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SAQ 1

A 2 year old girl is BIBA after a head injury. Her parents state she had climbed a gum tree in the backyard, before falling 2 metres and landing on her head. A cervical collar has been applied by SAAS. She is making incomprehensible sounds, thrashing about, and has an extensor response with no eye opening to pain. Her BP is 130/65, HR 90, and RR 8.

1. What is her GCS? Show your calculations for each component. (4 marks)
2. List three steps in your immediate management after the child is taken to the resuscitation room. (3 marks)
3. How is assessment of this child different to that of an adult? (5 marks)
4. List three consults you will seek for this child. (3 marks)

SAQ 2

A 14 year old female is BIBA under CPR after being found submerged in her backyard pool for an unknown length of time. Her parents removed her from the pool and called SAAS. CPR was commenced on SAAS arrival. On arrival to ED, she is GCS 3 and an urgent blood gas shows a pH of 7.1.

1. List five factors in drowning victims that suggest a poor prognosis. (5 marks)
2. After continued CPR, ROSC is achieved. You intubate the patient for airway protection. Briefly state your approach to ventilation in this patient with justification (3 marks)
3. Briefly state the evidence for steroids in this patient. (1 mark)

SAQ 3

Complete the following table comparing croup and epiglottitis. (10 marks)

Symptom/feature	Croup	Epiglottitis
Duration of onset
Cause of illness
Appearance of child
Cough/stridor
Associated symptoms
Common age affected
Temperature
Posture
Treatment(s)

SAQ 4

Complete the following table comparing pyloric stenosis and intussusception. (10 marks)

Symptom/feature	Pyloric stenosis	Intussusception
Age of onset
Male:female ratio
Cause
Signs/symptoms
Metabolic derangement
Diagnosis
Treatment option(s)

SAQ 5

A 6 year old boy is brought in by his mother with a 3 day history of initially watery diarrhoea and vomiting. There is now some blood in the bowel actions. The child is pale, lethargic, with a HR of 160 and a rectal temperature of 37.8°C. Initial pathology shows a creatinine of 170 (60-120μmol/L) and Hb of 70.

1. List five differential diagnoses for the child’s presentation. (5 marks)
2. List four organisms (genera) that may be responsible for his diarrhoea. Underline the most likely cause in this patient. (5 marks)
3. For the most likely organism causing his illness, state three complications and a management option for each. (6 marks)

SAQ 6

A 2 year old child is brought to ED after several episodes of haematemesis. His mother is concerned he may have ingested some of her vitamin tablets. His AXR is shown:

1. What is the likely ingestion? Justify your answer. (2 marks)
2. What is the risk assessment for this ingestion, i.e. what dose mandates admission/treatment? (2 marks)
3. List four symptoms that may occur with this ingestion. (4 marks)
4. State four investigations you will order and justify each. (4 marks)
5. The child is administered an antidote for this ingestion. State a clinical end point for treatment based on the use of this antidote. (2 marks)

SAQ 7

A 3 year old child is brought in by his distraught mother. The child was being babysat by his grandmother when he was found with a handful of medications. The mother and grandmother are unclear which medications, if any, the child had taken; the grandmother’s medications include amlodipine, metoprolol, gliclazide, and digoxin.

The child has a BP of 100/60, HR of 120, and drowsy. His BGL is 0.5. His ECG is shown below:

1. Of the medications listed, which two are the most likely cause of this child’s symptoms? Justify your answer. (4 marks)
2. For the other two medications, give a reason why they are unlikely to be the cause of his symptoms. (2 marks)
3. For the MOST likely toxic cause of his presentation, list two treatment options. (2 marks)