• Mutinta a four-year-old girl presented 3 days ago with

acute bloody diarrhoea. She was hydrated orally and

given nalidixic acid. On review this morning she was
found with severe pallor and was bleeding from the
nostrils Blood pressure is normal. The following are her
laboratory results.
• Hb 6.9gm/dl
• Platelets 50x106 /l
• WBC 6.4x 106/l
• Urea 20mmol/l
• K+ 6.0mol/l
A. What is the most likely diagnosis?

B. What confirmatory tests would you ask the

haematologist to do on the sample of blood
he already has?

• C. What organism is usually associated with

the condition?
 A five-year-old boy is brought to hospital because he has had
a fever for 3 days.
On examination:
Temp 38.6
Tender upper end of the right humerus
Results of the investigation revealed the following

• Hb 5gms%
• WBC 15x103/mm3
• Platelets 155x103/mm3
• Serum bilirubin 220mmol
• Uncongugated <5%
• What is the diagnosis?

• Mention one further investigation you would

do to confirm your diagnosis.

• C. List two important steps in management

• A 4-year-old child is brought to casualty
because he is fitting. The child had been
treated with penicillin injections once daily for
an upper respiratory infection. On
examination he is unconscious with severe
neck stiffness.
• What is the likely diagnosis?

• B. What investigations are you going to do?

• C. Outline management
• A three-month-old infant is admitted with four days of diarrhoea.
The grandmother has been giving formula feed and ORS. He has
been rushed to hospital because he has a prolonged generalized fit
lasting 20 minutes. On examination he is semi comatose, not
dehydrated- temp 37.2ºC
Results
• Blood sugar 4.6mmols
• Na+ 150mmol/L
• K+ 3.5mmol/L
• HCO3 24mmol
• PH 7.35
• What is your diagnosis?

• B. Outline your management

• A 10-month-old baby is brought to your clinic
because the mother has noticed that he has a
weak neck. Born at term, child had a birth
weight of 2.0 Kg. Uneventful neonatal period.
• On examination both weight and OFC are well
below third centile. Anterior fontanelle admits
two fingers and has marked head lag with
generalised spasticity.
•
• A. What is the likely diagnosis?

• B. What investigations are you going to carry

out?

• C. How would you manage this child?

• A 13 year old boy had been known to have
haemophilia since birth. Over the last 24
hours the patient has felt generally unwell. He
has been sweating and shivering, and has
complained of ill-defined abdominal pain. His
motions have become rather loose but he has
not vomited. For the last few hours the pain
has localized to his right iliac fossa and
movement of his right leg has become painful.
• On examination he looks unwell and in obvious pain.
He has a temp of 38.2◦ C. He looks pale and sweaty.
His heart rate is 120 bpm and his BP is 95/60 mmHg.
His heart/breath-sounds are normal. He guards his
abdomen on attempting to palpate his right iliac
fossa but has no rebound tenderness. The rest of his
abdomen is soft and not tender, and no masses are
palpable. He cannot raise his right leg off the bed as
this causes extreme pain.
• Give the MOST likely diagnosis.

• Give ONE differential diagnosis.

• What would be the most helpful

investigation?
• How is this boy’s haematological disorder
inherited?
 A 4 year old is admitted to hospital with a two-month history of
headache. He was born a term, with birth weight of 2.8 kg.
There were no concerns in the immediate neonatal period.
Apart from being treated for clinical Malaria at the age of 18
months at a local clinic, he has been in good health. He is fully
immunized. His development until two months ago was normal
for age. There is nothing of note in the family history.
On examination, Temp 36.6ºC
CNS: Fully Conscious Ataxic gait .Fundoscopy normal
Hypotonic with reduced reflexes bilaterally
The rest of examination essentially normal
• What is your diagnosis (anatomical)?

• List two investigations you would do to

confirm your diagnosis.

• What would be your immediate management

if he became semi comatose?
• A 28 month old child is brought into the ER
with a 2 week Hx of diarrhoea and vomitting.
On examination he has pedal edema 3+, -2 SD,
wasted ,acidotic breathing, CRT 4sec with cold
peripheries and sunken eyes

• OUTLINE YOUR MANAGEMENT.