QUESTION 1• What is your diagnosis?• Name 4 conditions in which it is seen.• What is the underlying mechanism?
ANSWER 1• Cherry Red spot• Tay sachs disease, Sandhoff disease, Niemann pick disease, central retinal artery occlusion.• Due to loss of transparency of the retinal ganglion cell layer secondary to lipid accumulation/edema. Because ganglion cells are not present in the fovea, the fovea transmits the underlying choroidal colour.
ANSWER• 2.5cm above the medial end of clavicle.• Sternoclavicular joint.• 4th costal cartilage.• Midclavicular line at 6th rib.• Midaxillary line at 8th rib.• Lateral border of erector spinae at 10th rib.• Oblique fissure – line joining spine of T3 vertebra to 6 th rib in midclavicular line.• Horizontal fissure – horizontal line extending from 4th costal cartilage continued to meet oblique fissure in midaxillary line.
QUESTION 4• You have done therapeutic aspiration of pleural fluid from a child with empyema. Mention how will you dispose the following after the procedure.• Gloves.• 18 gauge needle.• Disposable syringe.• Cotton and gauze.
QUESTION 7• Demonstration of cerebellar signs.
ANSWER 7• Nystagmus – gaze evoked nystagmus.• Gait – unsteady and irregular with a wide base.• Intention tremor.• Dysdiadokokinesia.• Past pointing.• Coordination – finger nose and heel shin test.• Reflexes – pendular knee jerk.• Dysarthria – scanning and robotic with syllable pronounced individually and slowly.
QUESTION 8• Counsel a mother whose child has been diagnosed to have Acute lymphoblastic leukemia.
ANSWER 8• Introduces self.• Says that child has been diagnosed to have leukemia which is a blood cancer of WBC’s.• Shows sympathy and reassures that the overall prognosis is excellent.• Says that the etiology is not known.• Says that treatment involves drugs (chemo) and occasionally radiotherapy.
• Says that the duration of treatment will be 2 ½ to 3yrs.• Says regarding side effects of chemo like hairfall, infections, bleeding tendencies etc.• Also mentions about long term complications like decreased growth, repeat cancer.• Stresses the need for neutropenic care – avoid giving outside food, avoid overcrowded places, avoid frequent visitors.• Mention the risk of relapse – CNS, testicular, blood and hence the need for regular followup after completion of treatment.• Mention about vaccination – to consult doctor before giving regular vaccines.
QUESTION 9• A 3 yr old child is brought with history of sudden onset of difficulty in breathing. The child was playing with toys and was found drowsy by the mother.• On arrival in the ER, the child is unresponsive, tachypneic, cyanosed with good peripheral pulses.• Mention the steps in management of this child.
ANSWER 9• Open the victim’s airway using a tongue-jaw lift and look for an object in the mouth and pharynx. If an object is visible, remove it. Do not perform blind finger sweeps.• Open the airway with a head tilt-chin lift and attempt to provide rescue breaths. If breaths are not effective, reposition the head and reattempt ventilation.
• If the breaths are still not effective, prepare to perform abdominal thrusts (Heimlich’s maneuver).• Repeat the steps until the object is dislodged and the airway is patent or until attempts have lasted approximately 1 minute. If the infant remains unresponsive after 1minute, activate the EMS system.
QUESTION 10• Elicit Moro’s reflex, rooting and sucking reflex, palmar and plantar grasp in this neonate.
QUESTION 11• This is the electrolyte report of a 1yr old infant who was evaluated for failure to thrive, recurrent vomiting and polyuria.• Na – 134mEq/dl, K – 2.6mEq/dl, Cl 100mEq/dl, HCO3 – 28mEq/dl.
QUESTION 11• What is your diagnosis.• Mode of inheritance?.• What is the underlying defect.• Treatment.
ANSWER 11• Barrter syndrome.• Autosomal recessive inheritance.• Defect in sodium and chloride resorption in the loop of henle.• Oral potassium supplement, potassium sparing diuretic, Indomethacin.
QUESTION 12• While drawing blood sample from a patient, whose HIV status is unknown, your hospital nurse has an accidental needle stick injury (non intact skin, small volume exposure).• Mention the setps which should be taken in such a situation with regards to the following.
QUESTION 12• Care of the exposed site.• Counselling of the health care personnel.• Counselling of the source.• Tests to be done and timing of the test.• Drug therapy – duration and dose.• Administrative action.
ANSWER 12• Wash the exposed site thoroughly with running water. Wash skin with soap.• Reassure and inform about PEP.• Counsel the source and obtain consent for testing – determination of HIV,HBV,HCV status of the source.• HIV,HBV,HCV testing of the health care personnel. HIV testing at zero hour, 6wks, 12wks, 6months.• Zidovudine 300mg BD & Lamivudine 150mg BD for 4 weeks.• Recording and reporting of the even.t
QUESTION 13• A 1-1/2 year old with VSD on antifailure drugs develops illness suggestive of influenza.• What Category does this child belong to as per govt of India guidelines.• Mention 2 appropriate steps recommended for this category• What is the correct dosage and duration of oseltamivir in children?
ANSWER 13• Category B• Home isolation and oseltamivir therapy• For weight 15kg 30mg BD for 5 days
QUESTION 14• 16 year old girl presents with h/o passing red coloured urine for the last few hours. There was no h/o fever. There was h/o drug intake for diarrheal illness 3 days ago. O/E she had gross pallor and a tinge of scleral icterus• What is the provisional diagnosis?• Describe the peripheral smear picture in this girl.• Immediate steps in management.
QUESTION 15• Mention the duration and temperature at which the following blood products can be stored?• 1.Red Blood Cells• 2.Fresh Frozen Plasma• 3.Platelet Concentrate• 4.Cryoprecipitate
ANSWER 15• Packed RBC – 42 days in the refrigerator or 10 years in the freezer.• FFP - 1 year in the freezer• Platelet Concentrate – 5 days at room temperature• Cryoprecipitate – 1 year in the freezer
QUESTION 16• This is the karyotype obtained from the bonemarrow of a 6 year old girl with a hematological malignancy.• Comment on the abnormality• Mention 1 favourable and 1 unfavourable translocation in ALL
QUESTION 19• Define Polio eradication and elimination• Mention core strategies for eradication of polio.
• Eradication – No cases of paralytic polio by wild polio virus in the last 3 calender years• Elimination – No cases of paralytic poliomyelitis by wild polio virus in 1 calender year.• CORE STRATEGIES:• Maintaining high routine immunisation coverage with 4 doses of OPV• Mass campaign• Sensitive Surveillence• Mop up campaign
QUESTION 20• HPV VACCINE• What are the types of vaccine available? Mention the serotypes covered by them.• What is the recommended dose?• What is the recommended age for vaccination?
ANSWER 20• Quadrivalent vaccine (gardasil) – serotypes 16, 18, 6, 11.• Bivalent vaccine (cervarix) – serotypes 16, 18.• 0.5ml intramuscular at deltoid. 3 doses - 0, 2, 6months – gardasil. 3 doses - 0, 1, 6months – cervarix.• Initiation of vaccine 10-12years of age. Catch up vaccination up to 26yrs of age.
QUESTION 21• Identify this graph.• What do the square and area of each square represent?• What do the horizontal and vertical line represent?• What does the diamond represent?• What does the centre of diamond represent?
ANSWER 21• Forest plot (forest plot shows information from individual studies that went into meta- analysis at a glance. They show the amount of variation between the studies and an estimate of the overall result.• Each square symbol represents a study contributing to metanalysis and the area of square corresponds to the weight of the corresponding study to the metaanalysis.
ANSWER 21• The horizontal line through the square shows the confidence interval. The solid vertical line represents no effect.• The diamond represents the overall estimate from the meta-analysis.• The centre of diamond represents the pooled point estimate and the horizontal tips represent the confidence interval.
QUESTION 22• Identify this peripheral smear.• What is the underlying defect?• Confirmatory test for diagnosis?• Treatment options?
ANSWER 22• Hereditary spherocytosis.• Defect in spectrin or ankyrin - results in uncoupling in the vertical interactions of the lipid bilayer skeleton and loss of membrane microvesicles.• Osmotic fragility test.• Folic acid 1mg/day, splenectomy.
ANSWER 29• Dense bones suggestive of osteopetrosis• Steroids,Interferon,Bone marrow Transplantation• Infections,Bleeds,Loss of vision
Question 30A 1 month old childwas brought with pinkstaining of the diaperssince birth. He also hadhistory of blisters onsun exposed areas.On examination thecolor of the urine is asshown.
1. What is your diagnosis?2. Name the deficient enzyme.3. What are the other clinical manifestations?4. Mention the diagnostic lab finding.
Answer:1. Congenital Erythropoietic Porphyria (Gunther disease)2. Uroporphyrinogen III synthase (UROS)3. Bullous cutaneous photosensitivity– hydroa aestivale, hypertrichosis, erythrodontia, hemolytic anemia, bone abnormalities4. Markedly elevated levels of uroporphyrin I and coproporphyrin I in urine,stool and RBC’s.