BHS20402 PBQ REVISION

1.     An 8-year-old girl is brought to the clinic due to several episodes during early morning hours over the past month. Her parents describe involuntary jerking movements of her left arm and face, sometimes associated with drooling and difficulty speaking. The episodes last 1–2 minutes and she appears tired and disoriented afterward. Her school performance has declined slightly. There is a family history of epilepsy in her older brother.

a. List THREE (3) clinical features that suggest focal epilepsy.

b. State THREE (3) investigations that will aid in confirming the diagnosis.

c. Outline FOUR (4) important components in the long-term management plan.

Answer explanation

Focal epilepsy is suggested by unilateral jerking movements, postictal tiredness, and speech difficulties. Investigations include EEG, MRI, and blood tests. Long-term management involves medication, education support, regular follow-ups, and safety measures.

1.     A 2-year-old previously healthy boy is brought to the emergency department after experiencing a seizure. His mother reports that he had a high fever (39.5°C) earlier in the day due to a recent upper respiratory infection. The seizure lasted approximately 3 minutes and involved generalized limb jerking. He returned to baseline shortly after the episode. There is no family history of epilepsy. This is his first seizure.

a. Identify THREE (3) features that suggest a febrile seizure.

b. List THREE (3) investigations that may be considered in this patient.

c. Describe FOUR (4) key steps in the management and follow-up of this child.

Answer explanation

Features suggesting a febrile seizure include: age (2 years), recent fever (39.5°C), and generalized limb jerking. Investigations may include CBC, electrolytes, and possibly a lumbar puncture. Management involves ensuring safety, monitoring, education, and follow-up.

1.     A 3½-year-old boy is brought to the clinic because his parents are worried that he is not speaking as much as other children his age. He mostly points or gestures when he wants something and occasionally uses two-word phrases. He follows verbal commands and interacts well with other children at daycare. His motor milestones are normal, and there are no behavioral concerns. No prior hearing test has been done.

a. List FOUR (4) clinical features that support a diagnosis of expressive speech delay.

b. Describe THREE (3) early interventions that can support speech development in this child.

Answer explanation

The child shows limited speech (mostly gestures), uses few two-word phrases, follows commands, and interacts well, indicating expressive speech delay. Interventions include speech therapy, reading together, and encouraging verbal play.

1.     A 2-year-old boy is brought to the clinic for a routine developmental check-up. His parents are concerned that he does not respond when his name is called and rarely makes eye contact. He has not yet started using meaningful words and often repeats certain hand movements like flapping. He prefers playing alone and gets distressed when his routine is changed. Milestones for walking and fine motor skills are normal.

a. List FOUR (4) early clinical features that are suggestive of autism spectrum disorder (ASD).

b. Describe THREE (3) key interventions or management steps following suspicion of ASD.

Answer explanation

Early features of ASD include lack of response to name, limited eye contact, delayed speech, and repetitive behaviors like hand flapping. Key interventions are early intervention programs, behavioral therapy, and family support.

A 5-year-old girl is brought to the emergency department with sudden onset of shortness of breath and noisy breathing that started while she was playing outside. Her mother reports that the child had mild flu-like symptoms earlier in the day but was otherwise well.

a. State FOUR (4) relevant history questions to ask about this presenting illness.

b. State THREE (3) clinical signs indicating respiratory distress.

c. State TWO (2) appropriate initial management steps for this child.

d. State ONE (1) differential diagnosis for this presentation.

Answer explanation

Relevant history questions include: 1) What were the child's symptoms before the episode? 2) Has she had any known allergies? 3) Was there any exposure to smoke or allergens? 4) Has she had similar episodes before? Signs of respiratory distress include: 1) Increased respiratory rate, 2) Use of accessory muscles, 3) Cyanosis. Initial management steps: 1) Administer oxygen, 2) Assess for foreign body obstruction. Differential diagnosis: Asthma exacerbation.

A 9-month-old infant is brought to the clinic with a 2-day history of cough, nasal congestion, and poor feeding. The mother reports that the baby has been breathing rapidly and has had noisy breathing, especially during sleep. On examination, the infant has nasal flaring, subcostal retractions, and bilateral wheezing. Oxygen saturation on room air is 89%.

a. List FOUR (4) clinical features suggestive of bronchiolitis.

b. State THREE (3) relevant history questions to support your diagnosis.

c. Describe TWO (2) key components of the initial management.

d. State ONE (1) possible differential diagnosis.

Answer explanation

Clinical features of bronchiolitis include cough, wheezing, rapid breathing, and nasal flaring. Relevant history questions could address exposure to respiratory infections, vaccination status, and duration of symptoms. Initial management includes oxygen supplementation and bronchodilators. A differential diagnosis could be pneumonia.