Station 1 This female neonate was born with a large mass in relation to the umbilical cord
• Identify the condition• Give three important aspects that you will take care of in the transport of such a neonate.
Answers• Exomphalos major/ omphalocele• Transport supine with the hernia suspended by a string• Cover the omphalocele with a waterproof covering• Provide additional fluids
Station 2 This male neonate was born with multiple fractures and deformities of the limbs
• Identify the condition• How is the condition inherited?• What is the biochemical defect?• What are the medical treatment options of this condition?
Answers• Osteogenesis Imperfecta• Autosomal dominant• Reduction in collagen formation• a. Growth hormone• b. Bisphosphonates/ allendronate/ pamidronate
STATION 3 Study this picture of an 8 month infant who developed a rash during the declining phase of fever starting with the cheeks
STATION 3• What is the most probable diagnosis?• What is the causative organism?• Name two situations where infection with this organism may be life threatening
Answers Station 3• Erythema infectiosum/ fifth disease/• Parvovirus B 19a. Aplastic crisis in hemolytic anemiab. Non-immune hydrops fetalis in fetal infection
Station 4 (Observed Station) An 8 yr old child is known case of IDDM for last 1 yr. He requires 6 units of long acting insulin and 4 units of short acting insulin for his day. Kindly load the syringe with both types of insulin
Material Required• Two vials of Insulin Marked Long acting and short acting• Insulin Syringes• Spirit swabs• Two chairs one for the examiner and one for the candidate
Methodology for the Examiner• Draw an amount of air equal to the dose of insulin required (Long acting + Short acting) and inject into the vial to avoid creating a vacuum. (2)• Swab the top of the vial with spirit swab provided (1)• Inject air into the long acting first keeping the vial upright. (2)• Then inject air into the short acting insulin. (2)• Turn the vial upside down and withdraw the short acting insulin first (2)• Then the long-acting insulin.(1)
Material Required Station 5• Insulin Syringes• Dummy• BCG Vial• Cutter• Saline ampoules
Methodology For the Examiner• (Each step carries 2 points)• Amount of vaccine (0.1 ml = 0.1 mg of reconstituted vaccine) and Load in to syringe (Breakage of vial)• Selection of area (Left deltoid just above its insertion)• Don’t clean the area with spirit• Keep the beveled end of needle up and technique of insertion• Don’t rub the area
STATION 6• 3 yr male child presented 3 days duration of loose stools 5 days back.• On 2nd day onwards patient passed blood along with stool.• On 4th day of illness loose motions stopped but pateient developed oliguria.• Patient became irritable.• Patient also had one episode of abnormal movement 1 hour back which subsided within 1 hour.• Parents were giving ORS for past 3 days.• Weaning was started 3 months back• On examination – Pallor ++, petechiae, hepatomegaly, tachypnoea, oedematous, BP – 100/60• Mild acidosis on ABG.
Questions Station 61. Name two differential diagnosis.2. Name surgical condition which can be associated with above clinical picture.3. Name three electrolyte disturbances which can be associated with it.4. Management plan.5. Name common agent causing it.
Answers Station 61 a) HUS b) AGN c) Dys-electrolytemia d) Intussuception2 Intussuception3 Hyponatremia / Hypenatremia / Hyperkalemia4 IVF (ARF regime), PD5 E Coli – 0157: H7
Station 7• 14 Year old female child c/o pain in abdomen for past 10 days. She also developed vomiting / loose motions for past 4 days.• Patient also c/o weakness of both lower limbs• Unable to walk past 24 hours• On examination - Patient was hypertensive, tachycardia +++, poor tone in both lower limbs, power grade 2 in both LL, DTR not elicitable.
Questions Station 71. Write 2 differential diagnoses (2 marks)2. Investigations revealed Na – 110 / K 4, SGPT 37, patient passed high colored urine - What is the probable diagnosis (1 mark)3. Suggest one investigation for diagnosis (1 mark)4. Treatment (1 mark)
Answers Station 71 GBS / Ac intermittent Porphyria / Hypokalemia2 Ac Intr PORPHYRIA3 Urine for Porphyria4 Glucose / Hematin
Station 8 15 year old male presented with pain in abdomen for past 25 days (acute intermittent, periumblical),also developed swelling over scrotum 6 days back which subsided within 24 hours. Past 2 days patient is having pain over Rt wrist with swelling of Rt knee. Patient also developed rash over gluteal region. Patient was passing red stool. Per abd examination showed empty Rt lower quadrant.
Questions Station 81 Name probable diagnoses (mark 2)2 X-ray abdomen as shown – What complication patient has developed (mark 2)3 Medical treatment (specific for disease – other than blood / resuscitative fluid) (mark 1)
Answers Station 81. HS Purpura2. Intussusception3. Steroids
Questions Station 91. Interpret this blood gas (1 mark)2. What is normal PaO2 level expected if a child is breathing at room air with normal lungs ? (1 mark)3. Above mentioned ABG was taken when patient was inspiring 60% Fio2. Choose the correct option to describe oxygen status of the patient (1 mark) • Corrected hypoxemia • Under corrected Hypoxemia • Normoxemia • Over corrected hypoxemia4. What is normal bicarbonate level in a normal blood gas write unit also. (1 mark)5. What is normal PaCo2 in normal blood gas – write unit also. (1 mark)
Answers Station 92. Respiratory acidosis with metabolic compensation3. 80-100 mmHg4. b5. 24mmol/L6. 40mmHg
Station 10• A patient is admitted to the ICU with the following lab values:• BLOOD GASES under room air• pH: 7.199 PCO2: 32.2 HCO3: 12 PO2: 86.6• ELECTROLYTES, BUN & CREATININE• Na: 136 K: 4 Cl: 103
Questions Station 101. Describe metabolic condition (1)2. Describe compensation (calculate exact compensation) (1)3. Calculate anion gap (1)4. Name two conditions with similar anion gap as above (2)
Answers Station 10• Metabolic acidosis with partial compensation• 1 bicarb fall decreases CO2 1-1.5• Anion gap 25• Septic shock, Inborn error (lactic acidosis), DKA etc
Station 115 year male child recently diagnosed as a case of AML.TLC 57000.Chest X Ray normal.Hemodynamically stable with RR of 23/min.Normotensive Pulse oximetry showed SpO2 of 98%.ABG reportpH 7.43PaCO2 34PaO2 47.6 mmHgBicarb 24
Questions Station 111. Above mentioned ABG was taken when patient was inspiring at room air. Kindly explain blood gas (1 mark).2. Suggest measure to improve PaO2 in above patient? (mark 1)
Answers Station 111. Pseudo Hypoxemia due to oxygen consumption by high TLC2. Send sample in ICE
Station 122. National Malaria Control Program ( NMCP) was launched in India in_______ year3. National Malaria Eradication Program ( NMEP) was launched in________ year.4. In NMEP the program was divided into 4 phases ( name them)5. Modified plan of operation under NMEP came into force from______ year.6. Endemic areas under modified plan of operation under NMEP is defined as annual parasite index ( API) > ________.7. Within the modified plan of operation an additional component known as "P. falciparum containment program" has been introduced from October 1977, through the assistance of_________________________ agency.
Answers Station 121. 19532. 19583. a) Preparatory b) Attack c) Consolidation d) Maintenance4. 19775. 26. Swedish International Development Agency
Station 13• You are resuscitating a newborn at birth. The baby has gasping respiration at 30 seconds after birth. Demonstrate what steps you would take for the next 30 seconds.
Checklist for examiner (2 marks each)1. Check Ambu Bag, mask, reservoir and oxygen source2. Attatch reservoir, and oxygen source3. Correct technique of ambu bagging4. Correct frequency of ambu bagging5. Counting heart rate at end of 30 seconds
Answer Following questionsbased on X Ray seen onSTATION 141. What is abnormal in this Xray?2. What is the ideal position ofplacement of umbilical arterialand umbilical venous line?3. After putting in a UA line, theright lower limb appears pale.What would you do?4. What is the level of the renalartery?5. How do you maintain a UAline?
Answers Station 141. Abnormally placed umbilical arterial line in the subclavian artery2. For umbilical arterial line - High: Between T7- T10; Low: Between L2-L3• For umbilical vein - Just above the diaphragm3. Warm the other limb; If still pale >1/2 hour, remove the UA line5. L-16. Use heparin infusion at rate of 0.5-1.0 Unit per hour
Station 15• A newborn presents on day 2 of life with seizures. Write first 5 steps of management in sequential order.
Answers Station 151. Management of the airway, breathing and circulation2. Do the blood sugar; If < 40mg%, give a bolus of 2ml/kg of D10%; If >40 proceed to next step3. Take sample for S. calcium; Give Inj. Calcium gluconate 2ml/kg 1:1 diluted. If seizures do not subside, proceed to next step4. Give Inj. Phenobarbitone in a dose of 20mg/kg as a slow iv injection. If seizures do not subside proceed to next step.5. Repeat Inj. Phenobarbitone in a dose of 10mg/kg after half hour of the first injection.
Station 16 Question for CT scan head What is your Diagnosis?
Answer Station 16• Right parietal lobe edema with midline shift.
Station 17• 2 year old female presents with seizures• GCS 6• HR 60/MIN• Irregular respiration• Normotensive with CT scan already shown –6. What is the Immediate management.7. Drug which can help the patient (assuming he is normotensive )8. What is the most common electrolyte disturbance associated with above patient?9. Which parasitic infection can mimic this condition?
Station 181. When was National tuberculosis control program started?2. When was Revised National tuberculosis control program was started? Fill in the blanks• Under RNTCP treatment services will be made most assessable to the patients with a view to achieve a cure rate of at least ______________% amongst all newly detected sputum positive cases .• In tuberculosis control program DTC stands for _____________________________________________ _______• One tuberculosis unit will function as managerial unit for __________________ million population
Answers Station 181. 19622. District tuberculosis center3. 19924. 85%5. 0.3 – 0.5 million
Questions Station 19• Define this problem (ECG diagnosis) and immediate management after ABC (Initial resuscitation), patient without pulses (2 mark)• Name common metabolic problems related with above diagnosis and drug of choice for antagonizing the described metabolic effect. (1 mark)
Station 20• Name anti arrhythmic agent which is best used in management of Torsade de pointes in acute settings? (2 mark)
Answers Station 201. Injectable Magnesium Sulphate
Station 211. Mention one indication other than antifungal agent2. Maximum intravenous dose (mg / kg / day) – Do not mention total cumulative dose3. Amphotericin B can be give through oral route True / false• Most common side effect of Amphotericin B therapy (Name the system effected)• Which of the following is not the side effect of Amphotericin Ba. Hypokalemiab. Hyperkalemiac. Hypomagnesemiad. Hypermagnesemia
Answers Station 211. LEISHMANIASIS / Echinococcus multilocularis2. 1.5 mg / kg day3. True4. Renal5. d
Questions Station 231. Identify the abnormality in this Karyotype2. Give the description of karyotype 47,XY,+21? What does it mean?
ANSWERS STATION 231. It’s a karyotype of Down syndrome3. The key to the karyotype description is as follows: 47: the total number of chromosomes XY: Is the sex chromosomes (Male) +21: Designates the extra chromosome as a 21
Questions Station 241. Identify the spot with its grade2. Give the grades of clubbing
ANSWERS STATION 241. Grade 4 or 5 clubbing2. Grade 1- Fluctuation and softening of the nail bed Grade 2- Loss of normal angle Grade 3- Accentuated convexity of the nail Grade 4- Broadened terminal pulp of the digit Grade 5- Shiny and glossy changes in the nail and adjacent skin
Station 25• 7 year old male child presents with cough 10 days, fever 5 days, fast breathing one day. Examine respiratory system of this child?
Answers Station 25• Points to be noted• Took permission from mother & child (1 mark)• Undressed the patient? (1 mark)• Examined the patient from head end or foot end for respiration? (1 mark)• Palpated for tracheal deviation (1 mark)• Percussed gently and followed rules of percussion (1 mark)
Station 26• HISTORY TAKING• A 2 yr old child presents to emergency department with severe pallor. Take the history of the child from mother.
Answers Station 26• Introduces himself and tries to make the mother comfortable 0.5 marks• Asks onset sudden or gradual 1 mark• History of bleeding or bluish spots 1 mark• History of associated symptoms: fever, failure to thrive 1 mark• Recurrent blood transfusions 1 mark• History of associated jaundice 1 mark• History of worm infestation 0.5 mark• Birth history 0.5 mark• Community and religion and history of consanguinity 1 mark• Dietary history 1 mark• Family history 0.5 mark• Drug history 1 mark
Question Station 27• What is your diagnosis?• What is the drug used to treat this condition?
Station 281. Define Median, 1st Quartile and 3rd Quartile.2. What is the difference between Rate and Ratio3. What is the basic difference between a ‘Case control’ and ‘Cohort’ Study design4. What is the difference between Incidence and Prevalence
Answers Station 282. If the observations are arranged in ascending or descending order: Median: 50% observations are below and 50% above this value 1st Quartile: 25% observations are below and 75% above this value 3rd Quartile: 75% observations are below and 25% above this value3. Rate: Numerator is part of denominator Ratio: Numerator is NOT part of denominator4. Case Control study is Retrospective and Cohort Study is Prospective5. Incidence: The number of NEW cases occurring in defined population during a specified period of time. Prevalence: Number of all cases old or new at a given point of time or over a period of time in a given population
Station 29Interpret the following statement:• In a RCT the ‘odds’ of developing HMD were 0.55 (95% CI 0.3 – 2.1) in infants whose mothers were given ‘Antenatal Steroids’.
Answers Station 29• In infants of mothers who had received antenatal steroids the chances of developing HMD are 45% less as compared to those whose mother had not received antenatal steroids. However, the 95% Confidence intervals are not significant