Pediatric OSCE : dealing with Observed stations

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

Lets go through marks distribution of practical exam.

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

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

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

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

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

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

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

About marking system of above osces:

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


1. CLINICAL EXAMINATION

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

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

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

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

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

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

For example.


Measuring tape:

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

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

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

Fundoscope:

CVS: Roths spot for IE.

GIT: Cherry red spots for storage disorders.

CNS: Pappiloedema.

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

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


2. FOCUSED CLINICAL EXAMINATION

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

Focused Clinical Examination.


3.COUNSELLING

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

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

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

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

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

Example

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

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

Common scenarios asked for counselling are.

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

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


4. HISTORY TAKING

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

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

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


5.PROCEDURES

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

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


6.NRP/PALS

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


7.DEVELOPMENTAL ASSESSMENT

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

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

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

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

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

Again remember ALL OBJECTS KEPT ON TABLE ARE THERE TO USE.

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

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

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

This is one of the most scoring observed osce station.


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OSCE: Nutrition & Dissorders

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

QUESTION 1

image_thumb4

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

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

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Focused Clinical Examination OSCE

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


  Dr Kishor Giri

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

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

So awareness of this subtype is very crucial.

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

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

Two grossly different formats are asked.

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

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

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


1. Examine 3 yr old child with tremors.

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

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

D/Ds will be

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

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


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

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

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

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

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

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

2.
(a) Clinical  signs  and  symptoms  of refeeding  syndrome. 7+3

(b) How will you manage such a case? 

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

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

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

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

6.
(a) What  is bias in medical  research? 2+(4+4)

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

7.
(a) Define child  abuse  and child  neglect. (2+2)+6

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

8.
(a) Attention-Deficit   Hyperactivity  Disorder  (ADHD).              5

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

9.
(a) What  is relative risk (RR) and discuss  its implications? 1+3

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

(c) Implications  of sensitivity and specificity. 3

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

Paper – II

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

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

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

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

5. 
a) Serologic  course  of acute  hepatitis  B.
b) Treatment  strategies  for  acute and chronic  hepatitis  B. 4+(3+3)

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

7. 
a) Neuraprotective    strategies  in CNS  injuries  in neonates.  5
b) Camplications   of   unconjugated  hyperbihrubinemia  in   a neonate. 5

8.
(a) Algorithmic   approach   to a neonate with  suspected   I.E.M.       5
(b) Silverman  Anderson   Scoring system.     5

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

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

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

Paper – III

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

2.   
a) Classification  of Spinal Muscular  Atrophies  (SMA). 5+5
b) Major   distinguishing   features   amongst   various   forms   of SMA.

3.
(a) Free  Radicals. 5
(b) Febrile neutropaenia  - Definition  & management. 1+4

4.
(a) What  is Developmentally  Supportive  Care?
(b) Components of Developmentally Supportive Care in neonates.                                                                                      
5. Algorithmic approach to a suspected case of Kawasaki disease. 3+7 Enumerate its complications  and outline the management. 5+(2+3)

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

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

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

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

10.
a) Congenital  varicella.  4
b) Complications  of  Pertussis.  3
c) Roseola  Infantum.  3

Related Post
1. Insulin Therapy                  2. Kawasaki Disease
3. Malaria: Must for exams         4. Acid base disturbances

Happy studying :) : Click link below to save as a PDF
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Pediatric MCQs : June 2016 Part 2

Monday, June 27, 2016   at  4:34:00 PM
 Dr Venkatasriram Gutta
 KKCTH, Chennai
For Part 1 Click here

156. Early treatment failure in malaria after what duration – 72hrs

157. Osler weber rendu inheritance-

158. Pierre robin sequence with respiratory distress- placement in prone position

159. Hypothermia – infant extremities appears pink, decreased O2 dissociation.

160. Stream indicator of organ perfusion- urine output.

161. Coning of cerebellar tonsils through foramen magnum, immediate effect- respiratory arrest.

162. Sinus venosus defect is associated with PAPVC

163. Heart defect associated with PPHN- Infracardiac type of TAPVC

164. Lorenzo’s oil slows down the cerebral white matter degenerative changes in ALD.

165. Diaper rash characteristics

166. SBP centile for compensated shock (MODS criteria)- less than 5th centile.

167. Febrile seizures major risk factor- Age less than 1year.

168. Gradenigo syndrome all except– contralateral eye pain.

169. Romanaward syndrome associated with long QT.

170. Ectopia cordial associated with Pentology of cantrel.

171. ROP- 28weeker, screening done at 32weeks/ 4weeks after.

172. GTCS child on valparin 10mg/kg, uncontrolled seizures- increase the dose of Valparin.

173. Fixed drug eruption scenario.

174. All sensations are carried by ventral tract except- proprioception.

175. CVP catheter is placed in which position- semi reclined position/ Supine/  lateral.

176. Heart disease associated with decreased pulmonary blood flow- ?VSD with PS.

177. Hyperdynamic apex- volume overload.

178. Most common cause of Under 5 mortality- Pneumonia.

179. Intensity of PS murmur in TOF – inversely proportional to the severity of stenosis.

180. Insulin administration and lipodystrophy- 6months/ 6months to 2yrs, 2 to 5yr, >5yrs.

181. Limb hypoplasia and Brain lobe associated- frontal/ parietal/ Temporal/ occipital.

182. HIE 2 stage associated with Miosis.

183. Pulmonary pressure maximal fall to adult value – 1day/ 3days/ 6days/ after 6days.

184. 1st sign of papilledema- Nasal obscuration.

185. Morphine dose in cyanotic spell- 0.2mg/kg.

186. Refractive error seen in ROP- Myopia.

187. In case of sepsis, AKI incidence after how many days- 1 to 3days/ 3 days to 7days/ 7 to 10 days.



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Related Posts
         
1. MCQ's: All posts                                 2. Chest tube insertion : Neonates    
3. OSCE hematology: All posts     4. Developmental screening            
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Pediatric MCQs : June 2016

Monday, June 20, 2016   at  9:00:00 AM


  Dr Venkatasriram Gutta
      KKCTH, Chennai
  1. at 4 months measure of head circumference-42cm.
  2. babbling at 7months
  3. infection in neonates with presentation similar to rds-group b streptococcus
  4. cherry red spot- gangliosidosis, taysachs, neiman picks
  5. viral infection associated with hypoglycorhacchia-mumps
  6. swimmers ear infection organism-pseudomonas aeruginosa
  7. erythrasma caused by corynebacterium
  8. gionnete crostie bodies seen in hepatitis b infection
  9. siadh criteria
  10. non ketotic hypoglycinemia
  11. fatty oxidation defect – absent urine ketones
  12. jssk programme, newborn followup for 30days
  13. home based newborn care, follow up of newborn for 42 days
  14. metachromatic leukodystrophy case scenario
  15. tof presentation with brain abscess as complication
  16. segawa syndrome (dopamine responsive dystonia)- levodopa drug of choice
  17. drug of choice for infantile spasms in tuber ous sclerosis- vigabatrin
  18. topiramate side effect – renal stones
  19. ready to use therapeutic feeds characteristics
  20. apert syndrome features
  21. delta brush pattern on eeg- anti nmda receptor encephalitis
  22. gm1 gangliosidosis presentation similar to hurler.
  23. exaggerated startle response in gm2 gangliosidosis
  24. investigations in a 4month old infant following a first episode uti
  25. non renal cause for which dialysis is indicated- metabolic acidosis
  26. hyperplastic nails in rubenstein taybi syndrome
  27. current recommendation for a large hemangioma treatment ??(intralesional bleomycin/ propronolol/ topical steroids)
  28. nystagmus retractorius
  29. 4yr old with gtcs for 10min, neurologicallly normal, next investigation-eeg
  30. neural tube closes between 3rd and 4th week
  31. preventive dose of folic acid for ntd-0.4mg
  32. wide opened af- achondroplasia
  33. markers seen in dermatitis herpitiformis- iga and anti ttg antibody
  34. multiple sclerosis common presentation- optic neuritis
  35. multiple sclerosis in prepubertal girl diagnosis
  36. large café au lait spot eith irregular margins- mc cune albright sydrome
  37. retinitis pigmentosa, ataxia….. case scenario of abeta lipoprotienemia
  38. percentage of infants with spastic diplegia with mri findings of pvl-70%
  39. all are caused by enterovirus ingfections except- papular purpuric glove and stock syndrome (parvo virus)
  40. right atrial hypertrophy ecg changes- p wave amplitude >2.5mm
  41. cardiac index to be maintained at >3.5ml/m2/min
  42. 10yr old with early morning seizures and dropping objects in the hand…- juvenile myoclonic epilepsy
  43. epilepsy syndrome that presents beyond infancy- lennox gestaut syndrome
  44. infantile epileptic encephalopathy
  45. drug of choice for west syndrome- acth
  46. gems study recent organism - cryptosporidia
  47. shigella affects colon
  48. ecoli which cause persistent diarrhea- enteroaggregative ecoli
  49. 6month old immunized uptodate presents with bacterial meningitis organism?- meningococcus.
  50. congenital glaucoma – from birth to 3yrs
  51. cornea reaches adult size by? 2yrs
  52. qrs complex reaches adult size- ? 4,5,6ys
  53. rl sodium content -130meq/l
  54. congenital toxoplasmosis presentation in neonate?- periventricular calcifications/ pneumonia/ encephalitis
  55. persistent tachycardia in neonate- >160/180/200/220
  56. earliest sign of septic shock- prologed crt/ tachypnea/…
  57. gh deficiency
  58. holt oram syndrome
  59. skin manifestations in vasculitis
  60. imnci danger signs
  61. menkes syndrome inheritence- x linked
  62. color blindness inherited in x linked pattern
  63. neurofibromatosis type 2 case scenario
  64. cranial affected on contralateral side in case of cavernous sinus thrombosis
  65. functional murmur –stills murmur
  66. vsd type associated with aortic regugitation- sub aortic
  67. true satement- risk of hydrocephalus increases with high spinal defects
  68. renal angina index severity score moderate grade criteria-?
  69. renal biopsy indicated in unremitting arf of >4weeks duration
  70. newborn vision is 20/400. by what age it reaches 20/20
  71. common refractive error in a infant with retinopathy of prematurity
  72. lch associated with both sensorineural and conductive deafness
  73. erythema multiformae description- target (bull eye shaped)
  74. spinal reflex elements (nerves)
  75. congenital myotonic dystrophy case scenario
  76. mobius syndrome- fascio scapulohumeral dystropy
  77. commenest type of sma is type2
  78. ragged red fibres are seen in all except- leighs
  79. all of the following are transmitted by a female except- limb girdle systrophy other options (dmd/bmd/mitochondrial disease).
  80. staphylococcus is common pathogen in chediak heggashi syndrome
  81. toxic epidermolysis necrolytica % of skin invovlement- >30
  82. both epidermis and subcutaneous tissue are involved in steven jhonson syndrome. others (angioedema/ urticaria/???)
  83. acne form erruptions seen with which drug- dapsone ( cotrimoxazole/erythromycin)
  84. microcomedones are early skin manifestation of acne
  85. ecg changes in alcapa
  86. qp:qs ratio where left atrial and left ventricular dilatation occurs
  87. seizure mimmic seen with gerd- sandifer syndrome
  88. unconscious child with hyperventilation…
  89. staging of levido reticularis done at what level of skin (between groin to knee/ knee to ankle/ shoulder to elbow/ below elbow)
  90. spider nevi in children commonly seen in which area of the body.
  91. commonest sequelae following bacterial meningitis- sensorineural hearing loss.
  92. following bacterial meningitis what is the test to be done prior to disharge- bera.
  93. cicatricial skin lesions with limb hypoplasia seen in congenital varicella
  94. child rights- participation, protection, survival, development
  95. true hermaphroditism
  96. lyme disease earliest symptom- fever and myalgia
  97. eosinophilic meningitis , number of eosinophils in csf >10
  98. tropical pulmonary eosinophilia- eosinophil count >3000 cells
  99. anti arrhythmic class of drugs responsible for torsedes depointes- class 1c and
  100. cons associated with csf shunt infection.
  101. indication for surgical intervention in case of cerebral abscess- presence of gas in the abscess
  102. icds programme – calories and protiens supplied (500cal and 10-15g)
  103. best specimen to isolate atypical chlamydiae –(sputum, naspharynseal swab, bal, pleural fluid)
  104. most common congenital defect in nose- choanal atresia
  105. common presentation to the er with foreign body in nose is (epistaxis/ history of insertion/ obstruction)
  106. practical method to assess severe dehydration in a child (skin pinch/measurement of weight loss/…)
  107. congenital glaucoma presentation all except –leucocoria
  108. pediatric asssesment traingle -appearance , wob and circulation
  109. shawl sign in dermatomyositis described in relation to the distribution of reash over – shoulder girdle region.
  110. nakayam bodies – roseola infantum.
  111. et co2 , in which phase the dead space gas will be exhaled/correlates- (phase 1, 2,3,4)
  112. pulse oxymetry reading is unaffected in a child with jaundice (hypothermia, nail polish/….)
  113. test useful to differentiate between complicated and uncomplicated sam- appetite test.
  114. a school going boy had a conflict with another boy and sustained injuries hematoma in the neck region. the next day morning he was found to have contralateral hemiplegia- reason? (aortic dissectiion/ lateral sinus thobosis /subdural hemorrhage).
  115. primary amoebic meningoencephalitis- naegleria fowleri/ acanthameba/ entemoeba hystolytica.
  116. extrapyramidal symptoms seen with ( metaclopramide, metronidazole, phenazothiazines)
  117. rop screening time in an infant born at 28weeks gestation-?
  118. 3yr old girl with developmental regression with wringing hand movements- retts syndrome.
  119. differential cyanosis.
  120. functional closure of ductus arteriosus- 10 to 15 hrs.
  121. accidental ingestion of imipramine- next line of management- sorbital + activated charcoal.
  122. tricyclic antidepressants accidental ingestion- ecg monitoring.
  123. peritonsillar abscess- tonsils are displaced (anteromedially / posteromedially/ downward / upward)
  124. lead levels at which medical treatment to be initiated ->45mg/dl
  125. wardenberg syndrome
  126. catch 22 syndrome- 22q11
  127. euvolemic hyponatremia- causes (low sodium intake)
  128. noorwood procedure done for hlhs
  129. bezolds abscess- extends into neck musculature.
  130. short pr interval –wpw syndrome
  131. bazetts formula- qtc interval calculation
  132. cranial nerve tests- correct procures.
  133. klippel fiel syndrome which is not characteristic feature.
  134. favorable prognosis in leukemia(all).
  135. mesial temporal sclerosis associated with refractory seizures-best treatment results with?
  136. anterior spinal artery ischaemia unaffected nerves-
  137. emergency procedure done in case of tga- atrial septostomy.
  138. takayasus arteritis is characterized by- diffuse aortics arch involvement/ aortic arch only/ aortic arch and pulmonary trunk involvement.
  139. proximal muscle weakness with vasculopathy, muscle calcifications
  140. di epoxy butane test used for diagnosis of fanconi anemia.
  141. polycythemia is central hct of >65%
  142. periungual fibromas in case of tuberous sclerosis appears by what age?
  143. severe hie changes on mri are seen as bilateral basal gnaglia and thalamus hyperintensities
  144. thalassemia major is characterized by all except- low serum iron
  145. warning sign in dengue- persistent vomiting
  146. left ventricular hypertrophy is seen in
  147. low osmolar ors reduces all except-- reduced antibiotic rates in dysentry.
  148. spasmus nutans is associated with-
  149. number of vitamin a doses by 5yrs of age as per rmnch a + programme
  150. ellis van crevald syndrome is associated with asd
  151. subcutaneous fat necrosis is complicated by hypercalcemia
  152. vaccine not included in mission indradhanush- typhoid
  153. cleft in the cerebral hemisphere- schizencephaly
  154. smooth cerebral convolutions- lissencephaly
  155. tinea pedis affects commonly which web spaces
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