Transcript Monash Trial Exam Q26

Monash Trial Exam
Q26
Dec 2015
Markers: Deb Leach, Hussein Alabodi
Q1 List 5 differential diagnoses
 Include a list of reasonable diagnoses based on the stem you
have been given
 Think of “things that must not be missed” IN THIS CHILD ie
must be a reasonable list for the picture that has been painted
 Do not repeat every form of sepsis as a possible cause of
fitting
…….better to think of a variety of
pathophysiological causes
Q1 List 5 differential diagnoses
Mandatory inclusions:
 must include meningitis & hypoglycemia
Qualification needed:
 febrile convulsion by definition age more than 6
months
 Unlikely diagnoses eg inborn error of metabolism, NAI
(nothing in stem suggested this)
Q2: State 4 management priorities
Management usually means:
 Supportive care
 Definitive treatment
 Disposition
Seek and treat hypoglycaemia
IV fluids 10-20ml/kg N/Saline
Ceftriaxone / cefotaxmine to treat CNS infection
Anticipate and prepare for further seizure
Early paeds involvement and admission
Q3 Prescribe 2 medications
 Not well done – surprising as we write drug charts so often
 Standard Drug chart (ie drugs not fluids required)
 Date
 Medication in correct space
 Dose is essential – not mg/kg, make a weight assessment and write the
actual dose for this patient
 Frequency and route
Q3 Prescribe 2 meds
 Mandatory:
 Meningitis antibiotics: ceftriaxone or cefotaxime
 Other examples of inclusions WITH DOSES:
 Dexamethasone
 Panadol
 Midazolam (PRN)
 Dextrose
Q4 State 2 rationale for choice of drug
 Need to be specific for the drugs you have chosen
 Better answers included consultant level information
 Eg
“antibiotics for CNS infection”
versus
“antibiotics within 30 mins of arrival at hospital to maximise
survival rate in meningitis”
Q5 Algorithm
 Most difficult section with high variance in marks
 Either knew the algorithm or didn’t
 If didn’t, could make educated guesses and still pass
 If mention a drug, also state its dose and route
 Look at RCH CPG
Q6 List two Ix with one pro and one con
 Need to be reasonable investigations eg LP, pathology, CT
 No marks for MRI, ECG
Broad issues
 Timing
 Long question
 End of the paper – many blank answers
 Consider your technique in pacing yourself
 Handwriting – please be legible
 Calculate weight of child and always include drug doses
 Don’t be daunted by an algorithm you haven’t used:
 Possibly not the best exam question (?guess what I’m thinking)
– my opinion
 Go back to first principles and complete with reference to the
management you would undertake….you should pass