Theory question bank update 2016: Part 3

Monday, April 24, 2017   at  11:17:00 AM

Theory question bank in parts, reorganized and updated till 2016: Part 3

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

10. SPECIAL HEALTH PROBLEMS DURING ADOLESCENCE

1. Discuss the special health problems of Adolescents (98/1)25
2. Etiological factors in Juvenile Delinquency (98/2)15
3. Role of health education to Adolescents (98/2)10
4. Adolescent Violence (03/1)15
5. Health problems of adolescents (03/2)15
6. Health education of adolescent girls 15
7. What are the common problems in Adolescence (05)5
8. What are the common problems in adolescence (05)5
9. Factors affecting Adolescent health and development (06)10
10. Juvenile Delinquency (02/1)15, Rpt(06/1)5
11. Problems of adolescence (07/2)10
12. Discuss briefly Adolescent Health Problems (07/2)10

11. IMMUNOLOGY

1. Laboratory investigation of a child suspected to have T-cell immunity Disorder (92)15
2. Prenatal Diagnosis of Primary Immunodeficiency diseases (94/2)10
3. Indications for various organ and tissue transplants in Pediatric practice and common considerations in selection of donors (95/2)10
4. Graft versus host disease (99/1)15
5. Approach to a child with suspected immune dysfunction (06/1)10
6. numerate functions of the Phagocytes and briefly describe defects of their functions. (09/1)4+6
7. Enlist the humoral immunodeficiency disorders. Outline the diagnostic approach and treatment. (10/1)4+6
8. Outline the characteristic features of primary immunodeficiency. Write in detail about pathogenesis and clinical features of chronic granulomatous disease. (11/1)4+3+3
9. Enumerate the methods of harvesting/ storing stem cells. Outline the indications of stem cell therapy. Discuss in brief the patient preparation required for stem cell therapy. Enlist important potential complications of stem cell therapy. (11/1)2+3+3+2
10. Discuss various components of primary immune deficiency, their clinical characteristics and investigations of a suspected predominant B-cell defect. (13/2)2+3+5
11. Discuss pathogenesis of Graft Versus Host Diseases (GVHD) Discuss clinical manifestations, staging and grading and management of acute GVHD. (13/2)2+3+2+3
12. Discuss the indications for stem cell transplantation therapy in children. What is its rationale and sources for stem cells. (13/2) 5+3+2
13. Stem cell therapy (14/2)5
14.
A) Components of immune system
B) Difference between innate and acquired immunity.
C) Role of T and B lymphocytes and the killer cells (15/1) 4+3+3
15. 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(15/2)
13. Wiscott-Aldrich Syndrome 3(Apr 16)
14. Graft vs Host Disease 4(Apr 16)
15. Immunological features associated with cow milk allergy 15

12. ALLERGIC DISORDERS

1. Pathogenesis and management of anaphylaxis (97/1)15
2. Mechanism, manifestations and management of anaphylaxis (92)15
3. Allergic Rhinitis (07/1)5
4. Enumerate the chemical mediators of allergic reactions and describe the important actions of histamine. (08/1)10
5. Clinical features, differential diagnosis and treatment of atopic dermatitis in infants. (10/1)3+3+4
6. What is atopic dermatitis? Describe the clinical features and differential diagnosis of atopic dermatitis. (11/2)2+5+3
7. What is atopic dermatitis? Describe clinical features, differential
diagnosis and treatment of atopic dermatitis. (12/1)1+3+3+3
8. What are the types of Atopic Dermatitis (AD) in children? Discuss in
detail the clinical features of AD. Describe the differential diagnoses in a case of suspected AD. (13/2) 2+4+4

13. RHEUMATIC DISEASES

KAWASAKI DISEASE

1. Kawasaki Syndrome (00/1)15
2. Phases and complications of Kawasaki’s disease (06)10
3. Discuss the presentation, diagnostic criteria for Kawasaki Disease. What is the management strategy? What are the complications?
(08/1)10
4. Discuss the pathogenesis, differential diagnosis and echocardiography findings in Kawasaki Disease (KD). How is the classical KD different from Atypical KD? (09/1)6+4
5. Describe clinical manifestations of classical and atypical Kawasaki disease. Provide algorithmic approach to a suspected case of Kawasaki disease. Enumerate various treatment modalities. (11/1)4+4+2
6. Write short notes on:Diagnostic criteria for Kawasaki Disease.(13/2) 5
7. Algorithmic approach to a suspected case of Kawasaki disease. Enumerate its complications and outline the management.5+(2+3)(15/2)

JRA

1. Classification and features of JRA (96/2)14
2. What are the clinical manifestations of juvenile rheumatoid arthritis. Discuss the differential diagnosis and management. (04/2)3+3+4
3. Write the current classification used in JRA. Outline the management plan for JRA (06)10
4. Tabulate differentiating features of various types of juvenile
Rheumatoid arthritis. (08/1)10
5. Tabulate the classification of Juvenile Idiopathic arthritis and state principles of its treatment. (10/2)4+6
6. Outline the diagnostic criteria of juvenile rheumatoid arthritis.
Tabulate the differentiating features of various types of JRA. Outline a scheme of investigation for a child with suspected JRA.(11/1)3+4+3
7. Tabulate the differentiating clinical features and the diagnostic approach of Juvenile Idiopathic Arthritis (JIA). Outline the principles of management of polyarticular JIA. (12/1)4+3+3
8. Define Juvenile Idiopathic Arthritis (JIA). Outline the classification of JIA. Discuss the mimickers of rheumatic diseases in children. (13/1)2+4+4
9. A six year old boy presents with painful swelling of his right knee. Enumerate the likely causes. Define Juvenile Idiopathic arthritis and discuss its management. (14/1)2+2+6
10.
A)disease modifying agents used for JIA
B)Biological anti-TNF agents for JIA (14/2) 5+5
11.
a) ILAR classification of juvenile idiopathic arthritis 4
b) clinical features of systemic onset disease and give the differential diagnosis thereof (15/1) 4+2
12. Macrophage activation syndrome 5(1/16)

H S PURPURA

1. Discuss briefly clinical presentation and management of H S Purpura (07/1) 10
2. Describe the diagnostic approach and management of a six year old child presenting with purpuric rash and pedal edema following an episode of acute diarrhoea. (11/2)4+6

MISCELLANEOUS

1. Classify vasculitis based on size of involved vessels and give examples of each category. Describe etiology, clinical features and management of Takayasu’s arteritis. (09/2)5+5

14. INFECTIOUS DISEASES

PUO

1. Discuss definition,etiology & approach to investigation of PUO (07/1)10
2. Outline the approach to management of a 2 month old infant having fever without focus. (09/1)10
3. Enumerate the common causes of pyrexia of unknown origin in a 5 year old child. Discuss diagnostic approach to fever with rash. (11/2)4+6

HIV

1. Prevention of HIV infection during childhood (02/1)15
2. HIV and Pediatrics (98/2)10
3. Post exposure HIV prophylaxis (03/2)15
4. An HIV positive mother has been admitted in labour. What will you do to prevent transmission of infection to the baby (05)10
5. Factors involved in perinatal transmission of HIV infection and the various preventive measures (06)10
6. Prevention of Childhood AIDS (07/2)10
7. Clinical Presentations requiring screening for HIV (07/1)5
8. HIV and TB (07/1)5
9. Outline clinical and immunological criteria for starting anti-retroviral treatment (ART) in a HIV infected child. How will you monitor a child initiated on ART? (09/2)6+4
10. Enlist the common opportunistic infections in HIV infected children. Describe the clinical features, diagnosis and management of herpes simplex infection in HIV infected children (11/2)3+2+2+3
11. Enumerate opportunistic infections in HIV infected children. How will you treat and prevent pneumocystis jiroveci infection. (12/1)5+3+2
12. Briefly discuss the pulmonary disorders seen in children with HIV/AIDS. (13/1)10
13. Discuss the key issues in the management of an HIV exposed infant. (13/2)10

TUBERCULOSIS

1. Failure in control of Tuberculosis (93/1)15
2. Prevention and early detection of TB (96/2)15
3. Short course chemotherapy for TB (98/2)10
4. DOTS chemotherapeutic management of Tuberculosis in National TB Control Programme (00/1)15
5. Diagnosis and management of a child with resistant TB (02/1)15
6. CNS changes in Tubercular meningitis(Pathological only) 15
7. Discuss the pathogenesis, clinical symptomatology and diagnosis of NeuroTB (06)10
8. How do you perform and interpret Mantoux Test. Enumerate 3 conditions each in which you can get a false positive and a false negative result. (06)10
9. Newer diagnostic modalities for TB (06)10
10. DOTS regimen and the problems involved in the implementation in childhood TB (06)10
11. What were the problems encountered in NTCP. Write the goals, strategies and essential components of RNTPC. Also discuss in brief categorization of patients and treatment protocols under RNTCP (06)10
12.
a) Describe the category based treatment in childhood TB (09/2)3
b) Describe the pros and cons of intermittent therapy for tuberculosis (09/2)3
c) What are the components of DOTS strategy as defined by WHO? (09/2) 4
13. Describe clinical manifestations, diagnosis and management of Neurotuberculosis. (11/2 3+4+3
14. Describe the flow chart for diagnosis of childhood tuberculosis under RNTCP. Write briefly on DOT PLUS program. (12/1)6+4
15. Discuss the recent guidelines for diagnosis and management of childhood tuberculosis. (13/1)10
16. Describe aetiopathogenesis, diagnosis and management of different types of neurotuberculosis. (13/2) 3+4+3
17. Clinical presentation, investigations and treatment of multidrug resistant TB. (14/2) 3+2+5
18.
A) Define DOTS, DOTS agents and DOTS plus. 3
b) List at least 4 important components Of DOTS 2
C) Give the categorization of treatment strategy in DOTS (15/1)5
19. MDR and XDR tuberculosis treatment strategies. 3+3 (1/16)

ENTERIC FEVER

1. Treatment of typhoid fever (93/1)10
2. Nontyphoidal salmonellosis (95/2)15
3. Management of typhoid fever (95/2)15
4. Interpretation of Widal test in immunized children (98/2)10
5. Define multidrug resistant (MDR) salmonella typhi (MDR – ST) and nalidixic acid resistant salmonella typhi (NARST). Discuss the mechanism of development of drug resistance for salmonella typhi.(08/1)10

DENGUE FEVER

1. Discuss the management of Dengue Shock Syndrome (97/1)10
2. Pathogenesis of bleeding and shock in Dengue fever (98/2)10
3. Dengue Fever (03/2)15
4. Define DHF and DSS and outline the treatment of DSS (05)10
5. Diagnosis and management of DHF and DSS (06/1)10
6. Outline the WHO criteria for diagnosis of dengue hemorrhagic fever. Draw an algorithm for volume replacement for a child with DHF and > 20% increase in hematocrit. (09/1)(3+7)
7. Define DHF and DSS. How does DHF differ from dengue fever with hemorrhage? Describe treatment of DSS. (09/2) 2+2+1+5
8. Classify severity of dengue hemorrhagic fever. Write in brief the management of dengue shock syndrome. (11/1)4+6
9. What are the fluid, metabolic and biochemical changes in a child with severe dengue? Discuss the underlying pathophysiology. (13/1)10
10. Define severe dengue and describe the WHO guidelines for its management. Enumerate the indications for transfusion in dengue. (14/1)2+6+2
11. Define severe dengue . Describe the WHO guidelines for its management. Enumerate complications of Severe Dengue 2+4+4(Apr16)
E COLI
1. Discuss the pathogenesis of E. coli diarrhea (94/2)15
2. Classification of E coli and pathogenesis of Invasive Diarrhoea (95/1)15

POLIO AND AFP

1. Pulse Polio Immunization (96/1)15
2. AFP Surveillance (99/2)15
3. Approach to a child with AFP and components of AFP surveillance (00/1)15
4. Pulse Polio programme (02/1)(98/1)15
5. AFP- Definition, Differential Diagnosis in details, how help in polio eradication (03/2)25
6. Discuss the differential diagnosis and management of acute flaccid paralysis in a 2 year old child. (04/2)5+5
7. What is AFP? Discuss the differential diagnosis and management of a child with AFP. Discuss AFP surveillance (05)2+3+2+3
8. Define criteria for declaring a country Polio free. What is the present status of wild polio virus transmission and strategies being used for its control in India? Elaborate on AFP surveillance (06)5+5
9. Define AFP. Enlist the causes and investigations of a case of AFP (06)10
10. What is acute flaccid paralysis? Describe the differential diagnosis and management of a child with flaccid paralysis. Describe AFP surveillance. (09/2)2+2+4+2
11.
a) define polio eradication 1
b) polio eradication in india. 2
c) immunisation issues following polio eradication. 3(15/1)

MALARIA

1. Define drug resistant malaria, what are the different types of drug resistance as per WHO criteria. Discuss the various management strategies of Drug resistant Malaria 25
2. Management of Cerebral Malaria 15
3. Malaria prophylaxis (94/2)15
4. Drug resistant Malaria (03/1)15
5. What are management guidelines of malaria under the national programme. How will you manage a case of cerebral malaria. (04/2)4+6
6. Enumerate manifestations of Severe Malaria and their management (06/2)10
7. A 4 year old girl presents with history of fever for 2 days associated with severe anemia, black colored urine and splenomegaly. Discuss the management of this patient. (08/2)10
8. Describe clinical manifestations of cerebral malaria. Enlist the differential diagnosis and investigations required. Write management of a case of cerebral malaria in high endemic area. (09/1)(2+3+5)
9. Define complicated malaria. Describe the management strategies of complicated malaria. (09/2)3+7
10. Provide algorithms for case-detection and treatment for a child with fever, suspected to have malaria, as per National Vector Borne Disease Control Program: (10/2)5+5
a) In an area where microscopy results are available within 24 hours; and
b) In an area where microscopy results are not available within 24 hours
9. Write short notes on: Laboratory diagnosis of malaria (11/2)5
10. List the WHO criteria to diagnose severe malaria. Discuss the mangement of a child with cerebral malaria. (13/1)4+6
11. Newer antimalarial drugs (15/1) 4

HEPATITIS B

1. Viral markers of Hepatitis B 15
2. Immunological markers of Hepatitis B 15
3. Hepatitis B infection in children (03/1)15
4. A 3 year old child is brought with a history of jaundice since 2 months. She gives a history of blood transfusion at 18 months of age. Her HBsAg is positive. Discuss briefly other viral markers of HepB infection which will help in monitoring and treatment of child. Discuss the management of fulminant hepatic failure. Add a note on Liver Transplantation. (06)10
5. Discuss the modes of transmission of hepatotrophic viral infections. Outline the clinical features, diagnosis and treatment of hepatitis B infection in children. (13/1) 2+3+3+2
6.
A)Serological course of Hepatitis B 4
b)Treatment strategies for acute and chronic hepatitis 3+3 (15/2)

MEASLES

1. Diagnosis and treatment of SSPE (95/2)10

PLAGUE

1. Management of Plague (95/2)10
GROUP A STREPTOCOCCUS
1. Management of acute Rheumatic Fever (93/2)10

CYSTICERCOSIS

1. Current management of Neurocysticercosis (92)15

MENINGOCOCCUS

1. Discuss prevention and prophylaxis against meningococcal infection (05)5+5
2. Prophylaxis of Meningococcemia (06/1)10
SYPHILIS
1. Radiological features and confirmatory laboratory tests for congenital syphilis (07/1)10

PERTUSSIS

1. Discuss the etiology, pathogenesis and prevention of pertussis in chidren. Write the differences in efficacy , duration of protection and adverse events between whole cell and acellular pertussis vaccine 6+4(1/14)

JAPANESE ENCEPHALITIS

1. Epidemology ,clinical features ,prognosis and prevention of Japanese Encephalitis (15/1) 2+3+2+3
SWINE FLU
1. Comment on clinical features, diagnosis and treatment of Swine flu in children. (09/2)2+3+5
2.
A) Virology and epidemiology of Swine Flu 1+2
b) How is the disease categorized according to the government of India guidelines? 3
c) Mention which children need to be immunized and who need to be given medication for the disease 2+2(Apr 16)

MISCELLANEOUS

1. Laboratory diagnosis of Viral diseases
2. Brain CT findings in a case of Congenital toxoplasmosis and cysticercosis (94)15
3. Nosocomial Infections (06)10
4. A seven year old girl is admitted with pain and swelling of right knee and left ankle joint of two weeks duration. Enumerate the likely causes. Discuss the differential diagnosis highlighting important pointers in history, examination and investigations.
5. Describe the etiology, mode of transmission, clinical features and management of viral hemorrhagic fever in children. (12/1)2+2+3+3
6. Roseola infantum 3(15/2)

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Pediatrics MCQs : Dec 2016

Friday, April 7, 2017   at  11:06:00 AM
Dr Someone who cares...
DNB Pediatrics December 2016 MCQ

1) Retinal detachment is seen in which stage of ROP
2) Pulmonary symptom of cough is seen in which parasitic infection
a) Tape b) Whip c) Round d) Thread
3) Re-somal Na+ concentration
4) Antiganglioside antibody in Miller Fischer variant of GBS
a) GM1 b) GD1A c) GT1B d) GQ
5) Iodine concentration in iodized salt
6) Vitamin D in pregnancy causes
7) Giardiasis radiological feature
8) Albendazole
9) Cystic echinoccocus
10) Multigene duplication and deletion is diagnosed by
11) SAM anganwadi nutrition therapy
12) Velocardiofacial micro deletion
13) Breteau index
14) 6 years’ iron and folic acid supplementation
15) Ro SSB crosses placenta at which gestational age
16) Drug induced lupus is not caused by
17) Antibody in drug induced lupus
18) Severe SAM MUAC:Head circumference ratio
19) Leimierre syndrome
20) Figure of 8 pulmonary graphics
21) Level of prevention in CP to prevent disability development
22) Two screening test applied at the same time for a disease
23) Trummer-field zone on X-ray
24) In SLE immunological response is
25) Level of lead for chelation therapy
26) APAC stands for in communication
27) Phenobarbitone is given in
28) Nasal polyp, aspirin sensitivity, triad
29) Steroid treatment guidelines in croup
30) SIADH diagnostic criteria
31) SIDS neurotransmitter involved is
32) Most common B cell defect
33) % of body weight for trace element
34) 11-week gestational age ANC scan omphalocele is present give advice
35) Marriage with 1st cousin increases chance of genetic disease by
36) ARDS diagnostic criteria
37) Patient with iron deficiency, hemosiderosis, hemoptysis
38) CD4:CD8>4 elevated D dimer in BAL is diagnostic for
39) Macrocytic anemia with reticulocytosis
40) Blood in stool, growth failure, fever abdominal pain for 18 months’ sigmoidoscopy normal
41) Blood in stool in healthy newborn
42) Marginal placental separation in full term NVD baby passes blood in stool how to differentiate from maternal blood and fetal blood
43) Monophonic wheeze
44) Salmon patch normal finding
45) Citrulline is increased in
46) Oculomotor apraxia
47) Feature of fetal alcohol syndrome
48) Genetic penetration with increasing age
49) Manganese as a cofactor deficiency causes
50) 100ml F100 protein and lactose content
51) Cabbage odor urine in which metabolic disorder
52) Garlic odor in which poisoning
53) True about bronchiolitis
54) After electrocution, no pulse on palpation, beat present on pulse oxymetry, CPR given next step
55) SVT
56) Fabray’s disease
57) Dominant gene mutation
58) Retropharyngeal abscess is seen in posterior pharyngeal wall in
59) Rheumatoid nodule in poly arthritis JIA seen in
60) In KF ring copper deposition occurs in which layer
61) Pregnanediol isoform
62) JIA is said when arthritis is present since
63) In aggressive polyarticular JIA is seen in
64) ANA positive in JIA
65) Plasma transfusion gives
66) Bernard solier syndrome
67) Wiskot-Aldrich syndrome
68) Normal complement level is seen in which nephritis
69) Vaccination can be given in which immune deficiency condition
70) 7 days old infant develop chicken pox
71) Recurrent staph infection in
72) Purulent conjunctivitis, corneal scarring, giemsa stain positive
73) Normal GFR at 1 month of age
74) GIR for infant
75) Newborn urine maximum concentrating ability
76) Treatment in pregnancy to treat heart block
77) Attributable risk calculation
78) Pathogenesis of erythromycin causing HPS
79) Hyper-oxea test
80) H-pylori study sample
81) Study for contact spread control
82) Measles attack rate
83) Cystic fibrosis presentation
84) Calcium gluconate in hypomagnesemia causes
85) Spo2 74% PaO2 210
86) Sensitivity, specificity
87) Thrombocytopenia treatment
88) JSSK study
89) Burn IVF
90) Minimata disease
91) Floppy infant
92) Enzyme decreased in metachromatic leucodystrophy
93) Continuous urine leak normal voiding
94) Parachute reflex
95) Normal fetal growth is produced by
96) Normal fetal growth is not affected by
97) 6 years’ breast enlargement, pubic hair, increased LH
98) 1st child has NTD 3 months pre-conceptional treatment with folic acid prevents NTD in next pregnancy by what %
99) Retinal growth in human milk
100) X linked dominant example
101) Vitamin A dose in < 6 months
102) Hypernatremia > 190mEq/L treatment
103) Descending paralysis
104) Dominant gene occurs
105) Skin lesion in Fabray’s
106) Earliest response to iron therapy
107) ABG Ph 7.319, Po2 170, Pco2 17.4, HCO3 8.7 base excess 14.5
108) Tumor lysis syndrome
109) Stroke in children is caused by
110) Parameters affecting mixed venous O2
111) Diaphragmatic hernia
112) EtCO2 is increased in
113) Chylothorax is most common in children with
114) Pulse oxymetry principal
115) SVT is caused by
116) Nutrition in critically ill child protein requirement
117) Levetiracetam dose in status epilepticus
118) Air leak management strategy in ventilation
119) Encephalopathy, dehydration, skin lesion
120) Polyneuropathy
121) Typical HUS
122) Investigation for dengue
123) WHO diagnostic criteria for dengue shock syndrome
124) Spirometry in asthma diagnostic criteria
125) Caffeine in apnea of prematurity is used
126) GOI NBSU criteria
127) Unilateral epistaxis
128) Cornea in newborn becomes adult size at which age
129) Cogan syndrome
130) Pendered syndrome gene
131) Polycythemia Vera diagnosis
132) Near vision in newborn is fixed at
133) Extra intestinal manifestation of cystic fibrosis
134) Girl with DM and necrotizing pneumonia
135) Rickettsia CSF finding
136) EBOLA diagnosis
137) Miltefosine
138) Vibrio cholera toxin
139) Rh negative pregnancy blood for exchange transfusion
140) Adverse effect of immunization to be reported
141) BNP
142) Chest circumference
143) Protease inhibitor
144) Net protein utilization
145) Hematopoietic stem cell transplantation most common complication.

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CME theory paper writing 2017

Friday, March 31, 2017   at  11:28:00 PM
Dr Amol Madave
Lilavati Hospital

The Department of Pediatrics, Lilavati Hospital Research Centre is glad to announce a three day CME on "effective theory paper writing for DNB students".

The mock exam will be conducted on 8th and 9th April 2017 in Mumbai. These papers will be checked by national level DNB examiners. These faculty will discuss the corrected answer sheets on one to one basis on the 20th March 2017.

Dr. Bipin Batra, Director- National Board of Examinations has agreed to grace the CME as chief guest. Details of the CME are attached as follows

Date Timing Paper
08 April 2017 9am to 12pm
Paper 1


12 to 1 PM

1 PM to 4 PM
Paper 2
Basic science as applied to pediatrics
Community pediatrics
Research methodology

Lunch

Neonatolgy
Perinatal medicine
09 April 2017







9 AM to 12 PM
Paper 3













12 PM to 1 PM

1PM to 4PM
Paper 4
General pediatrics including advances relating to pediatrics:
Infectious diseases
Genetics Immunology
Rheumatology
Psychiatry and behavioral sciences
Skin, Eye, ENT
Adolescent health ,
Critical care ,
Accidents and poisoning
Endocrinology,
Gastroenterology
Hepatotogy
Respiratory and Cardiovascular disorders

Lunch

General pediatrics including advances relating to pediatrics:

Growth and development and Immunization
Neurology and Nutrition
Disabilities
Nephrology
Hematology
Oncology
 
PROGRAMME SCHEDULECME- 20th April 2017

Inauguration- 9 AM to 10 AM

Welcome Address: Dr. Conrad Rui Vas, Medical Director, lliavati Hospital
Address by: Guest of Honour Lt Gen. Dr. Ravi Shankar, COO, Lilavati Hospital
Address by Chief Guest: Dr. Bipin Batra Director, National Board of Examinations, New Delhi
Vote of Thanks: Dr. Swati Kanakla, Co-ordinator, Department of Paediatrics

Lecture 1- Dr. Arvind Saili, 10AM to 10.45 AM - Preparing for DNB theory exams
Lecture 2- Dr. S. Bala.subramanian,10 am to 10.45 AM How to write a theory paper
Lecture 3- Dr. VS Sankaranarayanan, 11.30 AM to 12.15 PM Clinical Spotters in Paediatrics

Lunch -12.15 PM to 1.00 PM
Answer sheets Discussion - Groups 1 to 4 by rotation, 1.00 PM to 5 PM
Open House: 5 PM

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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)

FLUID THERAPY

1. Fluid therapy in special situations in neonates (06/1)10

HIGH RISK INFANT

1. Scheme for identifying High Risk Fetuses (92/2)15
2. Define ‘High risk infant’. Discuss the long term management of such infants with emphasis on detection and early intervention of infants with developmental disabilities (95/1)25
3. Discuss the basic elements of the ‘At Risk’ concept with regard to their advantages and disadvantages and fallacies if any as they relate to health care of mothers and children . (95/2)25

MISCELLANEOUS

1. Endocrine problems that can be diagnosed on the first day of life(95/1)10
2. Bullous skin eruptions in newborn babies (95/2)15
3. Placental dysfunction syndrome (95/2)15
4. Role of O2 free radicals in the pathogenesis of neonatal disorders (96/2)10
5. Prenatal steroid therapy (99/2)15
6. Fetal Therapy (03/2)15
7. Biology and role of cytokines in Newborn Infants (06/1)10
8. ECMO (06/1)10
9. Organization and levels of Newborn care (06/1)10
10. Steroid in neonatal care (07/1)5
11. Complications of infants born to diabetic mothers (07/2)10
12. Enumerate common peripheral nerve injuries in neonates. Describe their clinical characteristics and outline the management. (09/1)2+3+5
13. Discuss the proposed hypothesis on ‘fetal origins of adult disease’and its implications on burden of diseases. (11/1)5+5
14. Discuss the principles of safe and stable transport of a sick newborn. (13/1)10
15. Write short notes on: (14/1)5+5
a) Insure therapy in neonates
b) Developmentally supportive care in neonates Rpt (15/1) 3
c) Issues related to transport of sick newborn (14/2)5
16. A)Feeding of low birth weight babies 5
    B) probiotics in neonates (15/1)5
17. A)What is Developmentally supportive care. 3
    B)Components of developmentally supportive care in neonates (15/2)7
18. Neonatal hemochromatosis (15/1)5
19. Biology and role of cytokines in newborn infants (1/16)3
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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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