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MEQ ON FAILURE TO THRIVE

Arif, a 1 year old Orang Asli boy is brought to your KK by his parent for vaccination. From the follow
up book, you noted that his weight has fallen off from 75 th percentile to below 25 percentile over the
period of 6 months.

1) What is this patient’s clinical condition ? (2 marks)

2) List THREE causes that can lead to this condition. (3 marks)

3) State THREE investigations that you would like to do. (3 marks)

On further history taking, you noted that patient still on exclusive breast feeding.

4) What nutritional advice that you would like to give to the parent (2 marks)

Answer:

1) Failure to thrive
2) Causes: caloric deprivation/malnutrition/chronic infections/hyper or hypothyroidism/GI
abnormality-malabsorption//IEM
3) FBC/Renal function/liver function/thyroid function/stool for ova and cyst
4) Advice for weaning of breast feeding and to add additional bottle feeding as well as semi
solid food.
MEQ ON CHILD HEALTH

1. MDM AMINAH, 27 YEARS OLD WOMEN HAS GIVEN BIRTH TO HIS BABY BOY 1 MINUTES AGO ,
ACCORDING TO MALAYSIAN IMMUNIZATION SCHEDULE, WHAT TYPE OF IMMUNIZATION SHOULD BE
GIVEN TO A NEWBORN BABY

A.BCG

B.HEPATITIS B ( 2 MARKS )

2. BASE ON YOUR ANSWER ON QUESTION 1, WHAT IS THE TYPE OF PREPARATION FOR THE VACCINE

A. BCG ( WEAKENED BACTERIUM)

B. HEPATITIS B ( WEAKENED VIRUS ) ( 2 MARKS )

3. WHAT TYPE OF ABSOLUTE CONTRAINDICATION FOR GIVING LIVE VACCINE IN BABY

A. WEAKENED IMMUNE SYSTEM ( HIV BABY, ON LONG TERM STEROID THERAPHY, CANCER
TREATMENT)

B. PREVIOUS KNOWN ALLERGIC REACTION TO THE VACCINE( ANAPHYLAXIS) ( 2 MARKS )

4. GIVE AT LEAST 2 COMPLICATIONS THAT USUALLY CAN HAPPEN AFTER IMMUNIZATION WAS
GIVEN TO A BABY

A.FEVER, SWELLING ON THE INJECTED SITE,LOCALIZED TENDERNESS, ALLERGIC REACTION,DROWSY

( 2 MARKS )
MEQ ON CCF

50 YEARS OLD MAN PRESENTED WITH DIFFICULTY IN BREATHING ESPECIALLY ON EXERTION FOR THE
PAST 1 WEEK. HE ALSO COMPLAINS OF FATIGUE AND INABILITY TO LIE FLAT AS HE FEELS TO
BREATHLESS AND OCCASIONAL WHEEZE ON CLIMBING 2 FLIGHT OF STAIRS. THERE WAS NO HISTORY
OF CHEST PAIN OR COUGH NOTED. HE WAS A KNOWN CASE OF DIABETES MELLITUS ON T.
METFORMIN 1GM DAILY AND TABLET CHLOROTHIAZIDE ONE TABLET DAILY.

ON EXAMINATION HIS RESPIRATORY RATE IS 30 /MIN, BP 160/70, PULSE RATE 100/MIN, PITTING
OEDEMA UP TO MID SHIN BILATERALLY WAS NOTED WITH ELEVATED JVP. CARDIOVASCULAR
EXAMINATION REVEALED TACHYCARDIA, S4 HEARD BUT NO MURMUR. RESPIRATORY EXAMINATION
REVEALED BILATERAL CREPITATION WITH OCCASIONAL RHONCHI. THE HEPATOJUGULAR REFLUX IS
POSITIVE WITH MILD ENLARGED LIVER 2 FINGER BREATHS BELOW THE RIGHT SUBCOSTAL MARGIN

1. WHAT IS THE MOST LIKELY DIAGNOSIS ( 1 MARK)


CONGESTIVE CARDIAC FAILURE ( 1 MARK FOR CCF, 0 MARK FOR OTHER DIAGNOSIS )

2. LIST 4 INITIAL INVESTIGATIONS WOULD YOU ORDER?.( 4 MARKS, 1 MARK FOR EACH ANSWER
)
ECG, RANDOM BLOOD SUGAR, CHEST XRAY, CARDIAC PRO BNP, CARDIAC ENZYMES, RENAL
FUCTION TEST, LIVER FUNCTION TEST

3. HOW WOULD YOU MANAGE THIS PATIENT IN A KLINIK KESIHATAN/ GP CLINIC SET UP ( 5
MARKS, ONE MARK FOR EACH ANSWER )
i. EXPLAINED TO PT THE DIAGNOSIS OF CCF AND OFFER TO TALK TO PT RELATIVE IF
CONSENTED
ii. ARRANGE TRANSFER TO HOSPITAL, WRITE REFERRAL LETTER, CALL UP THE MO IN
CHARGE OF A&E
iii. REASSURANCE, PUT THE PATIENT AT EASE, GIVE O2 TREATMENT
iv. GIVE IV LASIX 80MG STAT
v. SET UP INTRAVENOUS CANNULATION
vi. SET UP CONTINOUS BLADDER DRAINAGE
vii. OFFER FOLLOW UP ONCE PATIENT DISCHARGE FROM HOSPITAL