For MCQS on All subjects & Licencing examinations.

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Visit : www.medicalmcqsdownload.blogspot.com

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2005

Photograph 9: A young child with a patch of hair loss on the scalp. Some small flakes of skin are present. What is your diagnosis? a) Tinea b) Psoriasis c) Alopecia areata d) Trichotillomania e) SLE Ans: A.

(JM: Common Skin Problems) * A 15 months old child was found with ambiguous genitalia, while in karyotype analysis 46xy was diagnosed. WOF is the next appropriate IX?

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AMC RECALL PAPERS: PEDIATRICS

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a) X- ray b) 17 hydroxy progesterone---increased in Congenital Adrenal Hyperplasia c) CT Scan d) US of pelvic region e) Testosterone level Ans: B.

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The term congenital adrenal hyperplasia encompasses a group of autosomal recessive disorders, each of which involves a deficiency of an enzyme involved in the synthesis of cortisol, aldosterone, or both. 

Classic congenital adrenal hyperplasia is generally recognized at birth or in early childhood because of ambiguous genitalia, salt wasting, or early virilization. Nonclassic adrenal hyperplasia is generally recognized at or after puberty because of oligomenorrhea or virilizing signs in females.

    

Deficiencies of enzyme activity involved in cortisol synthesis result in elevations in concentrations of corticotropic hormone (previously adrenocorticotropic hormone [ACTH]) that often cause hyperpigmentation. This hyperpigmentation may be subtle and is best observed in the genitalia and areolae. Hyponatremia, hyperkalemia, and/or hypoglycemia suggests the possibility of adrenal insufficiency. Hypoglycemia and hypotension may, in part, be due to associated epinephrine synthesis in the adrenal medulla due to cortisol deficiency. Children with simple virilizing 21-hydroxylase deficiency or 11-hydroxylase deficiency have early pubic hair, phallic enlargement, and accelerated linear growth and advanced skeletal maturation. Patients with aldosterone deficiency of any etiology may present with dehydration, hyponatremia, and hyperkalemia, especially with the stress of illness. Male or female patients with 11-hydroxylase deficiency may present in the second or third week of life with a salt-losing crisis. However, these patients develop hypertension, hypokalemic alkalosis, or both later in life. Upon maturation, mineralocorticoid responsiveness increases, and the elevated concentrations of deoxycorticosterone are sufficient to cause sodium retention, potassium excretion, and hypertension.
(http://emedicine.medscape.com/article/919218-overview )

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Ambigious Genitalia: Female; Male.

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An 8-year-old boy presents with photophobia, irritability & neck stiffness. Lumbar puncture findings show 50 neutrophils, 100 lymphocytes, proteins normal, glucose normal. Which is the most likely diagnosis? a) Tuberculosis meningitis b) H. influenza c) Echo virus d) E. Coli e) HSV encephalitis Ans: E.

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*A 5 month old baby unwell for a week is noticed by his parents to have episodes of leaning forward and shaking his arms. His parents are concerned, because he is not responding as he used to. What is the likely cause? a) Infantile spasm b) Febrile seizures c) Breath holding spells d) Infantile myoclonic seizures e) Petit mal epilepsy Ans: D.

Infantile Spasms (Hypsarrhythmia) (JM: Faints, fits and funny turns) These are generalised tonic seizures with sudden flexion of the arms, forward flexion of the trunk and extension of the legs, lasting only a few seconds, with usual age onset between 3 and 7 months. They are usually restricted to the first 3 years of life and are replaced by other forms of attacks. Prognosis for cognitive development is also unfavourable. The most effective therapy is corticotrophin (ACTH) IM injection. Otherwise, oral prednisolone or valproate can be used.

ANS: Observation

Salmon patch also regresses automatically but port wine doesn’t regress automatically.

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a) Cryotherapy b) Laser therapy c) Observation d) Injection of a sclerosing agent e) Simple excision

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A 2 month old child has strawberry naevus on its back between the scapulae, 2 cm in size. What is the most appropriate management?

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(Kaplan Pediatrics p.2)

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A child with perorbital oedema and anararca, BP is normal. All of the following are true, except? a) Steroids are useful in treatment b) Focal glomerulonephrits is the commonest cause c) Proteinuria more than 3 grams/day is usual d) This is commonest between 1 and 4 years of age e) ? Ans: C. Nephrotic Syndrome is the diagnosis.

A fully breast feed baby, from a mother on a healthy, balanced diet, can have deficiency of which vitamin? a) Vitamin A b) Vitamin B complex c) Vitamin C d) Vitamin D e) Vitamin K Ans: Vitamin K.

Vitamin k excess cause hemolysis, k deficiency cause bleeding, vitamin E deficiency causes hemolysis. (Kaplan p.23)

Ans: Abuse

Rickets: wrist x ray (wrist) Scurvy: Knee joint x ray.

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a) Rickets b) Vitamin C deficiency c) Pagets disease d) Non accidental injury e) Haemophilia

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You can see an infant with subdural haematoma, bruising and multiple subperiosteal sclerosing zones on x-ray of the limbs. What do you first think of?

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What is true about phenylketonuria inheritance? a) Only boys are affected b) Only girls are affected c) 1 in 2 chance of any sex being affected d) 1 in 4 chance of any sex being affected e) Sporadic Ans: AR (Kaplan Pedia)

An 8-week-old baby presents with unilateral sticky eye. Similar episode before was treated with antibiotics for 3 days and resolved. What is the most likely diagnosis? a) Gonococcal conjunctivitis b) Allergic conjunctivitis c) Inadequate antibiotic treatment d) Decreased Ig A in the tears e) Blocked naso-lacrimal duct Ans: E.

A neonate was born at full term with a birth weight of 1500 grams, was jittery on handling noticed to have cyanosis on the hands & feet. The infant had normal temparature; respiratory rate 40/min and lung & heart were normal on examination. The neonate has been given oxygen. Which of following is your step in management? a) Reassure the infants mother and check the infant later b) Check blood calcium c) Give high concentration oxygen via mask d) Take blood sample for blood sugar test e) Take blood for full blood examination Ans: D.

A child was recently vaccinated for polio, now presents with 1-week history of fever, flaccid paralysis of both lower limbs with no reflexes. The most likely diagnosis is? a) Infection with wild poliomyelitis b) Complication of the polio vaccine c) Gullian Barre syndrome d) UMN lesion e) Acute polyneuropathy Ans: GB

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Which of the following is the least likely cause of iron deficiency anaemia in children? a) Cows milk b) Thalassemia c) Prematurity d) Coeliac disease e) Multiple pregnancy (e.g. Twins) Ans: C.

*A baby delivered by normal vaginal delivery, is well after birth. On the 4th day, the baby is found collapsed in the cot, breathless and floppy. On examination there are no murmurs. Possible cause could be -- *** a) TOF b) PDA c) TGA with VSD d) Pulmonary stenosis e) L. Ventricular Hypertrophy f) Hypoplastic left heart syndrome. Ans: …………………………..

A 9-day-old baby with projective vomiting and dehydration with K 7.1, Na 125, Cl 80, & HCO3 20. What is your diagnosis: a) Pyloric stenosis b) Dlactosemia c) Sepsis d) Hypoglycaemia e) Congenital adrenal hypertrophy Ans: E

Ans: D.

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a) K 2.2 b) K 6.5 c) Na 132 d) Na 156 e) Cl 100

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A child with profuse diarrhoea for 5 days develops convulsions. Which of the following blood test results would most likely cause this convulsion?

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Ans: E (Kaplan Pedia: Newborn)

A child has trouble seeing the black board at school, but no problems when using the computer. His vision is improved with pinhole test. What is your diagnosis? a) Myopia b) Hypermetropia c) Cataract d) Glaucoma e) ? Ans: A.

A child with headache and morning vomiting, ataxia and nystagmus for 6 weeks. His school had a Chicken Pox 2 weeks ago. He has a family history migraine. What is the most probable diagnosis? a) Migraine b) Varicella cerebellitis c) Infratentorial Tumour d) Friedrich’s ataxia e) ? Ans: C.

In child dizziness, headache, vomiting indicates posterior fossa tumor until proved otherwise. (JM: Headache) Chicken pox: The incubation period is typically 10-14 days, although it may extend to 21 days. Chickenpox encephalitis classically presents with ataxia 3 to 4 days after onset of the rash, but may sometimes present after 8 days. The cerebellum is most commonly affected, but in some cases the cerebrum is involved, in which case the prognosis is worse.

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a) Congenital rubella b) Neonatal hepatitis c) Diabetes Mellitus d) Syphilis e) Galactosaemia

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A 37-year-old female gives birth to her 2nd child. At the 10th day the child becomes jaundiced. His mother tells the doctor that her first child had jaundice after birth and then developed bilateral cataract after the jaundice. What is the diagnosis?

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In Down’s syndrome, aside from the cardiac complications, all of the following are associated with Down’s syndrome, excepta) Acute leukaemia b) Myopia c) Hypothyroidism d) Vesicoureteric reflux*** e) Deafness f) Alzheirmer’s disease Ans: D. http://emedicine.medscape.com/article/943216-overview

a) Reassure the parents that this is a normal variant b) Reassess at 18 months c) Repeat mother child test for hearing d) Arrange for audiometry testing e) Rt. Orchidopexy Ans: Reassure.

(JM p.1089)

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a) reassurance & send home b) Admission into hospital for surgery c) Request the mother to bring the child to you immediately when the lump reappears again d) Review after 1 week e) ? Ans: Surgical consultation***

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A mother notices a lump in the right groin of her 2-year-old son, which disappeared after a few hours. Despite a thorough examination you are unable to discover anything. The most appropriate management would be?

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A 15-month-old child is brought to you by his parents. He was born at 36 weeks by normal vaginal delivery. At 8 months a mother child health centre test for hearing was done, which was normal. The parents say that he babbles, but does not speak 2-3 word phrases yet. On physical examination, the child appears normal. What will you do?***

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80% make a full recovery, although there is a significant mortality and some are left with morbidity such as mental retardation and seizures. Cerebellar ataxia specifically seen during the recovery period. Most common clinical features tremor ataxia and nystagmus.

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An 8-year-old boy was stung by a bee. He had difficulty breathing and facial oedema. What is the best treatment? a) Adrenalin 1:1000 IM/SC b) Adrenaline I/V c) Antihistamine iv d) Hydrocortisone iv e) Intravenous fluids Ans: A. (JM p.1343)

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A child has tenderness & pain at upper tibia of the left leg and swelling of the knee which is warm. He is febrile (39 degrees Celsius) and gets pain at 30 degrees flexion. What is your diagnosis? a) Osteomyelitis b) Osteosarcoma c) Septic arthritis d) Fracture tibia e) Irritable hip (Transient synovitis) f) Thrombophlebitis/Cellulitis Ans: Osteomyelitis.

Septic arthritis can be difficult to diagnose in the early stages of progression. Once purulence has developed and a bulging effusion is noted, diagnosis is made easily. Typically, the patient presents with fever and a joint that is hot, red, painful, distended, and has a markedly decreased range of motion. Restriction of movement occurs to active and passive attempts.

Ans: D.

Immunization schedule: JM p78

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a) Give antibiotics b) Tetanus Toxoid*** c) Tetanus Immunoglobin d) DTP vaccination*** e) Reassure & send home

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A 2-year-old child presents with a clean superficial laceration on the forehead. The child has never been immunized. What is the most appropriate management?

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Contraindications:

1. Febrile illness >38.5˚C.

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  

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All adult should receive an ADT every 10 years. All women in their childbearing age should have their MMR antibody status reviewed. Influenza vaccine annual basis: Chronic cardiac, pulmonary, kidney, metabolic diseases, persons over 65years and Aboriginal over 50. Pneumococcal vaccine same as influenza. Hepatitis to high risk group. Q fever vaccine for abattoir worker.

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reaction. than 2mg/kg/day. 6. OPV household contacts blood products. months apart. Not contraindication: pertusis vaccine.

2. Previous anaphylactic

3. Encephalopathy within 7 days of DTP vaccination. 4. For live vaccines OPV, MMR, Vericella, BCG 5. Immunocompromised eg. Chemotherapy or corticosteroids more

immunocompromised 7. MMR/Vericella: within 3 months of giving

8. MMR/ Vericella can be given same day or 4

1. Simple febrile convulsion in the past or pre existing neurological disease is not a contraindication for

2. Egg allergy is not a contraindication for MMR

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JM: Guide to Tetanus Prophylaxis

The commonest cause of hip pain in a 3-yearold child? a) Transient synovitis b) Perthes disease c) Slipped upper femoral epiphysis d) Arthritis e) Tuberculosis Ans: A.

Transient synovitis or irritable hip is the most common cause of hip pain and limp in childhood. (JM p.697)

A 2-week-old baby gained 200 grams/week since birth. The mother complaints that the child vomits milk soon after feeding, otherwise okey. What will you do?*** a) Reduce the time between feeds b) Shorten the duration of feeding c) Give water before feeding with milk d) Endoscopy e) Urine microscopy Ans: A. Small regular feeds and if necessary thicken it. Weight gain 250 gm/15 days. (GORD JM p.515)

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A child was born premature(30 weeks gestation), via vaginal delivery. APGAR 5 at 1 min. & 8 at 5 min. At 18 months, the child is brought by the mother with moderate mental retardation. Which family history would be likely cause of the mental retardation? a) Uncle has mental retardation*** b) Sister has febrile convulsions c) Mother has 2 café au lait spots d) Father is an alcoholic e) Paternal grandmother has hypothyroidism *** Ans: A.

5 min APGAR score is more important than 1 min APGAR score.

A 4-year-old child presents with sudden onset of cough, unilateral wheeze and decreased respiratory movement on one side. There is no family history of atopy. What is the most appropriate management? a) Chest X ray b) Full blood examination c) CT of chest d) Ultrasound e) Inspiratory & expiratory chest X ray

Ans: Inspiratory & expiratory chest X ray (Kaplan p.135)

An obese 8 yrs. Old boy came to you. O/E his weight was 48 kg, which is more than 98th percentile and the height was 140 cm, which is more than 90th percentile, otherwise normal. WOF is correct in relation to this boy--a) Advanced bone age b) Increased blood sugar level c) Thyrotoxicosis d) Hypothyroidism e) Primary hyperaldesteronism

Diabetes in this age group is IDDM and usually associated polyuria, polydipsia and weight loss.

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Ans: A. Advanced bone age.

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(Kaplan Pedia)

Some relevant questions from Pre-test about Bone age and Chronological age: (frequently asked topics) 430. A 13-year-old boy is below the third percentile for height (fiftiethpercentile for age 9). Which of the following would give him the best prognosis for normal adult height? (Pediatrics Pre-test: p.294) a) b) c) d) e) A bone age of 9 years A bone age of 13 years A bone age of 15 years Being at the fiftieth percentile for weight Being at the third percentile for weight

430. The answer is a. (Behrman, 16/e, pp 56, 59–60. McMillan, 3/e, pp 1776–1780, 1790–1791. Rudolph, 21/e, p 2015–2017, 2094.) The determination of bone age by the radiographic examination of ossification centers provides a measure of a child’s level of growth that is independent of his or her chronologic age. Height age is the age that

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434. Bone age will be advanced in short stature caused by which of the following? (Pediatrics Pre-test: Page: 295) a) b) c) d) e) Environmental deprivation syndrome Hypopituitarism Hypothyroidism Congenital adrenal hyperplasia Chronic administration of glucocorticoids in high doses

434. The answer is d. (Behrman, 16/e, pp 59–60, 1675–1680, 1698–1704, 1729–1736, 1738. McMillan, 3/e, pp 1776–1780. Rudolph, 21/e, pp 7–9, 466, 2017–2021, 2038–2042, 2045.) The appearance and union of the various centers of ossification follow a fairly definite pattern and time schedule from birth through adolescence. This process provides, through x-ray studies, a valuable criterion for estimating normal and abnormal growth. The skeletal maturity of any person is known as the bone age. Bone maturation is particularly influenced by the androgenic and estrogenic hormones. In congenital adrenal hyperplasia, a deficiency of enzyme (21-hydroxylase in 80% of cases) causes an interruption in the pathway for production of cortisol; the end result is hypersecretion of androgenic precursors and clinical manifestations of virilism and protein anabolism. In both males and females, muscles are well developed and there is rapid growth in stature, with marked acceleration of osseous maturation. The result is early closure of epiphyses and failure to achieve full growth. Thyroid hormone appears to act as a primary stimulant to skeletal maturation. Deficiency of thyroxine results in marked retardation of bone age. Failure to thrive as a consequence of profound environmental deprivation is characterized by very low levels of circulating pituitary hormones and is associated with a delay in skeletal maturation. Removal of the child from the abnormal environment results in dramatic catch-up growth and a rapid return of hormone levels to normal. Glucocorticoid excess, either endogenous or exogenous, is usually associated with a decrease in the rate of growth and a delay in the onset of puberty, the exception being a case of glucocorticoid excess resulting in significant virilization and rapid closure of growth plates. The effects of glucocorticoid excess appear to be mediated at end-organ sites as part of the catabolic effects of these steroids.

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corresponds to the fiftieth percentile for a child’s height. When bone age and height age are equally retarded several years behind chronologic age, a child is described as having constitutional short stature. Such a child is usually shorter than peers in adolescence because of the delayed growth spurt, but the prognosis for normal adult height is excellent because there is still the potential for growth. Detailed questioning will usually identify other family members with a history of delayed growth and sexual maturation but with ultimately normal stature. Children with genetic or familial short stature grow at an adequate rate, but remain small throughout life; their ultimate height is consistent with predictions based on parental heights. Bone age is within the limits of normal for chronologic age, and puberty occurs at the normal time. In all cases, a thorough history and physical examination are necessary to identify any other cause of growth delay.

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A baby is born a normal full term delivery. On examination of the newborn, which of the following may normally be seen? a) Breast enlargement in male infants b) Enlarged clitoris in female infants c) Fusion of labia d) Enlarge liver more than 5 cm and palpable e) Cleft palate Ans: Breast enlargement (Kaplan p.4 DH p.44)

A mother brings her baby who is babbling and squeaking, is able to hold his head, move from prone to supine position, is able to sit up unsupported, can reach for objects and when supported, can stand and bounce. What is the possible age of this child? a) 5 weeks b) 2 weeks c) 7 months d) 10 months e) 12 months

Ans: 12 months. (Kaplan p.43)

During 12 weeks of pregnancy Ultrasound shows nuchal thickness of the fetus. Keriotype also done. Now your advice should be--a) Terminate the pregnancy at 12 week b) Repeat Keriotype test c) Serum fetoprotein test at second trimester d) Full blood test

Nuchal scan is performed between the 11th and 13th week of gestation, because the accuracy is best in this period

After a difficult forceps delivery, it is noticed that the baby hangs his arm to the side, and cannot move it. What is the likely cause? a) Fracture humerus b) Erbs palsy

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Ans: A.

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Ans: C 5,6, C 8, T1 Klampke.

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a) Botulism b) Werdnig-hoffman disease(spinal muscular atrophy) c) Cerebral pulsy d) Myasthenia gravis e) Ans: A.

A 6 week old infant vomiting intermittently since birth. She looks thin, not gaining weight. No abnormality on physical examination. What is your Dx : *** a) cystic fibrosis b) pyloric stenosis c) subdural haematoma d) phenyl ketonuria e) regurgitation f) UTI Ans: E

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Six week old child initially was normal but after 3 wks she was not sucking milk. She appeared as a floppy child, which was progressively getting worse. WOF is your diagnosis--

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Photo: A child with rash on the buttocks and legs .Both ankles swollen and tender, also abdominal pain, but no fever. No neck stiffness.WOF is most common major complication(Dx:HS purpura ;AMC-286) a. Nephritis Photo: X-ray chest of a 8 months old infant with opacity in Rt lower zone and pneumatoceles (Staph. Pneumonia).Rx- (AMC: Fig-119) I/V Flucloxacillin

Photo: X-ray chest of a 9 months old infant as shown in AMC book (page-119). What is the Dx? Staph. Pneumonia (But most common in this age group is Streptococcus pneumonia) A baby has jaundice just after delivery. Mother is Rh –ve, baby also Rh –ve. Coomb’s Test is –ve. What may be the Dx? a. Autoimmune condition b. ABO incompatibility c. Rh incompatibility Ans: Coomb’s test is positive in Rh incompatibility, and weekly positive in ABO incompatibility. Jaundice 1st day is pathological. Day 2 to day 7: may be pathological and the Br doesn’t go beyond 12.5 to 15. Beyond 1 week it can be breast milk jaundice.

Ans: See page 44 Kaplan USMLE.

AOF are used in BISHOP Score, Excepta. Cervical length

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What a 3 yrs. Old can do? a. Draw a man with 6 parts: 48 m b. Hop on one foot: 48 m c. Climb stairs: 24 m d. Name four colours:??

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See page 11 Kaplan USMLE.

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b. Cervical dilatation c. Position relation to ischial spine d. Moulding of the head e. Cervical effacement CPEDS: Consistency, Position, Effacement, Dilation, Station WOF is X linked Recessive? Haemophilia. Notes:

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Child with her mother in a Supermarket picked a packet of Balloon. His mum snatched it & kept in place. The child started crying and at one stage he became unconscious but regain consciousness within 45 seconds.WOF may be the causea. Petitmal epilepsy b. infantile spasm c. Breath holding attack d. Complex partial seizure e. Grand mal seizure Ans: C.

Six month old infant was brought by his parents. He had funny turns, sudden flexion of upper and lower limbs for one week. Previously he had coryzal illness. Now child is not responding like previously. DxInfantile spasm: age- 4 to 8 months occurs during sleep or initial arousal. Presentation: Brief symmetrical contraction of neck, trunk and extremities. Types: flexors, extensors or mixed. EEG shows: Hypsarrhythmia. Treatment: ACTH and Prednisolone. Ans: Meningitis

Reassure the mother

RHP p.149

A 3 yrs old child came with her mother. The child has been suffering an attack usually once in a month. The attack lasts for 2-3 minutes and during the attack she is seen in spinning. She does not loose conscious during that, but feels frightened & runs to her mother’s lap for comfort.WOF is your Dx:

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Colic or unexplained crying: self limited and benign condition and etiology is unexplained. Gentle rocking movement, vibration, riding in a car can be helpful. See page 25 Kaplan USMLE.

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Mother came with her 3 month old baby, she told you that her baby cries a lot at evening time. Mother wants to know does the baby cry when he becomes hungry or any other cause and what she needs to do when her baby cries.

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a. Minor form of epilepsy b. benign positional vertigo c. partial complex seizure

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Complex partial seizures: http://emedicine.medscape.com/article/1183962-overview Simple partial seizures: http://emedicine.medscape.com/article/1184384-overview

An 11 yr old boy has difficulty climbing stairs and walking & running. O/E there is weakness of both legs and loss of reflexes. All other examinations are normal.WOF investigations will confirm the Dx? a. CSF analysis b. Forced vital capacity c. MRI d. Nerve conduction study e. X-ray

Ans: Diagnosis is Gullianbarre syndrome also known as acute post infectious neuropathy causing demyelination of motor and sensory nerves. Rubbery legs and areflexia are the initial symtoms. Infectious etiology: Campylobacter Jejuni, Mycoplasma Pneumoni, usually occurs 10 days after viral infection. Diagnosis: CSF- Albimino-cytogenic dissociation, marked elevation of CSF proteins and decrease in cell count. Treatment: Glucocorticoids, IVIG and plasmapheresis. See page: 228 Kaplan USMLE.

Laryngomalacia is a congenital abnormality of the laryngeal cartilage. It is thought to represent a delay of maturation of the supporting structures of the larynx. Laryngomalacia is the most common cause of congenital stridor and is the most common congenital lesion of the larynx. But cry is usually normal in laryngomalacia.

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Ans: Croup is usually associated with typical inspiratory stridors and seal like coughing, occurs in 3months to 5 years age group due to viral infection. Bronchiolitis is not associated with stridor.

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An infant presents with a typical crowing noise on inspiration. The noise is more noticeable on crying. There is no cough.WOF is the Dxa.Croup b. Laryngomalacia c. Bronchiolitis (Forrest-596 OHCS-558)

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Ans: simple partial seizures. There is always loss of consciousness in complex partial seizures along with automatism (Verbal or Motor). Benign positional vertigo is due to sudden change in the head position causing vertigo.

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Laryngomalacia: http://emedicine.medscape.com/article/1002527-overview
(Kaplan p.136)

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A 5 yr old boy brought by his parents, who is suffering from delayed development of speech after a period of normal development. O/E he avoids eye contact. Parents give h/o his unusual love for a toy Turtle.WOF is most probable Dxa. Autism b. ADHD c. Deafness Autism: see page 47 Kaplan Medicine.

Ans: …………………………..

WOF is true about ADHDa. Children has reading disability b. The child responds to cognitive therapy c. They respond very well to behavioural therapy d. commonly seen in pre-school age (5-7 yrs) Ans: 5 to 7 yrs. Behavioural therapy

http://www.emedicinehealth.com/attention_deficit_hyperactivity_disorder/page8_em.htm

Ans: c.

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A mother complains of her 10 months old baby who wakes up during night many times. The baby is otherwise healthy and gaining weight properly. The mother is worried about this. What is the Mx- *** a. Urine culture b. Give sedative to the baby c. Tell the mother to cuddle the baby when he cries

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Parents of a 6 yr old boy complain that their son is overactive, not cooperative enough with other children at kindergarten, also of destructive behaviour. But when kept alone, was found to be playing happily with toys and other children.WOF is correct- *** a. It is a normal variant b. ADHD c. Autism d. Poor parenting

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Ans: Hernia

Seminoma: As noted above, germ cell tumors are the most common solid tumors in men aged 15-35 years. Seminoma (the most common germ cell tumor) occurs most commonly in the fourth decade of life. Children represent only 2-5% of all patients with testicular cancer. Seminoma is considered a postpubertal tumor, although it has been reported in a patient as young as 8 years.

Two months old child’s mother noticed a firm lump in her baby in the left side of upper abdomen while bathing.Child has bilateral periorbital ecchymosis.what is the most likely cause? a.Neuroblastoma May-2000 b.Wilm’s tumour Ans: A. Blue berry muffin face.

Mother of a 3 year old child noticed a mass in the abdomen on the left side.AOF could be the cause,excepta.Hydronephrosis October’96 b.Neuroblastoma c.Nephroblastoma(Wilm’s tumour) d.Poly cystic kidneys e.Chr. constipation Ans: E.

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A mother of a 4 yr old child noticed that there is a solid mass in the Rt. Loin area of her child which she noticed for the first time with occasional blood in urine.WOF is your initial Dx: OHCS-220 a.Neuroblastoma Wilm’s tumour: Commonest intra abdominal tumour of b. Wilms tumour childhood. Haematuria not common, but fever, flank pain c c.Hydronephrosis abdominal mass found. US-pelvicdisortion, hydronephrosis d.Plycystic kidney disease .

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A 12 yr old boy presented with painless lump in the scrotum for the last 6 months. He is otherwise healthy grown up. What is the most likely Dx? a. Hernia b. Seminoma c. Encysted hydrocele of the cord d. Varicocele e. Haematocele

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A baby with Down’s syndrome is born to a couple who definitely refuse to take the child home after failure to convince them. The most appropriate course of action: Arrange temporary foster care

An 8 yr old girl presents with abdominal protusion,anaemia and tenderness.O/E there is a big irregular and mobile mass crossing the midline.DxNeuroblastoma Sixty-five percent of primary neuroblastomas occur in the abdomen, with most of these occurring in the adrenal gland. As a result, most children present with abdominal symptoms, such as fullness or distension. Symptoms are usually related to either an abdominal mass or bone pain secondary to metastatic neuroblastoma. Reports of fatigue, bone pain, and changes in bowel or bladder habits may contribute to an accurate diagnosis. Physical findings might include hepatomegaly; blanching subcutaneous nodules; or a large, irregular, firm abdominal mass. Derived from sympathetic neuroblasts,most common solid tumour in children<5yr.Likely to present with abdominal swelling and urinary catecholamines (vanillylmandelic& homovanillic acids) raised in 92% cases. Neuroblastoma has been called the great mimicker because of its myriad clinical presentations related to the site of the primary tumor, metastatic disease, and its metabolic tumor by-products. Sixty-five percent of primary neuroblastomas occur in the abdomen, with most of these occurring in the adrenal gland. As a result, most children present with abdominal symptoms, such as fullness or distension. Obtaining a complete history and physical examination are paramount to an accurate diagnosis and subsequent management of neuroblastoma. Eliciting a history of the child's general appearance, recent trauma, changes in appetite and weight, and recurrent abdominal pain is important. Symptoms are usually related to either an abdominal mass or bone pain secondary to metastatic neuroblastoma. Reports of fatigue, bone pain, and changes in bowel or bladder habits may contribute to an accurate diagnosis. Physical findings might include hepatomegaly; blanching subcutaneous nodules; or a large, irregular, firm abdominal mass. Typically, children with localized disease are asymptomatic, whereas children with disseminated neuroblastoma are generally sick and may have systemic manifestations, including unexplained fevers, weight loss, anorexia, failure to thrive, general malaise, irritability, and bone pain. The most common finding upon physical examination is a nontender, firm, irregular abdominal mass that crosses the midline. In contrast, children who present with Wilms tumor have a smooth mobile flank mass that typically does not cross the midline. At diagnosis, the site of neuroblastoma is predictably age-dependent. Infants often present with compression of the sympathetic ganglia in the thoracic region, which might result, for

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More than 50% of patients who present with neuroblastoma have metastatic disease. The fact that many other syndromes related to metastatic neuroblastoma are also common in these patients is not surprising. For example, Pepper syndrome occurs in infants with overwhelming metastatic neuroblastoma of the liver that results in respiratory compromise. Described by William Pepper in 1901, Pepper syndrome was identified as a localized primary tumor and metastatic disease limited to the skin, liver, and bone marrow in infants. Pepper syndrome has since been associated with stage 4S neuroblastoma, a unique entity that occurs only in infants younger than 1 year. Pepper syndrome generally confers a better prognosis, as it is associated with spontaneous regression. Some infants with stage 4S neuroblastoma, however, die of massive hepatomegaly, respiratory failure, and overwhelming sepsis. "Blueberry muffin" babies are infants in whom neuroblastoma has metastasized to random subcutaneous sites. When provoked, the nodules become intensely red and subsequently blanch for several minutes thereafter. The response is probably secondary to the release of vasoconstrictive metabolic tumor by-products. These nodules can be diagnostic of neuroblastoma, but leukemic infiltrates that metastasize to the skin should be considered in the differential diagnoses when these children are evaluated. Widespread metastasis of neuroblastoma to the bone may result in Hutchinson syndrome, which results in bone pain with consequent limping and pathologic fractures. Neuroblastomas that arise in the paraspinal ganglia may invade through the neural foramina, compress the spinal cord, and subsequently cause paralysis. Infrequently, neuroblastoma can become metastatic to the retrobulbar region, leading to rapidly progressive, unilateral, painless proptosis; periorbital edema; and ecchymosis of the upper lid. This lesion often can be confused with trauma or child abuse. Most neuroblastomas produce catecholamines as metabolic by-products, which result in some of the most interesting presentations observed in children with neuroblastoma. For example, Kerner-Morrison syndrome causes intractable secretory diarrhea, resulting in hypovolemia, hypokalemia, and prostration. This syndrome is caused by vasoactive intestinal peptide (VIP) tumor secretion and is more commonly associated with ganglioneuroblastoma or ganglioneuroma. Kerner-Morrison syndrome typically resolves following the complete removal of the tumor. A wide variety of neoplastic and nonneoplastic lesions might be confused with neuroblastoma. Wilms tumor and lymphoma are 2 malignant lesions that might be mistaken for neuroblastoma. The nonneoplastic lesions are particularly confusing, especially in the 511% of neuroblastomas that do not produce catecholamine metabolic by-products. Nonmalignant lesions that might be confused with neuroblastoma include ganglioneuroma and congenital mesoblastic nephroma.

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example, in Horner syndrome (myosis, anhydrosis, and ptosis) or superior vena cava syndrome. Older children typically present with abdominal symptoms because, as stated above, more than 40% of neuroblastomas are adrenal in origin. Children who are preschool aged should have working differential diagnoses for an abdominal mass, including lymphoma,hepatoblastoma, rhabdomyosarcoma, renal cell carcinoma, and neuroblastoma.

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All are autosomal recessive , Excepta.Neurofibroblastoma b.Phenylketonuria c.Galactossemia d.Cystic fibrosis e.Sickle cell anaemia Ans: A.

After his baby sister was born, a 6 yr old boy began suck his thumb and wetting his bed, behaviour he had grown out of long before. This is an instance ofa. Regression A child has swollen joints and cries whenever the napkin is changed, irritable, ecchymoses and hyperplastic gums. WOF is Dx ? a.Rickets b.Scurvy Ans: ……………………… Survy: Physical Features:

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The infant is apprehensive, anxious, and progressively irritable. Upon handling and changing of diapers, severe tenderness over the thighs is present. The excruciating pain results in pseudoparalysis. The infant assumes the frog leg posture (ie, keeping hips and knees slightly flexed and externally rotated) for comfort. Hemorrhages of the gums usually involve the tissue around the upper incisors. The gums have a bluish-purple hue and feel spongy. Gum hemorrhage occurs only if teeth have erupted. Subperiosteal hemorrhage is a typical finding of infantile scurvy. The lower ends of the femur and tibia are the most frequently involved sites. The subperiosteal hemorrhage is often palpable and tender in the acute phase. Petechial hemorrhage of the skin and mucous membranes can occur. Rarely, hematuria, hematochezia, and melena are noted. Proptosis of the eyeball secondary to orbital hemorrhage is a sign of scurvy. Costochondral beading or scorbutic rosary is a common finding. The scorbutic rosary is distinguished from rickety rosary (which is knobby and nodular) by being more angular and having a step-off at the costochondral junction. The sternum is typically depressed. Low-grade fever, anemia, and poor wound healing are signs of scurvy.

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Hypospadias: incidence of 1:350 male birth.

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Hyperkeratosis, corkscrew hair, and sicca syndrome are typically observed in adult scurvy but rarely occur in infantile scurvy.

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2007

A sudanese boy came to you after administration of Co-timoxazole with the complaints of pallor and increasing darkness of colour of urine. His reticulocyte count was 8%. His Coomb's test was negative, no family history and on electrophoresis Type A hb was detected. What is the Dx? Ans: G6PD deficiency

What is the most common association of childhood obesity in Australia? A. Above average height B. Hypercholesterolaemia C. DM D. Cataract Ans: A. (JM p.850)

Parental obesity is the strongest risk factor of obesity. Endocrine causes of obesity are rare.

A child came with pallor, drooling of saliva and stridor. What will be your initial management? A. Admit to hospital B. Give O2 C. Give antibiotics D. Do cricothyriodotomy

Epiglottitis:

Acute epiglottitis due to Haemophilus influenzae is a life-threatening emergency in a child. A toxic febrile illness, with sudden onset of expiratory stridor, should alert one to this potentially fatal condition. A high index of suspicion of epiglottitis is always warranted in such presentations.

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Ans: A.

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Recently, an infant with diffuse nonscarring alopecia of the scalp and radiologic features of scurvy was reported.4

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A child came shortly after birth when there was a murmur heard at the lest sternal border. This was systolic in timing. 3 months later he was lying down in hospital bed with URTI and there was no murmur. What could be the murmur?

Ans: A.

A child came with pain and redness and swelling of one eye. He had fever and was (probably) vomiting. i could diagnosis it as orbital cellulitis. Mn?

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A. CoA B. VSD C. AS

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A child came with a systolic murmur which radiated to the back and to the axilla. Femoral pulse was weak. Dx?

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Ans: Venous hum

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Croup is distinguished by a harsh inspiratory stridor, a hoarse voice and brassy cough. Other differential diagnoses include tonsillitis, infectious mononucleosis and bacterial tracheitis. The clinical features of croup and epiglottitis are compared in JM.

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The main alternative diagnosis is viral laryngotracheobronchitis (croup). There are, however, significant clinical differences. Epiglottitis is characterised by fever, a soft voice, lack of a harsh cough, a preference to sit quietly (rather than lie down) and especially by a soft stridor with a sonorous expiratory component.

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A. Ceftriaxon IV B. Ampi + Genta IV C. Cefurixime + metro Ans: A

A woman came G1P2 with prevoius delivery of a 4200 gm baby at 42 wks with shoulder dystocia. What do you do this time? A. Induce at 38 wks B. Induce prematurely C. do x-ray pelvimetry at term D. CS Ans: A. Regarding soulder dystocia, which is correct?

Ans: E.

Most often the brachial plexus is injured.

An infant was brought who was vomiting from birth. He was pale, dehydrated and not gainig weight. What is most likely to find? A. Lump B. Distension C. Anuria Ans: Distension.

Ans: D. (JM p.1089)

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A child presented with undescended testis at 6 weeks. What will you do a.do an immediate orchidopexy b. wait till 4 years and then do orchidopexy c. encourage the mother to massage the inguinal region to ‘milk down’ the testis and review after 2 months d. review after 6 months

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A. It is not assoc. with maternal DM B. Arrest occurs at pelvic inlet C. Increased possibility if epidual anaesthesia given D. Most cases can be resolved by hyperflexing the fetal thighs onto the abdomen. E Erb's palsy (C8-T1) is a complication

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Undescended testis is most frequently associated with a.neoplasm b.inguinal hernia

c.tortion Ans: Inguinal hernia.

A 4 year old child with lacerated wound after falling on garden bed. He has taken dtpa at 2 and 4 months. After that no vaccination was given. What will you do a) b) c) d) e) Give antibiotics Give immunoglobulins Give dtpa and Ig Give dtpa dtpa and booster after 2 months

Ans: B.

All of the following occurs in the first few days of neonatal life except. a.increase in right ventricular pressure b.closure of ductus venoses c.closure of ductus arterioses d.decreased flow through foramen ovale Ans: A.

What is true about portwine stain

Ans: ……………………….

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c) Treat immediately because of high potential to turn malignant

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a) Will regress spontaneously b) Will not regress spontaneously and might increase in later life

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2009

WOF is the most predisposing factors in developing atopic asthma? a.) house rugs b.) toys and lounge suit stuffed with animal ski and feathers c.) household pets
d.) house mites Ans: C.

(JM: Allergy)

WOF preservatives is allergic to asthma patients? a.) sulphites b.) benzyl benzoate c.) lecithin d.) terbutaline e.) ephedrine Ans: A Previous Question WOF is the most ill prognosis in a child who suffers from mealses in a developing country?***

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infections, especially colds allergies, e.g. to animal fur, feathers, grass pollens, mould allergy to house dust, especially the dust mites cigarette smoke, other smoke and fumes sudden changes in weather or temperature occupational irritants, e.g. wood dust, synthetic sprays, chemicals drugs, e.g. aspirin, NSAIDs, beta-blockers (oral, parenteral or topical) certain foods and food additives may trigger asthma monosodium glutamate metabisulphites/sulphite preservatives/food colouring agents seafood nuts

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a.) lack of proper treatment b.) poor accessibility to measles vaccines c.) lack of nutrition d.) poor sanitation e.) immune deficiency Ans: C.

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A young scientist has decided to study the causes of neonatal jaundice. He selects 150 babys with jaundice and 150 without, and examines there previous historiies looking for factors that could have determined there jaundice. This kind of study is called? a.) cohort study b.) case study c.) case control study d.) prospective study e.) Ans: B.

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A prospective cohort study is a cohort study that follows over time a group of similar individuals ("cohort") who differ with respect to certain factors under study, in order to determine how these factors affect rates of a certain outcome. For example, one might follow a cohort of middle-aged truck drivers who vary in terms of smoking habits, in order to test the hypothesis that the 20-year incidence rate of lung cancer will be highest among heavy smokers, followed by moderate smokers, and then non-smokers.

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A cohort study or panel study is a form of longitudinal study used in medicine, social science and ecology. It is one type of study design and should be compared with a crosssectional study. A cohort is a group of people who share a common characteristic or experience within a defined period (e.g., are born, leave school, lose their job, are exposed to a drug or a vaccine, etc.). Thus a group of people who were born on a day or in a particular period, say 1948, form a birth cohort. The comparison group may be the general population from which the cohort is drawn, or it may be another cohort of persons thought to have had little or no exposure to the substance under investigation, but otherwise similar. Alternatively, subgroups within the cohort may be compared with each other.

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Studies:

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In order to differentiate Retrospective versus Prospective Cohort, following analogy can be considered. A retrospective (historic) cohort study is different from a prospective cohort study in the manner in which it is conducted. In the case of a Retrospective Cohort Study, the investigator basically collects data from past records and does not follow patients up as is the case with a prospective study. However, the starting point of this study is the same as for all Cohort studies. The first objective is still to establish two groups - Exposed versus Non-exposed; and these groups are followed up in the ensuing time period. A case study is one of several ways of doing research whether it is social science related or even socially related. It is an intensive study of a single group, incident, or community. Other ways include experiments, surveys, or analysis of archival information.

Case-control is a type of epidemiological study design. Case-control studies are used to identify factors that may contribute to a medical condition by comparing subjects who have that condition (the 'cases') with patients who do not have the condition but are otherwise similar (the 'controls'). Case-control studies are a relatively inexpensive and frequently-used type of epidemiological study that can be carried out by small teams or individual researchers in single facilities in a way that more structured experimental studies often cannot be. They have pointed the way to a number of important discoveries and advances, but their retrospective, non-randomized nature limits the conclusions that can be drawn from them. (Wikipedia)

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*One child with red eye, pain, fever and ophthalmoplegia presented in the emergency. What is the best next investigation to do? a. Eye swab

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Rather than using samples and following a rigid protocol to examine limited number of variables, case study methods involve an in-depth, longitudinal examination of a single instance or event: a case. They provide a systematic way of looking at events, collecting data, analysing information, and reporting the results. As a result the researcher may gain a sharpened understanding of why the instance happened as it did, and what might become important to look at more extensively in future research. Case studies lend themselves to both generating and testing hypotheses.

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A retrospective cohort study, also called a historic cohort study, is a medical research study in which the medical records of groups of individuals who are alike in many ways but differ by a certain characteristic (for example, female nurses who smoke and those who do not smoke) are compared for a particular outcome (such as lung cancer).

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The prospective study is important for research on the etiology of diseases and disorders in humans because for ethical reasons people cannot be deliberately exposed to suspected risk factors in controlled experiments.

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b. CT scan c. Blood culture d. USG Ans: CT scan (JM and RHP)

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A couple came to your surgery. Father is a carrier; mother is not having any effect. What is the chance of getting a cystic fibrosis baby? a. 0 b. 25% c. 12.5% d. 100% Ans: 0 A Frequently asked topic: Relevant Diagrams

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A boy was stung by bee and developed severe breathlessness and urticaria. What is the management? a. Adrenaline IM b. Promethazine c. Corticosteroids

Ans: Adrenaline IM (JM: Emergency)

During operation a boy who has history of atopy suddenly developed whhezing. Anaesthetics managed the condition. What is the cause of the condition? a. Iodine b. Latex c. Isoflurane

Ans: B (JM: Allergy)

A boy while having milk shake ice cream suddenly develop urticaria and wheezing. What is the cause? a. Tertarazine Ans: Tertarazine

A small child of 8 years of age was playing in the laundry and suddenly started crying.

a. Esophageal stricture b. Respiratory failure c. Gastric perforation

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Far=ther saw washing powder in his mouth. What is the most serious complication?

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Ans: Esophageal stricture

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A one year old boy presented with fever, wheezing, retreaction of ICS. What is the diagnosis? a. Parainfluenza b. RSV c. RDS

Ans: RSV (Kaplan Pedia: RS)

A one year old boy presented with fever, wheezing, retreaction of ICS. What is the management? a. Nebulised sulbutamol b. Nebulised corticosteroids c. Nebulised adrenaline

Ans: C (Kaplan Pedia: RS)

A child presented with red tympanic membrane, no bulging and pain in the ear. What is the management? a. Amox b. Cipro c. Difluclox

A child presented with deafness. He has a history of AOM and antibiotics were given at 12 months of age. He is now 19. What is the diagnosis? a. Drug reaction

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Ans: amox (JM: Ear)

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b. Serous OM

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Ans: In children OM is most of the time bilateral. Gentamycin is rarely given to children for AOM. (JM)

A boy from Vietnam is presenting 6 weeks after migrating to Australia with fever and myelgia. What is the diagnosis? a. Malaria b. EBV c. HIV Ans: Malaria (JM: Travel Medicine)

A aboriginal boy presented with myelgia, arthralgia and rash. He was also having mild fever. What is the diagnosis? a. Ross river virus b. Chicken pox c. EBV Ans: Ross river.(JM)

A boy presented with petechie in few places of the body. There is a history of viral infection 7 days before. What of following investigation will lead to diagnosis?

b. INR c. APTT

A baby was born with jaundice. Mother is Rh positive and baby too. What is the most probable cause of jaundice (I think blood group was also given and it was compatible)? a. Infection

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Ans: full blood count (JM, Kaplan Pedia: Hemat)

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a. Full blood count

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Ans: Infection (Kaplan Pedia: Newborn)

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