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OSCE Pediatrics KKCTH 2007

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  1. 1. OSCE KKCTH OSCE – JAN 2007
  2. 2. Question No : 11) 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 endocarditis2) a) Reducing cardiac work
  3. 3. 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 DigoxinQuestion No : 2 .1) Identify the Organism2) 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?
  4. 4. 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 doseAlbendazole (albenza) 400mg once a day for 5 days POFurazolidone (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 recommendedQuinacrine (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
  5. 5. 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
  6. 6. Question No. 4A 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 %
  7. 7. Question no. 5 Match the following :1. Phyrostygmine : Mushroom2. Pyridoxine : Diazepam3. Diphenhydramine : Clonidine4. Dimercaptosuccinic acid : Dystonia5. Flumazenie : Ethylene Glycol6. Naloxone : Methanol7. Fomepizole : Betablocker8. EDTA : Arsenic9. Ethanol : Anticholinergic Agent10. 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
  8. 8. 9. 6 or 510. 7 Question No. 61. 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 Syndrome2. Match the Following :- a) Cow’s Milk - Paralbumin b) Egg - Vicilin c) Peanut - Ovomucoid d) Fish - Casein
  9. 9. 3. What is the ideal age for introducing the following foods:- a) Cow’s Milk b) Egg c) Peanut & Seafood Answer for Question No. 61. i) A ii) A iii) B iv) B v) B vi) A2. a) 4 b) 3 c) 2 d) 13. a) 1 year b) 1 ½ to 2 years c) 3 years
  10. 10. Question No. 71. 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?
  11. 11. 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. 81. 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?
  12. 12. 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. 910 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. 91) Rate - Bradycardia Rhythm - Idioventricular Complete Heart Block
  13. 13. 2) Autoimmune disorder, complex CHD, Myocarditis, long OT Syndrome3) Pacing Question No. 10A 1½ yrs old child presents with failure to thrive Muscle weakness,Constipation, Polyuria. ABG: Ph 7.55 Co2 37 Po2 99 Sao2 98 Hco3 37 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 : 101. Metabolic alkalosis uncompensated Probable bartter syndrome2. Laxative or diuretic use, persistent Vomiting, diabetic insipidus.
  14. 14. 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
  15. 15. 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 oedema1) What is the nutritional status of the child as per?
  16. 16. a) IAP Classification b) WELLCOME Classification c) GOMEZ Classification d) WATERLOW Classification2) Write details of Gomez and Waterlow classification. Answer for Question No : 131) A) Grade II PEM B) Under nutrition C) Grade II malnutrition D) Normal2) 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 %
  17. 17. 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 : 141) What is the radiological finding?2) Name three common aetiological agents.3) Name six complications of this condition. Answer for Question No : 141) Consolidation right upper lobe2) Pneumococcus H. Influenza Staphylococcus aureus3) Pleural effusion
  18. 18. Empyema Pericarditis Meningitis Septic arthritis Osteomyelitis Question No : 15A 14 yrs old girl is seen at the OPD with short stature, sexualinfantilism, 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 withthis condition?4) Name three skeletal deformities. You would look for in this child. Answer for Question No : 151) Turner’s syndrome2) Chromosomal analysis / Karyotyping
  19. 19. 3) Bicuspid aortic valve is the commonest cardiovascular anomalyseen in 1/3 to ½ of patients with turners.4)a) Short 4th metatarsal and metacarpalb) Epiphyseal dysgenesis of knees and elbowsc) Scoliosisd) Decreased mineralisation of bones. Question No : 16 CHICKENPOX VACCINE1) 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 : 161) 0.5 ml
  20. 20. 2) 13 yrs 4 – 8 weeks3) 72 hrs4) 30 minutes5) If mother develops Varicella 5 days before to 2 days afterdelivery6) Subcutaneous Question No : 17Fill up the contents of the following IV fluids1) 5 % GDW ----- / caloric / L2) Dextrose 10 % ----- / caloric / L3) Blood Na ----- / meq / L4) Ringer Lactate K ----- / meq / L Na ----- / meq / L HCo3 ----- / meq / L5) 3 % saline Na ----- / meq / L6) Calcium Gluconate 10 % Ca mg / ml7) Magnesium Sulphate 50 % Mg meq / ml
  21. 21. 8) Resomol solution K meq / L Glucose gm / L Na gm / L Answer for Question No: 171) 200 caloric / L2) 400 caloric / L3) 135 – 145 meq / L4) 4 meq / L 130 meq / L 28 meq / L5) 513 meq / L6) 9 mg / ml7) 4 meq / ml8) 40 mg / L 125 gm / L 45 gm / L Question No : 181) What is the cut off age limit for diagnosis of primary Amenorrhoea?2) Which is the commonest CNS tumour may be responsible forprimary Amenorrhoea?3) If FSH and LH levels are elevated, what is the aetiology forprimary Amenorrhoea?
  22. 22. 4) At which SMR, majority of girls reach Menarche?5) A girl with primary Amenorrhoea presents with recurrentabdominal pain. What is the commonest cause?6) Name one psychological disorder that can cause primaryAmenorrhoea? Answer for Question No: 181) 16 yrs2) Craniopharyngioma3) Primary Gonedal failure4) SMR 45) Imperforete hymen / Hematocolpus6) Anorexia nervose Question No : 19 HIV INFECTION IN NEW BORN1) 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
  23. 23. 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 fordiagnosis and what is its sensitivity and specificity. Answer for Question No. 191)a) It implies inatero infection and rapidly progressive diseaseb) It implies postnatal transmission and slowly progressive disease2) After 1 month of age (as false possibility rates are higher if donebefore)3) If two positive virologic tests (PCR / culture P24 antegen) areobtained from different blood samples.4) > 18 months of age – it is 100 % specificity sensitive. Question No : 20A 4 month old baby is brought with respiratory distress. On examination baby isfloppy 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?
  24. 24. Answer for Question No : 201) Spinal muscular atrophy type - I2) a) Genetic analysis for SMN gene (surviour motorneurogene) b) Muscle biopsy3) Autosomal recessive4) Introduce myself to the mother and form a rapport with her- appraise her regarding the genetic and progressive nature of theillness her baby had the possibility of recurrences in the nextpregnancy has to be discussedexplain the various prenatal diagnostic options available and ifpossible tell her where the tests are availableDiscuss the treatment options for her present child has the diseaseprogresses.Thanks the mother. Question No : 21Answer the questions regarding Turner’s syndrome1) What is the characteristic neonatal manifestation?2) Name 3 cardiac anomalies in Turner’s syndrome.3) Name 2 endocrine problems in turner’s
  25. 25. 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 : 211) Oedema2) a) Bicuspid aortic valveb) Coarctation of Aortac) Aortic stenosisd) Mitral valve prolapsee) Anomalous pulmonary venous drainage3) a) Autoimmune thyroid diseaseb) Type 2 diabetes mellitus4)a) IBDb) GI Bleed
  26. 26. C) Delayed Gastric Empyema5)a) GHb) Estrogenc) Progesteroned) Thyroxine6)a) Shortening of 4th metatarsal and metacarpal boneb) Epiphyseal dysgenesis in the joints of knees and elbowsc) Madeling deformityd) Scoliosise) Osseous mineralisation Question No : 22Obtain history from a mother who has brought her6 yrs old child with history of unprovoked seizures.Checklist:1) Introduces and establishes rapport.
  27. 27. 2) Asks her to act out or re-create a seizure3) Asks for Aura and automatism4) Asks about headache and vomiting5) Elicits h/o failure to thrive6) Asks for details of medications used that may precipitate seizure7) Asks for details of anticonvulsant therapy7) Asks for compliance8) Asks for family history9) Asks for developmental history10) Asks for birth and neonatal problem11) Asks for the time of occurrence of seizures12) Asks for frequency13) Asks for precipitating factor like from fever.14) Asks for personality change / school problem / Intellectual deterioration. Question No : 23When the mother is HIV positive1) What is the percentage of transmission of HIV through breastmilk?
  28. 28. 2) What should be mother be appraised of, if she chooses to breastfeed her baby?3) What are the methods by which breast milk can be processed toreduce chances of transmission?4) What criteria should be taken into account if mother wants tofeed the baby with formula milk? Answer for Question No : 231) a) 14 % if mother acquired infection before pregnancy b) 29 % increased risk if mother acquired infection duringpregnancy2) a) Benefits of breast feeding b) Risk of transmission while breastfeeding (e.g. through crackednipple) c) To avoid mixed feeding and to stop breastfeeds abruptly after4th month. d) Mother should be on ART while feeding3) a) Pasturised breast milk b) Boiled human milk
  29. 29. c) Frozen human milk d) Expressed breast milk allowed to stand and remove the lipidlayer4) a) Acceptability b) Affordability c) Sustainability d) Safety and feasibility Question No : 241) Define: a) Drowning b) Near drowning2) List 3 predisposing aetiological factor for drowning.3) List 2 electrolytic disturbances and 1 hematological complicationsof near drowning4) What is the commonest radiological finding? Answer for Question No : 24
  30. 30. 1. a) Death within 24 hours of an immersion event b) Any survival from an immersion event2. a) Seizures b) Long QT syndrome c) Poisoning with drugs3. 1. a) Hypernatremia b) Hyperkalemia c) Hypercalcemia d) Hypermagnesemia 2. Hemolysis4. 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.
  31. 31. Answer for Question No : 251) Emotional disturbances with motor hyperactivity / irritability / emotionallability2) Cardiomegaly and failure atrial fibrillation mitral regurgitation due topapillary muscle dysfunction.3) Propylthiocracil MethimazoleSevere reactionsAgranulocytosisHepatic failureGlomerulonephritis and Vasculitis Question No : 26A 6 yr old girl child is brought to ER with wheezing. She was diagnosedoutside as an asthmatic few months earlier. What relevant history would youlike to ask the mother?
  32. 32. Answer for Question No : 26Present history1) When did the present attack start and if the child is gettingbetter / worse / no improvement?2) Does the child have rapid breathing / difficulty in talking orfeeding?3) Any factors that triggered the present attack?4) What medications has she been administered for the presentattack at what dose and frequency?5) If associated with feverPast history1) How long has she been a wheezer / has frequent and for how manydays 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 complaintand 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
  33. 33. 6) Any admission to ICU and if so if mother has been told aboutwarning signs7) H/o exposure to passive smoking / pets and other triggers8) If wheeze is exercise induced?9) History regarding comorbid conditions like sinusitis / GER / otherallergiesFamily HistoryH/o asthma or atopy in family. Question No : 27 X - ray1) Describe 2 essential findings.2) What is the diagnosis?3) What is the pathogenesis?4) What is the treatment?
  34. 34. Answer for Question No : 271) (i) Emphysema of left upper lobe (ii) Herniation of left upper lobe to the right (iii) Mediastinal shift to right2) Congenital Lobar Emphysema3) (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 mediastinum4) Lobectomy Question No : 28An infant is being evaluated for IEM.The infant’s reports are as follows:Plasma NH3 is 500ABG – pH 7.38 pCo2 421) 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?
  35. 35. 5) Which is the most common form of these disorders? Answer for Question No : 281) Urea cycle defect2) (i) Carbamyl phosphate synthetase (CPS) (ii) Ornithine Transcarbamylase (OTC) (iii) Argininosuccinate Synthetase (AS) (iv) Argininosuccinate Lyase (AL) (v) Arginase (vi) N – Acetylglutamate Synthetase3) (i) Sodium Benzoate (ii) Phenylacetate (iii) Arginine (iv) Lactulose (v) Neomycin (vi) Citruline (vii) Carnitine4) OTC Deficiency5) OTC Defects
  36. 36. Question No : 294 months old child brought to hospital with generalized hypotonia /feeding difficulty since birth and h/o poor perception of fetalmovements 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 : 291) Congenital myopathy2) Myotubular myopathy Nemaline rod myopathy Central core disease3)(a) Maturational arrest of fetal muscle during myotubular stage ofdevelopment4)
  37. 37. (a) Confirm the disease(b) Physiotherapy(c) NG feeds(d) Genetic counseling Question No : 301. Picture A Picture AOutline 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 motherwho is 2 months pregnant?2. Picture B
  38. 38. Picture BWhat is the diagnosis?List 3 clinical features of this condition Answer for Question No. 30I. Varicellaa) Symptomatic treatment with antipyeretics / antihistamines /hygiene etc is adviced if child is healthy and is uncomplicatedvaricella. A cyclovir is started within 72 hrs if child is immunosuppressed /on steroids or salicylater. Child has chronic cardiac / pulmonarydisorder or is complicated varicella.b) Secondary bacterial skin infections Encephalitis / cerebellar ataxia Pneumonia Purpura / HUS
  39. 39. Nephritic syndrome Arthritis Myocarditis / pericarditis Pancreatitis c) Varicella vaccine can be given for 5 yrs old sister within 3 to 5days after exposure if she has not been infected or vaccinatedearlier. If mother has not been infected or vaccinated earlier.V21G can be given to the mother to prevent her from getting chickenpox but she has to be told that it may not prevent the fetus frombeing 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 + urethralsphineters developmental defect of eye including hormone syndromeand cataracts. Question No : 31 Regarding Mantoux skin test1) What is the composition of tuberculin used?
  40. 40. 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 : 311) 0.1 ml contains 1 TU of PPD stabilized with tween 802) 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 TB4) Children with immunosuppressive conditions – HIV / organ transplantation or oncorticosteriods > 15 mg / 24 hrs for > 1 month.
  41. 41. Question No : 32A baby born to HBSAG positive mother receives HBIG and HBV soon afterdelivery at 1 and 6 months.1) (i) When would you recommend post vaccination testing for HBSAG and antiHBS? (ii) How would you interpret the results?2) What is the strength of the HBV vaccine used at different ages and for theimmune suppressed?3) What would be the vaccination schedule for a 2-year-old child who has receivedonly 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 whatwould be your advice? Answer for Question No : 321) (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
  42. 42. 3) Give only one dose of HBV to complete the schedule.4) To start HBV vaccination and administer the I dose simultaneously with MMRat a different site. Question No : 33A 1 ½ years old child is admitted and treated for HAV infection. Child has notreceived any immunization so far as he comes from a tribal area. What will be theimmunizations you would advice for this child and at what schedule? Answer for Question No. 33As many vaccines as possible can be administered to this child simultaneouslyfollowing the IAP schedule and administering optional vaccines as per the mothersrequest. No need for HAV vaccine.
  43. 43. Question No : 34An 8 months old child is diagnosed to have HIB meningitis1) 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 spreadof this disease to other members in the household? Answer for Question No. 341) 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 fromblood, CSF and urine2) Major Neuro SequelaeBehavioural problemsLanguage disorder
  44. 44. Impaired visionMentalretardationMotor abnormalitiesAtaxiaSeizuresHydrocephalusHearing loss Question No : 35
  45. 45. 1)Comment on this smear 2)Mention atleast 3 DD of this smear 3)How do you confirm the diagnosis? Answer for Question No. 351) Hypochromic microcytic anemia with few target cells and tear drop cells. WBCand platelets appear normal.2)a) Iron deficiency anemiab) Thalassemiac) Sideroblastic anemia3) Serum Iron / TIBC Hemoglobin electrophoresis Bone marrow study.
  46. 46. Question No : 36Write your dietary advice for a child with CRF. Answer for Question No. 36Diet in CRF1) 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 yrsmild GFR (20 – 40) 1.8 1.4 1Mod GFR (5 – 20) 4.1 1 0.8Severe GFR (< 5) 1 0.8 0.63) 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 output5)If Hyperkalemic – avoid K containing food restriction of po4 if severe Po4 ishigh.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).
  47. 47. Question No : 37A 3 years old child is seen at OPD with short limbs, long narrow trunk and largehead. 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. 371) Achondioplasia2)(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
  48. 48. Question No : 3816 months old child with Thalassemia major, had urtricarial rashes following eggingestion brought for MMR vaccine.1) What history would you ask before vaccination & why?2) What precaution would you take to store, reconstitute and administer MMRvaccine?3) If the mother want to administer varicella vaccine also what would be youradvice. Answer for Question No. 381) When the child last received blood transfusion.Whether the child had anaphylaxis to egg ingestion – though it is not acontraindication for MMR the child has to be observed for 90 minutes aftervaccination if there is history of anaphylaxis.2) MMR has to be stored in the first shelf of the refrigerator and given within 4 hrsafter reconstitution it is given subcutaneously.3) Both can be given simultaneously at two different sites or at 4 – 8 weeksinterval.
  49. 49. Question No : 391) Write your comments on the x - ray2) Give 3 differential diagnosis which can led to this condition. Answer for Question No : 391) Normal lungs and heart Bilateral adrenal calcification2)a) TB of the adrenals b) Recovery after waterhouse fridrichsen c) Woolmans disease(Calcification is almost always unilateral in adrenal tumour)
  50. 50. Question No : 401) 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. 401) Pulse oximetry is a non-invasive method of measuring the oxygen saturation ofhemoglobin in arterial blood.2) Red and infra red light of different wavelengths when transmitted through thecapillary 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 ina) Poor perfusionb) Ambient light
  51. 51. c) Presence of carboxy hemoglobin / methhemoglobin4) As per the oxyhemoglobin dissociation curve Question No : 411) 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. 41I1) Langerhans cell histocytosis2) a)Familial erythrophagocytic lymphohistiocytosisb) Infection associated hemo phagocytic syndrome3) a) malignant histiocytosis
  52. 52. b) Acute monocytic leukemia2) a) seborrheic dermatitis / petechiab) Hypothalamic involvement / pituitary dysfunction – diabetis insipidus / primaryhypothyroidism.c) Osteolytic lesion in born with no evidence of reactive newborn formation /fractures / vertebral collapse / floating teeth.3) Hyperlipidemia, hypofibrinogenimia, elevated lever enzymes, extremelyelevated circulating interlukin 2 receptors Question No. 421) 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?
  53. 53. Answer for Question No. 421)a) Prominent occiputb) Cerebellar ataxiac) Macrocephalyd) Sunset Signe) Spasticity of lower limbs2) Dilated IV ventricle / III & lateral ventricles / Dandy walker malformation.3) Failure of development of roof of IV ventricles. Question No. 43Storage of Vaccines1. Picture of a RefrigeratorVaccines are stored in this refrigerator in your clinic. Mention the correct place ofstorage of the following.a) BCGb) OPVc) MEASLESd) DPT / DT / TTe) Varicella
  54. 54. f) Hepatitis – Bg) Hepatitis – Ah) Typhoidi) Diluentj) Ice Cubesk) Ice Packsl) Dial Thermometerm) Water Bottles Answer for Question No. 431) Top shelf2) Freezer3) Top Shelf / freezer4) Middle Shelf5) Lower Shelf6) Middle Shelf7) Middle Shelf8) Middle Shelf9) Crispator10) Freezer11) Freezer12) Top Shelf13) Side door
  55. 55. Question No. 441) 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. 441)a) Neurologic dysfunctionb) ADHDc) LDd) CP
  56. 56. Question No. 45Match the followingHb electrophoresis Hemoglobinopathy1) FA B – Thalassemia2) FAS Alpha Thalassemia3) FS Sickle cell trait4) F Normal5) FA Bart’s Sickle cell anemia Answer for Question No. 45Hb electrophoresis Hemoglobinopathy1) FA Normal2) FAS Sickle Cell Trait3) FS Sickle cell anemia4) F B – Thalassemia5) FA Bart’s alpha thalassemia
  57. 57. Question No. 46You are investigating some children with reference toHepatitis B. Interpret the reports and give your diagnosis.I. Child A - HbSAg +ve - Anti HbCAg Igm +ve - Anti HbSAg –ve - HbeAg +veII. Child B - HbSAg +ve - Anti HbcAg -veIII. Child C - HbSAg –ve - Igm Anti Hbc +veIV. Child D - HbSAg +ve - Hbe +ve - Anti Hbc IgG +veV. Child E - HbSAg –ve - Anti Hbc IgG –ve - Anti HbSAg +ve - Anti Hbe +ve
  58. 58. VI. Child F - HbSAg –ve - Anti Hbs +ve - Anti Hbc IgG –ve - Anti Hbe –veAnswer for Question No. 46I. Acute Hepatitis B highly infectiveII. CarrierIII. Acute Hepatitis BIV. Chronic Hepatitis B high infectivityV. Recovery from Hepatitis BVI. Immunised child / Remote hepatitis B infection
  59. 59. Question No. 471) 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. 471) 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 / hr3) - TTP - Antithrombic C, Pr C, Pr S deficiency
  60. 60. 4) a) Fibrinogen b) Factor VIII c) Factor XIII Question No. 48Write the correct symbols for the following used in pedigree chart.1) Sex unspecified2) Divorced3) Monozygotic twinn4) Proband5) Deceased individual6) Miscarriage7) Adopted into family8) Stillbirth9) No offspring10) Affected
  61. 61. Question No. 49I. 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 followinga) Palmar grasp gone - 8 monthsb) Transfers object from hand-to-hand - 4 monthsc) Turn pages of book - 5.5 monthsd) Thumb finger grasp - 12 months
  62. 62. Answer for Question No. 49I. a) 30 months b) – Makes tower of 7 cubes - Circular scribbling - Imitates vertical stroke - Dumps pellets from bottleII. a) 48 months b) – Hops on one foot - Throws ball menhead - Uses scissors to cut out pictures - Climbs wellIII. a) 4 months b) 5.5 months c) 12 months d) 8 months
  63. 63. Question No. 50E.T. Tube1) 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. 501) Endotracheal tube uncuffed2) a) Adaptor b) Markings on tube for nasal / oral fixing c) Vocal cord guide d) Murphy’s eye e) Radiological marker3) 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
  64. 64. http://oscepediatrics.blogspot.in/ http://dnbpediatricstheory.blogspot.in/http://groups.yahoo.com/group/PediatricsDNB/