• PTT 43.5 (35-44S)
• What is the diagnosis?
• What investigations are required to confirm the diagnosis?
• What is the immediate mangement?
An 11 yr old girl presented with a history of difficulty in breathing over aperiod of 25 days.
RR 35, SaO2 90-92% in air, BP 110/70. Temperature 37.2 and no lymphadenopathy.
Bronchodilators were prescribed without benefit. Chest movement and air entry on the left
side were reduced with dull percussion notes.

• Hb 12.2 gm%
• WCC 20.2 (N 43%,L 37%,E 17%, M 2.7%)
• Plt 390
• Pleural aspirate performed for diagnostic and treatment purpose
• Protein -46 mmol/L
• Lymphocytes - ++++
• Organisms – none
• Cytology - abnormal lymphocyte
• AAFB – negative
• Culture – Negative
• What the three most likely differential diagnoses?
• Which 2 investigations would you perform next?
A 6 yr old present with a 4 wk history of early morning headache and vomiting. Both
parents are healthy and they own a horse riding school. The boy shows normal
development and good performance at school. He is withdrawn and does not initiate
conversation by himself. He is described by his mother as being clumsy in the last 4 wk.

• On examination
• PR – 60/ min
• RR – 20 / min
• BP[ - 130 /70 mmHg
• Hb – 13.3 gm%
• WCC – 13.7 (N 8.3)
• Plt – 534
• Na– 140 mmol/L
• K – 3.9 mmol/L
• U – 6.5 mmol/L
• Cr – 25 μmol/L
• What is the diagnosis?
• List three possible causes.
• State one investigation as your first choice.
These are the results following an ITT, TRH and LHRH in a short
12 yr old boy
what is the diagnosis?
Which one further investigation is indicated?
Suggest 2 underlying causes.

0 20 min 30 min 60 min 90 min 120

Glucose 5.2 1.8 5.9 7.4 8.6 8.8
Cortisol 507 - 1058 1378 1033 778
GH 16 8.2 7 6 4 13
TSH 2.0 13 - 8.4 - -
FSH 0.6 - 2.6 3.6 - -
LH 1 - 5.6 4.8 - -
An 11 yr old girl present with history of bloody diarrhoea,
intermittent abdominal pain and wrist pain for the last three
days. Weight and height are on the 75th and 50th centiles
respectively. The rest of the the examination is normal.

• On laboratory findings
• Hb – 9.5gm %
• WCC – 7.9
• Plt – 656
• ESR – 58 mm/Hr
• Serum iron – 4.1 ( 4-10)
• Red cell folate and B12 – normal
• What is the most likely diagnosis?
• Name one test to support your clinical diagnosis?
• What organs need to be monitored regularly?
These are the lung functions of a child having difficulty in breathing.
What disease does the child suffer from?
What is the most likely cause?

Pred1.91icted Measured %
FVC 2.41 1.911 79
FEV 2.19 1.76 81
FEV1/FVC 91 92 2
PEF 314 275 88
FEF 1.29 1.14 89
A 2 month old infant presented with FTT and neonatal
hypoglycemia. Hepatosplenomegaly was noted on examination
What is th most likely diagnosis?
What are the diagnostic tests?
What is the prognosis?

• On examination
• Hb – 12.5
• WCC – 5.6
• Plt 56
• Triglyceride 14.5 mmol/L (0.6-1.7)
• Cholesterol 8.4 mmol/L (3-6.8)
• Glucose – 3.8 mmol/L
• Urine uric acid – 3.6 mmol (<2 mmol/L)
What 2 abnormalities show up in the ECG?
What is the most likely diagnosis?
Name three possible therapeutic procedures.
The following are the catheterization results of a 3 day old boy with
congenital heart disease.
What is the diagnosis?
What is the current treatment?

Saturation Pressure
PA 83 24
PV 97
LA 95 10
LV 89 104/10
AO 82 79
9 yr old albino boy has a history of increasing puffiness on his
face and body for last 5 days. There is a history of 3 days of URTI.
The urine is dark in color with hyaline cast.
What is the diagnosis?
What is the underlying cause?

• NA 131 mmol/L
• K 4.6 mmol/L
• U 12 mmol/L
• Cr 110 micromol/L
• BP 128/85
• Passed 400 ml urine in last 24 hours
What is the inheritance?
What is the sibling risk of getting the same disease?
A
b
Give 2 examples the blood diseases with same inheritance.
A 2 week old infant presented with heart failure, which is under
treatment with diuretics and digoxin.. Echocardiography data
show
What is the diagnosis?
What is the most immediate action to be taken?

LV 94/26
Descending aorta 67/43
Across AV 40
RV & RA 12
Sa O2 AO 100% in LV