Choose the best answer.
What is the most common cause of congenital hypothyroidism?
A. Grave’s Disease
B. Deficiency of thyroid-stimulating hormone (TSH)
C. Transplacenta auto-antibodies
D. Impaired iodine transport
E. Thyroid dysgenesis
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Written by CH LEE on 5/1/2009
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2009, every other person in the street owns a dSLR camera. Are you a dSLR owner, or a photographer? What make a dSLR owner become a photographer? When does a snap shot, become a piece of art?
Australian Dragon
Brandon is a 4 weeks old baby boy, borned at full term with a birth weight of 3.5kg. His mother brought him to the Emergency Department where you are working, complaining that Brandon has been vomiting with every breast feed. He started to vomit about 2 weeks of age, and the vomiting seems to be getting worse. His mother reported that the vomiting is projectile and milky in colour. Brandon is still keen to feed after the vomiting. His last wet nappy was 12 hours ago. He does not have diarrhea.
On examination, Brandon is 3.6kg. Heart rate 160bpm. Capillary refill time is 3 seconds, he has cold feet and hands. He is alert. Heart sounds are normal and respiratory examinations are normal. Abdomen is not distended, soft and non-tender, no palpable mass. Bowel sounds are normal.
Choose the best answer
1. What is the most likely diagnosis?
A. Gastroesophageal reflux
B. Intussusception
C. Pyloric stenosis
D. Gastroenteritis
E. Adrenal crisis
2. What is the most appropriate next step in managing this child?
A. Request for an abdominal x-ray
B. Arrange for Barium Meal and follow through
C. Insertion of a nasal-gastric tube for NG rehydration
D. Secure IV access and IV fluid resuscitation
E. Arrange Ultrasound scan of the abdomen
3. You send away a blood sample for biochemistry. What abnormality would you be expecting?
A. Metabolic acidosis with hyperkalaemia
B. Metabolic alkalosis with hyperkalaemia
C. Metabolic acidosis with hypokalaemia
D. Metabolic alkalosis with hypokalaemia
E. normal blood biochemistry
4. If you choose to fluid resuscitate the patient, what would be your choice of IV fluid?
A. 10ml/kg normal saline bolus
B. 150ml/kg/day 10% Dextrose
C. 4ml/kg/h 10% Dextrose
D. 4ml/kg/h 0.45% NaCl and 2.5% dextrose
E. 10ml/kg 10% Dextrose bolus
5. What is the most important management for this patient in the next 24 hours?
A. Immediate surgery
B. Management of fluid and electrolyte abnormality
C. Thicken feed
D. Anti-emetic medication
E. Starting proton pump inhibitor
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Written by CH LEE on 2/1/2009
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