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1

• Table. Characteristics of stroke cases &
controls
Case Commu Hospi
s
nity
tal
Control contro
l
Age
Male
(no)

P value
Hospital
control
Vs cases

P value
Community
control
Vs cases

32.5 33.4
66 42

0.56
0.06

0.04
0.03

32.1
63
Table 2 : Risk factors associated with ischaemic stroke: Results
of multivariable logistic regression

Risk factors

Cases Vs Community
Cases Vs hospital controls
controls
Odds ratio Confidence Odds ratio Confidence
Interval
Interval

FBS
Total
Cholesterol

4.55
0.86

1.63 – 12.67 1.17
0.44 – 1.68 1.97

0.68 – 2.02
0.97 – 3.82

HDL
Triglycerides
Smoking
Systolic BP

0.17
0.70
7.77
1.88

0.09 – 0.30
0.37 -1.32
1.93- 31.27
1.01- 3.49

0.17 – 0.44
0.40 – 1.11
1.61-9.71
0.74 – 1.73

0.27
0.67
3.95
1.13
1
• Comment whether community controls are 
age & sex matched with the cases?
• Comment whether hospital controls are age & 
sex matched with the cases?
• Which is the statistical tests used to compare 
the age of cases and controls?
• Which is the statistical tests used to compare 
the  sex of cases and controls?
• (1/2 x 4 =2)
1
• 5.  What are the significant risk factors of 
stroke when compared with the hospital   
controls?
• 6.What are the significant risk factors of 
stroke when compared with the community 
controls?
• 7.What are the significant protective factors 
of stroke when compared with the controls?(1 
x3 = 3)
Ans1

• Smoking. 
        Odds ratio is > 1. Confidence interval does 
not include 1. If the confidence interval extend 
from negative value to positive value it include 
one in the range. So there can be a situation 
where odds ratio become 1, in which there is 
no association between the groups.
• FBS, smoking, Systolic B.P
• HDL
       Odds ratio is < 1.Confidence interval does not 
include 1
ANS1
Cases and community controls are not age & sex matched. P value of both 
age & sex are <0.05. So the observed difference between the cases & 
controls is  significant  & They are not comparable.
• Cases and Hospital controls are age & sex matched. P value of both age & 
sex are >0.05. So the observed difference between the cases & controls is 
not significant & They are comparable
• Age is a continuous variable. Only 2 groups are there. So z test or t test 
can do to compare the two groups. 
• Sex is a qualitative variable. So Chi square test can do to compare the 
groups.
2
• What is the diagnosis of this child who
presented with pallor and fever and hepato
splenomegaly
• What is being focussed in the electron
microscope?
• How will you classify this disease?
• What is the specific immune histochemical
marker for the above condition?
• Name two common drugs used in the
treatment
ANS2
• Birbeck granules
• Langerhan cell histiocytosis
• Langerhan cell Histiocytosis,Hemophagocytic 
lympho Histiocytosis,Malignant Histiocytosis
• S100,CD1A,
• Etoposide/vinblastine,steroid
4
• This is the spirometric pattern before and 
after bronchodialator
• Comment on the spirometric dignosis that can 
be derived from the spirometric curve
• Mention the lung condition causing this 
pattern
4A
ANS4A
• Obstructive pattern  good response to 
bronchodialator  with air trapping
• Asthma,bronchiolitis,FB aspirn,cystic fibrosis
4B
• Identify the spirometry abnormality
• Mention the causes
4B
ANS4B
• Restrictive desease
• Chest wall abnormality,neuro muscular 
disease
4C
• Identify the spirometry abnormality
• Mention the causes
4C
ANS4C
• Box pattern.Fixed upper airway obstruction
•  Benign stricture follg. prolonged ET 
intubation
• Post tracheostomy tracheal stenosis
• Large goitre causing tracheal narrowing
5a 

• This new born had similar lesions over 
hands,elbows and scalp at birth.Otherwise 
active and thriving
1.Give the most likely
 diagnosis
2.Mention 3 major 
classes of this disorder
5A
• Epidermolysis bullosa
• EB simplex,DystrophicEB,Junctional EB
5b
• onychomadesis
• Exaggeration of Beau line leading to proximal 
separation of nail bed
5c 
• This is the photograph of left upper arm of a 
10 mo old infant who presented with high 
grade fever of 7 days duration. What is the 
most likely diagnosis?
5d
• Kawasaki disease
• Induration of BCG inoculation site
6
• Indicate  the most appropriate ventilator 
setting parameter to be changed in the 
following scenarios according to the 
respective ABG report.Also indicate the 
obvious acid base disturbance in each
                   6A

 ventilator setting            PRE TERM HMD
FiO2   %                                    70

Ti   sec                  0.4

Te sec              0.6

FLOW  L/mt               5

PIP m.bar             17

PEEP m.bar     5

ABG
Ph

7.27

PaO2  mm Hg

50

PaCO2 mm Hg

44
33 weeks Preterm 20 Hrs in to ventilation following
surfactant administration is clinically improving
VENTILATOR SETTINGS

•

FiO2   %                        80

Ti   sec                  0.4

Te sec              0.6

FLOW  L/mt               5

PIP m.bar             27

PEEP m.bar     4

ABG

•

Ph
PaO2  mm Hg

7.36
86

PaCO2 mm Hg

39
2kg infant with RDS 10 Hrs in to ventilation
Ventilator setting
FiO2   %                        60

Ti   sec                  0.4

Te sec              1.8

FLOW  L/mt               8

PIP m.bar             28

PEEP m.bar     6

ABG
Ph
PaO2  mm Hg

7.22
65

PaCO2 mm Hg

62
Ans6
1.met+resp acidosis
    Increase PIP
2.NORMAL
    DECREASE PIP
3.RESP ACIDOSIS
   DECREASE Te
7a
• 8yr old boy admitted in shock following mild
febrile illness.There is progressive visual loss
and scholastic backwardness.His MRI brain is
shown here.What is the most likely diagnosis?
7A
• Adrenoleukodystrophy
7B
• This 10 month old infant presented with
excessive irritability followed by seizures. He
was born out of a non consanguineous
parentage and was noted to have large head
from early infancy. No h/o trauma.
• 1.What is your diagnosis?
• 2.Mention 2 typical findings seen.
• 3.Name 2 drugs specifically recommended for
this condition
7B
• Glutaric aciduria type1
• Subdural hemorrhage ,wide sylvian fissure
and brain atrophy
• Carnitine ,Riboflavin
8
• This is Hamna Fathima, 2 ½ years old.
• She presented with pain & swelling of her
right knee of 8 months duration, left knee
and right ankle of 7months duration & left
ankle of 4months duration .She has
persistent symptoms with exacerbations &
remissions. She walks with a limp. For the last
2 weeks , she has pain & swelling of the small
joints of her fingers & she has difficulty in
holding a cup.She also finds it difficult to get
up from sleep
Investigation

8

HB- 8.8 g/dl, TC-10,000 cells/cumm, P-61, L-37,
M-2,
O/E She has mild pallor, no fever or rash, no
lympoadenopathy or organomegaly.
MCV - 54.2, MCH- 21 , MCHC-31.9,
RDW-17.3 Platelets- 3.99 L
ANA-negative . Peripheral Smear- Microcytic
Hypochromic Anaemia ESR – 55 mm/hr
•
SGPT- 32 RFT- Normal
8

• What is the most probable diagnosis?
( Write the full diagnosis)
• What specific complication can occur at 2
months after disease onset?
• Which investigation correlates well with this
complication?
• Presently, now what all complications can
occur?
• What treatment is recommended at 2
months after disease onset?
8
• 1.extended Oligoarticular JIA with iron
deficiency anemia
• 2.uveitis /Iridocyclitis
• 3.Antinuclear Antibody
• 4.MAS, distruction of joints,Growth failure
• 5.two months treatment Antiinflammatory
and Intraarticular steroid
9a
• ECG of a 2 month old girl with H/O recurrent
episodes of irritability,sweating,pallor and
feeding difficulty.
9A
• Alert.RR: 62/min Increased work of
breathing +
• HR 150/min Chest:Bilateral wheeze+
• CVS: Gallop rhythm+ No murmur
• Abdomen :Liver span 6 cm
• What is the most likely diagnosis?
• What is the ECG finding?
• What is the definite treatment
9a
• ALCAPA
• Deep and wide Q waves in leads 1,aVL and V2V6.
• Surgical treatment consists of detaching the
anomalous coronary artery from the
pulmonary artery and anastomosing it to the
aorta to establish normal myocardial
perfusion.
9B
• This is a rhythm strip of a 6 year old boy with
palpitation.

1. What is the ECG finding?
2. What are the diagnostic criteria?
3. Mention the indications for further
investigations and possible treatment
9b ans

1) Ventricular trigeminy
2)Wide complex QRS,T wave opposite in
polarity to QRS
3)(a) 2 or more ventricular premature beats in a
row,
(b) multiform PVCs,
(c) increased ventricular ectopic activity with
exercise,
(d) R on T phenomenon and
(e) the presence of underlying heart disease, a
history of heart surgery, or both
Q 11

1 yr old infant with h/o incessant cry since
previous night is brought with poor
responsiveness, fast breathing and peripheral
cyanosis.
His air way appears clear
Manage the child.
You may assign specific tasks to the observer
and also ask for relevant clinical parameters
ANS Q 11
• StartO2
• Ask for

•
•
•
•
•
•
•
•

a) RR – 60 b)HR-fast c)CFT-3Sec

d)BP-difficult e)spO2-90 f)GRBS
Ask for monitor - give ECG
Should not delay for IV
Straight away cardio version
Energy dose
Sync
Paddles – position
Gel
Clear
Q 12
• A term male baby is just born to a 30 yr old
primi with h/o APH. The baby is limp and not
breathing. No meconium staining
•
The warmer is on. You may ask for specific
assistance an information from the observer.
•
Now receive the baby and proceed to
resuscitation
•
Assume that you have taken sterile
precautions
Ans Q12
1.Dries and removes the wet towel (1/2)
2.Position – sniffing position (1/2)
3.Suction – mouth first (1/2) -- asks for pressure (1/2)—asks for the catheter size (1/2)
4.Stimulation (1/2)
5.Reposition (1/2)
6.Asks for status (1/2)
7.Selects appropriate mask (1/2)
8.No O2 (1/2)
9. Connects pulse oxymeter (1/2)
10.Correctly places and holds bag and mask (1/2)
11.Correct rhythm (1/2)
12.Asks for air entry/chest expansion (1/2)
13.Ventilation correction steps-MR SOPA
14.Re-adjusts the mask (1/2)
15.Repositions (1/2)
16.Suctions (1/2)
17.Ventilate with open mouth (1/2)
18.Increases the pressure (1/2)
19.Asks for HR, Breathing, and saturation (1/2)
Q 13

Show the posture and area of percussion for the
postural drainage from following different
segments of right lung of this child.
• Upper lobe: Apical
Anterior
Posterior
• Lower Lobe: Superior
Anterior Basal
Posterior Basal
Copy of osce cme24.04.2012 calicut
Copy of osce cme24.04.2012 calicut
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Copy of osce cme24.04.2012 calicut
Copy of osce cme24.04.2012 calicut
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Copy of osce cme24.04.2012 calicut
Copy of osce cme24.04.2012 calicut
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Q12A

3yrs old Veena was brought to the casualty by the
mother.Her father died in a road traffic accident
2wks back. Her mother was busy in packing as they
were planning to shift the place when she saw Veena
stumbling about with a flushed face & slurred
speech. She was soon taken to the hospital & on the
way to hospital she developed one episode of GTC
seizure.
• Veena was the only child of her parents with normal
growth &development. There was no history of
fever, rash, headache or vomiting. Child never had
convulsions before. There was no history of head
trauma / vaccination in the recent past.
12only HR 186/mt,
In the ER,she responds to pain
• BP-120/78mmHg Rt UL,
• RR-12/mt & shallow, SPo2 in room air-86% CFT-2sec
Temp-103F GRBS-178mg%
• Pupils dilated &sluggishly reacting
• Systemic examination revealed nothing abnormal
except for a distended bladder.
• ECG showed QRS interval 0.1 sec& QTc0.49secs with
frequent unifocal ventricular ectopics.
• Q 1.What is the most likely diagnosis?
• Q2. Will you choose to treat this rhythm
disturbance?
• Q3.After supporting ventilation and oxygen what
12
• Tricyclic Antidepressant poisoning
• yes
• NaHco3
12
• What are the typical clinical features due to
poisoning with fruits of this herb?
• What is the specific antidote?
12
• Dry like a bone,red as a beat,mad as a
hen,hotas a hare,blind as a bat
• physostigmine
13a

This is a 3.5yrs old girl
• What is the diagnosis?
• Mention any 2 complications this child is likely to develop
• What is this peculiar appearance called?
• What is the characteristic skeletal abnormality?
13a
•
•
•
•

Mc-Cune albright syndrome
Hypothyroidism,hypoadrenalism,PCOD
Coast of Maine appearance
Polyostotic fibrous dysplasia
13b
• Spot the diagnosis
• what would you expect in renal USG?
13b
• Ash leaf macules-Tuberous sclerosis
• Renal Angiomyolipoma
Q 14
• Advise this mother of 3 years old child, who is
being discharged from your hospital following
acute severe asthma regarding inhalational
therapy.
15
Rajat 3.5 yr old boy only child of non consanginous marriage
brought for the evaluation of FTT. Both the parents hailing
from Uttar Pradesh were of adequate height & weight. His
birth weight was 3Kg &length 52 cm. He was thriving
normally till 1 year of age when his father's job
. demanded a transfer to Kerala •
There was no history of significant illness or c/c medication
in the past. But he was not growing normally & was the
smallest child in his class. Examination revealed an active
child with stable vitals General examination was not
contributory except for pallor & mild abdominal distention.
. Systemic examination was normal

•

•

•
15

But he was not growing normally & was the smallest child.
.in his class
Examination revealed an active child with stable •
vitals.General examination was not contributory except for
pallor & mild abdominal distention. Systemic examination
was normal
Weight-11Kg
Height-88cm US:LS-1.25:1Head •
circumference-50cm MAC14cm Investigation
•
Platelet-1.34L/mmHb-9.2gm% MCV-106fl
TC-6700cells/mm3 DC-N45,L50, E2 M3 •
ESR-12mm/hr •
Urine & stool examination-normal TFT-normal •
A serologic information confirmed the •
 diagnosis •

•
15
• Q1.What is the most likely diagnosis?
Q2.What is the characteristic pathologic •
?finding
?Q3.How will you treat the anemia •
? Best serological test. 4 •
 
15
1.Celiac disease
villous atrophy & hypertrophy of crypts.2 •
folic acid-1mg/day.3
4. TTG
manned
Developmental assessment
• Assess the developmental age of this child
using the the materials provided
16A
• This is the CXR of a 2yr old girl who is being
evaluated for recurrent respiratory infection.
What is your diagnosis?
16a
• Nodular prominence of costochondral
junction consistent with rickets
16B
• These are the chest Xray & peripheral smear
of a 10 mo old infant. What is your diagnosis?
16B
• Right Isomerism
• Asplenia, Howell Jolly bodies
16C
• This is the xray of one month old child who
has been evaluated for neonatal cholestasis .
What is your diagnosis?
16C
• Celery stalk appearance
• Congenital rubella syndrome
16D
• This is the ray of the child who presented with
short stature
• What is the diagnosis?
16D
•
•
•
•

Small Sqare iliac wings,
horizontal acetabular roof,
narrow sacrosciatic notches,
decreasing inter peduncular distance L1 to L5
19

•
•
•
•
•
•

Akhil 2 month old male child was brought to
casualty with poor feeding,lethargy,vomiting,
cold extremities and pallor
Antenatal period was uneventful except for
last trimester AFI-25
O/E PR-100/mt BP-76mm Hg
Afebrile
Wt-2 Kg Length-54cm HC-35cm
Systemic Examination Chest –clear
Liver span 12 cm
19

Hb-9gm%
TC-5600 , DC-P46 L50 M4
ABG-pH: 7.48 , pCO2: 49mmHg, HCo3 : 36meq/l
Serum Na: 132, K-2.5meq/l, urine Na-25meq/l
• Urine chloride-30 meq/l
• Give 2 important differential diagnoses.
• How will you differentiate them?
• What is the abnormality in each?
19ANS
• Bartter Syndrome, Gitelman syndrome
• Bartter syndrome - Hypercalciuria
• Gitelman Syndrome -Hypomagnesemia and
hypocalciuria
• B syndrome - Autosomal recessive inborn
defect Na K 2Cl-cotransporter in thick
ascending limb of loop of Henle lead to Na ,Cl
and water wasting.
• G syndrome- defect in distal tubule Na+cl-co
transporter
20A
• What is the diagnosis?
• What is this peculiar appearance of the cells
due to?
• What is this peculiar appearance called?
• Mention the characteristic radiological
finding.
Ans20A
•
•
•
•

Gaucher cell
Due to accumulation of glucocerebroside
Crumpled tissue paper appearance
Erlen meyer-flask appearance of femur
20b
This the CBC of child
What abnormality in the psmear will give clue to diagnoses
What is the diagnoses
What specific test you will order to diagnose What are the drugs of choice
ANS20b
•
•
•
•

Macrocytic Anemia ,Increased RDW
Megaloblastic Anemia
B12,Folicacid Assay
B12,Folic Acid
21
• Advise regarding immunization in the following
situations
1. 12 Yr old child is a case of sickle cell disease
fully immunized as per the national immunization
schedule. He had also received MMR , hepatitisB and pneumococcal polysaccharide vaccine at
the age of 2.5 yrs.
2. 2.5 yr old girl child had underwent hematopoietic
stem cell transplantation 2 months ago . She is
fully immunized with HepB,Hib and MMR
vaccines.
• One dose of PCV13
• One dose of PPV23 ,8wks later
2
3 doses of DPT,IPV, Hib, HepB at 12mo, 14mo,
24mo post transplant
2 doses of PCV & 1dose of PPV23 at 8wks intervals,
beginning 12mo post transplant
Restart influenza vaccine 6 mo post transplant &
continue lifelong
MMR& Varicella vaccine at 24mo post transplant, if the
child is adjudged immunocompetent
21

You are called in to resuscitate a newborn going to
be delivered by emergency LSCS for fetal distress
evidenced by fetal bradycardia
When delivered you find an actively crying term
baby. But the heart rate remained less than 60.
Baby started feeding normally when put to breast
after 4 hrs.
• What is the most likely diagnosis?
• What general examination findings you will look
for?
• What is the treatment?
• What is the prognosis?
•
21

1.Congenital heart block-neonatal lupus
2.Neonatal lupus
3 .Cardiac pacing
4 .Excellent prognosis after pace maker
implantation .Future auto immune reaction is
rare.
If not corrected later exercise intolerance
arrythmia and death
5. Due to passive transfer of maternal antiRo(SSA) and anti-La(SSB)antibodies to fetus
22
A 9 month old infant was admitted with a history of fast
breathing,cough and fever of 5 days duration.There was
history of paternal death two months back.Examination
revealed oral thrush,cyanosis, chest retractions and bilateral
crepitations.SpO2 was 85% in room air. LDH was 1000mg/dl.
X Ray showed a ground glass pattern.
• 1. What is the most probable cause for the present
symptoms?
• 2.What is the drug of choice and dosage needed to treat this
condition?
• 3.What underlying condition will you suspect and what
definitive test will you do?
• 4.Outline any longterm medications this child will require if
the diagnosis is confirmed?
22
1.PCP pneumonia
2.Cotrimoxazole 20 mg/kg/day
3.HIV infection. DNA PCR
4. Anti retroviral therapy zidovudine,
lamivudine, nevirapine with cotrimoxazole
prophylaxis
23
2yr old Rajat, who was screaming like anything ,
was brought to the casualty. He was keeping
his right hand in pronated position & was not
allowing any one to touch it.
He was attending a party along with his parents.
Child was perfectly alright & playing with his
friends. All the problems started when the
mother stopped him by holding his Rt hand as
he was running to the pool side.
Q1 .What is the most likely diagnosis?
Q2. How will you manage?
23
1.Nursemaid’s elbow/pulled elbow
2.Rotate the hand & forearm to a supinated
position with pressure over the radial head
24a
• What is the diagnosis of this child who
presented with fever , pallor and bleeding
manifestation
• What is the specific genetic abnormality
commonly associated with this disease
• What is the Drug of Choice and what is its
mechanism of action
24a
•
•
•
•

Hypergranular AML M3
t 15;17
ATRA(all - trans Retinoic Acid)
24a
Able to bind to the PML/RAR alpha fusion
protein & allow subsequent transcription and
gene expression
24 B

This is a platelet Histo gram
What is the abnormality and mention
four common causes this
24 B
•
•
•
•
•

Increase in Mean Platlet Volume
Schistocytes
Microcytes
Giant platelets
Platelet clumps
Answer
1.Rapport
2. Grading of asthma
3.What is asthma?
4. Need for inhaler
5. Proper technique demonstration
6. Doubts
26

• A couple, husband 30 years and wife 24 years
comes to your clinic. Their first child has
clinical features of Down syndrome and
karyotyping report is shown. The wife has
missed her periods and is anxious to know
whether the same problem will be repeated
in this pregnancy also.
• What is the karyotypic abnormality
• What is the relevant investigation at this
stage?
• How will you stratify the risk as per the
investigation result
26
• 14, 21 translocation
• Parental karyotyping indicated
• Risk- if father is carrier risk is 2-3%, if mother
is carrier, risk 10-15%, if both have normal
karyotype, the risk is low but more than 1%
30
• 9 yr old boy is brought in coma with h/o high
grade fever of 2 days duration and seizures.
LP is deferred since he is unstable
• His peripheral blood smear is given
• What is your diagnosis
• Mention the 2 specific drugs of choice
• Name 4 important complications
30
•
•
•
•

Cerebral Malaria
Quinine sulphate i/v
Artemisine derivative
Anemia,Hpoglycemia,Shock(algid
malaria)Metabolicacidosis,seizures,Jaundice,

• Prostration,Acute renal Failure,Infection
31

• This is the growth chart of a 8 yrs old male
child. His height is 110cm & weight is 18 Kg.
Q1. What is his height age?
Q2. What is his weight age?
Q3.What is his bone age as per the chart?
Q4. Height of the father is 170cm & that of
mother is 160cm. What is the MPH?
Q5.His height after 4mo is 112cm. What is his
height velocity?
Ans31
1)
2)
3)
4)
5)

5 yrs
5yrs
4yrs
(170+160+13)—171.5cm
6 cm/yr

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