1

[1]
A 14 mo old, breast fed male infant was noticed to
get edema of both lower limbs, pallor, angular
stomatitis and became irritable, with poor appetite
and lost smiling. He has mild hepatomegaly, with
no ascites, and no jaundice. His serum K+ was 2.3
mEq/L, Na+ 128 mEq/L, blood sugar 56 mg/dL,
plasma albumin 1.5 gm/dL and Hb was 8.3 g/dL.
Q1] What is the diagnosis?
Q2] Mention an important differential diagnosis?
Q3] Mention other important investigations?
Q4] Mention three complications of such disease?

2
 1 Answers
1. PCM, Kwashiorkor
2. Nephrotic Syndrome
3. Urine albumin, LFT, Serum cholesterol
4. Infections, Hypokalemia, Hypothermia

3
KWO
Miserable Look
Angular Stomatitis
Dermatosis
Puffy eyes
Red hair
Sparse hair

4
KWO
Edema
Dermatosis
Ms wasting

5
KWO
Miserable Look
Angular Stomatitis
Edema of legs
Dermatosis (Flaky paint)
Puffy eyes
Pallor
Sparse hair 6
 [2]
A 9 yrs old boy, after 27 days of taking a meal from outside
home, has fever, abdominal pain, excessive somnolence, and
severe anorexia with vomiting and abd pain.
He passed deeply yellow-colored urine, and has yellow sclera,
and itchy skin. Liver was felt 5 cm below costal margin, soft
and tender, with no splenomegaly.
S.ALT= 345 u/L, S.AST= 623 u/L, T S Bil= 4.9 mg/dL, with D.
Bil. 3.7 mg/dL. PT was 16 sec.
Q1] What is the diagnosis?
Q2] What are the normal for abovementioned values?
Q3] What investigations required to know the causative agents?
Q4] What is the most serious complication?
Q5] How to protect his household and close contacts?

7
 2 Answers

1. Acute hepatitis A
2. S ALT < 30 u/L, S AST < 35 u/L, S T Bil < 1.2
mg/dL, D Bil < 0.4 mg/dL, and PT 12 sec.
3. Serum Ig M and Ig G against hepatotropic
viruses, and PCR.
4. Fulminant hepatic failure, in 1-2 % within 8 wks
after onset of the disease.
5. Immunoprophylaxis by Human serum
immunoglobulin,(0.02 mL/Kg within 2 wks after
exposure)

8
 [3]
A 3 yr old girl presented with a sudden onset of
fever, vomiting, headache and stiff neck.
CSF reveals WBC 380 cells/mm³, with 60% PMNLs;
glucose 35 mg/dL, & protein 102 mg/dL.
Random Bl sugar was 97 mg/dL.
1. What is the most accepted diagnosis?
2. Mention 3 common causative agents?
3. Give 3 common complications !
4. Mention a drug for decreasing ICP and its dose!
5. Mention another method to detect the
organisms in case of sterile culture !

9
3 Answers
1. Acute Bacterial meningitis
2. HiB, Strept Pneumonie, N.
Meningitidis
3. Sepsis and DIC, Abscess
formation, Sensorineural deafness
4. IV infusion of Mannitol 0.5-1
gm/Kg
5. Latex agglutination test
10
 [4]
A previously well 4 mo old infant has had a runny
nose for 2 days. Four hours ago, he has cough,
RD, irritability, and inability to suckle.
On exam. he has hyperexpansion of the chest, and
audible wheezing without rales.
CBC showed WBCs 6.8 x103/cmm, 63% Lymphocytes,
and PaO2 47 mm Hg, PaCO2 58 mmHg, and pH
7.3
1. What is the most likely diagnosis?
2. What is the most likely organism that causes this
disease?
3. Mention a specific drug used for the causative
agent?
4. Mention 3 complications?
11
4 Answers

1. Acute bronchiolitis with ARF

2. RSV
3. Ribavirin aerosol
4. ARF, Infection, HF, Air leak.

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Interstitial Bilateral
Air leak Pneumothorax

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 [5]
A 3 yr old girl has a 5-day history of dark-colored
urine. Physical exam reveals hypertension and mild
edema. Urinalysis reveals RBCs 65 /HPF, WBCS
32 /HPF, RBCs casts and mild proteinuria. ASOT
is 800 U/L.
1. What the most accepted diagnosis?
2. Mention 3 complications that may occur in this
disease.
3. Mention 3 other important investigations !
4. What are the main lines of drug treatment?
5. What is the definition of microscopic Hematuria !
6. *Indications of renal biopsy in this case
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5 Answers
1. Acute Post Strept.Glomerulonephritis
2. ARF, Hypertensive Encephalopathy,
Hypertensive HF
3. Serum C3, Blood urea, Serum
creatinine
4. Eradication of Streptococci,
Antihypertensives,
5. > 5 RBCs / HPF, Centrifuged, Fresh,
10 mL urine sample.
6. *Normal ASOT, normal c3,Rapidly progressive renal
failure,massive proteinuria&Uncontrolled HTN 15
Nephritic
Syndrome

APSGN
Periorbital
Edema
(Slit eyes)

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 [6]
An 8 yr child has periorbital, scrotal, and LL edema.
There is soft enlarged liver and positive shifting
dullness.
He has urine volume of 0.5 ml/kg/hr, protein of 56
mg/M2/hr, and lipid casts. Serum C3 is normal,
albumin 2.1 gm/dL, and cholesterol 342 mg/dL.
1. What is the diagnosis?
2. What is the definition of significant proteinuria?
3. Mention 3 important complications of this disease
!
4. Mention 3 important indications for renal biopsy !
5. Give the normal for the abovementioned lab
values !
17
6 Answers
1. Nephrotic syndrome (idiopathic)
2. Urine protein >4-<40 mg/M2/Hr
3. Pneum peritonitis, Renal vein
thrombosis, Growth failure
4. Low C3, Resistant / dependent,
persistent hematuria, Renal failure,
5. Urine vol 1-1.5 ml/Kg/Hr, Ptn <4
mg/M2/Hr, Serum albumin 4-6
gm/dL, Cholesterol 150- 200 mg/dL
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 Nephrotic
Syndrome
Onset of the
disease
7 yrs old girl
developed
edema and
7 yrs old
oliguria
over several
weeks
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Nephrotic
Syndrome

Puffy eyes
And
Cushingoid
appearance

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Nephrotic
Syndrome
On steroids
[alternate-
day therapy]

21
 [7]
An infant, 10 Mo old, on buffalo milk, has
vomiting, watery diarrhea, and excessive
thirst.
He was given excessive ORS. During IV
rehydration he developed convulsions aborted
by anticonvulsants. His serum Na+ was 156
mEq/L, blood pH 7.1, and total serum Ca was
7.3 mg/dL.
1. What is the diagnosis?
2. What are the other signs of dehydration
expected in this case?
3. Mention 3 probable causes of convulsions !
4. What is the percentage of this type of
dehydration in this case !
5. *Composition of WHO ORS???
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7 Answers
1. Acute GE, with hypernatremic dehydration
2. Depressed AF, Lack of tears, Dry tongue,
fair skin elasticity, irritability, and
insomnia
3. Cerebral edema, Cavernous sinus
thrombosis, ICH, CNS
infection,hypocalcemia
4. Hypernatremic dehydration is ~ 5-15%

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 Composition of WHO ORS

Na 90 110mmol/L

Cations K 20

Anions CL 80 110mmol/L

HCO3 30

Organic Glucose 111mmol/L

substances
 [8]
A 6 yr old child developed painful swollen both
knees with non itchy maculo-papular and
echymotic rash over the buttocks and lower
limbs and darkly red urine.
Platelet count was 322x103/cmm.Urine RBCs were
43/HPF, protein 33 mg/M2/Hr, and RBC casts.
ASOT was < 200 u/L.
1. What is the diagnosis?
2. What are other serious complications?
3. What are the indications of corticosteroid
therapy in such case?
4. Is there a disturbance of platelet functions?
5. Give the normal for the abovementioned values!
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8 Answers
1. Henoch-Schoenlein purpura
2. GN, Rectal Bleeding, cerebral
vasculitis
3. All of the above
4. No platelet dysfunction
5. Plt count 150-450 x103/cmm
Urine RBCs <5/HPF, No RBCs casts,
Urine ptns <4mg /M2/Hr,ASOT <400
u/L.
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Non itchy, echymotic rashes, over the lower limbs, sparing the trunk
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 [9]
A 4 yr old girl suffers abdominal pain with dysuria,
nocturia, and urinary urgency. There is history of
similar attacks since 1.5 yrs. Urine showed WBCs
>100/HPF, RBCs 56/HPF, and No casts. Urine
volume was 1.3 mL/Kg/Hr.
1. What is the diagnosis?
2. Mention 3 important complications!
3. Mention 2 important imaging investigations!
4. What is the important cause for recurrence?
5. Is there a probable role for surgery?

28
9 Answers
1. Recurrent UTI
2. Renal scarring, Pyelo-nephritis,
Sepsis, Growth failure.
3. Ascending cystourethrography
(ACUG), DMSA Scan,
4. Presence of VUR
5. In grade 4 and 5 VUR

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30
Lt VUR,
Grade V

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 [10]
A 3 yrs old child has severe stridor, RD, drooling of
saliva, dysphagia, and high fever.
He is toxic, irritable, and always sitting in bed
leaning forward.
CBCs showed leukocytosis, with neutrophilia. CRP was
48 mg/dL, ABG showed hypoxemia.
1. What is the diagnosis?
2. What is the commonest causative agent?
3. What is the abnormality seen in a requested X-
Ray?
4. What is the emergency treatment required?
5. Mention 2 suitable antibacterial drugs for such
child?
32
10 Answers
1. Acute epiglottitis
2. Hib
3. Enlarged shadow of the epiglottis,
encroaching on the air column
“Thumb sign”
4. Tracheostomy / ETT
5. Ampicillin / 3rd generation
cephalosporins.

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 Acute
Epiglottitis
(Thumb Sign)

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Thumb Sign

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Acute Epiglottitis
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