Safe prescribing practice scenarios

GIT
Case 1:
You are ST1 Paediatric trainee , Mohamed 4 year old presented
to the outpatient clinic with abdominal pain since 2 months that is
not related to meals , and you noticed mild abdominal distention
while examining his abdomen with present intestinal sounds,
while palpation you noticed a hard mass at the left lower
abdomen.
Mrs. Aida his mother told you that he find it difficult to pass stool ,
and she identified it as type 1 stool on Bristol stool chart (
separated hard lumps )
Also, She noticed the last week that his underwear is not clean
every now and then with stool staining.
Task : Please prescribe a safe prescription for his initial
condition.
 Case 2:
You are GP trainee at local hospital, Yusra 33 months old ,
13kg,presented to casualty with watery diarrhea since yesterday
night (about 10 motions per day in contrast to her normal two
motions per day).
There is moderate signs of dehydration noticed by clinical
examination.
Task: Prescribe a safe prescription for Yusra.
Case 3:
Mrs. Mona presented with her 8month old baby Hassan, weighing
9 kg who is admitted to the hospital 4 times by recurrent
pneumonia .
His Chloride sweat test is less than 60 mmol per Litre, and no
apparent cause except repeated vomiting of moderate amount of
milk .
Mrs. Mona noticed that sometimes her baby looks like arching
himself as if he is fitting.
Hassan was on sodium alginate for one month but with no
improvement..
Task : Prescribe a second step medicine for Hassan
 CVS
Case 1:
Mike 5 years old 20 kg rushed in the E.D with his mother very sick
and drowsy , you put the oximeter and the pulse rate read 240
beats per minute
You called your team and tried carotid massaging and immersing
his face in cold water (diving reflex) with no response.
IV line is now ready.
Task: Prescribe next step medication to stop this abnormal
electrical cardiac conduction.
Case 2:
You are a NICU resident and while follow up round your
consultant decided to wean Amir , a 32 + 5 preterm from
mechanical ventilation.
After the round you noticed that his oxygen saturation
deteriorating while decreasing ventilator parmeters, and you
heard a continuous murmur all over the precordium.
You called the consultant and decided to do echocardiography for
Amir.
The Echo. Report a large PDA.
Task: write a medication you will discuss with your consultant to
give for Amir in order to enable you to wean him off safely from
ventilator.
 MSK
Case 1:
You are ST2 GP, working at a local hospital
Mina 13 year’s old adolescent presented to the casualty after his
friend hit his ankle while playing football match.
You called Orthopedist and order ankle x-ray which showed no
bone abnormality.
Mina is suffering from mild pain while trying to put his heel on the
ground.

Task : Prescribe a proper medication for Mina’s pain. According

to WHO pain ladder.
Case 2:
Mrs. Carrol presented to the paediatric outpatient with Jone 3
years old who is diagnosed as Cerebral Palsy.
He is on Valproate for generalized tonic – clonic convulsion.
Recently, His extremities are stiff and rarely relax .
This made it difficult to feed him and interfered with the
occupational therapy program to improve his motor hand skills.

Task : Prescribe proper medication to help Jone Relaxing his

extremities.
 Nutrition
Case 1 :
Mira 3 years old , 13 kg from Finland came with her mother Mrs.
Lilly to the outpatient clinic.
Mrs. Lilly complained that she noticed Mira has some difficulty
in walking for the last month, which a GP told her that it’s
related to growing pains, and prescribed ibubrufen on demand
for her,but with no improvement.
You ordered lab tests for Mira with the following results :
Calcium 2 mmol / L
Phosphate 1.5 mmol / L
Alkaline phosphatase : 334 IU /L
Vitamin D 25 : 10 nanogram / mL
You ordered Wrist x-ray that showed metaphysial widening and
cupping.
Task : Prescribe proper medication according to above scenario.