4. PBQ: Kwashiorkor:
Case-Scenario:
Q. 2 years old girl was is brought to OPD with pitting edema in the B/L
lower limbs, diffuse pigmentation (flaky paint dermatitis) over the skin
& flag sign of hair. The child is lethargic & his appetite is poor. On
physical examination, the liver is enlarged and the abdomen is
distended. Serum albumin is very low (2 gm/dL).(2 +2+2+4)
• What is your diagnosis and justify your diagnosis?
• Write the socioeconomic factors for the given health condition?
• List the complications of the given disease?
• How will you prevent its occurrence in the community?
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5. Case-Scenario: KWASHIWORKOR
Q. A male child of 36 months of age is brought to OPD with pitting edema
in the B/L lower limbs, diffuse pigmentation (flaky paint dermatitis) on
the skin & flag signs of hair. The child is lethargic & his appetite is poor.
On physical examination, the liver is enlarged and the abdomen is
distended. Serum albumin is very low (2 gm/dL). (2+1+2+2+3)
A. What is your diagnosis and justify your diagnosis?
B. Write the socioeconomic factors for the given health condition?
C. List the complications of the given disease?
D. How will you treat the case?
E. How will you prevent its occurrence in the community?
6.
7. Case-Scenario: KWASHIWORKOR
QQ. A female child of 26 months of age is brought to OPD with pitting
edema in the bilateral lower limbs, diffuse pigmentation & thin hair.
The child is lethargic & his appetite is poor. On physical examination, the
liver is enlarged and the abdomen is distended. Serum albumin is very
low (2 gm/dL). (2+2+2+3)
a. What is your diagnosis and justify your diagnosis?(2)
b. What are the causes of the problem given in the question?(2)
c. How will you treat the case?(3)
d. How will you prevent its occurrence in the community?(3)
8.
9.
10.
11.
12.
13.
14. CHORINATION OF WATER
Q. In a medical college hostel, there is a square tank of 8 meter length & 8
meter of breath with a 10 meter depth of water is to be disinfected.
Horrock’s test shows blue color in the 6th cup. (4+1+1+1+3)
• Calculate the amount of bleaching powder required to disinfect the given
tank?
• Write the name of the indicator solution used in Horrock’s Apparatus?
• What does this blue coloration mean?
• What is the recommended level of free/residual chlorine in drinking water
after chlorination?
• Write the use and contents of the Horrock’s Apparatus?
15. CHORINATION OF WATER
Q. In a slum, there is a circular well which is measuring 4 meter in
diameter. The depth of the water is 10 meter. Horrocks test shows blue
color in the 5th cup. (3+3+3+1)
• A. Calculate the quantity of bleaching powder (CaOCl2) required to
disinfect the well?
• B. Explain the action of bleaching powder?
• C. Explain the steps in well disinfection?
• D. What is a Breakpoint Chlorination
16. IDA
Q. A 25 years old pregnant lady came to OPD with the complaints of fatigue,
weakness & shortness of breath. On Physical examination, she has angular
stomatitis, atrophic glossitis & koilonychia. Her conjunctiva, tongue, and
nails are pale. Her serum hemoglobin is 8 gm/dl with decreased serum iron,
and an increased total iron binding capacity (TIBC). The peripheral blood
smear in the patient shows hypochromic microcytic anemia. (2+1+2+1+4)
• What is the likely diagnosis and justify your diagnosis?
• What investigation will you ask for in this case to conform your clinical
impressions?
• List the important causes for the given health condition?
• How will you treat anemia in this case?
• Briefly discuss the strategies for prevention and control of anemia in
pregnancy?
17. Vitamin A deficiency
Q. Aradhya is a 12 years old child from Baijanath Rural Municipality who was
brought by her mother to Pediatrics OPD of NGMCH with the complaints
that she often fell down in the late evening while playing around with
friends. She had been weaned at an early age and the food she was
receiving contained only rice and potato. On examination, a triangular
silvery white patch was noticed on both sclera. (2+2+4+2)
• A. What is your diagnosis and justify your diagnosis?
• B. How will you treat the case?
• C. How will you prevent its occurrence in other children?
• D. What is xerophthalmia? Name the ocular manifestations of
xerophthalmia.
18. IDA
Q. A 25 years old pregnant lady came to Obs & Gynae OPD of NGMCH with the
complaints of fatigue, weakness & shortness of breath. On Physical examination, she
has angular stomatitis, atrophic glossitis & koilonychia. Her conjunctiva, tongue, and
nails are pale. Her serum hemoglobin is 8 gm/dl with decreased serum iron, and an
increased total iron binding capacity (TIBC). The peripheral blood smear in the
patient shows hypochromic microcytic anemia. (1+1+2+1+2.5)
• What is the likely diagnosis and justify your diagnosis?
• What investigation will you ask for in this case to conform your clinical
impressions?
• List the important causes for the given health condition?
• How will you treat anemia in this case?
• Briefly discuss the strategies for prevention and control of anemia in pregnancy?
19. NUTRITION
Q. A family consists of following members (3+2.5+2)
• i. Adult male - 50kg
• ii. Adult female- 45 kg(lactating)
• iii child of 2 years -14 kg
• How much protein they require per day?
• Mention the source of protein.
• Why egg protein is reference protein?
20. VIT D DEFICIENCY
Q. 5 year child visited Hospital with mother and she complaints of soft
bone in skull and on examination it was felt like Ping-Pong
ball.(3+2.5+2)
• What is your diagnosis and its cause.
• Mention its other clinical features.
• What are the other disease associated with its deficiency
21. Case-Scenario: Chickenpox
Q. During the month of January 2018, 15 children from the local brick factories
attended at Hospital with complain of mild grade fever, cough and skin rashes.
The attending pediatrician clinically diagnosed as chicken pox(Varicella). Only
five children got full vaccination according to national EPI.
a. Describe epidemiology of chicken pox.
b. What is pathognomonic sign of chicken pox?
c. List the vaccines included in the national EPI program.
d. Discuss the prevention and control of Varicella.
22. MEASLES
Q. A 3 years male child was brought in OPD with fever, cough, sneezing,
running nose, and redness of eyes. The mother told that her child developed a
fever 4 days back. On examination: Some small, bluish-white spots on a red
base were seen on the buccal mucosa opposite the first and second lower
molars. The immunization status of the child was not known.
•
• What is your probable diagnosis? Justify your diagnosis. (2)
•
• What is the Pathognomonic clinical feature of the upper mentioned
disease? (1)
• Explain the clinical stages in the natural history of this disease. (2)
• What are the complications of this disease? (2)
• Discuss the prevention and control measures of the disease in community.(3)
24. PBQ
Q. The test result of ECG is given below:
• Find out the following measures of ECG test:
a. Sensitivity
b. Specificity
c. Positive predictive value
d. Negative Predictive value
MI Present MI Absent
Positive ECG 300 100
Negative ECG 25 75
36. PBQ
1. In a town with mid-year population of 150,000 following vital events
occurred (7.5)
Total live birth: 3200
Total death: 1400
Infant death: 270
Maternal death: 10
Calculate: (a) Crude Birth Rate, (b) Crude Death Rate, (c) Infant
mortality rate, (d) Maternal mortality rate
42. Case Scenario: Acute diarrheal diseases
Q. A 8 months old child presents to the hospital in emergency. He started vomiting in
the morning. After six hours, he started passing watery stools and watery stools passed
4 times.
On examination, he is drowsy, has sunken eyes, and skin pinch takes 2 seconds to go
back.
a. What is your diagnosis? Justify your diagnosis.
b. Write about mode of transmission and risk factors of the given health condition.
c. How much dehydration is presentation?(Assessment of dehydration).
d. How will you manage this child?
e. Discuss on control of disease in the community. 42
