OSCE Pediatrics KKCTH

OSCE–kkcth

Question No : 1

List 4 findings on the x- ray

a) What is the radiological diagnosis?

b) List 4 causes for the finding in the left

lung

c) List 4 causes for the finding in the left lung

Answer for Question No : 1

a) Mediastinal shift (L) Pneumothorax (L) Atlectasis (L) lung

Bronchopnemonic changes (R)

b) Pneumothorax Bronchopneumonic changes (R) (Non – homogenous opacities

c) 1) Pneumonia2) Asthma3) Foreign body in lung4) Trauma

5) Cystic fibrosis6) Tracheotomy7) Subclavian line present8) Thorococentesis9) Transbronchial biopsy10) Lymphomas & other malignancies11) Ehlers Danlos syndrome12) Marfan syndrome13) Gangrene14) Lung abscess

Question No : 2

LINEZOLID1) What group of drug is this?

2) Mode of action

3) Name 2 organisms for which this is a

specific drug?

4) Dosage

5) Mention important hematological side

effect?


1) Oxazolidinone

2) Translation initiation by blocking, formation

of protein synthesis initiation complex by

binding to 50 S ribosomal RNA.

3) MRSA vancomycin resistant Enterococci,

coagulase negative staphylococci, penicillin

resistant pneumococci

4) 10mg / kg / dose Q8 –12 hrs

5) Thrombocytopenia

Question No : 3

QUINUPRISTIN / DALFOPRISTIN

1) What group of drug is this?

2) What is the mode of action?

3) Against which of the following organisms

this is in effective?

Mycoplasma, chlamydia, staph. aureus

enterococcus faecalis.

Answer for Question No: 3

1) Streptogramins Strepto gramins

2) Synergistic action on bacterial ribosomal

subunit to protein synthesis

3) Enterococcus faecalis.

Question No : 4

pH - 7.38

Pco2 - 38

BE - 3

Hco3 - 21

Po2 - 98

1) Interpret the ABG?

2) List the indicators of compensation in ABG

in following conditions.

a) Metabolic Acidosis

b) Metabolic Alkalosis

c) Respiratory Acidosis – Acute/ Chronic

d) Respiratory Alkalosis – Acute/ Chronic

Answer for Question No : 41) Normal ABG

Met. Acidosis PCo2 = 15 x (HCo3) +8+/-2

Metabolic Alkalosis - PaCo2 increases by

7mm of Hg for each 10mq increases in the

(HCo3 -)

Respiratory Acidosis Acute – (HCo3)

increases by 1 for each 10mm increased in

Pco2.

Chronic – (Hco3) increases by 3.5 for each

10mm increase in PCo2.

Respiratory Alkalosis Acute – (HCo3) fall by

2 for each 10mm Hg decrease in PCo2.

Chronic – (HCo3) decreased by 4 for each

10mm of decrease in PCo2.

Question No : 51) You are asked to counsel a mother who’s 9 month of

infant has AWD regarding ORT

Check list:

i) Introduces himself

ii) Explains that the main treatment is ORT and explains

the need for rehydration.

iii) Explains correctly the preparation of ORT

whole packet in 1 liter of water.

iv) Advises feeding by spoon discourages bottle feeding.

2) Mother asks what to do if the baby vomits

v) Stop ORT for 5 – 10minutes and restart feed, give slowly

spoonful every 2 – 3 minutes

vi) Advise giving small aliquots of 5 – 10ml each time.

vii) Explains the danger signs of dehydration and

explains when she should seek medical attention

Does not become better in 3 days or develops danger

Signs (Seizure / unconscious / rapid breathing etc).

viii) Encourage continuance of breast feeds / normal feeds /

home available feeds.

ix) Checks, whether the mother has understood or not.

x) Ask the mother whether there are any doubts.


1) You are asked to counsel a mother who’s 9 month of

infant has AWD regarding ORT

Check list:

a. Introduces himself

b. Explains that the main treatment is ORT and explains the

need for rehydration.

c. Explains correctly the preparation of ORT

whole packet in 1 liter of water.

d. Advises feeding by spoon discourages bottle feeding.

2) Mother asks what to do if the baby vomits

v) Stop ORT for 5 – 10minutes and restart feed, give slowly

spoonful every 2 – 3 minutes

vi) Advise giving small aliquots of 5 – 10ml each time.

vii) Explains the danger signs of dehydration and

explains when she should seek medical attention

Does not become better in 3 days or develops danger

Signs (Seizure / unconscious / rapid breathing etc).

viii) Encourage continuance of breast feeds / normal feeds /

home available feeds.

ix) Checks, whether the mother has understood or not.

x) Ask the mother whether there are any doubts.

Question No : 6

6 yrs old boy is brought for bed-wetting. His

frequency in day time is normal. He is dry in the

day. He is never been dry in the night.

1) Define this problem? What type is it?

2) Is it complicated or uncomplicated?

Enumerate 4 differences between

complicated and uncomplicated.

3) Name 3 drugs and dosage for the

pharmacological therapy of this condition.

Name 3 non – pharmacological measures for

the management of this condition.

Answer for Question No : 61) Nocturnal Enuresis. Primary Nocturnal Enuresis

2) Uncomplicated

Uncomplicated Complicated

Onset Primary Secondary

Daytime symptoms absent +

Stream Normal Abnormal

Physical Normal Abnormal

Urine analysis Normal Abnormal

3) Drug “ODI!!!” Dose

DDAVP 10 – 40 mcg/day

Nasal spray

Oxybutinin 10 - 20 mg/day PO

Imipramine 0.9 – 1.5 mg/kg/day

Non-pharmacological

Behavioral modification, Bladder exercises, alarm device.

Question No : 7

List 3 abnormalities in this ECG

1) What is the ECG Diagnosis?

2) List 4 causes for the same

3) Drug of choice

4) Mention 1 complication


1) Fibrillary waves

Absence of P waves

Irregular Ventricular response / rhythm

2) Atrial Fibrillation

3) Rheumatic Valvular disease

Thyrotoxicosis

Following cardiac surgery

Pulmonary embolism

Pericarditis

WPW syndrome

Mitral regurgitation

4) Digoxin

5) Stroke / Thromboembolism

Question No: 8

1) Identify the organism?

2) Name the method and steps used for the

preparation for the smear?

Answer for the Question No: 8

Acid-fast bacilli

Ziehl neelsen technique CSEWM

Heat and dry. Fix the smear.

Add strong carbol fushcin

Heat approximately for 5mins. Do not boil.

Decolorise the smear with 20% sulphuric acid

Decolorise with ethanol

Wash with water

Counter stain with methylene blue

Question No : 9

1) Describe the pedigree

2) What is the mode of inheritance?

3) Give 4 examples.

Answer for Question No : 91) 3 generation pedigree chart showing

All daughters of the affected males have

the disease

Sons of the affected males are normal

Affected females affect ½ of the males

and ½ of the daughters

2) X- linked dominant inheritance

3) Hypophosphatemic rickets ( Vit.D resistant)

Incontinentia pigmenti XD RHIO

Oro facial digital syndrome

Rett syndrome

Question No : 10

The following food substances, which contain Vit.A,

need to be arranged based on Vitamin A content

from high to low.

Papaya,

Guava

Amaranth

Drumstick leaves

Egg

Human milk

Carrot


VIT A : CADEPM

Carrot 1167

Amaranth 515

Drumstick leaves 300

Egg 140

Papaya 118

Human Milk 38

Guava 0

Question No : 11

1) Vitamin A prophylaxis programme in India -

Mention the dosage and schedule.

2) Daily requirement of Vitamin A.

3) Name two manifestation of hypervitaminosis A?

Answer for Question No : 111) 5 doses 9 months – 3 yrsOral retinol palmitate 1lakh 9 months (along with measles) 2lakh 1½ yrs 2lakh 2 yrs 2lakh 2 ½ yrs

2lakh 3 yrs2) 400mg to 600mg of requirement Retinal / RE B –carotene I.U 0-1yr 350mcg 1200mcg 1166.671-6yrs 400mcg 1600mcg 1333.33>7yrs 600mcg 8400mcg 2000 1mcg = 3.3 IU 1 IU of vitamin A = 0.3mcg at retinal

3) Nausea, vomiting, anorexia, sleep distress, irritability

Skin desquamationHepatomegalyPseudo tumor cerebri (diplopia/ papilledema /cranial N.Palsy)

Alopecia, seborrhea,

cutaneous leisions craniotabes Tender bony swellingsFissures at corners and mouth

Question No : 12

Match the following:

1) BCG - Toxoid & killed bacteria

2) OPV - Live attenuated bacteria

3) DPT - Bacterial sub unit

4) Hib - Viral Antigen

5) Hep B Vaccine – Live attenuated viral

6) Typhoid V I - Killed virus

7) Hep A Vaccine – Capsular polysaccharide

8) Acellular pertusis – Capsular polysaccharide

Question No : 13

Answer the following:

What is the Diluent for BCG?

What is the Diluent for MMR?

How long can reconstituted BCG be used?

How long can reconstituted MMR be used?

Name 5 vaccines which should not be frozen

What does IAP recommend at 5 yrs -

(DPT/DT)?


1) BCG - Live attenuated bacteria

2) OPV - Live attenuated viral

3) DPT - Toxoid & killed bacteria

4) Hib - Capsular poly saccharide

5) Hep B Vaccine - Viral Antigen

6) Typhoid V I - Capsular poly saccharide

7) Hep A Vaccine - Killed virus

8) Acellular pertusis - Bacterial sub unit

Answer for Question No : 13 Diluent for BCG is Sterile NS

Diluent for MMR is Distilled water

Reconstituted BCG can be used for 3 hrs

Reconstituted MMR can be used for 1 hr.

DPT, Hepatitis A & B, Varicella, Hib, TT

IAP recommends DPT at 5 yrs.

What are indications for Acellular pertusis –

vaccine?

Mention 4 indications for pneumococcal vaccine?


Indications are:

Persistent / inconsolable Cry 3 or more hrs in 48 hrs.

Temperature > 40º within 48 hrs

Collapse / shock with (HHE within 48 hrs)

Convulsions with or without fever within 72 hrs of

immunization.

Encephalopathy within 7 days, behavioral problems.

3) Indications:

Prior to splenectomy,

HIV

CSF Rhinorrhea

Sickle cell

Asplenia

CRF

Chronic lung / heart disease

Question No : 14

A 6 year old girl has been referred for evaluation

of anemia. Answer the questions after seeing the

peripheral smear?

a) What is your diagnosis?

b) What would be the confirmatory test to

clinch your diagnosis ?

c) What is the definitive treatment of this

condition ?


1) Hereditary spherocytosis

2) Incubated osmotic fragility

3) Splenectomy

Question No : 15

You are asked to resuscitate a newborn with the

provided equipments.

Please ask questions regarding status of infant –

wherever necessary.

1) Check the following equipments before

proceeding further

Bag mask valve

Laryngoscope

2) Get information about the infant from the

observer before proceeding to resuscitate

and at each step whenever necessary


1) Check list for observer.Bag mask valve…does he - attach reservoir?

- check pop off valve? - check for leak?

Laryngoscope – Checks bulb & handle Does candidate ask the following 5 questions?

Meconium staining of liquor or not? Term or preterm? Crying well – breathing well or not? Pink or blue colour? Good muscle tone?

The Observer Should Say Baby Is Not BreathingDoes he clear airway/provide warmth/ position dry infant? 1..5 marks

and then ask status of baby

Observer Says: Baby Still Not Breathing wellDoes he give PPV for 30 seconds? Correct position EC clamp technique Chest expansion

and then ask status of baby Observer Says Hr- 50/Min, Blue

Does he start chest compressions? Correct technique?

Question No : 16

1) What is the diagnosis?

2) This infant is 8 months old, what is the most

likely type?

3) What is the earliest sign of this disorder?

4) What is the first radiological change that

occurs in response to specific therapy?

5) How could this have been prevented?

6) What are the non – specific urinary findings

in this disorder? (at least 2)


1) Rickets

2) Vitamin D deficiency

3) Craniotabes

4) Appearance of provisional zone of

calcification

5) Supplement of 400IU of vitamin D

6) Generalized aminoaciduria

Glycosuria

Phosphaturia

Elevated urinary citrate

Impaired renal acidification.

Question No : 17

You have performed ICD on a child with

empyema. How will you dispose the used items

given below?

Scalpel blade, hypodermic needles, trochar,

used ampoules

Cotton, gauze, linens, suture material,

surgical mask, gloves

Pus, 3 way connector

Syringe, plastic covers of gloves and ICD

bag cover


Blue / white transparent puncture proof

container

Yellow bag

Red bag

Black plastic bag.

Question No : 18

This child has fever with URI


2) What is the causative organism?

3) Name one serious hematological complication

in this disease.

4) Name one orthopedic complication.

5) Name one cause for intrauterine fetal

demise.

6) What treatment is recommended for severe

hematological complications?


1) Erythema Infection or fifth disease

2) Parvovirus B 19

3) Transient aplastic crisis

4) Arthropathy

5) Non – immune fetal hydrops

6) IvIg

Question No : 19

Calculate the mean, median, mode and mean

deviation of the diastolic pressures given

below.

83,75,81,79,71,95,75,77,84


Mean = 80, Median = 79, Mode = 75 and

Mean deviation = 5.1

The average of the deviations from

arithmetic mean

MD = ∑ (x -xˉ)/n ∑ = summation x = item values xˉ = Mean x - xˉ = deviation from mean n = No. of items

Question No :20

Take relevant history from this parent

whose child is suspected to have urinary

tract infection for the first time.


Introduces himself

History of fever

History of constipation

History of urgency

History of malodorous urine

History of suprapubic pain

History of loin pain

Details of coevute toilet training

Wiping from back to front

History of incontinence

History of threadworm infection

Family history of renal disease / stones

Family history of UTI / VUR

Note of thanks

Question No : 21

You are asked to perform rapid sequence

intubation.

Write the steps sequentially.

Mention the names of drugs wherever

necessary.


Brief history and assessment

Assemble equipment, medications, etc.

Preoxygenate patient

Premedicate with lidocaine atropine

Sedation and analgesia induced

Pretreat with nondepolarizing paralytic agent

Administer muscle relaxants

Sellick maneuver

Endotracheal intubation

Secure tube, verify position with roentgenogram

Begin mechanical ventilation

Step – 5 : Sedatives:

Thiopental

Diazepam

Ketamine

Analgesics:

Fentanyl

Morphine

Succinylcholine

Vecuronium or Pancuronium or rocuronium

Question No : 22

A 2 year child presents with the following

5 episodes of abscesses in 6 months

Photosensitivity

Light skin and silvery hair

Peripheral smear shows large inclusions in all

nucleated blood cells.


2) What is the cause for the lighten hair?


4) Name one life threatening hematological

complications?

5) What is the neurological manifestation?

6) Which drug is indicated?


1) Chediak – Higashi syndrome

2) Melanosomes or melanocytes are oversized.

Failure to properly disperse the giant

melanosomes to keratinocytes and hair

follicles.

3) Autosomal recessive. Mutated gene for CHS

Chromosome 1q2-q44.

4) Accelerated phase of a lymphoma like

syndrome characterized by pancyopenia.

5) Peripheral neuropathy and ataxia

Motor Sensory

6) High – dose ascorbic acid

200mg / 24hrs for infants

2,000mg/24hrs for adults. (2g !)

Question No : 23

Perform Hand Washing


a) Remove ornaments / watch etc. hand

sleeves above elbows.

b) Perform six steps of hand washing

1) Palm to Palm

2) (i) Right palm over left dorsum

(ii) Left palm over right dorsum

3) Fingers interlace palm to palm

4) Back of fingers to opposing palms

5) (i) Rotational rubbing of right thumb

(ii) Rotational rubbing of left thumb

6) (i) Rotational rubbing of left palm

(ii) Rotational rubbing of right palm

c) Perform in 2 minutes

d) Air dry / dry with sterile towel / paper

e) Discard towel in black cover.

Question No : 24

1) A Lumbar puncture is performed and

the CSF is xanthochromatic. What are

the four possible causes?

2) CSF protein levels are 400mg/dl. What

are the three possible causes for the

same?

3) CSF Glucose in 200mg/dl and blood

glucose is 112mg/dl. List five causes for

the same.

4) CSF is also cloudy, what does it imply?


1) a) Hyperbilirubinemia

b) Subarachnoid hemorrhage

c) Markedly elevated CSF protein

d) Carotenemia

2) a) TB Meningitis

b) GBS

c) Tumors of spinal cord / brain

d) Degenerative disorders

e) Vasculitis

f) Multiple sclerosis

3) a) Bacterial meningitis

b) TBM

c) Fungal meningitis

d) Aseptic meningitis

f) Neoplasms of meninges

4) Elevated WBC or RBC count

Question No : 25

An adolescent presents with history of

ingestion insecticides and has clinical

features of organophosphorus poisoning.

1) Mention 2 methods of decontamination

needed.

2) What is the mode of action of 2

antidotes used?

3) What 2 laboratory parameters are used

to confirm the diagnosis of

organophosphorus poisoning?


1) Activated charcoal for gastric

decontamination. Skin decontamination by

removal of clothes stained with

organophosphorus.

2) Atropine – blocks acetylcholine receptor.

Reverses the muscarinic and CNS effects.

Pralidoxime (PAM) – breaks the bond

between the organophosphate and the

enzyme, liberating the enzyme and degrading

the organophosphate.

3) Red cell cholinesterase and pseudo

cholinesterase levels.

Question No : 26

Answer the following questions after seeing

the X-ray.

1) What are the findings?

2) Name 5 aerobic organisms, which can

cause this?


1) Air and fluid filled cyst.

Lung abscess, pneumatocele

2) Streptococcus

Staphylococcus aureus

Escherichia coli

Klebsiella

Pseudomonas

Question No : 27

Dobutamine

1) What is the mode of action?

2) 7kg child requires Dobutamine infusion.

How do you prepare the infusion? What

is the dose?

3) What is T ½ of the drug / peak action?

4) Mention 3 contraindications?

5) Mention at least 6 adverse effects?


1) Act on the β1 adrenergic receptors of the

myocardium. It increases stroke volume –

increased COP – causes peripheral vasodilatation –

decreases the sympathetic vascular tone –

decreases the after load and there by improving

the myocardial function.

2) Dose 2.5 – 15mcg/kg/min. infusion rate of 6mg/kg

in 100ml normal NS, 1ml/hr will give 1mcg/kg/min.

3) T ½ - 2min, peak action 10 – 20min. ( Dobu2min ! )

4) IHSS, atrial fibrillation and atrial flutter, sulfite

sensitivity, hypotension.

5) Increase myocardial O2 demand tachycardia,

ectopic heartbeat, angina / palpitations /

tachyarrythmias, tingling sensation, parasthesia

and leg cramps, diarrhoea and abdominal cramps.

Question No : 28

4 year old child is being evaluated for

syncope.

1) Identify the ECG?

2) Mention 2 acquired causes for the above

abnormality?

3) Drug of choice.

4) What should be taught to parents?


1) Prolonged QT interval - > 0.45secds.

2) Myocarditis / electrolyte abnormality

like calcium, mitral valve prolapse and

drug induced.

3) Beta adrenergic antagonist- β blockers

4) Parents should be taught

cardiopulmonary resuscitation.

Question No : 29

1) a) List the components of IMNCI?

b) List the components of reproductive and

child health programme?

2) Mention 4 highlights of the Indian

adaptation of IMNCI?

3)Which vaccine project has been

introduced as a part of pilot project in

IMNCI?


1a) Family planning

Child survival and safe motherhood

Client approach to health care

Prevention and management of RTI /STD/ AIDS

b) Improvement in case management skills of health staff,

through provision of locally adopted guidelines and activities

to promote their care.

Improvement in overall health system

Improvement in family and community health care system.

2) Inclusion of 0-7 days age in the programme

Incorporating national guidelines on malaria

Anemia, Vit.A supplementation, and immunization schedules

Training of the health personnel begins with sick young

infants upto 2 months

Proportion of training time devoted to sick young infant

and sick child is almost equal

3) Hepatitis B vaccine

Question No : 30


2) What is the confirmatory test?

3) What neurological complications can

occur?

4) Mode of inheritance?

5) What antibiotic is prescribed for this

as prophylaxis?


1) Sickle cell anemia

2) Hemoglobin electrophoresis or HPLC

3) Stroke

4) Autosomal recessive

5) Penicillin

Question No : 31

These lesions are tender


2) What 2 common infections and drugs

can trigger this?

3) What 2 non – infectious systemic

disorders can trigger this?


1) Erythema Nodosum

2) TB, Streptococcus

Sulfa, Phenytoin, Oral contraceptives

3) IBD, Spondylo arthropathy, Sarcoidosis

Question No : 32

You are asked to provide prophylaxis for bacterial

endocarditis for 2 children with the following clinical

details.

Child 1: 8 year old boy with rheumatic mitral

regurgitation is to undergo dental extraction

tomorrow.

1) What is the drug of choice?

2) Dosage and timing

Child 2: 2 years old male with VSD is to undergo

Cystocopy tomorrow.

1) What is the drug of choice?

2) Dosage and timing.

Child 3 :3 year old who has undergone PDA ligation

2 years back is to undergo dental extraction.

What is the appropriate advice?

Child4: 2 year old with TOF is to undergo circumcision.

What is the appropriate advice?


1) Oral amoxycillin 50mg/kg 1hr before

surgery (or)

Ampicillin IV/IM 50mg/kg ½ hr before

surgery

2) IV Ampicillin 50mg/kg + gentamycin

1.5mg/kg 30mins before surgery

followed 6hrs later by IV/oral

Ampicillin/amoxycillin 25mg/kg

3) No prophylaxis needed

4) No need for anti microbial prophylaxis.

Question No : 33

Pedigree chart:

1) Identify the Mode of inheritance?

2) Give 3 examples of clinical disorders?

3) What is the significance of the pedigree symbols

used in this?


1) Autosomal dominant

2) Neurofibromatosis, Huntington’s

chorea, Myotonic dystrophy.

3) - Normal Male - Normal female

- Affected male - Affected female

- Proband - Dead

Question No : 34

Pneumococcal 7 valent conjugate vaccine

1) What is the protein conjugate?

2) Route of administration?

3) Youngest age for administration?

4) Dosing interval?

5) Primary immunization schedule for infants

< 6 months of age?

6) Dose if started at 12 – 23 months of age?

7) Dose if started > 24 months to 9 yrs of

age?


1) Diphtheria CRM 197 protein

2) IM

3) 6 weeks

4) 4 to 8 weeks

5) 3 doses < 1 year

1 dose 12 to 15 months

6) 2 doses

7) 1 dose

Question No : 35

A study was carried out to assess the utility of IgM

Elisa test in the diagnosis of Leptospirosis. Blood culture

positive cases were considered the gold standard for

diagnosis.

A total of 100 cases were studied.

Leptospira were grown in blood culture in 40 of

these cases.

IgM Elisa was positive in 70 out of 100 cases. Out of

these 70 cases, Leptospira were cultured in 30.

IgM Elisa was negative in 30 cases, out of this 30,

Leptospira was grown in culture in 10 cases.

Calculate the following for IgM Elisa as a diagnostic

test for Leptospirosis.

1. Specificity

2. Sensitivity

3. Positive Predictive Value

4. Negative Predictive Value


Blood c/s

+

Blood c/s

- IgM elisa + 30 (a) 40 (b) 70 IgM elisa - 10 (c) 20 (d) 30

40 60 100

1) Specificity: d x 100 20 x 100 = 33.3% d + b 20 + 402) Sensitivity: a x 100 30 x 100 = 75% a + c 30 + 103) Positive predictive value: a x 100 30 x 100 = 42.85% a + b 30 + 40 4) Negative Predictive value: d x 100 20 x 100 = 66.6%

c + d 10 + 20

Question No: 36

A 2 year old child presents with biphasic fever, severe

arthragia and rash tourniquet test is negative. Platelet

count is normal. Hb is 10.28gm.

1) What is the most probable diagnosis?

a) Dengue hemorrhagic fever

b) Measles

c) Chikunguniya fever

d) Roseola infantum

2) List 2 criteria for case definition of this probable

case and4 criteria for confirmed case

3) What neurological complication can develop?

4) What family does this virus belong to?


1) Chikunguniya

2)

• Features of suspect case -Fever with chills

/ arthralgia / rash / rheumatic

manifestations.

• Case definition – features of suspect case

and positive serology in acute and convalesce

phase.

• Confirmed case – probable case with any of

the following :

a) 4 fold rise in antibodies in paired sera

b) Positive IgM

c) Virus isolation from serum

d) Positive RT PCR in serum

e) Positive RT PCR in serum

3) Meningo encephalitis

4) Toga viridiae

Question No : 37

A 10 year old female weighing 30kg; diagnosed case

of IDDM on insulin therapy as follows:

10 (regular) Morning: 40 units 30 (lente) 7 (regular)Evening: 20 units 13 (lente)

Her recent morning blood sugars are becoming

high. (Blood sugar at 7.00 am 280 mg%)

1) What is Somogyi and Dawn phenomenon?

2) How will you differentiate these two in this

case?

3) How will you treat in either case?


1) Somogyi phenomenon : Hyperglycemia begetting

hypoglycemia due to counter regulating hormones

in response to insulin induced hypoglycemia.

Dawn phenomen: Hyperglycemia (early morning)

without preceding hypoglycemia due to decreased

availability of insulin and increased GH release.

2) Measure blood sugar at 3 am, 4 am, and 7 am.

• If blood sugar > 80mg/dl in 1st two sample, and

high in 3rd Diagnosis – Dawn phenomenon

• If blood sugar <60mg/dl in first two sample and

high in 3rd. Diagnosis – Somogyi phenomenon

3) Treatment-

• Dawn phenomenon – increased evening dose of

Lente insulin by 10 – 15%

• Somogyi phenomenon – decreased evening dose of

Lente insulin by 10-15%.

Question No : 38

Councell the mother of a child who is being discharged

from your hospital following acute severe asthma.


1) Introduces himself

2) Clearly explains about asthma as hyperactive

airway disease and not infective.

3) Explains that there is no curative treatment and

treatment reduces the severity and complications.

4) Explains how to use MDI.

5) Explains preventive strategies at home.

6) Explains danger signs / warning signs of acute

attack.

7) Tells the treatment at home and reach nearest

hospital. Tells difference between Rescue and

prophylactic inhalers.

8) Explains other alternatives, and ask for any

doubts and clears it.

9) Need for regular follow up.

10) Note of thanks and availability.

Question No : 391) A child has massive GI bleed.

His clotting time is 12 mins. His PT test is 40 secs,

control 14secs and PTT test is 60 secs, control is 30

His Hb is 11gm and Platelet count is 2.5lakhs.

What blood product would you transfuse? And how

much?

2) List 4 other indications for transfusion with this

blood product?

3) List 4 clotting factors deficiencies, which will be

corrected by this transfusion?

4) Name 2 parasitic disease transmitted by blood

transfusion?


1) Fresh Frozen Plasma - 15ml/kg

2) a) Severe clotting factor deficiency and

bleeding

b) Severe clotting factor deficiency and invasive

procedure.

c) Emergency reversal of warfarin effects

d) Dilutional coagulopathy and bleeding.

e) Anticoagulant protein (AT – III, protein C,

Protein S, FTTP)

3) II, V, X and XI

4) Malaria / Chagas disease

Question No : 40

A 13 year old HIV positive boy is seen in OPD for

abrasions injuries over left thigh following RTA 2

days back. He was vaccinated with TT at age of 10

yrs.

1) What immunization advice is

appropriate?

2) Mention the dose and route?

3) What is the amount of Tetanus toxoid

present in DPT, DT and TT?

4) What is the preservative in TT?

5) What is the role of Aluminum Phosphate

in TT?


1) a) Clean the wound with soap and water.

b) Administer TT & TIG

c) Advice booster dose.

2) a) TT 0.5ml IM on one buttock

b) TIG 500U IM on opposite buttock

3) 10 Lf of TT component.

4) Thiomerosol 0.01% w/v

5) TT is adsorbed on to aluminum compounds

and increases potency, by reaching high

titers. It also gives long lasting immunity.

Question No : 41

An infant is being evaluated for ambiguous

genitalia. You find clitoral hypertrophy and other

signs of virilization. On investigations Sr. cortisol

levels are low. ACTH & PRA are markedly elevated.

ACTH skin stimulation test reveals markedly

increased 17 – OH progesterone. Serum

testosterone is also elevated. Child also has severe

hyponatremia.

1) What is your diagnosis?


3) What is pre-natal diagnosis?

4) What advice will you give her for the next

pregnancy?

5) What treatment you offer for this baby?


1) Congenital adrenal hyperplasia due to 21

hydroxylase deficiency


3) 1sttrimesterCVS,2ndtrimester amniocentesis

for DNA common mutations or polymorphic

micro satellite markers if affected siblings

samples are available for comparison.

4) Dexamethasone 20mg/kg pre pregnancy

maternal wt in two – three divided doses.

Prefer CVS. continue treatment if female

child.

5) Hydrocortisone 10 to 20mg/m2/day tds.

(Increase in stress situation)

Mineralo corticoids 0.1 – 0.3mg/day BD

Sodium supplements 1 – 3gm.

Surgical correction.

Question No : 42

Drug: Carbamzepine

1) Mention 4 clinical indications?

2) In which type of seizures it is avoided?

3) What is therapeutic drug levels in blood and

recommended time to draw sample?

4) Mention 4 common drugs, which increases its

toxicity?

5) What dose adjustment is needed in ARF?

6) What is the standard concentration in

suspension?

7) Mention dosage of frequency of suspension?

8) What & how frequent lab monitoring is

needed?

9) Mention 4 life threatening complications?

10) What is treatment of toxicity?

Answer for Question No : 421) GTCS, partial seizures, trigeminal neuralgia,

bipolar disorders.

2) Myoclonic seizures

3) 4 –12mg/L, 30min. before oral dose.

4) Erythromycin, INH, TCA, clozapine, itraconazole,

cimetidine.

5) Mild, mod forms - dose adjustment is not

necessary, severe (Creatnine clearance < 10;

decrease dose by 75%)

6) 5ml = 100mg

7) 10-20mg/kg/day, increased 100mg/day at 1 week

interval (BD/QD).

8) CBC, SGOT, SGPT every monthly for first 3-4

months and then as needed.

9) Hyper sensitivity reactions, aplastic anemia,

pancytopenia, hepatic toxicity, thrombocytopenia.

10) Gastric lavage repeated dose of activated

charcoal, hemoperfusion or hemodialysis.

Question

1 ½ year old male with acute gastroenteritis develops

anuria. His Hb is 8.9, Platelet count 90,000 & Pt –

24/20, PTT – 28/30. His PS is shown below.

1) Describe PS

2) Mention two MC D/D for it.

3) Which single test will help differentiate your

D/B?

4) This baby’s renal functions de--erated after 2

units of FFP. What would be the possibility?

5) What are indications of steroids in this

scenario?

6) Which other conditions here similar PS

findings?

Answer

1) Microangiopath--- hemolytic anemia with

helmetcells, burn cells, he------- RBCs

2) HUS, RVT

3) Doppler USG -------

4) HUS due to strep pneumonia

5) Seizures

6) Malignment HTN, SLE

Question

A 10 year old male with acute onset progressive lower

limb weakness. On detailed CNS examination you find

he is cons--- alert and normal cranial nerve

examinations. No bowel / bladder involvement. His

knee and ankele re--- are brisk and has grade II

power on both lower limbs. You also notice abdominal

reglesses below ----- is absent alibbus sensory system

normal.

1) what is your progressive diagnosis?

2) Mention 4 conditions where you get

hypotension and diminished referes in UMN

lesion?

3) Mention 3 major points to differentiated extra

modular from intramedially lesions?

4) Mention a congential conditions leading to non

compressive myelopathy?

Question No : 43

A 8 year old boy is brought because his mother

feels he is short for his age. His height is 80cm.

His father’s height is 160cm and mother’s height is

148cm. His US/LS ratio is 1. 4: 1

1) What type of short stature does this child

have?

2) What is the mid parenteral height of this

child?

3) Name 3 causes for the short stature in this

child?

4) What is the normal US/LS ratio at this age?

5) Name 3 conditions in which there is

advanced US/LS ratio?


1) Dysproportionate dwarfism

2) 160cm

3) Achandroplasia, cretinism, short limb

dwarfism.

4) 1.1:1

5) Arachynodactyl, chandrodystrophy, spinal

deformity and eunochodism

Question No : 44

An infant with seizures is being investigated. The

following are the lab reports.

Serum Calcium: 6.6mg%

Po4: 9mg%

SAP: 500 units

Mg: 3mg%

1) What is the probable diagnosis?

2) What will be the levels of PTH & 1, 25(OH2)

D3?

3) The same infant is also noted to be dark and

having mucocutaneous candidiasis.

What is your diagnosis?

4) CT brain is carried out. What finding do you

expect?


1) Hypoparathyroidism

2) Both are low

3) Type I polyendocrinopathiy (with

Addison’s)

4) Basal ganglia calcification

Question No : 45

A 16 week infant is examined for

developmental assessment. Write what

patterns of behaviour will you expect in this

age?


Prone : Lifts head and chest, arms extended.

Ventral suspension : head above plane of body

Supine : TNR and reaches toward and misses

objects.

Sitting : No head lag on pulling, head steady,

tipped forward, enjoys sitting with truncal

support.

Standing : when held erect, pushes with feet.

Adaptive : Sees pellet, makes no move to it

Social : Laughs out loud, excited at sight of food,

may show displeasure if social contact is broken.

Question No : 46

A child with meningoenclphalitis is comatose. His

serum sodium is 116 and you are contemplating

diagnosis of SIADH

1) Which of the following lab values will be

present?

a) Urine OSM <100 mosm/l

b) Plasma volume normal or increased

c) Urine Na 200mg/L

d) Serum uric acid 10mg%

2) Name 2 drugs which increases the vasopressin

levels?

3) The fluid intake should be restricted to

4) Which drug may be given?

5) 2 acute respiratory illnesses, which cause this?

6) Anticonvulsant, which decreases ADH

production?


1) a) Urine OSM <100 mosm/l - Negative

b) Plasma volume normal or increased -

Positive

c) Urine Na 200mEq/L - Positive

d) Serum uric acid 10mg% - Negative

2) CBZ, Vincristine, TCA

3) 1000ml/ m2 /24hr

4) Demeclocycline

5) Broncholitis, pneumonia

6) Phenytoin

Question No : 47

1) Identify this.

2) What is the route of entry of this organism?

3) Name 2 conditions that are high risk for this

infection?

4) What hematological clue will occur?

5) Drug of choice?

6) 1 complication


1) Strongyloides stercoralis Larvae

2) Skin

3) HIV/ Immunosuppression, PEM, MR,

Autoimmune disease

4) Eosinophilia

5) Ivermectin 200mcg/kg OD for 1 – 2 days

6) Hyperinfection syndrome

Question No : 48

A child with stroke is noted to have Ectopia Lentis,

arachinodactyly blue eyes and developmental delay.

1) What is the likely diagnosis?

2) What urine screening test will be positive?

3) Estimation of plasma amino acids will show

↑ cystine

↑ Methionine

↑ Homocystine

4) Which vitamin is indicated?

5) What other drug is needed?

6) Mode of inheritance?


1) Homocystinuria

2) Positive cyanide nitroprusside test

3) ↑ cystine - Negative

↑ Methionine - Positive

↑ Homocystine - Positive

4) B6 200 – 1000mg/24hr

5) Betaine

6) AR

Question : 49

You are to meet a child with Thalassemia major

1) When do you start transfusion?

2) Optimum Hb

3) Intervals for transfusion

4) What is the risk in keeping Hb > 14?

5) When will HbF be low?

6) How do you reduce non-hemolytic febrile

transfusion?

7) What is the level of serum ferritin to be

maintained?

8) Indications for splenectomy

9) When to give vaccines before splenectomy?

10) Antenatal diagnosis How and When?

Answerfor Question No : 49

1) < 7gm

2) 9 – 10gm

3) 2 – 4 weeks

4) Thrombosis

5) After repeated transfusions

6) Leukocyte filter, pheneramine with paracetamol

7) < 1000mg/L

8) > 220ml/kg/yr of PRBCs, hypersplenism,

massive spleen with prominent abdominal

discomfort.

9) Atleast 4 weeks

10) CVS- mutation, 12to 14 weeks (MTP < 20weeks)

Question No : 50

Match the disease with the Urine Screening Test

1) Galactosemia Nitroprusside test

2) PKU CN PT

3) MPS DNPH

4) HCU Benedicts test

5) Organic aciduria spot test

(Toludene blue test)

6) Cystinuria Fecl2


1) Galactosemia Benedicts test

2) PKU Fecl2

3) MPS MPS spot test

(Toludene blue test)

4) HCU (Nitroprusside test)

5) Organic aciduria DNPH

6) Cystinuria CNPT

Question : 51

DRUG: Vigabatrine

1) Mode of action?

2) Dosage

3) Important side effects

4) Mention important uses


1) Y aminobutyric acid, transaminase

inhibitor

2) 30mg/kg/d, od /bd upto 100mg/kg/d

3) Visual field constriction, Optic atrophy,

optic neuritis

4) Infantile spasms, Tuberous sclerosis

adjuvant for poorly controlled seizures.

Question No : 52

A 2 year old child is brought for Toe walking.

1) What is the commonest cause?

2) What is the Differential diagnosis?

3) Upto what age is it normal?


1) Normal children

2) Cerebral palsy, Duchenne muscular

dystrophy, tethered cord, congenital

tendo-achilles contracture, leg-length

discrepancy, CDH and habitual

3) 3 year

Question No : 53

1) What is premature thelarche?

2) Upto what age is it benign?

3) What is exaggerated or atypical

thelarche?

4) What will be the level of FSH, LH,

oestradiol in benign premature

thelarche?

5) What will be the USG findings?


1) Isolated breast development

2) < 3 yrs

3) Associated with accelerated bone age

due to systemic ostrogen effects

4) Low

5) Small Ovanian cysts

Question No: 54

A child has chronic polyarthritis of 4 joints and is

ANA positive.

2) What arthritis is it likely to be?

3) What complication should we anticipate?

4) In which type of JRA is HLA β27 positive ?

5) A child with JRA presents with fever,

leuepenia and hepatosplenomegaly and

lymphadenopathy. What is the diagnosis?

6) What drug is indicated in treatment of Q4?


1) JIA pauciarticular type I

2) Chronic uveitis

3) Pauciarticular type II

4) MAS

5) Cyclosporin

Question No :55

Oxygen therapy

1) Below what blood O2 does WHO recommend

O2 therapy?

2) What are the clinical indications for O2

therapy?

3) O2 concentration with reference to FiO2

Nasal prongs @1-2 lit/min, Nasopharyngeal

catheter


1) <90%

2) Central cyanosis, unable to drink due to

respiratory distress.

In those with pneumonia, Broncholitis and

asthma- severe lower chest in drawing, RR >70,

Grunting, Head nodding

3) FiO2 30 – 35 %, 45 – 60 %

Question No : 56

A child is brought with snakebite.

1) In which of the following is appropriate as

first aid.

a) Splint the limb

b) Apply ice

c) Apply tourniquet to occlude venous flow

d) Clean the wound

e) Transport to hospital

2) 2 specific indication for ASV

3) What is the dose of ASV to a 3 year old?

4) What is the diluent for ASV?


1) a) Splint the limb -

b) Clean the wound –

c) Transport to hospital –

2) Indications:

a) Systemic signs of envenomation

b) Local symptoms like severe necrosis, swelling

of > half of the limb

3) Same as adult

4) Normal saline (2 to 3 volumes)

Question No: 59

1) What are the 4 types of lesions?

2) What bacteria cause this?

3) Which drug can induce this?

4) Name 4 drugs used?

5) What Dietary advice will you give?


1) Open Comedones – blackhead

Closed comedones – whitehead

Papules, pustules and nodulocystic lesions

2) Propionibacterium acnes

3) Corticosteroid, androgens, INH, phenobarbital,

Phenytoin, B12 and lithium

4) Benzoyl Peroxide, Tretinoin, Adapalene,

Topical – Erythromycin and clindamycin

Use for 4 to 8 weeks:

Systemic therapy: Tetracycline, Doxy, Minocycline

Isotretinoin (nodulocystic) (teratogenic)

Intradermal triamcinolone

5) Normal

Question No : 57

A child presents with muscle cramps. The serum

Magnesium is 1mg/dl, K is 1.6mg/dl and Hco3 is 40mg/dl.

There is no dehydration.

1) What electrolyte in urine will you estimate?

2) Why?

3) The level of the urinary electrolyte estimated is

high – BP is normal. List 3 possible diagnosis?

4) There is no history of drug ingestion or failure to

thrive hypertension. What is the diagnosis?

5) 3 drugs for treatment

6) What will be level of renin and aldosterone in

serum?

7) What will be the urinary calcium level?


1) Calcium

2) To distinguish low and high urine calcium

levels

3) Barter’s, giltelman’s and base administration

4) Giltelman syndrome

5) Na, mg and spiranolactone

6) Normal

7) Low

Question No : 58

A child is admitted with TCA poisoning.

1) What are the 3 ‘C’s in manifestations?

2) What ECG findings do you anticipate? (3)

3) Which of the following is correct?

a) Emesis is indicated

b) Activated charcoal to be given

c) Na Hco3 must

d) PH should be 7.45 to 7.55

e) Lidocaine not be used for any time

f) Quinidine & procainamide - to be used

g) NaHco3 is used to prevent cardiac

arrhythmias


1) Coma, convulsion, cardiac toxicity

2) Widening of QRS, Q-T prolongation,-, flat

or inverted T , ST depression, RBB, CHB

3) A) No

b) Yes

c) Yes

d) Yes

e) No

f) No

g) Yes

Question No : 61


2) Name 2 topical agents of use?

3) Duration and frequency?

4) 2 drugs for systemic therapy?

5) Commonest organisms?


1) Tinea corporis

2) Miconazole, ketoconazole, clotrimazole,

econazole, terbinafine, niftifine

3) Bd, 2 to 4 week

4) Griseofulvin – several weeks

Itraconazole – 1 – 2 week

5) T. Rubrum, T. Mentagrophytes

Question No : 60

Write the calorie value of

Rice – 1 cup

Puri – 1

Upma – 1 cup

Idli – 1

Dosa – 1

Kichidi - 1 cup

Boiled egg - 1

Vada - 1

Pizza – 1 slice

Oil – 1 tbsp

Ice cream – ½ cup

Peanuts – 50 nos

Banana – 1

Cashew nuts – 10

Milk chocolate – 25gm

Answer for Question No : 60Rice – 1 cup - 170

Puri – 1 - 100

Upma – 1 cup - 270

Idlli – 1 - 75

Dosa – 1 - 125

Kichidi - 1 cup - 200

Boiled egg – 1 - 90

Vada – 1 - 70

Pizza – 1 slice - 200

Oil – 1 tbsp - 60

Ice cream – ½ cup - 200

Peanuts – 50 nos - 90

Banana – 1 - 90

Cashew nuts – 10 - 95

Milk chocolate – 25gm - 140

Question No : 62

This girl has palpitation, diarrhea, and loss of

weight


2) The thyroid swelling is not tender, not

nodular. She has exophthalmos. What is the

cause?

3) List 4 other causes?

4) Investigations

5) 2 drugs used


1) Hyperthyroidism

2) Graves Disease

3) Toxic adenoma, toxic multinodular , subacute

thyroiditis, Lymphocytic thyroiditis, iodine

induce, exogenous hormone, pituitary

adenoma and ovarian tumor.

4) TSH is decreased, T4 increased. Thyroid

uptake increased

5) β blockers, methimazole (propylthiouracil)

Question No : 63

A spirometry is performed in an asthmatic child

1) What will be abnormalities in the following:

FEV1

FEV1 / FVC

Improvement in FEV1

Exercise challenge

2) What PEFR variation that is consistent with

a diagnosis of asthma?


1) FEV1 – Low

FEV1 / FVC ration < 0.8

Improvement in FEV1 with inhaled β2 agonist

≥12%

Exercise challenge – worsening in FEV1 ≥ 15%

2) Morning to afternoon variation ≥ 20%

Question No : 64

The following is the ABG is an infant

PH - 7.2, Hco3 – 10, CO2 – 30


2) Why?

3) Give an example of a common clinical setting

for this condition?

4) Write the other compensation in acid bone

disorder. Which are appropriate?


1) Metabolic acidosis – respiratory acidosis

2) Expected Co2 = 1.5 X (10) + 8 ± 2

= 21 to 25

Co2 >25

3) Pneumonia with sepsis (lactic acidosis and respiratory

acidosis)

4) Metabolic alkalosis Pco2 ↑ 7mm for 10meq/L of Hco3

Respiratory acidosis – Acute: Hco3 ↑ 1 for 10mm ↑ in

Pco2

Chronic: Hco3 ↑ 3.5 for 10mm ↑ in Pco2

Respiratory alkalosis Acute: Hco3 ↓ 2 for 10mm ↓

in Pco2

Chronic: Hco3 ↓ 4 for 10mm↓ in Pco2

Question No : 65

Serum Na - 136, Cl - 102 and Hco3 - 10

1) What is the anion gap?

2) What is the normal anion gap?

3) In which of the following is anion gap normal or

increased?

Diarrhea

Lactic acidosis

DKA

ARF

RTA

Salicylate poisoning

Urinary tract diversion

IEM

Septic shock

Post hypocapnea


1) (136) – (102 + 10) = 24

2) 8 – 16

3) Diarrhea - Normal

Lactic acidosis - increased

DKA - increased

ARF - increased

RTA - Normal

Salicylate - increased

Urinary tract diversion - Normal

IEM - increased

Septic shock - increased

Post hypocapnea - Normal

Question No : 66


2) 2 examples

3) Characteristics of the inheritance

4) Plasma ammonia in this child is normal. What

is the likely diagnosis?

5) There is no odor or skin lesion, but there is

ketosis. What is the likely diagnosis?


1) XLD

2) VDRR (Hypophosphotemia), incontinentia

pigmenti

3) Affected men all affected

All normal

All + of affected have 50% inheritance

Rare XLD - milder disease

Thrice as common as male

4) Organic acidemia

Urea cycle – NH3 , anion gap – normal

Amino acid defects

or

Galactosemia NH3 – normal, anion gap – normal

5) MMA,

Propionic acidemia,

Ketothiolase deficiency

Odor + - MSUD / isovaleric

Skin + - Multiple carboxylase deficiency

Ketosis - Acyl CoA, 3Hydroxy 3HGA, HMG co -

synthetase deficiency

Question No : 67

1) What is the clinical classification of leprosy

in India?

2) What are the differences in leprosy

constitution?

3) What is the WHO recommended standard

treatment regime for children aged 10 – 14

yrs?


1) Indeterminate

Tuberculoid Paucibacillary 1 to 5 lesions

Borderline in skin

Lepromatous Multi bacillary > 5 lesions

Pure neuritis

2) Case of leprosy – clinical sign +

Bacilli in smear +

Not completed treatment

Paucibacillary – 1 to 5 lesions

Multibacillary

Adequate treatment

Repeated treatment

Newly diagnosed case

Defaulter

Relapsed case

3) Multi Bacillary (completed in 12 months)

RMP 450mg once a month

Clofazamine 150mg once a month (supervised)

Clofazamine 50mgEod (self administered)

Dapsone 5omg once a month (supervised)

Dapsone 50mg daily dose ( domiciliary)

Pauci Bacillary (completed in 6 months)

Rifampicin 450mg once a month

Dapsone 50mg OD daily (domiciliary)

Question No : 68

Midday meal program

1) What are the principles?

2) Write a model menu?


1) Meal – a supplement, not a substitute to

home diet

Should supply 1/3 of total energy, ½ of protein

Cost low

Easily cookable in school

Use locally available foods

Change menu frequently

2) Cereals & and millets – 75gms

Pulses - 30

Oil & fat - 8

Leafy vegetable –30

Non-leafy - 30

Question No : 69

Answer the following questions with regard to

cold chain equipment:

1) Which vaccines are stored in deep freezers?

2) Which vaccines are stored in ILR?

3) Which vaccines are kept in the basket of

ILR?

4) What is the function of cold boxes?

5) What are Day carriers used for?

6) What are vaccine carriers used for?

7) Which vaccines should not be frozen?


1) Measles & OPV

2) All

3) TT, DPT, DT and diluents (not in the floor –

may be frozen)

4) Transportation of vaccines

5) Carry small quantities of vaccines to a nearly

session.

6) Carry small quantities of vaccines to out of

reach session

7) DPT, DT, TT, Typhoid, BCG, HBV, diluent

Question No :

A 11 year old boy is brought with a penetrating crush

injury with a compound fracture. His immunity and

immunization status for tetanus is unknown. Which of the

following action is correct with regard to tetanus

prevention?

a) Nothing is required

b) Toxoid 1 dose

c) Toxoid 1 dose + TIG

d) Toxoid complete course + TIG

His 8 year old sister has multiple clean abrasions. She

has earlier received 3 doses of DPT in the first year and

1 booster at 1 ½ year and no other vaccines after that

What prevention will you carry out?

Answer for Question No :

All wounds – surgical t------ < 6hr, clean, non

penetrating with negligible tissue damage

a) Nothing

b) TT 1

c) TT 1

d) TT complete course

All wounds – surgical t------ other wounds immunity

category.

a) Nothing

b) TT 1

c) TT 1 + TIG

d) TT complete course + TIG

a) Complete course + Bon----- < 5 yrs

b) Complete course + 5 to 10 yrs

c) Complete course + > 10 yrs

d) Immunity unknown + has not heel a complete

course of toxoid.

Question No : 70

The peak flow rates of 10 children of same age are

as follows:

250, 260, 290, 200, 240, 240, 260, 270, 270, 290

1) What is the range?

2) What is the mean deviation and Mean?

3) What is the standard deviation?


1) 90 (200 to 290)

2) Mean Deviation =∑ (x – x)

N

Mean – 257, Mean Deviation – 19.8

3) Standard deviation = ∑ ( x – x ) 2 (>30)

n

Standard Deviation = ∑ ( x – x ) 2 (<30)

n-1 in this case (10-1)

Take the deviation of each value from Mean (x-x)

Square each (x – x )2

Add and squared deviation ∑ ( x – x ) 2

Divide by no. of observation or n-1 if <30

Then take square root

Answer No for Question No : 71Resected tissue from OT Chemical disinfect ion

and discharge into drain

Waste from laboratory Chemical disinfect ion

culture / autoclave /

microwave and mutilation

shredding

Needles and syringes Disinfect ion / shredding

Discarded medicines Autoclaving / microwaving

/ incineration

Linen contaminated Incineration autoclaving

with Blood / Microwaving

Used IV set Incineration and drug

disposal in secured land

fills

Liquid waste from house Incineration / deep burial

keeping

Question No : 71Write the correct method of treatment and disposable

of the following categories of biomedical work?

Resected tissue from OT Incineration / deep burial

Waste from laboratory Autoclaving / microwaving

culture / incineration

Needles and syringes Disinfect ion / shredding

Discarded medicines Incineration and drug

disposal in secured land

fills

Linen contaminated Incineration, autoclaving

with Blood / Microwaving

Used IV set Chemical disinfect ion /

Autoclaving / microwaving/

Multilation/ shredding

Liquid wask from house Chemical disinfect ion

keeping and discharge into drain

Question No : 72

This child also has joint hypermobility


2) What is the usual mode of inheritance?

3) What is the defect?

4) How many clinical forms?

5) What cardiac among can occur?

6) What surgical emergencies?

7) Difference with Cutis Laxa


1) Ehlers Danlos

2) AD

3) Defect of fibrillar collagen – quantitative

4) 10

5) MVP, AR

6) Rupture of great vessels, dissecting aneurysm,

stroke, rupture of uterus in pregnancy,

echymoses, periodantitis.

7) Cutis Laxa – skin hangs in redundant folds – AR

EDS – hyperextensible snaps back into place when

stretched - AD

Cutis Laxa – Bloodhound appearance, aged appearance

Hyperelasticity and hypermobility of joints, hoarse cry,

lax vocal cords

Question No : 73

A child is brought with a history of accidental

ingestion of Iron tablets.

1) Which one of the following would be of

benefit?

Gastric Lavage

Activated charcoal

Whole bowel irrigation

2) When would you measure serum Iron?

3) What is the level of serum Iron which

indicate significant toxicity?

4) If serum iron level reports were delayed,

how would you confirm iron ingestion?

5) What are the 2 indications for giving

desferioxime?

6) What system exhibits symptom first?

When?


1) Whole bowel irrigation

2) 4 – 8 hrs after ingestion

3) >500µg/dl

4) X – ray abdomen

5) Level >500µg/dl

Moderate to severe symptoms

6) GI, 30 minutes to 6 hr

Question No : 74


2) What 2 findings are characteristics?

3) What is the effect of treatment?

4) List 4 drugs useful

5) What physical therapy will help?


1) Psoriasis

2) A) Plaques with yellowish white scale like

mica

b) Auspitz sign – pinpoint bleed or removal

3) Koebner phenomenon lesions appear

4) Coal tar, topical steroid, salicylic acid,

calcipotriene (Vit.D analog), Methotrexate &

cyclosporine and retinoid

5) UV light

Question No : 75

Assess the development of this 3 year

old


Motor : Rides tricycle, stands on the foot

momentarily

Adaptive : Tower of 10 cubes, imitates bridge

construction of 3 cubes, copies a circle, imitates

a cross

Language : Knows age and sex, counts 3 objects

correctly, repeats 3 numbers or a sentence of 6

syllables

Social : Plays simple games with other children in

parallel, helps in dressing – put on shoes,

unbuttons, washes hands.

Question No : 76


2) Commonest organism?

3) Treatment


1) Cutaneous larva migrans

2) A. Braziliense (Hook worm of dogs and cats)

(other anky + & Strongyloides)

3) Ivermectin – 200mg/kg/one 1 to 2 days

Albendazole – 1 OD X 3 days

Topical thiabendazole

Question No :

A mother says she has the following problems in breast-

feeding

1) A not enough milk

2) The baby is reluctant to breast feed

Answer for Question No : If not enough milk – poor weight ----- <500/---

<125gm/---

< birth weight after 2 weeks

<6 times / day urine strong / smelling concentrated urine

Common reasons :

Poor breast feed p------- :

Poor attachment, no night feeds, delayed start, short feeds,

rigid schedule, broke, other feeds

Psychological – strem, tired

Physical causes

Baby is illness / con---- among

Advice :

Refusal or reluctance to breast feed :

Baby is in pain, ill, sedation

Encourage to ---- and feed more often

Use EBM

Rooming in

Correct positioning

Clear ------ nose

Treat oral

↓ sedation to mother

Question No : 77

Amniocentesis is brief contemplated for pregnant

woman for genetic counseling

1) What is the ideal time?

2) What is the most common indication?

3) Name 4 other indications?


1) 15 to 16 weeks

2) Advanced maternal age > 35 yrs

3) a) Previous child: chromosomal anmaly

b) Either parent - a translocation cause

c) History of genetic disorder diagnosed

by DNA analysis / biochemistry

d) Sex detection in XLD / XLR diseases

e) Maternal blood testing (triple screening)

indication risk

f) Work up for fetal anomalies suggested by

USG

Question No : 79

1) Identify the abnormality in RBC?

2) This child has chronic diarrhea. What is

the diagnosis?

3) Which vitamin deficiency in these children is

associated with neurological symptom?

4) Which lipid abnormalities are

characteristics?

5) What is the fundus finding?



1) Acanthocytosis

2) A Betalipoprotenemia

3) Vit. E

4) Cholesterol

TGL

Absent B Liproteins

5) Retinitis pigmentosa


Question No : 78

An infant has cough and difficult breathing

The respiratory rate 70 / min

The infant has severe respiratory distress (head

nodding)

1) What does the infant have as per ARI

programme?

2) What are other criteria for this status?

3) Will you treat this infant as OP or IP?

4) What is the antibiotic therapy regimen?


1) Very severe pneumonia

2) Central cyanosis

-------- to feed / drunk or vomited

everything

--------- / lethargy / -----------

3) IP

4) Ampi + Gent—for 5 days

Oral ------- for 5 days

Or

CM for 10 days

Or

Ceftriaxone

Question No: 80

1) Identify the organism?

2) What 4 stains are used?

3) What is the treatment?

Answer for Question No : 801) Pneumocystis carinii

2) Grocott- Gomori cyst

Toluidine blue

Polychrome – Giemsa

Trophozoites and sporozoites

Fluorescent labeled MAB

3) 5mg/kg once daily 3 day a week

Cotrimoxazole

15 – 20mg in 4

3 weeks for AIDS

2 weeks for others

Pentamidine

Atovaquone, trimextrate + steroids

Answer for Question No . 82

1) Giandia Lambia

2) Acute Explosive fowl smelling watering diarrhoea Abd distusion / flatuluce / nansea anorara and epigastic cramps

3) FTT / Lactose Mal Absorbtion / Persistant Steattorrhoea, E hystlylica diarrhoea injection

4) Metronidayole 15 kg

Date post:	29-Nov-2014
Category:	Health & Medicine
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OSCE Pediatrics KKCTH

Health & Medicine