Paediatric practical examinations.

Station 1
A mother brings her five year old girl for
consultation’. History reveals that she has been
complaining of general body pains, vomiting and
intermittent abdominal pains. She has lost her
appetite s well. Mother gave panadol at home.
a.Other signs will you ask to confirm your
diagnosis? (2marks)
 Fever, IMCI any fever = Malaria
b.How will you manage the case
1.How would you manage this case?
2.LA _ (dose to be given)
3.Pcm – Dose
4.OPD case
5.Encourage feeding
c. You are asked to see the same girl at mid
night. The mother complains that the illness is
getting worse ie. She is vomiting everything
  How will you classify vomiting everything
(A danger sign according IMCI)
d.What other four significant features will you
ask for or observe (4marks)
 Lethargy
 Loss of consciousness
 History convulsions or convulsing now
 Refusing to eat
e.What is your Diagnosis now? (2 marks)
 Answer: Severe malaria
f. How would you manage the case now at
health centre level (5 marks)

Espected answers
 Quinine 10 mg IM start
 ORS as much as possible
 10% glucose IV push 5ml/kg
 BF for malaria taken
 Encourage feeding while waiting transport
 Document and refer patient to hospital
for further management
 g.Mention the most two common forms of
severe malaria in Malawi (2 marks)

Expected answerers
 Severe malaria with severe anaemia
 Cerebral malaria

Station 2

A 10 month old bay present to you with a history

of passing watery stools, vomiting, following two
days of common cold.
On examination she is :-
i. lethargic
ii. No fever.
iii. Sunken eyes

a.Classify the Diarrhoea

 Expected answer: Diarrhoea with sere
dehydration

b.Why have you given this classification

Answer
i. Lethargic
ii. sunken eyes
c. What other significant futures will you be
interested to know. What will be your
expectations (2 marks)
i. Skin pinch very slow to return
ii. Refusing to eat anything
d.How will you manage the case (5marks)

Expected answers
i. Ringers lactate 100/kg ( 2 Mark)
ii. 3oml/kg to run in ½ hour ( ½ Mark)
iii. 70mlkkg to run in 3 ½ ( ½ Mark)
iv. ORS as much as possible (1Mark)
v. Glucose 10% 5mls/kg ( ½ Mark)
 vi. Encourage feeds ( ½ Mark)
vii. Reassess every 6hours and implement a
new plan accordingly (1 mark)

Section 3

Malnutrition has been classified as acute or

chronic, severe acute.
Malnutrition is present quite often in Malawi
due to shortage of food, manly during dry
season.
a.Mention one common form of severe acute
malnutrition in Malawi you know
Possible answers
i. Severe marasmus
ii. Severe marasmic kwashiorkor
iii. Severe kwashiorkor
b.How does severe acute malnutrition
present commonly (5 marks)
Possible answers
i. Wasting
ii. Apathy
iii. Oedema
iv. Thin loose hair
v. Organomegally (spleen, Liver)
c. Mention the gold indicators used to asses
MN? (3 marks)
Possible answers
i. MUAC 11 CM OR 110 MM
ii. Bilateral oedema
iii. WH below 75%
Station 4
A 4 years old girl comes for consultation with the
mother. She complains of problems to breathe
properly following 3 days of fever and poor
appetite. On examination there is palmer pallor
and dyspnoea

1.How do you asses for pallor?

a.Comparer the palms of the patient with
those of the mother
2.Dyspnoea – four (4 marks)
a.Nasal flaring
b.Fast breathing
c. Sub costal / intercostals resonance
d.Granting in young babies
3. What is your diagnosis?
a.Severe Anaemia
b.Malaria
4.Give dosage for the following.
a.Iron 6mgs /kg
b.Blood cells 10ml/kg
5.When do think it appropriate to transfuse?
a.Hg below 5grm /dl
b.Features suggesting heart failure ie gallop
enlarged spleen oedema
6. When is frusimide indicated?
a.In malnourished cases
b.When transfusing whole blood