Dec 2015 Markers: Deb Leach, Hussein Alabodi Monash Trial Exam Q26

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