Theory question bank update 2016: Part 2

Monday, December 26, 2016   at  8:13:00 PM

Theory question bank in three parts reorganized and updated till 2016

What new in this update
1. All questions reorgnaised.
2. Questions arranged chapterwise as per appearance in Nelson’s textbook of Pediatrics.
3. Arranged in chronological order old first and latest last.
4. Adequate space and gaps given to take side notes and jot doin points for last minute revision.

HOW TO INTERPRET THE QUESTIONS

1. Questions are divided based on Chapters of Nelsons Textbook of Pediatrics
2. Questions contain two numbers at the end. Numbers within bracket indicates the year. For example (97/1)- 97 means year 1997 & 1 means June (2 means December). Thus (06/1) means June 2006
3. Number at the end of the question (not within bracket) indicates marks

6. ACUTELY ILL CHILD

DROWNING

1. Near drowning in children (06)10 Rpt (15/1) 4 marks
2. An 18 month old child was brought to you after he fell upside down in a tub filled with water. Briefly describe the possible injuries and preventive strategies to avoid similar situation in future. (08/1)10
3. Describe the pathogenetic mechanism of injury in near drowning. Discuss the steps of initial resuscitation and subsequent hospital management. (08/2)10
4. Discuss the pathophysiology of submersion injury. A 4 year old boy was rescued 10 min back from a pond and rushed to the hospital emergency. Mention the basic principles of management. (12/1) 5+5
5. A. Define near drowning 2
B.Pathophysiology and management of near drowning 4+4 (1/16)

PAIN

1. Pain management in infants and children (98/1)15
2. Pathogenesis and management of pain in children (06)10
3. Enumerate various sedatives and analgesics recommended for children undergoing painful procedures. Describe their main action, indication in pediatric practice and important side – effects in a tabular format. (08/1)10
4. Write short notes: (12/1) 5+5
a)Non-pharmacological methods in pain management.
(Rpt 4 marks)(Apr16)
b) Drug therapy in neonatal pain management.

BURN

1. How is the degree of Burns classified? Write the initial fluid therapy for a one year old child weighing 10 kg with 20% 2ND degree burns (06)10
2. Provide classification of burns injury. Describe the clinical manifestation of electrical burns. Outline emergency management of a child with 20% burns. (11/2)2+3+5

COLD INJURIES

1. Cold Injury (07/1) 10

BRAIN DEATH

1. Brain Death (98/1) (99/2) 15
2. Define Brain Death. Write age specific criteria for Brain Death in children. (11/2)2+8

P.A.L.S.

1. Draw an algorithm for managing pulseless ventricular tachycardia and ventricular fibrillation. (08/1) 10
2. How will you assess that a 10 year old child who has fallen unconscious in front of you required basic life support. What are the steps for basic life support to such a child (as per American Heart Association Guidelines for CPR) (09/1) 3+7
3. What is Rapid sequence intubation (RSI)? Outline the steps involved. Discuss the indications and advantages of RSI. (14/2) 2+5+3

MECHANICAL VENTILATION

1. Describe the various pressures which are used or varied during mechanical ventilation. What is ‘Cycling’ and ‘Control’ in mechanical ventilator? Describe the differences in pressure controlled and volume controlled ventilation. Illustrate with suitable indication use of these forms of ventilation. (08/2)10
2.Write short notes on: Central hypoventilation syndrome. (13/2) 5
3.A) High frequency oscillatory ventilation (HFOV) 5(15/1)
  B) pulmonary graphics 5

MISCELLANEOUS

1. Discuss the management of a 3 year old unconscious child (99/1)25

7. GENETICS

1. Early stimulation in Down syndrome (92/2)15
2. Genetic counseling of a case of Down Syndrome (99/1)15
3. Prenatal diagnosis of Down syndrome and Duchenne Muscular Dystrophy 15
4. Briefly discuss the principles of genetic counseling. Outline the counseling of a family with a child with Down’s syndrome. (04/2)5+5
5. Gene Therapy in Children (06/1)10
6. Gene therapy (07/1)5
7. Enumerate and describe the structural abnormalities of autosomes. Illustrate with suitable examples. (08/1)10
8. What are trisomies? What are predisposing factors? Discuss clinical features of 3 common trisomies seen in clinical practice? (08/1)10
9. A couple has a child with Down Syndrome. Outline the principles of genetic counseling and antenatal management for the subsequent pregnancy. (09/1)10
10. Write a short note: Karyotyping (09/2)5 Rpt (14/2)
11. What are mutations? Describe their consequences. (10/1)5+5
12. Discuss the genotypic and phenotypic features of Turner’s syndrome (11/1) 4+6
13. What are mitochondrial genes? How are they transmitted? Briefly discuss diseases transmitted by them? (11/2)2+2+6
14. Enumerate classic and non-classic forms of genetic inheritance. Discuss in brief the characteristics of autosomal recessive inheritance. Illustrate with a pedigree chart. (13/1) 5+3+2 (13/2) 2+2+6
15. Describe the symbols used in pedigree chart. Draw pedigree charts over 4 generations depicting a) X – linked dominant disease b) X – linked recessive disease. 4+3+3 (Apr16)
16. Define transloction.Write the inheritance pattern for translocations. Describe clinical features of any one translocation disorder. 6(Apr16)
17. Primary and secondary prevention of genetic disorders 5+5 (1/16)


8. METABOLIC DISEASES

1. Homocysteinuria (94/2)15
2. Screening tests for Inborn Errors Of Metabolism (96/2)10
3. Metachromatic Leukodystrophy (96/1)12
4. Discuss the diet plan in various metabolic disorders (99/1)15
5. Write briefly about glucose metabolism in body. Describe briefly glycogen storage disorders. (04/2)4+6
6. Laboratory Screening tests for metabolic Disorders (06/1)10
7. Provide a diagrammatic representation of urea cycle. Indicate and name related disorders of urea cycle metabolism at each step. (08/1) (Rpt 15/2) 10
8. Discuss the enzymes replacement therapy and substrate reduction strategies in management of metabolic disease. (08/2)10
9. Enlist the inborn errors of metabolism (IEM) with their associated peculiar odor. Provide the investigative approach for an infant with suspected IEM. Describe the treatment of phenylketonuria. (09/2) 4+4+2


9. NEONATOLOGY


ANTENATAL DIAGNOSIS

1. Amniocentesis in prenatal diagnosis (92)15
2. Intrauterine Diagnosis (93/2)10
3. Discuss the methods of detection of congenital malformations in the fetus and their prevention (95/1)25
4. Antenatal Diagnosis (98/2)10
5. Methods to diagnose fetal disorder. Fetal medical therapy (05)5+5
6. List various methods for Fetal diagnosis and assessment along with indications (06)5
7. Prenatal Diagnosis and Fetal therapy (06/1)10
8. Treatment and prevention of fetal diseases (07/1)10
9. Medical management of Fetal Problems (07/2)10
10. What are the methods of diagnosis of fetal disorders? Describe the fetal medical and surgical therapeutic options for various fetal disorders. (09/2) 10
11. Antenatal screening for Down syndrome (13/1) 5
12. Outline the methods of assessing fetal well being with their clinical indications. (13/2 10
13. Fetal therapy 5(1/16)

FETUS

1. Describe in detail tests for antepartum and intrapartum monitoring of fetal distress (06)5
2. Fetal monitoring (06) 10
3. Discuss the complications in the fetus and newborn of a mother with diabetes during pregnancy. (08/1)10

RESPIRATORY DISTRESS

1. Pathophysiology of RDS of newborn (94)15
2. Tests for pulmonary maturity and surfactant therapy for RDS (94/2)15
3. Surfactant therapy (98/2)10
4. Surfactant therapy for HMD 15
5. Discuss RDS with special reference to surfactant therapy (98/2)15
6. Describe the surgical causes of Respiratory difficulty in newborn (02/1)25
7. HMD- pathophysiology and management (03/1)25
8. List the causes of respiratory distress in preterms. Outline the principles of surfactant therapy in preterms. Outline the manifestations of oxygen therapy in newborns. (04/2)2+4+4
9. Etiology, pathogenesis and management of a neonate with RDS (06/1) 10
10. CPAP (06/2)10
11. Briefly discuss normal fetal development of Surfactant. List the uses of Surfactant in newborn (07/2)10
12. Discuss the pathophysiology of hyaline membrane disease in premature newborns. (10/2)10
13. Describe the pathophysiology of hyaline membrane disease (HMD) in newborns. Outline important available strategies to prevent HMD.
(11/1) 5+5
14. A)CPAP for neonatal RDS 5
B) Surfactant replacement therapy 5 (15/1)
14. Silverman Anderson scoring system 5 (15/2)

MECONIUM ASPIRATION SYNDROME

1. Meconium Aspiration Syndrome (97/2)15
2. Discuss the pathogenesis and management of MAS (00/1)25

BPD

1. BPD (97/1)15
2. Outline and discuss the strategies to prevent lung injury and bronchpulmonary dysplasia in a preterm baby. (13/1) 10

PPHN

1. Describe in brief PPHN (or PFC) with regard to Pathology, pathophysiology, Diagnosis and management (94/2)25
2. What is the etiopathogenesis of PPHN of Newborn. Outline the
diagnosis and management (05)3+3+4
3. PPHN (06/1)10
4. Discuss the diagnosis and management of PPHN (07/2)
5. Enumerate causes of persistent pulmonary hypertension in neonates and discuss its pathophysiology. (08/1)10
6. Discuss the approach to diagnosis of Persistent Pulmonary Hypertension of Newborn (PPHN). Outline the available modalities of management, highlighting their key features in a tabular format.
(10/2)4+6
7. Etiology and management of persistent pulmonary hypertension. (14/2) 3+7
8. Pathophysiology of persistent fetal circulation. (15/1) 3

SURGICAL

1. Enumerate congenital anomalies presenting as severe respiratory distress in a newborn. Describe the pre-operative and post operative care of a neonate with trachea-esophageal fistula. (10/1)4+3+3
2. Enumerate causes of persistent vomiting in a 4 week old child.
Describe clinical features and management of hypertrophic pyloric stenosis. (12/1)3+3+4
3. Describe the development of the midgut. Enumerate the causes for bilious vomiting in a two week neonate and discuss its management. (14/1) 3+2+5

RESUCITATION

1. Steps in Neonatal Resuscitation 15
2. Fetal circulation and changes at birth (00/1)15
3. How do you assign APGAR score to a neonate. In which 5 conditions will you get a low score without associated hypoxia? What are
fallacies of APGAR score. (06)10
4. What is the sequence of events leading to the first breath after
Delivery ? What is the significance of establishment of Functional
Residual Capacity? (06)10
5. A term baby is apnoeic. What information of the perinatal events you would like to know? What are the initial steps of management in the labor room? What are the possible complications in the next 48 hours? (08/2)10
6. Describe the changes taking place in circulation at birth and their
implications in neonatal resuscitation. (09/1)5+5
7. Enumerate the newer recommendations of neonatal resuscitation by American Academy of Pediatrics 2010 guidelines. Comment on the level of evidence for each of the changes. (12/1) 6+4
8. Discus the recent changes in guidelines for resuscitation of new born and older children with the rationale for the change. (13/1)10
9. Cyanosis in newborn 5 (Apr16)

BIRTH ASPHYXIA

1. HIE (93/1) (92/2)15
2. Prognosis of Birth Asphyxia (93/1)10
3. HIE in newborn (95/1)10
4. Discuss the etiopathology and management of birth asphyxia (96/2)25
5. HIE (97/2)15
6. Clinical and laboratory correlates of neuromotor outcome in Birth asphyxia (97/1)10
7. Discuss briefly pathophysiology and recent modalities of management of HIE (99/2)25
8. Perinatal asphyxia- clinical features and management (02/1)15
9. What are the etiological causes of Fetal Hypoxia? Write
pathophysiology of Fetal Hypoxia. Describe stages of HIE (06)10
10. Pathophysiology of Hypoxic Brain injury in neonate (06/1)10
11. Discuss the pathophysiology of hypoxic Ischemic Encephalopathy (HIE) in neonates.(09/1)10
12. Discuss etiology, pathophysiology, clinical manifestations and management of Hypoxic- Ischemic Encephalopathy. (13/2) 2+2+2+4
13. Neuroprotective strategies in CNS injuries in neonates 5(15/2)

NEONATAL SEIZURES

1. Etiopathogenesis of neonatal seizures (02/1)15
2. Management of Resistant Neonatal Seizure (03/2)15
3. Classify neonatal seizures. Outline their etiology and provide a brief clinical description. Provide general principles of management of a seizure in neonate. (12/1) 2+2+3+3

IVH

1. IVH (03/1)15
2. Outline the risk factors, pathophysiology and principles of management of intraventricular hemorrhage in preterm neonates. (10/2)3+3+4
3. Discuss the pathogenesis of intracranial hemorrhage in newborn
infants. Outline the possible promoters and protectors for occurrence of subsequent white matter disease. (12/1)6+2+2
4. Pathophysiology and managment of intraventricular hemorrhage. 5(15/2)

PAIN

1. Discuss the impact of pain on a preterm neonate. Identify common procedures associated with pain in a newborn. Describe the strategies for pain management in a newborn. (08/2)10
2. Write short notes: (12/1)5+5
a) Non-pharmacological methods in pain management.
b) Drug therapy in neonatal pain management.
3. Neonatal pain 5 (1/16)

NEONATAL HYPOGLYCEMIA

1. Management of neonatal hypoglycemia (98/2)(92/2)10
2. Define Hypoglycemia in newborn. List its causes. Describe stepwise treatment if hypoglycemia in a newborn (06)10
3. Define hypoglycemia. Describe clinical features and management of hypoglycemia in newborn and children. (11/2)1+4+5
4. A. Etiological classification of neonatal hypoglycemia 2
   B. Clinical features & mgmt. of neonatal hypoglycemia 3+5(1/16)

TEMPERATURE

1. Thermoregulation peculiarities in newborn (94/2)15
2. Hypothermia in the newborn (97/1)15
3. Thermal regulation in newborn (98/2)10
4. Prevention of Hypothermia in the newborn (98/2)15
5. Physiological and biochemical consequences of Hypothermia in Neonate (99/1)15
6. Thermal balance in Neonates (03/2)15
7. Discuss management of Neonatal Hypothermia (06)5
8. Write the components, pre-requisites and benefits of Kangaroo Mother care. (08/2) 10, (11/2)5+2+3
9. Discuss the principles of care of the skin in neonates. Outline the role of touch and massage therapy in newborn infants. (10/2)4+3+3
10. Describe the advantages and methods of giving Kangaroo Mother Care (KMC). Enlist metabolic consequences of hypothermia. (13/1) (4+4)+2

NUTRITION

1. Write short notes on: Trophic feeding (13/1)5
2. Discuss attributes, complications and monitoring of total parenteral nutrition in a newborn (13/1)5
3. Write short notes on: (14/1)4+3+3
a) Human Milk Fortifiers
b) Vitamin D supplementation in neonates
c) Medium chain triglycerides in neonatal nutrition

RENAL

1. Kidney functions in neonate (98/2)(99/2)10

INFECTIONS

1. Antibiotic treatment of Neonatal Meningitis (93/2)10
2. Early diagnosis of Neonatal Septicemia (94/2)15
3. Infants of HIV seropositive mothers (95/1)15
4. Infants of HBV seropositive mothers (95/1)15
5. Rapid diagnostic tests in a suspected case of Neonatal Septicemia (95/2) 10
6. Congenital toxoplasmosis (97/2)15
7. Infection control in neonatal intensive care (98/2)10
8. Newer modalities in the management of neonatal sepsis (99/2)15
9. Screening tests for neonatal sepsis 15
10. Prevention of Mother to Child transmission of Hep B 15
11. Sepsis Screen in neonates (06/1)10
12. Candidiasis in Neonates (06)10
13. Adjuvant therapy in Neonatal sepsis (06)10
14. Differential Diagnosis of Neonatal sepsis (07/1)10
15. Discuss various adjunct therapies in neonatal sepsis. (08/1)10
16. Discuss the risk factors for vertical transmission of HIV infection and methods to prevent parent to child transmission of HIV. (09/1)4+6
17. Discuss the predisposing factors, causative agents, methods of diagnosis and treatment of neonatal osteomyelitis. (09/1)4+6
18. A 3 day old home delivered boy (Weight 1450g, Gestation 36 wk) is brought to you with abnormal body movements and not accepting feeds. The child is cold to touch and capillary filling time is 5 sec. Outline the immediate, short term and long term management of this child. (09/1) 4+6
19. Enumerate the clinical features that indicate presence of a possible intrauterine infection in a neonate. Describe the interpretation of TORCH screen. (09/2)6+4
20. Clinical features, investigations and prevention of Congenital Rubella Syndrome. (10/1)3+3+4
21. Outline the clinical presentation, diagnosis and management of a neonate with intrauterine CMV infection. (11/1)3+4+3
22. Discuss the available strategies for prevention of mother to child transmission of HIV. (12/1)10
23. Write short notes on: Various adjunctive therapies in the management of overwhelming sepsis in neonates. (13/2) 5
24. A three days old neonate is brought to the Emergency woth history of not accepting feeds for one day. He is found to be lethargic with a HR of 180/min, and capillary filling time of 4 secs and cold extremities. Outline your approach to this neonate along with management of the case. (14/1) 4+6
25. Newer diagnostic tests for neonatal sepsis (15/1) 5
26. Congenital varicella (15/2)4

SFD

1. Factors associated with IUGR (93/1)10
2. Immune status of SFD babies (98/1)15
3. List the principles of community care of LBW infants. Define Kangaroo Mother care. Outline its advantages and disadvantages. (04/2)4+2+4
4. Outline the handicaps in enteral feeding of LBW newborns. Briefly discuss the feeding strategies for LBW babies. (04/2)3+4+4
5. Enumerate the etiology of fetal or intrauterine growth retardation (IUGR). Describe the screening and diagnosis of IUGR. (11/2) 3+4+3
6. Immediate and late problems due to low birth weight (13/1)5

APNEA OF PREMATURITY

1. Pathophysiology of Apnea Of Prematurity (97/2)15
2. A 10 day old preterm neonate has recurrent cessation of breathing lasting for more than 20 seconds with bradycardia. Classify and enumerate causes for this condition. Discuss in brief the management of this condition. (12/1)4+6
3. Management of neonatal apnea. (13/1) 5
4. Apnea Of Prematurity 5(Apr16)

RETINOPATHY OF PREMATURITY

1. ROP (07/1) 10 Rpt (Apr 16 )5mrks

OSTEOPENIA OF PREMATURITY

1. Osteopenia of prematurity (06)10

NEONATAL JAUNDICE

1. Pathogenesis of kernicterus (96/2)10
2. A 3 week old infant brought to the hospital with moderate jaundice. Discuss the Diagnosis (97/2)10
3. Kernicterus (97/1)15
4. Discuss the Bilirubin metabolism and list the causes and approach to Diagnosis of Hyperbilirubinemia in a neonate (00/1)25
5. Discuss reasons for Physiological Jaundice in a Newborn. Define and list causes of pathological jaundice in a newborn. Discuss clinical manifestations (acute and chronic)of kernicterus (06)10
6. Outline the normal metabolism of bilirubin. Outline the principle of phototherapy for treatment of neonatal jaundice. List factors that influence efficacy of phototherapy. (08/1)10(09/1)10,(10/2)4+3+3
7. Critically describe the role of various treatment modalities for treating neonatal unconjugated hyperbilirubinemia. (11/2)10
8. Outline and discuss various strategies to mange hyperbilirubinemia in newborns (13/1)10
9. Short note on side effects of phototherapy (14/2)5
10. Complications of unconjugated hyperbilirubinemia in a neonate (15/2)5

NEC

1. Pathogenesis of NEC (97/1) (92)15
2. NEC (97/2)15
3. Etiology and pathology of NEC 15
4. Etiology of NEC, staging and management. (04/2)10
5. Discuss management of NEC (06)5
6. Discuss the clinical features, diagnosis and management of neonatal necrotizing enterocolitis. (09/1)3+7
7. Discuss the pathophysiology, classification and diagnostic features of necrotizing enterocolitis. (10/2)4+3+3
8. A 6 day old preterm neonate presents with abdominal distension, feed intolerance, vomiting and blood in stools. Discuss the differential diagnosis, diagnostic approach and principles of initial stabilization. (12/1)4+3+3

NEONATAL HYPOTHYROIDISM

1. Clinical features of Cretinism in newborn babies (97/1)10
2. Describe in brief the etiology, clinical features, diagnostic investigations and management of congenital hypothyroidism. (11/1) 2+2+3+3

PRETERM

1. Enumerate the socio-demographic factors associate with Low birth weight babies. Discuss the clinical problems of Preterm babies (96/1)25
2. Pharmacotherapy in prematurity clinical decisions salient features (03/1)15
3. Management of Patent Ductus Arteriosus (PDA) in preterm neonates (10/1)10
4. Enumerate the factors associated with prematurity and low birth weight. Discuss the potential pathways by which infection plays a role in
premature delivery. (13/1)4+6
5. Describe the development of the ductus arteriosus. Enumerate the duct dependent lesions in the newborn and outline their management. (14/1)3+2+5

HAEMATOLOGY

1. Hemorrhagic Disease of The Newborn (95/2)15
2. Management of Neonatal Thrombocytopenic Purpura (00/1)15
3. Hydrops Fetalis (03/1)15
4. What is Hydrops fetalis. Discuss etiology of Non immune hydrops fetalis. What is the management of a case of Non immune hydrops fetalis (05)2+5+3
5. Discuss etiopathogenesis, diagnosis and management of a Bleeding Neonate (06/2)10
6. Anemia in newborn infant (07/1)10
7. Non immune hydrops fetalis (03/2)15, (07/1)10
8. Define polycythemia in a newborn. What are the factors predisposing to it? Describe the impact of polycythemia on various systems and their clinical presentation. Describe the management of polycythemia in newborn. (08/2)10
9. Outline the classification, clinical manifestations, laboratory findings and differential diagnosis of vitamin K deficiency bleeding. (12/1)3+3+2+2
10. A)Anemia of prematurity 5
   B)Treatment options for a 3 month old preterm who has Hb of 6gm%. 5(15/2)
11. Causes of Anemia in the Newborn (93/1)10 Rpt 5marks(Apr16)
12. Outline management of polycythemia 4(1/16)

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Theory question paper: Dec 2016

Thursday, December 15, 2016   at  12:14:00 AM
Dr Annasaheb Lokhande
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
PAEDIATRICS
PAPER -I
PART A

1.
a) Outline the steps involved in the synthesis of Vitamin D. 3+(3+2+2)
b) A seven year old boy presents with deformities suggestive of rickets. What are the possible causes? Enumerate the investigations for resistant rickets and treatment of hypophosphataemic rickets.
2. Etiopathogenesis and management of septic shock. 5+5
3.
a) Measures of central tendency. 3+2+5
b) Odds Ratio.
c) Management of raised intracranial tension.
4. Mechanism of action, therapeutic usage with dosages and adverse effects in children on: 3+4+3
a) Infliximab.
b) Gamma globulins.
c) Pegylated interferons.
5 Management of status epilepticus in children. 10

PAPER -I
PART B

6. 3+4+3
a) Mission Indradhanush: Its targets and strategy
b) Child Health Screening and Early Intervention Services in
Rashtriya Bal Swasthya Karyakram (RBSK).
c) Objectives and components of National Iodine Deficiency
Disorders Control Programme.
7. 2+3+(2+3)
a) First Referral Unit.
b) Management of neurocysticercosis
c) Enumerate causes of "Failure to Thrive" and a schematic evaluation plan for the same.
8. 5+(2+3)
a) Embryology of heart development.
b) Clinical features and management of hypoplastic left heart
syndrome.
9. 5+5
a) Early Biomarkers of sepsis.
b) Management of moderate persistent asthma.
10. Clinical features and management of snake bite by a viper. 5+5

PAPER II
PART A

1. Clinical features and management of hypoxic ischemic encephalopathy in newborns. 6+4
2.
a) Grading of vesicoureteric reflux. 2+3+5
b) Outline the evaluation plan for an Infant presenting With UTI.
c) Treatment of Bowel Bladder Disorder.
3. Management of 5+5
a) Hypothermia In newborns.
b) Apnea in preterms.
4.
a) Define obesity 2+{3+5)
b} Enumerate causes and management of childhood obesity.
5.
a) Enumerate advances in the treatment of thalassemia major. 5+5
b) Risk stratisfaction of acute lymphatic leukemia

PAPER - II
PART B

6.
a) Management of childhood autism. 4+6
b) Treatment and outcome of neonatal and congenital varicella.
7.
a) Definition and treatment of dengue haemorrhagic fever. 3+4+3
b) Clinical presentation and diagnosis of Mycoplasma pneumoniae infection.
c) Clinical features and treatment of Chikungunya fever.
8.
a) Clinical presentation of Vitamin K deficiency in newborns and infants. 5+(2+3)
b) Its prevention and management.
9.
a) Differentiate a bleeding disorder from a clotting disorder. 3+(2+5)
b) Investigation and treatment of a 2 year old boy presenting with spontaneous hemarthrosis.
10.
a) Causes of prolonged hyperbilirubinemia (beyond 14 days) in newborns. 3+(4+3)
b) Outline steps of investigation and management of prolonged hyperbilirubinemia in newborns.

PAPER III
PART A

Write short notes on:
1. Causes, investigations and treatment of a child with suspected intestinal malabsorption. 3+3+4
2.
a) Cognitive behavior therapy in pediatrics. 5+(3+2)
b) Causes and treatment of congenital cataract.
3.
a) Enumerate various causes of childhood deafness. 3+(3+4)
b) Investigations and management algOrithm of childhood deafness.
4. Clinical presentations, investigations and treatment of Wilson's disease. 4+3+3
5. Clinical features, investigations and treatment of congenital hypothyroidism. 3+3+4

PAPER-III
PART B

6. Management of: 5+5
a) Hepatic encephalopathy.
b) Acne in adolescents.
7. Outline the hospital management of severe acute malnutrition (SAM). 10
8. Causes, clinical features and management of the following electrolyte abnormalities in children. 5+5
a) Hyperkalaemia. b) Hypernatraemia.
9.
a) AIDS defining illnesses in children. 5+5
b) Drugs for procedural sedation In children.
10
a) Pentavalent vaccine. 5+5
b) Microarray and DNA sequencing for diaqnosis.
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Cracking code of theory: Aspiration Syndromes

Monday, December 5, 2016   at  9:35:00 PM

Aspiration Syndromes
The spectrum varies from asymptomatic condition to acute life-threatening events,
Occult aspiration of nasopharyngeal secretions into the lower respiratory tract is a normal event in healthy people, usually without apparent clinical significance.

A. Aspiration of Gastric contents:
Large volume aspiration of gastric contents usually occurs after vomiting;
It is an infrequent complication of general anesthesia, gastroenteritis, and an altered level of consciousness.
Pathophysiologic consequences depends primarily on:
o The pH
o Volume of the aspirate
o The amount of particulate material.
Increased clinical severity is noted with volumes greater than approximately 0.8 mL/kg and/or pH < 2.5.
Hypoxemia, hemorrhagic pneumonitis, atelectasis, intravascular fluid shifts, and pulmonary edema all occur rapidly after massive aspiration.
These occur earlier, become more severe, and last longer with acid aspiration.

Most clinical changes are present within minutes to 1–2 hr after the aspiration event.
In the next 24–48 hr, there is a marked increase in lung parenchymal neutrophil infiltrations, mucosal sloughing and alveolar consolidation that often correlates with increasing infiltrates on chest radiographs.

Infection after aspirations
Infection usually does not have a role in initial lung injury after aspiration of gastric contents
Aspiration impair pulmonary defenses, predisposing the patient to secondary bacterial pneumonia.
In the patient who has shown clinical improvement but then develops clinical worsening, especially with fever and leukocytes, secondary bacterial pneumonia should be suspected
Treatment:
  1. If a patient has had large volume or highly toxic substance aspiration it is important to perform immediate suctioning of the airway.
  2. When immediate suctioning cannot be performed, later suctioning or bronchoscopy is usually of limited therapeutic value.
  3. An exception to this is if significant particulate aspiration is suspected.
  4. Attempts at acid neutralization are not warranted because acid is rapidly neutralized by the respiratory epithelium.
Patients suspected of large volume or toxic aspiration should :
o Be observed,
o Have oxygenation measured by oximetry or blood gas analysis,
o Have a chest radiograph taken, even if asymptomatic.
If the chest radiograph and oxygen saturation are normal, and the patient remains asymptomatic, home observation, after a period of observation in the hospital or office, is adequate.

No treatment is indicated at that time, but the caregivers should be instructed to bring the child back in for medical attention should respiratory symptoms or fever develop.
  1. For those patients who present with or develop abnormal findings during observation, oxygen therapy is given to correct hypoxemia.
  2. Endotracheal intubation and mechanical ventilation are often necessary for more severe cases.
  3. Bronchodilators may be tried, although they are usually of limited benefit.
  4. corticosteroids does not appear to have any benefit, unless given nearly simultaneously with the aspiration event; their use may increase the risk of secondary infection.
  5. Prophylactic antibiotics are not indicated, although in the patient with very limited reserve, early antibiotic coverage may be appropriate.
  6. If used, antibiotics should be used that cover for anaerobic microbes.
  7. If the aspiration event occurs in a hospitalized or chronically ill patient, coverage of Pseudomonas and enteric gram-negative organisms should also be considered.
A mortality rate of ≤5% is seen if 3 or fewer lobes are involved.
Unless complications develop, such as infection or barotrauma, most patients will recover in 2–3 wk, although prolonged lung damage may persist, with scarring and bronchiolitis obliterans.

Prevention:
Prevention of aspiration should always be the goal when airway manipulation is necessary for intubation or other invasive procedures.
Feeding with enteral tubes passed beyond the pylorus and elevating the head of the bed in mechanically ventilated patients have been shown to reduce the incidence of aspiration complications in the intensive care unit.

B. Hydrocarbon Aspiration:

The most dangerous consequence of acute hydrocarbon ingestion is usually aspiration and resulting pneumonitis.

Hydrocarbons with lower surface tensions (gasoline, turpentine, naphthalene) have more potential for aspiration toxicity than heavier mineral or fuel oils.

Ingestion of >30 mL (approximate volume of an adult swallow) of hydrocarbon is associated with an increased risk of severe pneumonitis.

Clinical findings of chest retractions, grunting, cough, and fever may occur as soon as 30 min after aspiration, or may be delayed for several hr.

*Diagnosis

Lung radiograph changes usually occur within 2–8 hr, peaking in 48–72 hr.

Pneumatoceles and pleural effusions may occur.

Patients presenting with cough, shortness of breath, or hypoxemia are at high risk for pneumonitis.

Persistent pulmonary function abnormalities can be present many years after hydrocarbon aspiration.
Other organ systems, especially the liver, central nervous system, and heart, may suffer serious injury.

Cardiac dysrhythmias may occur and be exacerbated by hypoxia and acid-base or electrolyte disturbances.

*Treatment:

Gastric emptying is nearly always contraindicated because the risk of aspiration is greater than any systemic toxicity.

In Case volumes >30 mL, such as might occur with intentional overdose, may benefit from gastric emptying
Treatment is generally supportive with oxygen, fluids, and ventilatory support as necessary. 
The child who has no symptoms and a normal chest radiograph should be observed for 6–8 hr to ensure safe discharge. 
Certain hydrocarbons have more inherent systemic toxicity. 
The pneumonic CHAMP refers collectively to these: camphor, halogenated carbons, aromatic hydrocarbons, and those associated with metals and pesticides. 
Cuffed endotracheal tube can be placed without inducing vomiting, this should be considered, especially in the presence of altered mental status.
Other substances that are particularly toxic and cause significant lung injury when aspirated or inhaled include baby powder, chlorine, shellac, beryllium, and mercury vapors.

Repeated exposure to low concentration of these agents à chronic lung disease, such as interstitial pneumonitis and granuloma formation. Corticosteroids may help reduce fibrosis development and improve pulmonary function, although the evidence is limited.

C. Chronic Recurrent Aspiration

Etiology:

The recurrent aspiration of small quantities of gastric, nasal, or oral contents can lead to several clinical presentations.

These include recurrent bronchitis or bronchiolitis, recurrent pneumonia, atelectasis, wheezing, cough, apnea, and laryngospasm.

Pathologic outcomes may include:
o Granulomatis inflammation,
o Interstitial inflammation,
o Fibrosis,
o Lipoid pneumonia,
o Bronchiolitis obliterans
Oropharyngeal incoordination is reportedly the most common underlying problem associated with recurrent pneumonias of hospitalized children.

Lipoid pneumonia may occur after the use of home/folk remedies involving oral or nasal administration of animal or vegetable oils to treat various childhood illnesses.

Conditions Predisposing to Aspiration Lung Injury in Children:
A. Anatomical and Mechanical
  1. Tracheoesophageal fistula
  2. Laryngeal cleft
  3. Vascular ring
  4. Cleft palate
  5. Micrognathia
  6. Macroglossia
  7. Achalasia
  8. Esophageal foreign body
  9. Tracheostomy
  10. Endotracheal tube
  11. Nasoenteric tube
  12. Collagen vascular disease (scleroderma, dermatomyositises)
  13. Gastroesophageal reflux disease
  14. Obesity
B. Neuromascular
  1. Altered consciousness
  2. Immaturity of swallowing/prematurity
  3. Dysautonomia
  4. Increased intracranial pressure
  5. Hydrocephalus
  6. Vocal cord paralysis
  7. Cerebral palsy
  8. Muscular dystrophy
  9. Myasthenia gravis
  10. Guillain-Barré syndrome
  11. Werdnig-Hoffmann disease
  12. Ataxia-telangiectasia
  13. Cerebral vascular accident
C. Miscellaneous
  1. Poor oral hygiene
  2. Gingivitis
  3. Prolonged hospitalization
  4. Gastric outlet or intestinal obstruction
  5. Poor feeding techniques (bottle propping, overfeeding, inappropriate foods for toddlers)
  6. Bronchopulmonary dysplasia
  7. Viral infection
causes of aspiration syndromes

Gastroesophageal reflux is also a common underlying finding that may predispose to recurrent respiratory disease, but it is less frequently associated with recurrent pneumonia.

Recurrent microaspiration has been reported in otherwise apparently normal newborns, especially premature infants.

Aspiration is also a risk in patients suffering from acute respiratory illness from other causes, especially respiratory syncytial virus infection, This emphasizes the need for a high degree of clinical suspicion of ongoing aspiration in a child with an acute respiratory illness who is being fed enterally and who deteriorates unexpectedly.

DIAGNOSIS:

Underlying predisposing factors are frequently clinically apparent but may require specific further evaluation.

The caregiver should be asked about spitting, vomiting, arching, or epigastric discomfort in an older child; and the timing of symptoms in relation to feedings, positional changes, and nocturnal symptoms such as coughing or wheezing.

Coughing or gagging may be minimal or absent in a child with a depressed cough or gag reflex.

Observation of a feeding is an essential part of the examination when considering a diagnosis of recurrent aspiration.

Particular attention should be given to nasopharyngeal reflux, difficulty with sucking or swallowing, and associated coughing and choking.

The oral cavity should be inspected for gross abnormalities and stimulated to assess the gag reflex.

Drooling or excessive accumulation of secretions in the mouth suggests dysphagia.

Lung auscultation may reveal transient crackles or wheezes after feeding, particularly in the dependent lung segments.

Diagnosis of Recurrent microaspiration :
The diagnosis of is challenging because of the lack of highly specific and sensitive tests. 
A plain chest radiograph is the usual initial study for a child suspected of recurrent aspiration.
The classic findings CXR :
Segmental or lobar infiltrates localized to dependent areas may be apparent
Other findings:
Diffuse infiltrates,
Lobar infiltrates,
Bronchial wall thickening,
Hyperinflation,
Even normal-appearing chest x-rays.
 Barium esophagram:
Useful for anatomic abnormalities such as :
  1. vascular ring, stricture,
  2. Hiatal hernia,
  3. Tracheoesophageal fistula.
  4. It also yields qualitative information about esophageal motility and, when extended, of gastric emptying.
The esophagram is insensitive and nonspecific for aspiration or gastroesophageal reflux.
Modified barium swallow with videofluoroscopy:
Generally considered the gold standard for evaluating the swallowing mechanism.

This study is preferably done with the assistance of a pediatric feeding specialist and a caregiver to try to simulate the usual feeding technique of the child.

The modified barium swallow occasionally detects aspiration without apparent respiratory abnormalitie
 Gastroesophageal “milk” scintiscan :
Offers theoretical advantages over a barium swallow in being more physiologic and providing a longer window of viewing than the barium esophagram for detecting aspiration and gastroesophageal reflux.
        This procedure has been a relatively insensitive test for detecting aspiration.
“Salivagram: useful in assessing aspiration of esophageal contents, although its sensitivity has not been well studied.
Fiberoptic endoscopic evaluation of swallowing:
Used effectively in adults, has been reported to be useful in pediatric patients.
The swallowing is observed directly, without radiation exposure.
The endoscope may alter the assessment of function, depending on level of comfort and cooperation.
CT scans (generally not indicated to establish a diagnosis of aspiration) may show infiltrates with decreased attenuation suggestive of lipoid pneumonia.
Tracheobronchial aspirates :
For patients with artificial airways, the use of an oral dye and visual examination of tracheal secretions is useful. This test should not be done on a chronic basis due to possible dye toxicity. 
It is important to use an adequate volume of dye, but even this may be relatively insensitive compared to measuring lactose or glucose in airway secretions.

Quantitation of lipid-laden alveolar macrophages from bronchial aspirates has been shown to be a sensitive test for aspiration.
     False-positive tests: seen in
Endobronchial obstruction,
Use of intravenous lipids,
Sepsis,
Pulmonary bleeding.
Bronchial washings may also be examined for various food substances, including lactose, glucose, food fibers, and milk antigens.
TREATMENT:

Treatment should be directed towards underlying medical condition.
Milder dysphagia can be treated with:
o Alteration of feeding position,
o Limiting texture of foods to those best tolerated on modified barium esophagram (usually thicker foods), or
o Limiting quantity per feeding.
Nasogastric tube feedings can be utilized temporarily during periods of transient vocal cord dysfunction or other dysphagia.

Post-pyloric feedings may also be helpful, especially if gastroesophageal reflux is present. Several surgical procedures may be considered.

Tracheostomy, although sometimes predisposing to aspiration, may provide overall benefit from improved bronchial hygiene and the ability to suction aspirated material.

Fundoplication with gastrostomy or jejunostomy feeding tube will reduce the probability of gastroesophageal reflux–induced aspiration, but recurrent pneumonias often persist because of dysphagia and presumed aspiration of upper airway secretions.

Medical treatment :
o Anticholinergics: glycopyrrolate or scopolamine,
o Botulism toxin.
Aggressive surgical intervention with salivary gland excision, ductal ligation, laryngotracheal separation, or esophagogastric disconnection can be considered in severe, unresponsive cases.
Poor prognostic factors:
   In hydrocarbon poisoning prior lavage,
   Hypoxemia at admission,
   Need for ventilation,
   Secondary pneumonia
   Ventilator related complications were associated with poor outcome.
Aspiration syndrome
About the Author
Dr Ranjith Kumar CS  is Currently persuing DM in medic oncology from JIMER, completed DNB from Kanchi Kamakoti Child Trust Hospital with a gold medal, has great academic interests, contributed about 9 chapters  in scott pediatriks clinical methods  |  View Ranjith Kumar CS  posts

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Theory question bank update 2016: Part 1

Monday, November 14, 2016   at  11:10:00 PM

Theory question bank in three parts reorganized and updated till 2016

What new in this update
1. All questions reorgnaised.
2. Questions arranged chapterwise as per appearance in Nelson’s textbook of Pediatrics.
3. Arranged in chronological order old first and latest last.
4. Adequate space and gaps given to take side notes and jot doin points for last minute revision.

HOW TO INTERPRET THE QUESTIONS

1. Questions are divided based on Chapters of Nelsons Textbook of Pediatrics
2. Questions contain two numbers at the end. Numbers within bracket indicates the year. For example (97/1)- 97 means year 1997 & 1 means June (2 means December). Thus (06/1) means June 2006
3. Number at the end of the question (not within bracket) indicates marks

1. GROWTH AND DEVELOPMENT

DELAYED SPEECH

1. Approach to a child with Delayed Speech (02/1)15

DEVELOPMENTAL REGRESSION

1. Discuss the causes and approach to a Preschool child with Developmental Regression (02/1)25
2. A 2 yr old child presents with history of regression of milestones for past 6 months and hepatosplenomegaly.Discuss the differential diagnosis and diagnostic approach 7+3(1/16)

GROWTH CHARTING AND MONITORING

1. Define Growth, Development, and Velocity of growth mean, median, percentiles. Enumerate causes of retarded growth. Briefly outline a schedule for investigation of such a case (92/2) 25
2. Factors affecting Development of children (92) 15
3. Gessel Developmental schedule (93/1)15
4. Describe the events of sexual development in relation to physical growth. Name the most important regulatory factors (94) 25
5. Discuss the basis for use of Growth Standards. What should be taken as a reasonable approach for India (94/2) 25
6. Sexual Maturity Rating in female adolescents (95/2) 15
7. Velocity and cross-sectional standards as applied to Human Growth (95/2) 15
8. What are the developmental disorders in preschool years? Discuss the management (97/1) 15
9. Growth Monitoring (98/1) 15
10. Growth Factors (99/1) 15
11. Principles of Growth and Development (00/1) 15
12. Importance of Bone age assessment in children 15
13. SMR (03/2)
14. What is SMR? Discuss the secular trend in Children 5+5 (05/02)
15. How would you assess sexual maturity of a female adolescent (06) 10
16. Write the height velocity curves of girls and boys from birth to adolescence, describe the principles and factors governing the growth and development in children (06)10
17. Bone age assessment and its usefulness (07/2) 10
18. Growth and development in second year of life in children (07/1) 10
19. Describe: (09/2) 5+5
a) Factors affecting child development
b) Developmental screening tests available and suitable for use in Indian children.
20. Developmental milestones in first two years of life. (10/1) 10
21. Outline the fine motor milestones along with their normal age of achievement in sequence attained between birth and 5 years of age.
(10/2)10
22. Discuss the evolution and characteristics of WHO growth charts. Discuss their implications on the magnitude of malnutrition in Indian setting. (11/1) 3 +4+3
23. Enumerate the available methods and indications for determination of bone age in children and adolescents. Outline the differential diagnosis of a child with short stature on the basis of bone age. (11/1) 3+3+4
24. Describe Tanner’s Sexual Maturity Rating (pubertal staging) in boys based on
a) Genitalia and
b) Pubic hair development. (11/2) 5+5
25. Describe in detail the physical growth and development in all domains from birth till completion of first year. (11/2) 5+5
26. Define growth velocity. Draw a typical height velocity curve from birth to puberty for boys and girls. Discuss the utility of determining growth velocity. (12/1) 2+4+4
27. What is developmental screening? Enumerate common developmental screening test. What issues they identify in a child? (12/1) 2+4+4

SHORT STATURE

1. Define Short Stature. Discuss the approach to a child with short stature and the role of GH in Short Stature (05)2+5+3
2. Approach to a child with short stature (06/1) (07/2) 10
3. Short stature – definition, differential diagnosis and management approach. (10/1) 2+3+5
4. Define short stature. Outline the approach to clinical evaluation and management of a child with short stature. (13/1) 2+8
5. A)What is short stature
b) What are the common causes of short stature?
c) Algorithmic approach to manage a 5 yr old child with short stature. 1+3+6(1/15)
6. A 12year old female child presents with short stature and delayed puberty.
a. Enumerate various possible causes
b. Approach to diagnosis and their management. 2+8(1/16)

DEVLOPMENTAL DELAY

1. What is developmental delay? Describe different tools used for screening of developmental delay. (11/2)3+7
2. Define developmental delay and developmental dissociation.Outline the screening and definitive tests for diagnosis of developmental delay. (13/1)5+5
3. What is global developmental delay? What are the common causes of global developmental delay? Discuss the algorithmic approach to evaluate a child with global developmental delay. (13/2)2+3+5
4. What is developmental delay? Describe different tools used for screening and for diagnosis of developmental delay. (15/2)2+4+4

2. PSYCHOLOGIC DISORDERS

PSYCHOSOMATIC ILLNESS

1. Management of Conversion reactions (98/1)15
VEGETATIVE DISORDER
1. Encopresis (99/2)15
2. What is Vegetative Disorder (05) 5
3. What is vegetative disorder? Discuss management of a child with injuries (05) 5+5
4. Rumination (06/1) 5
5. Pica (07/1) 5

HABIT DISORDER

1. Habit Disorders in children (07/1)10
MOOD DISORDER
1. Childhood Depression (06)10
2. A) Aetiology of depression in adolescents 2 (15/1)
b) comorbidities ,clinical features and treatment of depression in adolescents 3+3+2 (15/1)
3. Management of
a.  Post traumatic stress disorder 4(1/16)
b. Tourette’s disorder 3
c.  PANDAS 3

DISRUPTIVE BEHAVIORAL DISORDERS

1. Common Behavioral problems in children (97/2) 15
PERVASIVE DEVELOPMENTAL DISORDER AND CHILDHOOD PSYCHOSIS
1. Autism (03/2)15
2. Define autism. Outline its etiology. Outline the clinical markers of autism and its prognosis. (04/2) 2+3+3+2
3. Etiology, clinical manifestations and treatment of Autistic Disorder (06/1)10
4. Autistic Disorder (07/1) 10
5. Autistic spectrum disorder (07/2) 10 Rpt Apr16 3marks
6. Describe the etiology, clinical manifestations and management of autistic spectrum disorders in children. (09/2)2+3+5
7. Discuss briefly the diagnostic features and management of Pervasive Developmental Disorders/ autistic spectrum disorders. (11/2)4+6
8. Enumerate various pervasive developmental disorders and autism spectrum disorders. Outline one core feature of each of them. (12/1) 5+5
9. Define autistic spectrum disorders. Enumerate their clinical features and discuss their managements (13/2) 2+4+4
10. What are Autistic Spectrum Disorders? Discuss the differential diagnosis and management of a child with Autism. (14/1) 3+3+4
11. Discuss the management of a child with schizophrenia (04/2)5
12. Discuss the management of a child with Schizophrenia (05)5
NEURODEVELOPMENTAL DYSFUNCTION IN THE SCHOOL AGED CHILD
1. Attention Deficit Disorders (97/1)(95/2) (00/1)15
2. ADHD (03/1)15Rpt (15/2) 5marks
3. Describe clinical manifestations, diagnosis and management of ADHD (06)10
4. Define Dyslexia. Briefly discuss its management. (14/2) 5

SLEEP MEDICINE

1. Sleep Disorders in children (99/2)10
2. Pathophysiology of Sleep Apnea (03/1)15
3. Outline the basic principles of sleep hygiene for children and adolescents (09/1)10 (12/1) 5+5
4. Principles of sleep hygiene in children (13/1) 5
5. Evaluation of Obstructive sleep Apnea (14/2) 5
6. A)mention anatomical and functional factors responsible for obstructive sleep apnea in children 5
b) How do you diagnose and treat this condition 2+3(15/2)
7. Obstructive sleep apnea: diagnosis and management 5(1/16)

ENURESIS

1. Enuresis (96/2)15
2. Define Enuresis. Discuss its manifestations and management (06)5
3. Management of nocturnal Enuresis. (07/1)5
4. What is nocturnal enuresis? Outline the causes for the same. Describe the modalities for managing a 6 year old child with enuresis.
(08/2)10
5. Discuss evaluation and management of an 8 year old male with primary nocturnal enuresis. (10/2)4+6

3. SOCIAL ISSUES, CHILDREN WITH SPECIAL HEALTH NEEDS


FAILURE TO THRIVE

1. Approach to a child with Failure To Thrive (96/1)14
2. Causes of Failure to Thrive in infancy (96/2)15
3. Define failure to thrive. Outline a diagnostic approach for a child with failure to thrive. (04/2)2+8
4. Non organic failure to thrive (07/1)10
5. Define failure to thrive. Give its etiology, classification, clinical features and management. (09/2) 1+2+2+2+3
6. Define failure to thrive and tabulate its causes. Outline the approach to manage a child with failure to thrive. (10/2) 2+3+5
7. Failure to thrive (15/1) 6

ADOPTION

1. Role of Pediatrician in Adoption of a child (95/1)10
2. Adoption (03/2)
3. Role of pediatrician in adoption of a child (13/1)5
4. Laws of adoption in India 4(Apr 16)

CHILD ABUSE

1. Management of the sex abused child (95/2)15
2. Define child abuse. List the etiology of child abuse in India. Outline strategies for prevention. (04/2)
3. Discuss Child maltreatment. What are the factors related with child abuse (05)5+5
4. Define Child Abuse. Describe clinical manifestations of Child Abuse. Discuss some useful investigations in a suspected case of Child Abuse (06)10
5. Define child abuse. Describe in brief the factors responsible for child abuse. Outline management of a child who is suspected of being abused. (11/1)2+3+5
6. Define child abuse and neglect. Discuss various clinical manifestations, diagnostic work up and management of physical abuse. (11/2)2+3+2+3
7. Write short notes on : (09/2) 5+5
a. Female infanticide (14/2) 5
b.karyotyping (14/2)5
8. Write short notes on :child abuse (14/2) 5
9. a)Define child abuse and child neglect 2+2
b) Outline the steps involved in managment of suspected child of sexual abuse 6 (15/2)
10. Steps to curb female infanticide. 5 (Apr 16)
11. Munchausen syndrome by proxy 4 (01/16)

MENTAL RETARDATION

1. Various physical features that are likely to be associated with specific syndromes of mental retardation (95/2)10
2. Preventable and treatable causes of Mental retardation (96/2)10
3. Enumerate the causes of mental retardation in children. Give an outline of management of a child with mental retardation. (10/1)4+6
4. Enumerate the criteria for diagnosis of mental retardation (MR). Classify MR and describe its evaluation. (14/1)2+2+6


4. NUTRITION

PEM


1. Discuss the influences of malnutrition on mental functions in relation to its onset, severity and type of functional losses with supportive advances. (93/1)25
2. Prevention of hypocalcaemia in PEM (93/1)15
3. Biochemical changes in PEM (96/2)10
4. Immunological changes that take place in PEM (98/2)10
5. Age independent Anthropometric criteria for assessment of PEM (06)5
6. Management of a 4 year old child with grade 4 PEM (07/2)10
7. Outline the initial management (in first 48 hours) of a 2 year old severely malnourished child (weight 5.5kg) who is cold to touch and has edema and poor peripheral pulses. (08/1)10
8. Discuss biochemical and metabolic derangements in a child with severe malnutrition. Discuss factors associated with high mortality in severe PEM. (08/2)10
9. Outline the 10 steps of management of severe malnutrition, as per WHO guidelines, in appropriate sequence. (10/2)10
10. Define ‘Severe Acute Malnutrition (SAM)’. Outline the tools for its diagnosis in the community and discuss their merits/ demerits.
(12/1)2+4+4
11. Enlist the clinical and anthropometric criteria for diagnosis of Severe Acute Malnutrition (SAM). Discuss the principles of management of Sam in an 18 months old baby who also has watery diarrhea. (13/1)3+7
12. What are the different growth charts? Discuss the WHO growth chart. What is Sam (Severe Acute Malnutrition)? How do you manage a child with SAM? (14/1) 2+2+2+4
13. A) Clinical signs and symptoms of refeeding syndrome. 7
b) how will you manage such a case ? 3 (15/2)
14.a)What is Severe acute malnutrition (SAM) 2
b) What are clinical signs of SAM? 2
c) Management of SAM in an 1 year old child weighing 5 kg. 6(Apr 16)

VIT A

1. Hazards and virtues of Vitamin A in pediatric practice (96/2)10
2. Vitamin A supplementation (07/1) 5
3. Enumerate functions of vitamin A in human body. Tabulate the WHO classification of vitamin A deficiency. Outline the treatment schedule for managing Xerophthalmia in children. (10/2)2+3+5
4. Describe WHO classification of eye manifestation of vitamin A deficiency. Discuss prevention & mgmt of Vit. A deficiency in children (14/2) 4+6
5. Hypervitaminosis A 4 (Apr16)Rpt 3marks (1/16)

VIT B

1. Discuss the etiopathogenesis, clinical features, diagnosis and management of cobalamine deficiency. (12/1) 2+3+1+4

VIT D

1. Clinical manifestations of Rickets (93/2)10
2. Vitamin D Resistant Rickets (96/2)12
3. Renal Rickets (97/2) 15
4. Functions of vitamin D (98/2) 10
5. Resistant Rickets 15
6. Outline the metabolism and function of Vitamin D in human body. Describe in detail the etiology and pathological changes in rickets (99/2)25
7. What are the causes of non nutritional rickets? How will you manage such a child? (04/2)3+7
8. Classify the various causes of rickets and outline how to differentiate them (05)5+5
9. Diagnostic approach to a child with resistant rickets (06)10
10. Resistant Rickets (06/1)10
11. Discuss calcium and vitamin D metabolism. Outline an approach to a case of Resistant Rickets (07/1)10
12. Discuss the pathophysiological basis of clinical and radiological manifestations of nutritional rickets. (09/1)10
13. Describe vitamin D metabolism. Describe diagnostic approach to a 3 year old child with rickets who has shown no response to treatment with 6 lac I.U. of vitamin D. (09/2) 4+6
14. Outline the clinical features, radiological changes, diagnosis and treatment of nutritional vitamin D deficiency rickets. (10/2) 2+2+2+4
15. Write in brief the role of vitamin D in health and disease in children. Outline the management of Vitamin D deficiency disorder. (12/1) 6+4
16. Hypervitaminosis D 4(Apr16)Rpt 3marks (1/16)
17. a. Outline the physiology of vitamin D 4
b. Diagnosis and treatment of vitamin D dependent Rickets.3+3 (1/16)

VIT C

1. Scurvy- radiological changes. How are they produced? What is the role of Blood Level of Vit C in the diagnosis (05)10

VIT E

1. Enumerate the functions and therapeutic uses of Vit E (98/1)15
2. Vitamin E and its role in human nutrition (92/2)15

VITAMINS

1. Hypervitaminosis in Children (96/1) 12

COPPER

1. What are the dietary sources of copper? What are the diseases associated with abnormal copper metabolism? Describe investigat., clinical features and treatment of any one of them. (09/2)1+2+7

ZINC

1. Relevance of Zinc in human nutrition (92)15
2. Role of Zinc in health and diseases of children (97/1)10
3. Effects of Zinc supplementation in persistent diarrhea (98/2)10
4. Give dietary requirements of Zinc in children and discuss its role in childhood immunity and infections (07/1) 10
5. Write short notes on: Zinc supplementation – when and how? (11/2) 5

MAGNESIUM

1. Sources, deficiency state and uses of magnesium in children.
(10/1)3+3+4
2. Magnesium in therapy 3(14/1)
3. Mechanism of action, therapeautic dose, and adverse effects in children of magnesium sulphate. 5(1/16)

MILK

1. Anti-infective properties of Human milk (95/2)10
2. Differences in the composition of Milk secreted by mothers delivering Term and Preterm babies (96/2)10
3. Bioactive factors in Human Milk (98/1)15
4. Discuss the physiology of Breast Milk secretion and advantages of breast feeding with special reference to metabolic aspects. What are the causes of lactation failure (99/1) 25
5. Enlist the problems of breastfeeding and outline the management of the same (05) 4+6
6. Explain the occurrence of low prevalence of Hypoglycemia and iron deficiency anemia in breast fed infants (05)10
7. How would you assess the adequacy of breast milk for a 2 months old baby. Enumerate 4 features of good attachment of a baby to the breast. What can be the problems with poor attachment (06)10
8. Compare the composition of human milk with cow’s milk. Outline the difference in the milk composition of a mother with a premature neonate from that of a term neonate. Describe the immunological factors present in human milk. (08/2) 10

IODINE 

1. Prevention of Iodine deficiency (95/1)15

FLUORINE

1. Prevention of Fluoride toxicity (95/1)15
2. Fluoride and disease 2 (Apr16)

OBESITY

1. Approach to a child with obesity (99/1)15
2. Define obesity in childhood. List the causes of obesity in children. Outline strategies for its prevention. (04/2)2+3+5
3. What is Obesity? Discuss the management in children (05)3+7
4. Approach to a child with Obesity (06/1)(07/2)10
5. Outline the diagnostic measures and clinical manifestations of obesity. Enlist the differential diagnosis of childhood obesity. (09/2) 2+3+5
6. Define syndrome X. Outline the diagnostic criteria and laboratory work up for obese children. (10/1)2+3+5
7. Define obesity. List causes of obesity. Discuss approach to a child with obesity. (11/1)2+3+5
8. A 2 year old toddler presents with a weight of 25 kg. Discuss the possible causes, evaluation and treatment for this child. (14/1)3+4+3

MISCELLANEOUS

1. Metabolism of fat absorption along with role of MCT in nutrition (03/1)15
2. What is Complimentary Feeding? Discuss the feeding problems in first year of life (05)5+5
3. How would you assess the nutritional status of a child whose age is not known (05)10
4. Describe the attributes of complimentary feeding. What is the safe age of introduction of complementary feeding in your opinion – Justify. Describe some foods appropriate for complimentary feeding. (08/2)10
5. Daily nutritional requirements as recommended Daily Allowance (RDA) in infants and children. (10/1)5+5
6. Define complimentary feeding. Outline the attributes of complimentary foods. Enumerate the recommendations on complimentary feeding, as per the National guidelines on Infant and Young Child Feeding (IYCF) (10/2) 2+2+6
7. Name the micronutrients required for various body functions. Discuss briefly their dietary sources and the effects of deficiency of mineral micronutrients (trace elements). (11/2)3+2+5
8. Outline the nutritional support of a critically ill child. List the complications during management of such a child. (12/1)7+3
9. Enteral feeding in the sick child 4(14/1)
10. Role of micronutrient in pediatric health and diseases. 5(Apr16)

5. PATHOPHYSIOLOGY OF BODY FLUIDS AND FLUID THERAPY ACUTELY ILL CHILD

SHOCK

1. Define Shock. Describe the pathophysiology and management of septic shock in children (94/2)25 Rpt(04/2)5+5
2. Management of Cardiogenic shock (96/1)12
3. Discuss the classification and causes of shock in children (97/1)15
4. Shock-pathogenesis of different types and pathological changes in different organs (03/1)25
5. Discuss the management of an infant with Shock (00/1)25
6. How do you classify Shock in children? Write its etiopathogenesis and management (06)10
7. Discuss the pathophysiology of cardiogenic shock. How are the various hemodynamic parameters affected in cardiogenic shock? Discuss steps in monitoring and treatment of cardiogenic shock. (08/2)10
8. Define fluid refractory shock. Describe the management strategy for a 2 year old child with fluid refractory shock. (10/1) 3+7
9. Define septic shock. Describe the etiopathogenesis and clinical features in a 15 month old child presenting with septic shock. (11/2)2+4+4
10. Discuss the pathophysiology of septic shock. Describe the international consensus definition for pediatric sepsis. (13/1)5+5
11. Define SIRS, sepsis, severe sepsis and septic shock. Discuss the management of septic shock. (13/2) 1+1+1+1+6
12. Etiology and management of cardiogenic shock. (14/2) 3+7
13. Pathophysiology and management of Refractory shock 5(15/2)
14. What is the defining criteria of systemic inflammatory response syndrome (SIRS).Name the mediators involved and their mode of action. 5+5(15/2)
15. Etiology , pathogenesis, clinical features and management of cardiogenic shock? 2+3+2+3 (15/2)

POTASSIUM

1. List the causes of Hypokalemia. Discuss the clinical features, laboratory diagnosis and management of Hypokalemia (06)10
2. Define hypokalemia. Enlist its causes and outline clinical features and its treatment (09/2) 1+3+2+4
3. Discuss the diagnostic algorithm for investigating persistent hypokalemia in a child. (13/2)10
4. Define hyperkalemia. Discuss management of hyperkalemia (14/2)2+8
5. Hyperkalemia 3 (Apr16)

SODIUM

1. List the causes of Hyponatremia. Discuss the clinical features, lab
diagnosis and management of Hyponatremia . (05)3+4+3
2. Enumerate common causes of Hyponatremia (06)5
3. Define hypernatremia. Describe the pathophysiological changes and steps of management of hypernatremia. (10/1)2+4+4
4. Define hyponatremia. Enumerate the etiology of hyponatremia.
Describe the management of hypovolemic hyponatremia. (10/2) 2+3+5
5. Define hypernatremia. Enumerate the etiology of hypernatremia.
Describe the management of hypernatremic dehydration.(11/1) 3+4+3
6. Write short notes on: Causes and management of hypernatremia in children. (13/2)5
7. Hypernatremia 3 (Apr 16)
8. Hypernatremic dehydration 5(1/16)

PHOSPHATE

1. Etiology, pathogenesis, clinical features and management of Hypophosphatemia 2+3+2+3(Apr 16)

ACID-BASE BALANCE

1. Define pH and base excess. Discuss briefly regulation of Acid-base homeostasis and management of Respiratory Acidosis (93/1)15
2. Physiological compensatory mechanisms during Metabolic Acidosis (97/1)15
3. Describe briefly how the acid-base balance of body is maintained in health (98/1) 25
4. Anion Gap (98/2) (00/1)10
5. Pathophysiology of Acid-base disorders (03/1)15
6. Anion Gap (03/2)15
7. Define anion gap and its utility. Outline the major causes of metabolic acidosis in children. Outline the treatment of renal tubular acidosis. (04/2)2+4+4
8. Outline the normal mechanism of acid-base regulation in children. What is anion-gap? Describe the causes and management of a child with metabolic acidosis (07/2)10
9. List the causes of metabolic alkalosis. Describe the pathophysiology, clinical features and treatment. (08/2)10
10. Classify metabolic acidosis based on anion gap. Mention the various causes of lactic acidosis. Describe the approach to diagnosis of inborn error of metabolism in an infant. (08/2)10
11. Classify and enlist the causes of metabolic alkalosis. Outline the treatment modalities. (10/1)3+3+4
12. Define anion gap. Enlist causes of increased anion gap acidosis and discuss its management in brief. (11/1)2+3+5
13. What is anion gap? Discuss the acid base distribution in metabolic acidosis. Enumerate the causes of increased anion gap and normal anion gap metabolic acidosis. 1+5+(2+2)(15/2)

DEHYDRATION

1. Why children are more vulnerable to develop dehydration (96/2)10
2. One year old infant with AGE develops Abdominal Distension. Discuss the differential diagnosis (97/1)10
3. Pathogenesis and Management of Hypernatremic Dehydration (97/2) 15
4. Management of Acute Diarrhea in children (98/1)15
5. Management of Hypernatremic Dehydration (02/1)15
6. Hypernatremic Dehydration (03/1)15
7. Hyponatremic Dehydration (03/2) 15
8. Steps in management of patient with Hypernatremic Dehydration (06)10
9. A one year old infant weighing 5.5kg presents with Acute Dysentery and severe dehydration. Discuss its complete management (06/1)10
10. A one year old baby weighing 5.5kg comes in severe dehydration. Discuss complete management (07/2)10
11. Discuss causes, predisposing factors and pathophysiology of Hypernatremic dehydration in young children (07/1)10
12. Describe the pathophysiology of hyponatremic dehydration. Briefly discuss the management of a child with serum sodium of 110meq/liter presenting with moderate dehydration and seizures (08/2) 10

MISCELLANEOUS

1. Pathophysiology of regulation of Plasma Osmolality (06)10
2. Discuss etiopathogenesis, clinical manifestations and management of Bartter Syndrome. (13/2) 2+4+4
3. Define osmolarity. Discuss the mechanism of regulation of plasma osmolarity in the human body. (14/2) 2+8
4. How is plasma osmolality calculated?Discuss its determinants.What are the diagnostic criteri of SIADH? 3+4+3 (Apr 16)
5. Pathophysiology and regulation of plasma osmolality 5(1/16)
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