osce kkcth 2007
DESCRIPTION
OSCE Pediatrics KKCTH 2007TRANSCRIPT
OSCE KKCTH
OSCE – JAN 2007
Question No : 1
1) 4 causes for diastolic dysfunction and 4 causes for systolic
dysfunction.
2) Principles of Management of congestive cardiac failure.
What are the specific drugs used in the
management of congestive cardiac failure?
Answer for Question No : 1
1) a) MS / TS
b) Constrictive Pericarditis
c) Dilated cardio myopathy
d) Myocardial ischemia
e) Acute volume overload (AR & MR)
f) Restrictive cardiomyopathy
Anemia
RHP
SVT
UAO
Cong. HD complicated by anemia, fever endocarditis
2) a) Reducing cardiac work
b) Augmenting myocardial contractility
c) Improving cardiac performance by reducing the heart
size
d) Correcting the underlying cause
Reduce fever, anemia, and infection sedating the Patient
Vasodialators
Captopril after load reducing agents
Enalapril
Digoxin
Question No : 2
.
1) Identify the Organism
2) Which immunodeficiency is associated with chronic
symptomatic infection with this organism?
3) Which 3 malabsorbtion can occur in this infection?
4) What is the appropriate antimicrobial therapy for treating
this infection?
Answer for Question No : 2
1) Giardia Lamblia -Trophozoite
2) Hypo or agammaglobilinemia
3) a) Carbohydrate b) Fats c) fat soluble vitamins
4) Antiprotozoal agent Pediatric dose
Albendazole (albenza) 400mg once a day for 5 days PO
Furazolidone (Furoxone) 6 mg/kg/24 hr divided qid PO for 10
days
(maximum : 400mg/24 hr)
Metronidazole (Flagyl) 15mg/kg/24hr divided tid PO for 5
days
(maximum : 750mg/24 hr)
Paromomycin Not recommended
Quinacrine (Atabrine) 6mg/kg/24 hr divided tid PO for 5
days
(maximum : 300mg/24 hr)
Tinidazole 50mg/kg once(maximum :2g) Not
available in the United States
Question No. 3
1. Identify the organ
2. Name 2 GI complications due to this organism
3. Drug of Choice for the GI Complications and dose
4. Name one Pulmonary Complication
5. What is the life span of this organism?
Answer for Question No : 3
1. Ascaris
Ova
2. a) Intestinal Obstruction
b) Biliary Obstruction
3. a) Piperazine citrate 150 mg / kg stat
Follwed by 6 doses of 65mg / kg Bd
4. Loeffler’s Syndrome
5. 10 to 24 Months
Question No. 4
A child weighing 12Kg is admitted with 25% burns
1. What is the total volume of fluid and what fluid is required
for resuscitation?
2. What is the duration for replacement ?
3. How is it spaced?
4. Is colloid indicated in this child?
5. When is colloid indicated?
Answer for the Question No. 4
1. 1180 ml of Ringer Lactate
2. 24 hrs
3. 50% in the first 8 hrs (590ml)
50% in the next 16 hrs (590ml)
4. No
5. Burns more than 85 %
Question no. 5
Match the following :
1. Phyrostygmine : Mushroom
2. Pyridoxine : Diazepam
3. Diphenhydramine : Clonidine
4. Dimercaptosuccinic acid : Dystonia
5. Flumazenie : Ethylene Glycol
6. Naloxone : Methanol
7. Fomepizole : Betablocker
8. EDTA : Arsenic
9. Ethanol : Anticholinergic Agent
10. Glucogen : Lead
Answer for Question no. 5
1. 9
2. 1
3. 4
4. 8
5. 2
6. 3
7. 5 or 6
8. 10
9. 6 or 5
10. 7
Question No. 6
1. A Mother is being counseled for Prevention of
Allergy. She wants to know which of the following
could be
(A) Food intolerance (B) Food Hypersensitivity
i) Lactose intolerance
ii) Migraine
iii) Urticana
iv) HEINER Syndrome
v) CELIAC disease
vi) Irritable Bowel Syndrome
2. Match the Following :-
a) Cow’s Milk - Paralbumin
b) Egg - Vicilin
c) Peanut - Ovomucoid
d) Fish - Casein
3. What is the ideal age for introducing the following
foods:-
a) Cow’s Milk
b) Egg
c) Peanut & Seafood
Answer for Question No. 6
1. i) A
ii) A
iii) B
iv) B
v) B
vi) A
2. a) 4
b) 3
c) 2
d) 1
3. a) 1 year
b) 1 ½ to 2 years
c) 3 years
Question No. 7
1. A child with Rickets has following Laboratory
findings:-
Sr. Ca - 9 mg/dl
Sr. Phosphare - 1.5 mg/dl
ALP (Alkaline Phosphatase) - 2000 units
a) What is the diagnosis?
b) What is the mode of inheritance?
c) What is the first clinical manifestation?
2. Another child with Rickets has the following findings:-
Sr. Ca - 7 mg/dl
Sr. Phosphare - 1.7 mg/dl
ALP (Alkaline Phosphatase) - 5000 units
This child has got Alopecia
a) What is the diagnosis?
b) What is the type of inheritance?
c) What is the Rx of choice & the dose?
Answer for Question No. 7
2. a) Familial Hypophosphotemia
or
Vit – D Resistant Rickets
b) x – linked Dominant
c) Bowing of lower extremities
3. a) Vit – D dependent Rickets
or
Hypocalcemic Rickets Type II
b) Autosomal recessive
c) 1,25 Hydroxy Vit D3
15 –30 micro gm / 24 hrs
Question No. 8
1. What is the dose of Methotrexate in JRA?
2. Name two important side effects?
3. Which Micronutrient supplementation is necessary while
giving Methotrexate on a long-term basis?
4. Name one skin condition where Methotrexate is used?
5. What is the mode of Action?
Answer for Question No. 8
1. 5 to 15 mg / m2 / week
2. a) Hepetotoxicity
b) Megaloblastic anemia
3. Folic Acid
4. Psoriasis
5. Antimetabolite
&
Inhibits DNA & Purine Synthesis
Question No. 9
10 yrs old girl presented with history of recurrent spells of
dizziness, fatigue, syncopal attacks, her HR was 52/min
1) What are the ECG findings?
2) What are the probable causes for this
bradyarrhythmia? (Atleast 3)
3) What is the treatment of choice?
Answer for Question No. 9
1) Rate - Bradycardia
Rhythm - Idioventricular
Complete Heart Block
2) Autoimmune disorder, complex CHD, Myocarditis, long OT
Syndrome
3) Pacing
Question No. 10
A 1½ yrs old child presents with failure to thrive Muscle
weakness, Constipation, Polyuria.
ABG:
Ph 7.55
Co2 37
Po2 99
Sao298
Hco337
1. What is your interpretation of the ABG
2. List 2 clinical conditions in which this ABG finding can be
seen
3. What electrolyte abnormality is associated
with this condition?
Answer for Question No : 10
1. Metabolic alkalosis uncompensated
Probable bartter syndrome
2. Laxative or diuretic use, persistent Vomiting, diabetic insipidus.
3. Hypokalemia
Question No : 11
1) Identify the rhythm.
2) What would be the management of a child with this rhythm
and palpable pulses?
3) Name three possible treatable causes for this arrhythmia.
4) Name three drugs used to treat this.
Answer for Question No : 11
1. Ventricular tachycardia
2. Support ABC / Synchronized cardioversion
3. Hypoxia / Hypovolemia / Hypocalcemia
Hypokalemia / Toxin / Tension pneumothorax Thromboemboli /
Tamponede / Pain
4. Lignocaine
Procainamide
Amiodorone
Question No : 12
1) Identify the abnormality in the ECG.
2) What electrolyte abnormality can cause this?
3) Why is it important to identify this rhythm disturbance?
Answer for Question No : 12
1. Prolonged QT interval.
2. Hypocalcemia.
3. As it can degenerate into dangerous rhythm – V Tac/VF and cardiac
arrest.
Question No : 13
A one year old child has a
- Weight of 6.4 kg
- Length of 70 cm
- There is no oedema
1) What is the nutritional status of the child as per?
a) IAP Classification
b) WELLCOME Classification
c) GOMEZ Classification
d) WATERLOW Classification
2) Write details of Gomez and Waterlow classification.
Answer for Question No : 13
1) A) Grade II PEM
B) Under nutrition
C) Grade II malnutrition
D) Normal
2) Gomez Weight for age
Normal >90 %
I degree malnutrition 75 – 90 %
II degree malnutrition 60 – 75 %
III degree malnutrition < 60 %
Waterlow classification
Height for age
Normal > 95 %
I degree stunting 90 – 95 %
II degree stunting 85 – 90 %
III degree stunting < 85 %
Weight for height
Normal > 90 % of expected
I degree wasting 80 – 90 %
II degree wasting 70 – 80 %
III degree wasting < 70 %
Question No : 14
1) What is the radiological finding?
2) Name three common aetiological agents.
3) Name six complications of this condition.
Answer for Question No : 14
1) Consolidation right upper lobe
2) Pneumococcus
H. Influenza
Staphylococcus aureus
3) Pleural effusion
Empyema
Pericarditis
Meningitis
Septic arthritis
Osteomyelitis
Question No : 15
A 14 yrs old girl is seen at the OPD with short stature, sexual
infantilism, broad chest and cubitus valgue deformity.
1) What would be the clinical diagnosis?
2) What investigations would you ask for to confirm your
diagnosis?
3) What cardiovascular anomaly is most commonly associated
with this condition?
4) Name three skeletal deformities. You would look for in this
child.
Answer for Question No : 15
1) Turner’s syndrome
2) Chromosomal analysis / Karyotyping
3) Bicuspid aortic valve is the commonest cardiovascular
anomaly seen in 1/3 to ½ of patients with turners.
4)
a) Short 4th metatarsal and metacarpal
b) Epiphyseal dysgenesis of knees and elbows
c) Scoliosis
d) Decreased mineralisation of bones.
Question No : 16
CHICKENPOX VACCINE
1) What is the dose?
2) Above what age are 2 doses recommended and at what
intervals?
3) For postexposure prophylaxis within what period after
exposure, should the vaccine be administered?
4) How long can the vaccine be used after reconstitution?
5) What is the indication for giving Varicella zostel
Immunoglobulin in newborn?
6) What is the route of administration?
Answer for Question No : 16
1) 0.5 ml
2) 13 yrs
4 – 8 weeks
3) 72 hrs
4) 30 minutes
5) If mother develops Varicella 5 days before to 2 days after
delivery
6) Subcutaneous
Question No : 17
Fill up the contents of the following IV fluids
1) 5 % GDW ----- / caloric / L
2) Dextrose 10 % ----- / caloric / L
3) Blood Na ----- / meq / L
4) Ringer Lactate K ----- / meq / L
Na ----- / meq / L
HCo3 ----- / meq / L
5) 3 % saline Na ----- / meq / L
6) Calcium Gluconate 10 % Ca mg / ml
7) Magnesium Sulphate 50 % Mg meq / ml
8) Resomol solution K meq / L
Glucose gm / L
Na gm / L
Answer for Question No: 17
1) 200 caloric / L
2) 400 caloric / L
3) 135 – 145 meq / L
4) 4 meq / L
130 meq / L
28 meq / L
5) 513 meq / L
6) 9 mg / ml
7) 4 meq / ml
8) 40 mg / L
125 gm / L
45 gm / L
Question No : 18
1) What is the cut off age limit for diagnosis of primary Amenorrhoea?
2) Which is the commonest CNS tumour may be responsible for
primary Amenorrhoea?
3) If FSH and LH levels are elevated, what is the aetiology for
primary Amenorrhoea?
4) At which SMR, majority of girls reach Menarche?
5) A girl with primary Amenorrhoea presents with recurrent
abdominal pain. What is the commonest cause?
6) Name one psychological disorder that can cause primary
Amenorrhoea?
Answer for Question No: 18
1) 16 yrs
2) Craniopharyngioma
3) Primary Gonedal failure
4) SMR 4
5) Imperforete hymen / Hematocolpus
6) Anorexia nervose
Question No : 19
HIV INFECTION IN NEW BORN
1) Mother has HIV infection and if baby is PCR positive within 48
hrs
What does it imply?
PCR negative at 48 hrs but PCR positive within 7 – 90 days
What does it imply?
2) How early can P24 antigen test be done?
3) When do you label a newborn as HIV infected?
4) After what age is HIV ELISA considered the best test for
diagnosis and what is its sensitivity and specificity.
Answer for Question No. 19
1)
a) It implies inatero infection and rapidly progressive disease
b) It implies postnatal transmission and slowly progressive
disease
2) After 1 month of age (as false possibility rates are higher if
done before)
3) If two positive virologic tests (PCR / culture P24 antegen) are
obtained from different blood samples.
4) > 18 months of age – it is 100 % specificity sensitive.
Question No : 20
A 4 month old baby is brought with respiratory distress. On examination baby is
floppy with absent. DTR has clubfoot and fasiculations in the tongue.
1) What is the most likely diagnosis?
2) Name two definitive diagnostic tests for this condition.
3) What is the mode of inheritance in this condition?
4) How will you counsel the mother?
Answer for Question No : 20
1) Spinal muscular atrophy type - I
2) a) Genetic analysis for SMN gene (surviour motorneurogene)
b) Muscle biopsy
3) Autosomal recessive
4) Introduce myself to the mother and form a rapport with her
- appraise her regarding the genetic and progressive nature of
the illness her baby had the possibility of recurrences in the
next pregnancy has to be discussed
explain the various prenatal diagnostic options available and if
possible tell her where the tests are available
Discuss the treatment options for her present child has the
disease progresses.
Thanks the mother.
Question No : 21
Answer the questions regarding Turner’s syndrome
1) What is the characteristic neonatal manifestation?
2) Name 3 cardiac anomalies in Turner’s syndrome.
3) Name 2 endocrine problems in turner’s
4) Which GI problems can occur?
5) Name 3 hormones used in Turner’s.
6) What are the most common skeletal abnormalities?
Answer for Question No : 21
1) Oedema
2) a) Bicuspid aortic valve
b) Coarctation of Aorta
c) Aortic stenosis
d) Mitral valve prolapse
e) Anomalous pulmonary venous drainage
3) a) Autoimmune thyroid disease
b) Type 2 diabetes mellitus
4)
a) IBD
b) GI Bleed
C) Delayed Gastric Empyema
5)
a) GH
b) Estrogen
c) Progesterone
d) Thyroxine
6)
a) Shortening of 4th metatarsal and metacarpal bone
b) Epiphyseal dysgenesis in the joints of knees and elbows
c) Madeling deformity
d) Scoliosis
e) Osseous mineralisation
Question No : 22
Obtain history from a mother who has brought her
6 yrs old child with history of unprovoked seizures.
Checklist:
1) Introduces and establishes rapport.
2) Asks her to act out or re-create a seizure
3) Asks for Aura and automatism
4) Asks about headache and vomiting
5) Elicits h/o failure to thrive
6) Asks for details of medications used that may
precipitate seizure
7) Asks for details of anticonvulsant therapy
7) Asks for compliance
8) Asks for family history
9) Asks for developmental history
10) Asks for birth and neonatal problem
11) Asks for the time of occurrence of seizures
12) Asks for frequency
13) Asks for precipitating factor like from fever.
14) Asks for personality change / school problem / Intellectual
deterioration.
Question No : 23
When the mother is HIV positive
1) What is the percentage of transmission of HIV through breast
milk?
2) What should be mother be appraised of, if she chooses to
breast feed her baby?
3) What are the methods by which breast milk can be
processed to reduce chances of transmission?
4) What criteria should be taken into account if mother wants to
feed the baby with formula milk?
Answer for Question No : 23
1) a) 14 % if mother acquired infection before pregnancy
b) 29 % increased risk if mother acquired infection during
pregnancy
2) a) Benefits of breast feeding
b) Risk of transmission while breastfeeding (e.g. through
cracked nipple)
c) To avoid mixed feeding and to stop breastfeeds abruptly
after 4th month.
d) Mother should be on ART while feeding
3) a) Pasturised breast milk
b) Boiled human milk
c) Frozen human milk
d) Expressed breast milk allowed to stand and remove the
lipid layer
4) a) Acceptability
b) Affordability
c) Sustainability
d) Safety and feasibility
Question No : 24
1) Define:
a) Drowning
b) Near drowning
2) List 3 predisposing aetiological factor for drowning.
3) List 2 electrolytic disturbances and 1 hematological
complications of near drowning
4) What is the commonest radiological finding?
Answer for Question No : 24
1. a) Death within 24 hours of an immersion event
b) Any survival from an immersion event
2. a) Seizures
b) Long QT syndrome
c) Poisoning with drugs
3. 1. a) Hypernatremia
b) Hyperkalemia
c) Hypercalcemia
d) Hypermagnesemia
2. Hemolysis
4. Pulmonary edema
Question No : 25
A 13 yr old girl is diagnosed to have graves disease.
1) What are the earliest signs in children with graves disease?
2) What cardiovascular complications would you anticipate in
this child?
3) Name 2 drugs used in the treatment of graves disease and
mention three severe reactions they can cause.
Answer for Question No : 25
1) Emotional disturbances with motor hyperactivity / irritability / emotional
lability
2) Cardiomegaly and failure atrial fibrillation mitral regurgitation due to
papillary muscle dysfunction.
3) Propylthiocracil
Methimazole
Severe reactions
Agranulocytosis
Hepatic failure
Glomerulonephritis and Vasculitis
Question No : 26
A 6 yr old girl child is brought to ER with wheezing. She was diagnosed
outside as an asthmatic few months earlier. What relevant history would you
like to ask the mother?
Answer for Question No : 26
Present history
1) When did the present attack start and if the child is getting
better / worse / no improvement?
2) Does the child have rapid breathing / difficulty in talking or
feeding?
3) Any factors that triggered the present attack?
4) What medications has she been administered for the present
attack at what dose and frequency?
5) If associated with fever
Past history
1) How long has she been a wheezer / has frequent and for how
many days the episode last / seasonal / how often symptomatic
at night / how often absent from school?
2) If child is on long term medications – if she has been
complaint and if using MDI, if she follows the right technique?
3) How often she has to use reliever MDI / get nebulised.
4) H/o previous hospitalization and if she needed
Parenteral or oral steroids / IV medications?
5) Frequency of visits to ER
6) Any admission to ICU and if so if mother has been told about
warning signs
7) H/o exposure to passive smoking / pets and other triggers
8) If wheeze is exercise induced?
9) History regarding comorbid conditions like sinusitis / GER /
other allergies
Family History
H/o asthma or atopy in family.
Question No : 27
X - ray
1) Describe 2 essential findings.
2) What is the diagnosis?
3) What is the pathogenesis?
4) What is the treatment?
Answer for Question No : 27
1) (i) Emphysema of left upper lobe
(ii) Herniation of left upper lobe to the right
(iii) Mediastinal shift to right
2) Congenital Lobar Emphysema
3) (i) Congenital deficiency of bronchial cartilage
(ii) External compression by aberrant vessels
(iii) Bronchial stenosis
(iv) Redundant mucosal flaps
(v) Kinking of bronchus due to herniation into mediastinum
4) Lobectomy
Question No : 28
An infant is being evaluated for IEM.
The infant’s reports are as follows:
Plasma NH3 is 500
ABG – pH 7.38
pCo2 42
1) What is the most likely defect leading to IEM?
2) Give 4 example of disorders in this group.
3) List 5 drugs used in treatment.
4) Which of these disorders affect males more severely?
5) Which is the most common form of these disorders?
Answer for Question No : 28
1) Urea cycle defect
2) (i) Carbamyl phosphate synthetase (CPS)
(ii) Ornithine Transcarbamylase (OTC)
(iii) Argininosuccinate Synthetase (AS)
(iv) Argininosuccinate Lyase (AL)
(v) Arginase
(vi) N – Acetylglutamate Synthetase
3) (i) Sodium Benzoate
(ii) Phenylacetate
(iii) Arginine
(iv) Lactulose
(v) Neomycin
(vi) Citruline
(vii) Carnitine
4) OTC Deficiency
5) OTC Defects
Question No : 29
4 months old child brought to hospital with generalized
hypotonia / feeding difficulty since birth and h/o poor perception
of fetal movements by mother and polyhydramios antenatally.
1) What would be the probable diagnosis?
2) Name 3 specific types of this disease.
3) What is the basic pathology causing this condition?
4) What would be the line of management for this child?
Answer for Question No : 29
1) Congenital myopathy
2) Myotubular myopathy
Nemaline rod myopathy
Central core disease
3)
(a) Maturational arrest of fetal muscle during myotubular stage
of development
4)
(a) Confirm the disease
(b) Physiotherapy
(c) NG feeds
(d) Genetic counseling
Question No : 30
1. Picture A
Outline the treatment for this condition.
List 4 complications of this condition.
Any medications you would advise for his 5 yr old elder sister and his mother
who is 2 months pregnant?
2. Picture B
What is the diagnosis?
List 3 clinical features of this condition
Answer for Question No. 30
I. Varicella
a) Symptomatic treatment with antipyeretics / antihistamines /
hygiene etc is adviced if child is healthy and is uncomplicated
varicella.
A cyclovir is started within 72 hrs if child is
immunosuppressed / on steroids or salicylater. Child has
chronic cardiac / pulmonary disorder or is complicated varicella.
b) Secondary bacterial skin infections
Encephalitis / cerebellar ataxia
Pneumonia
Purpura / HUS
Nephritic syndrome
Arthritis
Myocarditis / pericarditis
Pancreatitis
c) Varicella vaccine can be given for 5 yrs old sister within 3
to 5 days after exposure if she has not been infected or
vaccinated earlier. If mother has not been infected or
vaccinated earlier.
V21G can be given to the mother to prevent her from getting
chicken pox but she has to be told that it may not prevent the
fetus from being infected or prevent development of total
embryopathy.
II. a) congenital varicella syndrome
b) Shortened / malformed extremities
Zigzag scarring of skin – cicatrix
Neurological defects including dysfunction of anal +
urethral sphineters developmental defect of eye including
hormone syndrome and cataracts.
Question No : 31
Regarding Mantoux skin test
1) What is the composition of tuberculin used?
2) After what duration does it become reactive following TB
infection?
3) Mention 4 host related factors, which can depress the skin
test in a child infected with M.T.B.
4) When can a tuberculin reaction of > 5 mm be taken as
positive? (Mention 2 conditions)
Answer for Question No : 31
1) 0.1 ml contains 1 TU of PPD stabilized with tween 80
2) 3 weeks to 3 months (most often between 4 – 8 weeks)
3)
(i) Malnutrition
(ii) Immune suppression by measles, mumps, varicella, influenza
(iii) Vaccination with live virus vaccine
(iv) Immunosuppression by drugs
(V) Disseminated TB / military TB
4) Children with immunosuppressive conditions – HIV / organ transplantation or on
corticosteriods > 15 mg / 24 hrs for > 1 month.
Question No : 32
A baby born to HBSAG positive mother receives HBIG and HBV soon after
delivery at 1 and 6 months.
1) (i) When would you recommend post vaccination testing for HBSAG and anti
HBS?
(ii) How would you interpret the results?
2) What is the strength of the HBV vaccine used at different ages and for the
immune suppressed?
3) What would be the vaccination schedule for a 2-year-old child who has received
only two doses of HBV vaccine at 1 ½ and 2 ½ months of age?
4) A 15 months old child due for MMR has missed HBV vaccine is infancy what
would be your advice?
Answer for Question No : 32
1) (i) 9 – 15 months of age
(ii) If positive for anti HBS – immune to HBV
If negative for HBSAG and anti HBS a second complete
HBV series of vaccination followed by retesting.
If positive for HBS the parent should be counselled.
2) 0 – 10 yrs 5 microgram or 10 microgram
>10 yrs 10 microgram or 20 microgram
Immune
suppressed 40 microgram or 40 microgram
3) Give only one dose of HBV to complete the schedule.
4) To start HBV vaccination and administer the I dose simultaneously with MMR
at a different site.
Question No : 33
A 1 ½ years old child is admitted and treated for HAV infection. Child has not
received any immunization so far as he comes from a tribal area. What will be the
immunizations you would advice for this child and at what schedule?
Answer for Question No. 33
As many vaccines as possible can be administered to this child simultaneously
following the IAP schedule and administering optional vaccines as per the mothers
request. No need for HAV vaccine.
Question No : 34
An 8 months old child is diagnosed to have HIB meningitis
1) What are the factors, which would influence the child’s prognosis? (Mention 3)
2) Mention five major neurological sequelae this child can have.
3) What would be your advice to the child’s parents regarding prevention of spread
of this disease to other members in the household?
Answer for Question No. 34
1) Prognosis depends on
(a) Age at presentation
(b) duration of illness before appropriate antimicrobial therapy
(c) CSF polysaccharide concentration and the rapidity with which it is cleaned from
blood, CSF and urine
2) Major Neuro Sequelae
Behavioural problems
Language disorder
Impaired vision
Mentalretardation
Motor abnormalities
Ataxia
Seizures
Hydrocephalus
Hearing loss
Question No : 35
1)Comment on this smear
2)Mention atleast 3 DD of this smear
3)How do you confirm the diagnosis?
Answer for Question No. 35
1) Hypochromic microcytic anemia with few target cells and tear drop cells. WBC
and platelets appear normal.
2)
a) Iron deficiency anemia
b) Thalassemia
c) Sideroblastic anemia
3) Serum Iron / TIBC
Hemoglobin electrophoresis
Bone marrow study.
Question No : 36
Write your dietary advice for a child with CRF.
Answer for Question No. 36
Diet in CRF
1) Calories – at least the daily requirement of 100 kcal / kg / day
should be given.
For stunted children. RDA for height age is given.
20 % extra calories can be recommended.
2) Protein - Protein (g / kg)
0 – 1 yr 1 – 5 yrs 5 – 10 yrs
mild GFR (20 – 40) 1.8 1.4 1
Mod GFR (5 – 20) 4.1 1 0.8
Severe GFR (< 5) 1 0.8 0.6
3) Salt – no added salt of edema / hypertension is severe (or)
Restrict to 0.5 gm / day in infants and 1 gm / day is older child.
4) water – Insensible water loss and previous days output
5)If Hyperkalemic – avoid K containing food restriction of po4 if severe Po4 is
high.
Vitamins – water soluble – routinely supplemented.
(AEK) Fat soluble vitamins – not needed
W & D supplementation – based on PTH / ca / phosphorous levels
(maintain ca x p level < 55).
Question No : 37
A 3 years old child is seen at OPD with short limbs, long narrow trunk and large
head. The limb shortening is greatest in the proximal segments.
1) What would be your diagnosis?
2) Mention 5 skeletal radiological changes associated with this condition.
3) What two neurological complication would you anticipate in this child?
Answer for Question No. 37
1) Achondioplasia
2)
(a) Short vertebral pedicles
(b) Progressive decrease in interpedicular distance from L1 to L5 spine
© Short and round iliac bones with flat acetabular roof
(d) Irregular and flared metaphysis and short tubular bones
(e) Disproportionately long fibula compared to tibia
(f) Large calavarial bone with small cranial and skull bones.
3)
(a) Hydrocephalus
(b) Lumbar canal stenosis
Question No : 38
16 months old child with Thalassemia major, had urtricarial rashes following egg
ingestion brought for MMR vaccine.
1) What history would you ask before vaccination & why?
2) What precaution would you take to store, reconstitute and administer MMR
vaccine?
3) If the mother want to administer varicella vaccine also what would be your
advice.
Answer for Question No. 38
1) When the child last received blood transfusion.
Whether the child had anaphylaxis to egg ingestion – though it is not a
contraindication for MMR the child has to be observed for 90 minutes after
vaccination if there is history of anaphylaxis.
2) MMR has to be stored in the first shelf of the refrigerator and given within 4 hrs
after reconstitution it is given subcutaneously.
3) Both can be given simultaneously at two different sites or at 4 – 8 weeks
interval.
Question No : 39
1) Write your comments on the x - ray
2) Give 3 differential diagnosis which can led to this condition.
Answer for Question No : 39
1) Normal lungs and heart
Bilateral adrenal calcification
2)a) TB of the adrenals
b) Recovery after waterhouse fridrichsen
c) Woolmans disease
(Calcification is almost always unilateral in adrenal tumour)
Question No : 40
1) What is pulseoximetry?
2) What is the principle behind it?
3) What are its limitations?
4) How does it co-relate with Po2?
Answer for Question No. 40
1) Pulse oximetry is a non-invasive method of measuring the oxygen saturation of
hemoglobin in arterial blood.
2) Red and infra red light of different wavelengths when transmitted through the
capillary have differential absorption by oxy hemoglobin and reduced hemoglobin.
This ratio is the detected by a transducer and displayed as oxygen saturation.
3) False values occurred in
a) Poor perfusion
b) Ambient light
c) Presence of carboxy hemoglobin / methhemoglobin
4) As per the oxyhemoglobin dissociation curve
Question No : 41
1) What are the 3 classes of histiocytosis syndrome in children?
2) Name 2 of each in class I histiocytosis.
1) Dermal manifestations.
2) Endocrine problems
3) X – ray skeletal findings.
3) What are the serological abnormalities seen in class II histiocytosis?
Answer for Question No. 41
I
1) Langerhans cell histocytosis
2) a)Familial erythrophagocytic lymphohistiocytosis
b) Infection associated hemo phagocytic syndrome
3) a) malignant histiocytosis
b) Acute monocytic leukemia
2) a) seborrheic dermatitis / petechia
b) Hypothalamic involvement / pituitary dysfunction – diabetis insipidus / primary
hypothyroidism.
c) Osteolytic lesion in born with no evidence of reactive newborn formation /
fractures / vertebral collapse / floating teeth.
3) Hyperlipidemia, hypofibrinogenimia, elevated lever enzymes, extremely
elevated circulating interlukin 2 receptors
Question No. 42
1) What would be the clinical presentation? Describe atleast 5 clinical features.
2) Describe the CT Scan findings.
3) What is the pathologic defects in this condition?
Answer for Question No. 42
1)
a) Prominent occiput
b) Cerebellar ataxia
c) Macrocephaly
d) Sunset Sign
e) Spasticity of lower limbs
2) Dilated IV ventricle / III & lateral ventricles / Dandy walker malformation.
3) Failure of development of roof of IV ventricles.
Question No. 43
Storage of Vaccines
1. Picture of a Refrigerator
Vaccines are stored in this refrigerator in your clinic. Mention the correct place of
storage of the following.
a) BCG
b) OPV
c) MEASLES
d) DPT / DT / TT
e) Varicella
f) Hepatitis – B
g) Hepatitis – A
h) Typhoid
i) Diluent
j) Ice Cubes
k) Ice Packs
l) Dial Thermometer
m) Water Bottles
Answer for Question No. 43
1) Top shelf
2) Freezer
3) Top Shelf / freezer
4) Middle Shelf
5) Lower Shelf
6) Middle Shelf
7) Middle Shelf
8) Middle Shelf
9) Crispator
10) Freezer
11) Freezer
12) Top Shelf
13) Side door
Question No. 44
1) If 2 or more soft neurologic signs are persistent it correlates with 4 conditions.
What are they?
2) ELICIT SOFT NEUROLOGICAL SIGNS
(Observer: Dr. Ganesh)
a) TANDEM WALKING
b) DISDIADOKOKINESIS
c) SYNKINESIS (MIRROR IMAGE MOVEMENT)
d) HAND PATS
e) REPETITIVE AND SUCCESSIVE FINGER
MOVEMENT
f) ARM PRONATION – SUPINATION MOVEMENT
g) FOOT TAPS
h) HOPPING
i) ELICITS CHOREOATHETOSIS BY EXTENSION OF
ARMS.
Answer for Question No. 44
1)
a) Neurologic dysfunction
b) ADHD
c) LD
d) CP
Question No. 45
Match the following
Hb electrophoresis Hemoglobinopathy
1) FA B – Thalassemia
2) FAS Alpha Thalassemia
3) FS Sickle cell trait
4) F Normal
5) FA Bart’s Sickle cell anemia
Answer for Question No. 45
Hb electrophoresis Hemoglobinopathy
1) FA Normal
2) FAS Sickle Cell Trait
3) FS Sickle cell anemia
4) F B – Thalassemia
5) FA Bart’s alpha thalassemia
Question No. 46
You are investigating some children with reference to
Hepatitis B. Interpret the reports and give your diagnosis.
I. Child A - HbSAg +ve
- Anti HbCAg Igm +ve
- Anti HbSAg –ve
- HbeAg +ve
II. Child B - HbSAg +ve
- Anti HbcAg -ve
III. Child C - HbSAg –ve
- Igm Anti Hbc +ve
IV. Child D - HbSAg +ve
- Hbe +ve
- Anti Hbc IgG +ve
V. Child E - HbSAg –ve
- Anti Hbc IgG –ve
- Anti HbSAg +ve
- Anti Hbe +ve
VI. Child F - HbSAg –ve
- Anti Hbs +ve
- Anti Hbc IgG –ve
- Anti Hbe –ve
Answer for Question No. 46
I. Acute Hepatitis B highly infective
II. Carrier
III. Acute Hepatitis B
IV. Chronic Hepatitis B high infectivity
V. Recovery from Hepatitis B
VI. Immunised child / Remote hepatitis B infection
Question No. 47
1) Name the factors deficiency of which will be corrected by transfusion of FFP.
(At least 4)
2) What is the dose?
3) List 1 renal condition and 1 thrombolic condition in which FFP may be useful?
4) What are the components of cryoprecipitate?
Answer for Question No. 47
1)
a) Factor II
b) Factor V
c) Factor X
d) Factor XI
e) Functional deficiency of factors II, VII, IX, X in emergencies (rapid reversal
of warfarin effects)
2) 15 ml / hr
3) - TTP
- Antithrombic C, Pr C, Pr S deficiency
4)
a) Fibrinogen
b) Factor VIII
c) Factor XIII
Question No. 48
Write the correct symbols for the following used in pedigree chart.
1) Sex unspecified
2) Divorced
3) Monozygotic twinn
4) Proband
5) Deceased individual
6) Miscarriage
7) Adopted into family
8) Stillbirth
9) No offspring
10) Affected
Question No. 49
I. Child ‘A’ walks up and down stairs one leg at a time, climbs on
furniture and jumps.
a) What would be your assessment of the age of this child?
b) Name 2 adaptive milestones specific for this age.
II. Child B - copies cross and square
- Imitates construction of “gate” of 5 cubes
a) What would be the child’s probable age?
b) Mention 2 specific motor milestones for this age.
III. Match the following
a) Palmar grasp gone - 8 months
b) Transfers object from hand-to-hand - 4 months
c) Turn pages of book - 5.5 months
d) Thumb finger grasp - 12 months
Answer for Question No. 49
I.
a) 30 months
b) – Makes tower of 7 cubes
- Circular scribbling
- Imitates vertical stroke
- Dumps pellets from bottle
II.
a) 48 months
b) – Hops on one foot
- Throws ball menhead
- Uses scissors to cut out pictures
- Climbs well
III.
a) 4 months
b) 5.5 months
c) 12 months
d) 8 months
Question No. 50
E.T. Tube
1) Identify the instrument.
2) Name its parts.
3) What size would you use in a 6 yrs old child?
4) Mention 5 physiological changes, which occur when it is used in children.
Answer for Question No. 50
1) Endotracheal tube uncuffed
2)
a) Adaptor
b) Markings on tube for nasal / oral fixing
c) Vocal cord guide
d) Murphy’s eye
e) Radiological marker
3) 5.5 cm uncuffed (tubes 0.5 cm less and greater in size to be kept ready)
4)
a) ICP
b) Laryngospasm
c) Hypoxia
d) Tachycardia and hypertension in older children
e) Bradycardia and Hypotension in infants
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