MD (PAEDIATRICS) EXAMINATION — JANUARY 2018 Date: 23" January 2018 Time: 9.00 a.m. — 12.00 noon PAPERI STRUCTURED ESSAY QUESTIONS) Answer all five questions. Answer each question in a separate book. Qu. 1.1. What is the standard classification of Germinal Matrix Haemorrhage-Intra Ventricular Haemorrhage(GMH-IVH) of a preterm brain. (20 marks) 1.2. List fifteen (15) risk factors for the development of GMH-IVH ina preterm baby. (30 marks) 1.3. What are the ways in which GMH-IVH is known to present in a preterm baby (30 marks) 1.4. Briefly outline the prevention and management of GMH-IVH in a preterm baby. (20 marks) Q2. 2.1. Provide a very brief definition for each of the following terms. (a) Dead space ventilation (b) Venous admixture (c) Closing capacity (a) Alveolar ventilation (20 marks) vw i Explain why an infant is physiologically more likely to develop respiratory distress when compared to an older child. (30 marks) Contd...../2-23s 2.3.1. Briefly describe the pathogenesis of bronchiolitis obliterans (obliterative bronchiolitis). (16 marks) 2.3.2. List five (05) non-infective causes of bronchiolitis obliterans (obliterative bronchiolitis). (15 marks) 2. 4, Mention five (05) advantages of high-flow nasal oxygen therapy. (25 marks) Q3. You are recently appointed as a Consultant Paediatrician to a Base Hospital. A fourteen-year old girl is admitted to the Paediatric Ward with the history of alleged penetrative sexual abuse which occurred thirty (30) hours prior to admission. 3.1. Outline the clinical care of the above-mentioned child. (30 marks) 3.2. List the possible consequences of child sexual abuse. (20 marks) 3.3. Asa paediatrician, what measures would you take to improve the quality of care of sexual abuse vietims in your area. (30 marks) 3.4. List four (04) reasons why appropriate sexual health education is important at school. (20 marks) Q4. 4.1. Name three (03) genetic conditions which would cause hyperammonaemia. (10 marks) 4.2. List ten (10) clinical features of hyperammonaemia. (20 marks) 4.3. Mention ten (10) relevant investigations you could perform in a child with hyperammonaemia due to a genetic defect. (20 marks) 4.4. Mention two (02) principles of treatment strategies for lowering the ammonia level in hyperammonaemia. (10 marks) 4.5. Outline the management of acute hyperammonaemia due to genetic defects. (25 marks) 4.6. Outline the long-term management of the commonest genetic cause of hyperammonaemia. (15 marks)we Qs. “Injuries are one of the common causes of death during childhood in both developed and developing countries.” 5.1. Briefly outline why children are comparatively more susceptible to injuries than adults. (20 marks) ib . List five (05) factors which increase the risk of injuries in children. (20 marks) 5.3. Describe the interventions which can be taken to prevent injuries due to road traffic accidents in children. (30 marks) 5.4. Discuss the paediatrician’s role in reducing the morbidity and mortality due to childhood injuries in Sri Lanka. (30 marks)