CME: Books to Bedside 2017

Tuesday, October 11, 2016   at  12:12:00 AM

Date and Venue: Jan 6 to 8, 2017 at Nagpur, India. 
Theme: Supportive care in pediatrics, neonatology, Pediatric ICU

Basic topics like fluids, electrolytes, acid base disturbances, non-invasive ventilation & many more. 

A pre-conference workshop on Applied Basic Life Sciences, Non-Invasive Ventilation and Simulation based Pediatric ICU training on 6th of Jan 2017. 

Eminent International & renowned national faculties in pediatric super specialities

Programme details:
Contact: Dr Anand Bhutada
9922066527, 071276095915

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OSCE: Immunization

Friday, October 7, 2016   at  1:16:00 PM

Question: 1
What are the recent updates to the IAP Immunization schedule?

Answer 1

Preferably be avoided in primary vaccination series (at 6, 10 and 14 weeks)
Instead of OPV at 6, 10, 14 weeks and 15 months, So OPV only at birth, 6 months, 9 months and 5 years
Hepatitis B vaccine:
The final (third or fourth) dose in the Hepatitis B vaccine series should be administered no earlier than age 24 weeks and at least 16 weeks after the first dose
MMR vaccine:
At 9 months and 15 months, No need for booster at 5 years
Typhoid conjugate vaccine:
(TypBar) given at 9 to 12 months, with a booster at 2 years of age
Hepatitis A:
Single dose for live attenuated H2-strain Hep-A vaccine
Two doses for all killed Hep-A vaccines are recommended at 12 months and 18 months
Only 2 doses of either of the two HPV vaccines for adolescent/pre-adolescent girls aged 9-14 years
For girls 15 years and older, and immunocompromised individuals 3 doses are recommended
For two-dose schedule, the minimum interval between doses should be 6 months.
For 3 dose schedule, the doses can be administered at 0, 1-2 and 6 months

Question: 2
What are special vaccines you would advise for high risk category children?

Answer: 2

High-risk category of children:
  1. Congenital or acquired immunodeficiency (including HIV)
  2. Chronic cardiac, pulmonary, hematologic, renal and liver disease
  3. Children on long term steroids, salicylates, immunosuppressive or radiation therapy
  4. Diabetes mellitus, CSF leak, Cochlear implant, Malignancies
  5. Children with functional/ anatomic asplenia/ hyposplenia
  6. Laboratory personnel and healthcare workers
  7. Travelers
IAP recommended vaccines for High-risk children
  1. Influenza Vaccine
  2. Meningococcal Vaccine
  3. Japanese Encephalitis Vaccine
  4. Cholera Vaccine
  5. Rabies Vaccine
  6. Yellow Fever Vaccine
  7. Pneumococcal vaccine (PPSV 23)

Question: 3
  1. What is pre-exposure prophylaxis for rabies and for whom should we advise?
  2. What are the advantages of giving it?
    Answer: 3
    1. Children having pets in home
    2. Children perceived with higher threat of being bitten by dogs such as hostellers, risk of stray dog menace while going outdoor
    3. Veterinarians, those who work with animals
    4. Three doses are recommended to be given intramuscularly on days 0, 7 and 28
    In case of bite,
    Two doses are to be given on days 0 and 3. Rabies immunoglobulin (RIG) are not needed in these children.

    Question: 4
    11 year old boy adopted, no medical records available and BCG scar is not seen. The adoptive parents want to know what vaccines have to be given. What will you advise?

    Answer: 4
    1. TDaP vaccine- single dose
    2. MMR- 2 doses at 4-8 weeks gap
    3. Hep B- 3 doses at 0,1 and 6 months
    4. Hepatitis A- 2 doses at 0, 6 months
    5. Typhoid- 1 dose every 3 years
    6. Varicella- 2 doses at 4-8 weeks

    Question: 5
    Influenza Vaccine
    1. What are the types of influenza vaccines in India?
    2. When is a LAIV not recommended?
    3. What is IAP recommended target prioritization for influenza vaccines?
      Answers: 5


      Trivalent inactivated vaccines (TIV) and Live Attenuated Influenza vaccines (LAIV).
      LAIV not recommended below 2 years of age, in high-risk individuals and in pregnant women.
      (1-Highest priority, 4-Lowest priority)

      1.Elderly (> 65 years) / nursing-home residents
      2.HIV/AIDS, and pregnant women (especially to protect infants 0–6 months)
      3.Other groups: Health care workers, asthmatics, and children from ages 6 months to 2 years.
      4.Children aged 2–5 years and 6–18 years, and healthy young adults.

      Question: 6
      Meningococcal Vaccine
      What are the categories to be vaccinated as per IAP recommendations?

      Answers: 6

      A.During disease outbreaks
      B. Vaccination of persons with high-risk conditions/situations
      1. Complement component deficiencies
      2. Functional/anatomic asplenia/hyposplenia
      3. HIV
      4. Healthcare workers exposed routinely to Neisseria meningitides
      5. Adjunct to chemoprophylaxis
      C. International travellers – Study abroad/ Hajj/ Sub-Sahara Africa

      Question: 7
      Answers yes or no
      1. Can BCG be given in symptomatic HIV cases
      2. Can OPV be given in symptomatic HIV cases
      3. Can measles, MMR and Varicella be given in symptomatic HIV cases
        Answer: 7
        1. No
        2. Yes – if IPV not affordable
        3. Yes, if CD4+ count > 15%

        Question: 8
        1. What solution is used to swab the site prior to vaccination?
        2. When will you consider the BCG administration technique to be successful?
        3. What is the normal reaction at the vaccine site following successful vaccination?
        4. What condition is associated with BCG vial contamination?
          Answer: 8
          1. Normal saline
          2. A wheal of 5 mm at injection site
          3. A papule develops by 2-3 weeks, increases to size of 4-8mm by 5-6 weeks, ulcerates and heals with scarring by 6-12 weeks
          4. Toxic shock syndrome

          Question: 9
          Which is the Polio vaccine of choice for outbreak control?Which Polio vaccine type is more efficacious – Trivalent OPV or Bivalent OPV?What is enhanced IPV?

          Answer: 9
          1. OPV
          2. Bivalent OPV more efficacious than Trivalent OPV – as competition between different serotypes is eliminated
          3. Enhanced IPV contains
          type 1 – 40 Ag U
          type 2 – 8 Ag U
          type 3- 32 Ag U

          Question: 10
          1. What are the conditions that predispose to VDPV
          2. Name the Polio serotypes more frequently associate with VAPP and VDPV

          Answer: 10

          a) Dropping immunization coverage
          b) High population densities
          c) Tropical conditions
          d) previous eradication of wild polio virus
          VAPP – Type 2
          VDPV – Type 3

          Question: 11
          What is VVM and how will you interpret?


          Answer: 12


          Question: 13
          1. What is AEFI and when will you consider it serious?
          2. What are the different types?

          Answer: 13

          AEFI is adverse Event Following immunization
          An AEFI will be considered serious, if it:
          Results in death
          Is life-threatening
          Requires in-patient hospitalization or prolongation of existing hospitalization
          Results in persistent or significant disability/incapacity
          Is a congenital anomaly/birth defect or
          Requires intervention to prevent permanent impairment or damage.
          Types of AEFI:

          1. Vaccine reaction:
          Event caused by the vaccine or precipitated by the vaccine when given correctly eg. VAPP after OPV

          2. Programme error:
          Event caused by an error in vaccine preparation, handling, or administration. Egs- TSS after measles vaccine due to improper storage

          3. Injection reaction:
          Event from anxiety about, or pain from the INJECTION, rather than vaccine. Eg abscesses

          4. Coincidental:
          Event that happens after immunization, but NOT caused by it. Eg SIDS

          5. Unknown:
          The cause of the event cannot be determined.

          Question: 14
          What are the recommended time limits for using vaccines after reconstitution?

          Answer: 14
          1. Varicella : 30 mins (and protect from light)
          2. MMRV: 30 mins (and protect from light)
          3. Yellow fever: 1 hour
          4. MEASLES/MMR : 4 to 6 hours
          5. Meningococcal PS vaccine: 30 mins
          6. DTaP/Hib combination: 30 mins

          Question: 15
          How do you store vaccines in the refrigerator?

          Answer: 15

          1. Freezer: OPV
          2. Top shelf: BCG, Measles, MMR
          3. Middle shelf: T- vaccines, IPV, Hib, Combination vaccines, HPV, Typhoid, Hep A, PCV, influenza, rota virus
          4. Lower: Varicella

          Name some contraindications and precautions for vaccination.

          Answer: 16

          A condition in a recipient which greatly increases chances of a serious adverse reaction. Egs- severe allergic reactions
          OSCE Immunisation 1

          A Condition in recipient which might increase chance or severity of a serious adverse reaction or might compromise ability of vaccine to produce immunity

          osce immunisation 2

          Question: 17
          What is freeze watch indicator?

          Answer: 17

          Small vial of red liquid attached to a white card and covered in plastic.
          Vial breaks if temperature drops below 0 Celsius for >1 hour
          Useful for T vaccine

          Disclaimer: These OSCE are for helping each other, and are not copyrighted, in case there is any copyright from any author, please inform us, we will remove the content

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          Pediatric OSCE : dealing with Observed stations

          Monday, September 12, 2016   at  12:36:00 PM
          Hi, friends, I am back with another subset of OSCE, sharing some ideas about Observed OSCE in pediatric practical exams.

          Lets go through marks distribution of practical exam.

          Observed osce’s generally accounts for 50 marks out of 150 marks. So this subset is very crucial for passing or you can say difficult to get through if u couldn’t do well here.

          Now some words about ideology of Natboard behind Observed osces. Observed osces are as name suggest are OBSERVED . 

          You are given a task and you have to perform it and examiners will OBSERVE you and will 
          give you marks as per key provided to them by NBE.

          The time allotted is exactly 8 minutes, but marks may very as per individual osce’s but generally sum total of all observed osces is constant around 50 marks.

          5-6 observed osce’s are asked in every session. The topics for this type of osce are based on day to day ward /OPD if u have worked well during residency, it is very easy to pass in these osce’s but u definitely need practice to speak out what you know.

          Here is list of topics generally asked in in observed Osces.

          1. Clinical examination.
          2. Focused clinical examination.
          3. Counselling
          4. History taking
          5. Procedures
          6. NRP/PALS
          7. Developmental assessment.

          About marking system of above osces:

          Even if you go unprepared for these (with good clinical work experience in past), you will be able to score 50% of these marks. But DNB keys are prepared in such a way that there is always a point in key worth 20% marks, which makes them understand about your clinical work experience.
          Lets, elaborate individual categories.


          Generally Task in question is given in form of clinical scenario or some equipment's are also kept. REMEMBER, WHATEVER OBJECTS KEPT ON TABLE ARE THERE TO BE USED. you can loose marks if you don’t use them. After reading task just have a look at equipment's. Take 30 sec to plan your action before you start.

          This could save you from probable loss of silly mistakes like,
          “ Not standing on Rt. Side of pt. in Abdominal system examination,
          Not checking/purcussing on both symmetrically opposite sides.

          This could save you from probable loss of silly mistakes like,
          “ Not standing on Rt. Side of pt. in Abdominal system examination,
          Not checking/purcussing on both symmetrically opposite sides.”

          You should be thorough with all systemic clinical examination proformas. Its always useful to have nice revision of clinical methods from standard clinical examination text book Before starting the task don’t forget initial steps of consent, explanation, hand hygiene, maintaining dignity of patient and warming hands.

          You are expected to give running commentary of what you are doing and for what you are looking.

          In examination kit provided to you if you find any unexpected objet then you should be smart enough to think of utility of that object in given task beyond the proformas you mugged up.

          For example.

          Measuring tape:

          RS: measure chest circumference and also check after full inspiration.

          GIT: Abdominal girth, xiphisternum to umbilicus and umbilicus to pubic symphysis distance. Span of liver, spleen.

          CNS: Head circumference, limb circumference to check nutrition of muscles.


          CVS: Roths spot for IE.

          GIT: Cherry red spots for storage disorders.

          CNS: Pappiloedema.

          Whether you get findings or not doesn't matter, examiner wants to OBSERVE whether you know what to look for and method.

          Remember, this is one of the most scoring observed osce station.


          This is recently introduced subtype of observed osces. Here is the detailed explanation regarding the topic.

          Focused Clinical Examination.


          Another task, which is really tricky. Generally its in the form of clinical scenario where-in you have to counsel the parents.

          After reading the task please take 30 sec in mind to think and PLAN YOUR APPROACH IN 10 STEPS OF COUNSELLING GIVEN IN NELSONs text book.

          In this osce your body language, EYE CONTACT, attitude, confidence, patience and content of knowledge is checked. So mind your behavior and eye contact.

          Start with introduction, ask for preferred language of communication. Then discuss the problem. Give prompt and brief knowledge. Instigate and encourage the parent to ask any query. And IF THEY ASK, be patient listener and solve their doubt. Dont show them dominating or bossing attitude. Dont ask them unnessesary questions, this is counselling station not a history taking.

          Practice is the only way out to these types of osce. In this type of osce there is high chance of having unexpected points in the answer Key which are way more specific than we think off.


          Counselling for child born with ambiguous genitalia (nov-2015)

          All points given in standard text book was allotted 0.25- 0.5 marks each. But a sample advice to delay registration of birth certificate and official documents till final lab results are available, would score  1 mark ! (Just a common sense)

          Common scenarios asked for counselling are.

          Neonatal situations ( jaundice, breast feeding, hypothyroidism, prematurity, ambiguous genitalia etc. Every session there is min. 1 scenario about neonate).

          Diet advice (FTT, Renal diet, celiac diet, hepatic diet etc.)
          Counselling for child with syndromes
          Consent for clinical procedure.
          Counselling for child with habit/conduct /behaviour/learning disorders.
          Situational counselling like shifting to ICU, Bad news etc.

          4. HISTORY TAKING

          Clinical scenario or symptom is given. Before starting the task take 30 sec and think all possible DDs and preferably covering all systems for that given symptoms. Ask for Name/age /sex... as if you are talking real life case. Dont forget to ask for relevant negative history and go upto socioecnomical /family history.

          YOUR RELEVENCE OF QUESTIONS/SEQUENCE AND FLOW OF VERBAL OUTPUT makes examiner understand that you deserves/ do not deserves degree!

          Its nice to practice with all clinical symptoms from all systems.


          All clinical and ICU procedures are covered under this. Read up task. You should be thorough with procedure methods. Before starting the task don’t forget initial steps of consent, explanation, hand hygine, maintaining dignity of patient and warming hands.

          You are expected to give running commentary of what you are doing. After demonstrating procedure don’t forget to speak about biomedical waste management and post procedure monitoring.


          These are life saving procedures to know in life of pediatrician, after and before exam also! These stations are lethal as they have got negative markings, and also scoring because you have to learn to perform them as it is. NALS, PALS and PGALS are the only stations which can fetch you 100% marks. so revise them as many times as possible.


          Again an indispensable part of pediatrics. You should be thorough with developmental assessment till 5 yrs of age. Its also important for case as it is allotted 5 marks in each case , be it CNS or be it CVS. In this osce age may be given or may be asked to guess.

          Start with gentle attitude, make child friendly and do relevant tasks. Cover all domains if not specified. start with higher age which you expect and if child is unable to do the task then then bring down to lower age.

          For motor assessment like asking 5 year old child to jump backward, better to show him personally. it saves time. If you are asked to guess the age of child then don’t forget to demonstrate inability of child to perform higher age task.

          For example 4 yr old child is given, he is able to climb down steps 1 foot per step but then also ask him to jump backwards (5 yr milestone) which he wont be able to, thus ruling out that he is not 5 year old. If age is provided in question then no need to go for this.

          For assessment of fine motor skills if you are using cubes then first show child how to make bridge/gate/train.


          It is also better to know age groups for tests and tasks to be used like form board for 1.5 yrs-2.5 years. Draw a man test for > 3 years. Scissors for > 3 yr etc. This saves time.

          Whether you get findings from child or not doesn't matter, examiner wants to OBSERVE whether you know what to look for and method of performance.

          Dont forget to thanks child at end. Don't forget to tell your assessments result to examiners with clear word. If question has asked you to find out motor and fine motor age then say “by assessment gross motor age is **** and fine motor age is ***”

          This is one of the most scoring observed osce station.

          Ok, so thats all for now, Please add suggestions and correction in the comment box below, don't forget to like, comment, share and SUBSCRIBE this and other post, it encourages us!
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          OSCE: Nutrition & Dissorders

          Monday, July 25, 2016   at  9:17:00 AM

          QUESTION 1


          This is the x-ray of a 2year old child who presents with anorexia, vomiting and poor weight gain.
          1. Write the findings on this x-ray.
          2. What is your diagnosis?
          3. What will be the presenting feature of this condition in an infant?
          4. Name the neurological complication that occurs in this condition.
          5. Mention one close differential radiological diagnosis.

          ANSWER 1
          1. Cortical hyperostosis of ulna and tibia, absence of metaphyseal changes
          2. Hypervitaminosis A
          3. Bulging fontanel
          4. Pseudotumor cerebri
          5. Infantile cortical hyperostosis

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          Focused Clinical Examination OSCE

          Monday, July 18, 2016   at  10:30:00 AM

            Dr Kishor Giri

          Pediatric Focused Clinical Examination is a new sub type of question brought forward by National Board Of Examinations in recent Pediatric practical examination under  observed OSCE examination. 

          To emphasize importance of this types of observed stations i would like to recollect here that observed stations approximately form 35% of total marks of OSCE, that is around 50 marks out of 150.

          So awareness of this subtype is very crucial.

          In case-taking the whole clinical knowledge of subject is tested in prospective aspect in the form of coverage while in OSCE the accuracy of knowledge is tested in the form of depth. Previously observed clinical scenarios used to have a case format given and they use to ask to look for specific system.

          But focused clinical examination format makes you to apply your knowledge retrospectively and it also checks depth of knowledge in particular topic.

          Two grossly different formats are asked.

          A. Diagnosis is given
          you should be able to elicit and show all possible findings of that condition in the given subject in given standard time of 8 minutes.
          You should start like any other case, starting from general examination and going to systemic examination and simultaneously commenting of what you are doing and for what you are looking for ? Your knowledge and clinical skills , both are assessed. I will explain with example.

          1. Examine for hydrocephalus (Nov-2015 session)
          Greet and obtain consent from parent and explain child.
          Gen examination- sensorium/large head/nystagmus/visible leg activity
          Vitals- PR/RR/ BP
          Examine for hydrocephalus- AF/ dilated veins/ Take head circumference / eyes ( check with fundoscope)
          Specific signs of hydrocephalus- Transillumination
          CNS findings- LL tone/power/reflexes
          Associated spine and skin examination.- neurocuteneous markers.
          Look for associated syndromic features- murmers/ meningocele/ eyes/ dysmorphic features
          Thanks parents.
          Tell your findings to examiner.
          2. Examine child with infective endocarditis? (Nov-2015 session)
          Greet and obtain consent from parent and explain child
          General examination- sensorium/comment about hemodynamic stability
          Vitals- PR/RR/ BP.
          Check temperature for fever
          Look skin for pallor/associated skin lesions/–petechiae/janeways lesions/splinter haemorrhages/oslers nodes/clubbing.
          Examine eye –with fundoscope for roths spot
          CVS examination- look for rhythem/murmurs/hyperactive precordium/ position of apex.
          P/A- look for spleenomegaly.
          Palpate all peripheral pulses for presence and equality to r/o thromboembolic phenomenon.
          Thanks parents.
          Tell your findings to examiner.

          B. Clinical symptom/ sign is given
          This type of scenarios really make you stretch your imaginations and think retrospectively. After getting such type of osce first most importent thing to do is to be cool and do not panic. take 30 sec. And make atleast 3-4 significant possible D/Ds from given information and also keep in mind some non specific or minor D/Ds.
          Then go on tracing these D/ds retrospectively in case-examination format.
          Look for specific findings of these possible D/Ds in the examining field. I will explain with example.

          1. Examine 3 yr old child with tremors.

          First 30 sec think possible D/Ds which can have tremors in 3 yr old child. Here are the D/Ds in this case.
              1. Nebulisation with asthalin
              2. Hypoglycemia
              3. Cerebellar disorder
              4. Metabolic encephalopathy- Though cerebellar disorder seems to be first to come in mind, you should also think of other systems too in broader aspect)
          Greet and obtain consent from parent and explain child.
          General exam for titubations/swaying/ tremors/nystagmus/other associated abnormal involuntary movements
          Look for sensorium- agitated- Asthama, CO2 retention
          Dull- metabolic encephalopathy
          Vitals- PR /RR-tachypnea in asthama / BP.
          Skin- for neuro cuteneous markers/signs of liver cell failure.
          CNS- all cerebellar signs/tone/power/reflexes/speech/gait
          RS- air entry- asthama
          Pattern of breathing- acidotic in metabolic acidosis.
          GIT- palpate for liver and look for fluid
          Thanks parents.
          Tell your findings to examiner

          2. Examine 8 year old female child with short stature.

          D/Ds will be

          1. Familial short stature
          2. Constitutional
          3. Syndromic
          4. GHD
          5. Hypothyroidism
          6. Cushings syndrome
          7. Nutritional
          8. Chronic liver disease
          9. Chronic liver failure

          Greet and obtain consent from parent and explain child 
          First take anthropometric measures or make an attempt to prove it as short stature, also ask for parents height and previous height records. 
          US:LS ratio affected (skeletal dysplasias, hypothyroidism)
          Short stature with obesity is always endocrinal or syndromic and never nutritional
          Vitals- PR- (low in hypothyroidism), RR
          BP- (affected in cushings, CRF)
          Dysmorphic features (genetic syndromes)
          Midline defects like cleft palate, micropenis, single central incisor- Growth hormone deficiency.
          Webbed neck, wide spaced nipples with increased carrying angle in female child-Turners syndrome
          Coarse skin, neck swelling- Hypothyroidism
          Jaundice, spider nevi, bleeding tendancies- Chronic liver failure
          Purplish striae, central obesity, buffalo hump,proximal muscle weakness- Cushings
          Signs of vit deficiencies – Malabsorption, Rickets.
          CNS- Low intelligence- hypothyroidism
          Delayed relaxation of tendon jerks- hypothyroidism
          RS - Pattern of breathing- acidotic in metabolic acidosis.
          GIT- palpate for liver and look for fluid
          Thanks parents.
          Tell your findings to examiner

          These were some of examples which i brought forward just to give you an idea about approach to focused clinical examination pattern in pediatric OSCE.

          The crux is you should able to think of all aspects from all systems pertaining to given clinical scenario or question.

          Here are more questions to make you think. Repeated practice of such types of OSCE will definitely help you in scoring more.
          1. 4yr old child is unable to walk. Do the relevant examination.
          2. 5 yr old child with recurrent wheezing episodes.
          3. 7 year old child with spleenomegaly.
          4. 3 year old child with cystic fibrosis.
          5. 9 year old child with Wilsons disease
          6. 12 year old female with SLE

          We will come with more of such examples and their answers next time.
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          Theory question paper: Dec 2015

          Monday, July 4, 2016   at  8:42:00 AM
          Dr Hemang Mendpara
          Read the questions carefully and answer to the point neatly and legibly.
          Do not leave any blank pages between two answers
          Indicate the question number correctly for the answer in the margin space.
          Answer the parts of a Single question together.
          Start the answer to a question on a fresh page or leave adequate space  between two answers.
          Draw table/diagrams/flowcharts wherever appropriate.
          Time        : 3 hours
          Max. Marks    : 100
          Paper – 1

          1. Give a diagrammatic representation of urea cycle. Indicate and name related disorders of urea cycle metabolism at each step. 10

          (a) Clinical  signs  and  symptoms  of refeeding  syndrome. 7+3

          (b) How will you manage such a case? 

          (a) Mention  the  anatomical  and functional  factors  responsible for obstructive  sleep  apnoea  in children. 5+2+3

          (b) Mention  the  anatomical  and functional  factors  responsible for obstructive  sleep  apnoea  in children. 5+2+3

          4. Characteristic hematological features, laboratory findings and treatment of congenital    hypoplastic anaemia. (Dlamond Blackfan  anaemia). 3+3+4

          5. Pathophysiology clinical  manifestations   and  management   of carbon  monoxide  poisoning. 3+3+4

          (a) What  is bias in medical  research? 2+(4+4)

          (b) Common  types  of bias  and the methods  to minimize  bias  in
          analytical  studies. 

          (a) Define child  abuse  and child  neglect. (2+2)+6

          (b) Outline  the  steps  involved  in  management   of  a  suspected child of sexual  abuse.

          (a) Attention-Deficit   Hyperactivity  Disorder  (ADHD).              5

          (b) Gastroesophageal    Reflux   Disease   (GERD)   in  paediatric 
          population. 5

          (a) What  is relative risk (RR) and discuss  its implications? 1+3

          (b) What  is the usefulness  of confidence  interval? 3

          (c) Implications  of sensitivity and specificity. 3

          10. Safe   injection   practices   at   level   III   care   with   respect   to
          burden/deficiencies,   risks, technique,  handling and disposal. 2x5

          Paper – II

          1. What   is  Anion   gap?   Discuss   the   acid-base   disturbance    in metabolic  acidosis.   Enumerate  the causes  of increased  anion gap  and normal  anion  gap metabolic  acidosis. 1+5+(2+2)

          2. Utility   of  newer   Neuro-imaging   modalities   In  paediatric   age group  and their  cost-effective- benefits. 5+5

          3. Pathophysiology   and  managernent  of:
          a) Refractory  shock.  5
          b) Intraventricular   hemorrhage.  5

          4. What  is 'Developmental   delay'?   Describe  different  tools  used for screening  and for diagnosis  of developrnental  delay. 2+(4+4)

          a) Serologic  course  of acute  hepatitis  B.
          b) Treatment  strategies  for  acute and chronic  hepatitis  B. 4+(3+3)

          a) Anaemia   of  Prematurity.
          b) Treatment   options  for  a 3 month  old  preterm  who has  Hb  of 6 gm% 5+5

          a) Neuraprotective    strategies  in CNS  injuries  in neonates.  5
          b) Camplications   of   unconjugated  hyperbihrubinemia  in   a neonate. 5

          (a) Algorithmic   approach   to a neonate with  suspected   I.E.M.       5
          (b) Silverman  Anderson   Scoring system.     5

          9. Tabulate    the   mechanism    of  action, dosage, indications  and side  effects  of the  following. 2*5

          a) Zonisamde b) Rufinamide c) Stiripental d) levetiracetam  e) Lacosamide

          10. What are the definining    criteria    of   Systemic    Inflammatory Response Syndrome (SIRS)? Name the mediators involved and their mode of action.

          Paper – III

          1. Pathophysiology, clinical manifestations and  management   of salicylate  poisoning. 3+3+4 

          a) Classification  of Spinal Muscular  Atrophies  (SMA). 5+5
          b) Major   distinguishing   features   amongst   various   forms   of SMA.

          (a) Free  Radicals. 5
          (b) Febrile neutropaenia  - Definition  & management. 1+4

          (a) What  is Developmentally  Supportive  Care?
          (b) Components of Developmentally Supportive Care in neonates.                                                                                      
          5. Algorithmic approach to a suspected case of Kawasaki disease. 3+7 Enumerate its complications  and outline the management. 5+(2+3)

          6. Pathophysiology,   clinical  manifestations  and  management  of
          Gluten sensitive  enteropathy. 3+4+3

          7. A  2  month  old  baby  presents  with  history  of  failure  to  gain weight, tachypnea, tachycardia,  difficulty in  taking  feed  and excessive perspiration. On examination - no cyanosis, hepatomegaly and   a   systolic   murmur is noted.   Discuss differential  diagnosis,  investigations and management. 4+3+3

          8. What is the pathogenesis of graft Vs host disease? What are its clinical   manifestations? What measures can be taken to prevent it in case of stem-cell transplantation? 4+3+3

          9. Outline management of:
          a) Steroid  resistant  nephrotic syndrome.  5
          b) Child with pulmonary  involvernent with cystic fibrosis. 5

          a) Congenital  varicella.  4
          b) Complications  of  Pertussis.  3
          c) Roseola  Infantum.  3

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          3. Malaria: Must for exams         4. Acid base disturbances

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