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OSCEkkcth

Question No : 1

List 4 findings on the x- ray


a)

What is the radiological diagnosis?

b)

List 4 causes for the finding in the left


lung

c)

List 4 causes for the finding in the left lung

Answer for Question No : 1


a)

Mediastinal shift (L)


Pneumothorax (L)
Atlectasis (L) lung
Bronchopnemonic changes (R)

b)

Pneumothorax
Bronchopneumonic changes (R)
(Non homogenous opacities

c) 1) Pneumonia
2) Asthma
3) Foreign body in lung
4) Trauma

5) Cystic fibrosis
6) Tracheotomy
7) Subclavian line present
8) Thorococentesis
9) Transbronchial biopsy
10) Lymphomas & other malignancies
11) Ehlers Danlos syndrome
12) Marfan syndrome
13) Gangrene
14) Lung abscess

Question No : 2
LINEZOLID
1)

What group of drug is this?

2)

Mode of action

3)

Name 2 organisms for which this is a


specific drug?

4)

Dosage

5)

Mention important hematological

side

effect?

Answer for Question No : 2


1)

Oxazolidinone

2)

Translation initiation by blocking, formation


of protein synthesis initiation complex by
binding to 50 S ribosomal RNA.

3)

MRSA vancomycin resistant Enterococci,


coagulase negative staphylococci, penicillin
resistant pneumococci

4)

10mg / kg / dose Q8 12 hrs

5)

Thrombocytopenia

Question No : 3
QUINUPRISTIN / DALFOPRISTIN
1)

What group of drug is this?

2)

What is the mode of action?

3)

Against which of the following organisms


this is in effective?

Mycoplasma, chlamydia, staph. aureus


enterococcus faecalis.

Answer for Question No: 3


1)

Streptogramins

Strepto gramins

2)

Synergistic action on bacterial ribosomal


subunit to protein synthesis

3)

Enterococcus faecalis.

Question No : 4
pH

- 7.38

Pco2 - 38
BE

-3

Hco3 - 21
Po2

- 98

1)

Interpret the ABG?

2)

List the indicators of compensation in ABG


in following conditions.

a)

Metabolic Acidosis

b)

Metabolic Alkalosis

c)

Respiratory Acidosis Acute/ Chronic

d) Respiratory Alkalosis Acute/ Chronic

Answer for Question No : 4


1)

Normal ABG

Met. Acidosis PCo2 = 15 x (HCo3) +8+/-2

Metabolic Alkalosis - PaCo2 increases by


7mm of Hg for each 10mq increases in the
(HCo3 -)

Respiratory

Acidosis

Acute

(HCo3)

increases by 1 for each 10mm increased in


Pco2.
Chronic (Hco3) increases by 3.5 for each

10mm increase in PCo2.

Respiratory Alkalosis Acute (HCo3) fall by


2 for each 10mm Hg decrease in PCo2.
Chronic (HCo3) decreased by 4 for each
10mm of decrease in PCo2.

Question No : 5
1) You are asked to counsel a mother whos 9 month of
infant has AWD regarding ORT
Check list:
i)

Introduces himself

ii)

Explains that the main treatment is ORT and explains


the need for rehydration.

iii)

Explains correctly the preparation of ORT


whole packet in 1 liter of water.

iv)
2)

Advises feeding by spoon discourages bottle feeding.

Mother asks what to do if the baby vomits


v) Stop ORT for 5 10minutes and restart feed, give slowly
spoonful every 2 3 minutes
vi)

Advise giving small aliquots of 5 10ml each time.

vii)

Explains the danger signs of dehydration and


explains when she should seek medical attention
Does not become better in 3 days or develops danger
Signs (Seizure / unconscious / rapid breathing etc).

viii) Encourage continuance of breast feeds / normal feeds /


home available feeds.
ix)

Checks, whether the mother has understood or not.

x)

Ask the mother whether there are any doubts.

Answer for Question No : 5


1) You are asked to counsel a mother whos 9 month of
infant has AWD regarding ORT
Check list:
a. Introduces himself
b. Explains that the main treatment is ORT and explains the
need for rehydration.
c. Explains correctly the preparation of ORT
whole packet in 1 liter of water.
d. Advises feeding by spoon discourages bottle feeding.
2)

Mother asks what to do if the baby vomits


v) Stop ORT for 5 10minutes and restart feed, give slowly
spoonful every 2 3 minutes
vi)

Advise giving small aliquots of 5 10ml each time.

vii)

Explains the danger signs of dehydration and


explains when she should seek medical attention
Does not become better in 3 days or develops danger
Signs (Seizure / unconscious / rapid breathing etc).

viii) Encourage continuance of breast feeds / normal feeds /


home available feeds.
ix)

Checks, whether the mother has understood or not.

x)

Ask the mother whether there are any doubts.

Question No : 6
6 yrs old boy is brought for bed-wetting. His
frequency in day time is normal. He is dry in the
day. He is never been dry in the night.
1)

Define this problem? What type is it?

2)

Is

it

complicated

Enumerate

or

uncomplicated?

differences

between

complicated and uncomplicated.


3)

Name

drugs

and

dosage

for

the

pharmacological therapy of this condition.


Name 3 non pharmacological measures for
the management of this condition.

Answer for Question No : 6


1)

Nocturnal Enuresis. Primary Nocturnal Enuresis

2)

Uncomplicated
Uncomplicated

Onset

Primary

Daytime symptoms

absent

Stream

Normal

Complicated
Secondary
+
Abnormal

Physical

Normal

Abnormal

Urine analysis

Normal

Abnormal

3)

Drug ODI!!!
DDAVP

Dose
10 40 mcg/day
Nasal spray

Oxybutinin
Imipramine

10 - 20 mg/day PO
0.9 1.5 mg/kg/day

Non-pharmacological
Behavioral modification, Bladder exercises, alarm device.

Question No : 7

List 3 abnormalities in this ECG


1)

What is the ECG Diagnosis?

2)

List 4 causes for the same

3)
4)

Drug of choice
Mention 1 complication

Answer for Question No : 7


1)

Fibrillary waves
Absence of P waves
Irregular Ventricular response / rhythm

2)

Atrial Fibrillation

3)

Rheumatic Valvular disease

Thyrotoxicosis
Following cardiac surgery
Pulmonary embolism
Pericarditis
WPW syndrome
Mitral regurgitation
4)

Digoxin

5)

Stroke / Thromboembolism

Question No: 8

1) Identify the organism?


2) Name the method and steps used for the
preparation for the smear?

Answer for the Question No: 8


Acid-fast bacilli
Ziehl neelsen technique

CSEWM

Heat and dry. Fix the smear.


Add strong carbol fushcin
Heat approximately for 5mins. Do not boil.
Decolorise the smear with 20% sulphuric acid
Decolorise with ethanol
Wash with water
Counter stain with methylene blue

Question No : 9

1)

Describe the pedigree

2)

What is the mode of inheritance?

3)

Give 4 examples.

Answer for Question No : 9

1)

3 generation pedigree chart showing

All daughters of the affected males have


the disease
Sons of the affected males are normal
Affected females affect of the males
and of the daughters
2)

X- linked dominant inheritance

3)

Hypophosphatemic rickets ( Vit.D resistant)

Incontinentia pigmenti

Oro facial digital syndrome

Rett syndrome

XD RHIO

Question No : 10
The following food substances, which contain Vit.A,
need to be arranged based on Vitamin A content
from high to low.
Papaya,
Guava
Amaranth
Drumstick leaves
Egg
Human milk
Carrot

Answer for Question No : 10


VIT A : CADEPM
Carrot

1167

Amaranth

515

Drumstick leaves

300

Egg

140

Papaya

118

Human Milk

38

Guava

Question No : 11
1) Vitamin A prophylaxis programme in India Mention the dosage and schedule.
2) Daily requirement of Vitamin A.
3) Name two manifestation of hypervitaminosis A?

Answer for Question No : 11


1) 5 doses 9 months 3 yrs
Oral retinol palmitate
1lakh 9 months (along with measles)
2lakh 1 yrs
2lakh 2 yrs
2lakh 2 yrs
2lakh 3 yrs
2) 400mg to 600mg of requirement
Retinal / RE B carotene I.U
0-1yr
350mcg
1200mcg
1166.67
1-6yrs
400mcg
1600mcg
1333.33
>7yrs
600mcg
8400mcg
2000
1mcg = 3.3 IU
1 IU of vitamin A = 0.3mcg at retinal
3) Nausea, vomiting,
anorexia, sleep distress, irritability
Skin desquamation
Hepatomegaly
Pseudo tumor cerebri (diplopia/ papilledema
/cranial N.Palsy)
Alopecia, seborrhea,

cutaneous leisions craniotabes


Tender bony swellings
Fissures at corners and mouth

Question No : 12
Match the following:
1) BCG

- Toxoid & killed bacteria

2) OPV

3) DPT

- Bacterial sub unit

4) Hib

- Viral Antigen

5) Hep B Vaccine

Live attenuated bacteria

Live attenuated viral

6) Typhoid V I

- Killed virus

7) Hep A Vaccine

Capsular polysaccharide

8) Acellular pertusis Capsular polysaccharide

Question No : 13
Answer the following:
What is the Diluent for BCG?
What is the Diluent for MMR?
How long can reconstituted BCG be used?
How long can reconstituted MMR be used?
Name 5 vaccines which should not be frozen
What does IAP recommend at 5 yrs (DPT/DT)?

Answer for Question No: 12


1) BCG

2) OPV

Live attenuated bacteria


-

Live attenuated viral

3) DPT

Toxoid & killed bacteria

4) Hib

Capsular poly saccharide

5) Hep B Vaccine

Viral Antigen

6) Typhoid V I

Capsular poly saccharide

7) Hep A Vaccine

Killed virus

8) Acellular pertusis -

Bacterial sub unit

Answer for Question No : 13


Diluent for BCG is Sterile NS
Diluent for MMR is Distilled water
Reconstituted BCG can be used for 3 hrs
Reconstituted MMR can be used for 1 hr.
DPT, Hepatitis A & B, Varicella, Hib, TT
IAP recommends DPT at 5 yrs.

What are indications for Acellular pertusis


vaccine?
Mention 4 indications for pneumococcal vaccine?

Answer for Question No : 13


Indications are:

Persistent / inconsolable Cry 3 or more hrs in 48 hrs.

Temperature > 40 within 48 hrs


Collapse / shock with (HHE within 48 hrs)
Convulsions with or without fever within 72 hrs of
immunization.

Encephalopathy within 7 days, behavioral problems.


3) Indications:

Prior to splenectomy,
HIV
CSF Rhinorrhea
Sickle cell
Asplenia

CRF
Chronic lung / heart disease

Question No : 14
A 6 year old girl has been referred for evaluation
of anemia. Answer the questions after seeing the
peripheral smear?

a) What is your diagnosis?

b) What would be the confirmatory test to


clinch your diagnosis ?
c) What is the definitive treatment of this
condition ?

Answer for Question No : 14

1)

Hereditary spherocytosis

2)

Incubated osmotic fragility

3)

Splenectomy

Question No : 15
You are asked to resuscitate a newborn with the
provided equipments.
Please ask questions regarding status of infant
wherever necessary.
1)

Check the following equipments before


proceeding further
Bag mask valve
Laryngoscope

2)

Get information about the infant from the


observer before proceeding to resuscitate
and at each step whenever necessary

Answer for Question No : 15

1) Check list for observer.


Bag mask valvedoes he
- attach reservoir?
- check pop off valve?
- check for leak?
Laryngoscope Checks bulb & handle
Does candidate ask the following 5 questions?
Meconium staining of liquor or not?
Term or preterm?
Crying well breathing well or not?
Pink or blue colour?
Good muscle tone?
The Observer Should Say Baby Is Not Breathing
Does he clear airway/provide warmth/ position dry infant?
1..5 marks
and then ask status of baby
Observer Says: Baby Still Not Breathing well
Does he give PPV for 30 seconds?
Correct position
EC clamp technique
Chest expansion
and then ask status of baby
Observer Says Hr- 50/Min, Blue
Does he start chest compressions?
Correct technique?

Question No : 16

1)

What is the diagnosis?

2)

This infant is 8 months old, what is the most


likely type?

3)

What is the earliest sign of this disorder?

4)

What is the first radiological change that


occurs in response to specific therapy?

5)

How could this have been prevented?

6)

What are the non specific urinary findings

in this disorder? (at least 2)

Answer for Question No: 16


1)

Rickets

2)

Vitamin D deficiency

3)

Craniotabes

4)

Appearance

of

provisional

calcification
5)

Supplement of 400IU of vitamin D

6)

Generalized aminoaciduria
Glycosuria
Phosphaturia
Elevated urinary citrate

zone

of

Impaired renal acidification.

Question No : 17
You have performed ICD on a child with
empyema. How will you dispose the used items
given below?
Scalpel blade, hypodermic needles, trochar,
used ampoules
Cotton,

gauze,

linens,

suture

material,

surgical mask, gloves


Pus, 3 way connector
Syringe, plastic covers of gloves and ICD
bag cover

Answer for Question No : 17

Blue / white transparent puncture proof


container

Yellow bag
Red bag
Black plastic bag.

Question No : 18

This child has fever with URI


1)

What is the diagnosis?

2)

What is the causative organism?

3)

Name one serious hematological complication


in this disease.

4)

Name one orthopedic complication.

5)

Name one cause for intrauterine fetal


demise.

6)

What treatment is recommended for severe


hematological complications?

Answer for Question No : 18

1)

Erythema Infection or fifth disease

2)

Parvovirus B 19

3)

Transient aplastic crisis

4)

Arthropathy

5)

Non immune fetal hydrops

6)

IvIg

Question No : 19

Calculate the mean, median, mode and mean


deviation of the diastolic pressures given
below.
83,75,81,79,71,95,75,77,84

Answer for Question No : 19

Mean = 80, Median = 79, Mode = 75 and


Mean deviation = 5.1
The average of the deviations from
arithmetic mean
MD = (x -x)/n

= summation
x
= item values
x
= Mean
x - x = deviation from mean
n
= No. of items

Question No :20
Take relevant history from this parent
whose child is suspected to have urinary
tract infection for the first time.

Answer for Question No : 20


Introduces himself
History of fever
History of constipation
History of urgency
History of malodorous urine
History of suprapubic pain
History of loin pain
Details of coevute toilet training
Wiping from back to front
History of incontinence
History of threadworm infection
Family history of renal disease / stones

Family history of UTI / VUR


Note of thanks

Question No : 21

You are asked to perform rapid sequence


intubation.
Write the steps sequentially.
Mention the names of drugs wherever
necessary.

Answer for Question No : 21


Brief history and assessment
Assemble equipment, medications, etc.
Preoxygenate patient

Premedicate with lidocaine atropine


Sedation and analgesia induced
Pretreat with nondepolarizing paralytic agent
Administer muscle relaxants

Sellick maneuver
Endotracheal intubation
Secure tube, verify position with roentgenogram
Begin mechanical ventilation
Step 5 : Sedatives:
Thiopental
Diazepam
Ketamine
Analgesics:
Fentanyl
Morphine
Succinylcholine
Vecuronium or Pancuronium or rocuronium

Question No : 22
A 2 year child presents with the following
5 episodes of abscesses in 6 months
Photosensitivity
Light skin and silvery hair
Peripheral smear shows large inclusions in all
nucleated blood cells.
1)

What is the diagnosis?

2)

What is the cause for the lighten hair?

3)

What is the mode of inheritance?

4)

Name one life threatening hematological


complications?

5)

What is the neurological manifestation?

6)

Which drug is indicated?

Answer for Question No : 22


1)

Chediak Higashi syndrome

2)

Melanosomes or melanocytes are oversized.


Failure to properly disperse the giant
melanosomes to keratinocytes and hair
follicles.

3)

Autosomal recessive. Mutated gene for CHS


Chromosome 1q2-q44.

4)

Accelerated phase of a lymphoma like


syndrome characterized by pancyopenia.

5)

Peripheral neuropathy and ataxia


Motor

6)

Sensory

High dose ascorbic acid

200mg / 24hrs for infants


2,000mg/24hrs for adults. (2g !)

Question No : 23

Perform Hand Washing

Answer for Question No : 23


a)

Remove ornaments / watch etc. hand


sleeves above elbows.

b)

Perform six steps of hand washing

1)

Palm to Palm

2)

(i) Right palm over left dorsum


(ii) Left palm over right dorsum

3)

Fingers interlace palm to palm

4)

Back of fingers to opposing palms

5)

(i) Rotational rubbing of right thumb


(ii) Rotational rubbing of left thumb

6)

(i) Rotational rubbing of left palm


(ii) Rotational rubbing of right palm

c)

Perform in 2 minutes

d)

Air dry / dry with sterile towel / paper

e)

Discard towel in black cover.

Question No : 24
1) A Lumbar puncture is performed and
the CSF is xanthochromatic. What are
the four possible causes?
2) CSF protein levels are 400mg/dl. What
are the three possible causes for the
same?
3) CSF Glucose in 200mg/dl and blood
glucose is 112mg/dl. List five causes for
the same.
4) CSF is also cloudy, what does it imply?

Answer for Question No : 24


1)

a) Hyperbilirubinemia
b) Subarachnoid hemorrhage
c) Markedly elevated CSF protein
d)

Carotenemia

2) a) TB Meningitis
b) GBS
c) Tumors of spinal cord / brain
d) Degenerative disorders
e) Vasculitis
f) Multiple sclerosis
3)

a) Bacterial meningitis
b) TBM
c) Fungal meningitis
d) Aseptic meningitis
f) Neoplasms of meninges

4)

Elevated WBC or RBC count

Question No : 25
An adolescent presents with history of
ingestion

insecticides

and

has

clinical

features of organophosphorus poisoning.


1) Mention 2 methods of decontamination
needed.
2) What is the mode of action of 2
antidotes used?
3) What 2 laboratory parameters are used
to

confirm

the

diagnosis

organophosphorus poisoning?

of

Answer for Question No : 25


1)

Activated

charcoal

for

gastric

decontamination. Skin decontamination by


removal

of

clothes

stained

with

organophosphorus.
2)

Atropine blocks acetylcholine receptor.


Reverses the muscarinic and CNS effects.
Pralidoxime
between

(PAM)

the

breaks

the

organophosphate

bond

and

the

enzyme, liberating the enzyme and degrading


the organophosphate.
3)

Red

cell

cholinesterase

cholinesterase levels.

and

pseudo

Question No : 26
Answer the following questions after seeing
the X-ray.
1) What are the findings?
2) Name 5 aerobic organisms, which can
cause this?

Answer for Question No : 26


1) Air and fluid filled cyst.
Lung abscess, pneumatocele
2) Streptococcus
Staphylococcus aureus
Escherichia coli
Klebsiella
Pseudomonas

Question No : 27
Dobutamine
1) What is the mode of action?
2) 7kg child requires Dobutamine infusion.
How do you prepare the infusion? What
is the dose?
3) What is T of the drug / peak action?
4) Mention 3 contraindications?
5) Mention at least 6 adverse effects?

Answer for Question No : 27


1)

Act on the 1 adrenergic receptors of the


myocardium.

It

increases

stroke

volume

increased COP causes peripheral vasodilatation


decreases

the

sympathetic

vascular

tone

decreases the after load and there by improving


the myocardial function.
2)

Dose 2.5 15mcg/kg/min. infusion rate of 6mg/kg


in 100ml normal NS, 1ml/hr will give 1mcg/kg/min.

3)

T - 2min, peak action 10 20min. ( Dobu2min ! )

4)

IHSS, atrial fibrillation and atrial flutter, sulfite


sensitivity, hypotension.

5)

Increase myocardial O2 demand tachycardia,


ectopic

heartbeat,

angina

palpitations

tachyarrythmias, tingling sensation, parasthesia


and leg cramps, diarrhoea and abdominal cramps.

Question No : 28
4 year old child is being evaluated for
syncope.
1) Identify the ECG?
2) Mention 2 acquired causes for the above
abnormality?
3) Drug of choice.
4) What should be taught to parents?

Answer for Question No : 28


1) Prolonged QT interval - > 0.45secds.
2) Myocarditis / electrolyte abnormality
like calcium, mitral valve prolapse and
drug induced.
3)

Beta adrenergic antagonist- blockers

4) Parents

should

be

cardiopulmonary resuscitation.

taught

Question No : 29
1) a) List the components of IMNCI?
b) List the components of reproductive and
child health programme?
2)

Mention

highlights

of

the

Indian

project

has

been

adaptation of IMNCI?
3)Which

vaccine

introduced as a part of pilot project in


IMNCI?

Answer for Question No : 29


1a) Family planning
Child survival and safe motherhood
Client approach to health care
Prevention and management of RTI /STD/ AIDS
b) Improvement in case management skills of health staff,
through provision of locally adopted guidelines and activities
to promote their care.
Improvement in overall health system
Improvement in family and community health care system.
2) Inclusion of 0-7 days age in the programme
Incorporating national guidelines on malaria
Anemia, Vit.A supplementation, and immunization schedules
Training of the health personnel begins with sick young
infants upto 2 months
Proportion of training time devoted to sick young infant
and sick child is almost equal
3) Hepatitis B vaccine

Question No : 30

1) What is the diagnosis?


2) What is the confirmatory test?
3) What

neurological

complications

can

occur?
4) Mode of inheritance?
5) What antibiotic is prescribed for this
as prophylaxis?

Answer for Question No : 30


1) Sickle cell anemia
2) Hemoglobin electrophoresis or HPLC
3) Stroke
4) Autosomal recessive
5) Penicillin

Question No : 31
These lesions are tender
1) What is the diagnosis?
2) What 2 common infections and drugs
can trigger this?
3) What 2 non infectious systemic
disorders can trigger this?

Answer for Question No : 31

1) Erythema Nodosum
2) TB, Streptococcus
Sulfa, Phenytoin, Oral contraceptives
3)

IBD, Spondylo arthropathy, Sarcoidosis

Question No : 32
You are asked to provide prophylaxis for bacterial
endocarditis for 2 children with the following clinical
details.
Child 1: 8 year old boy with rheumatic mitral
regurgitation is to undergo dental extraction
tomorrow.
1) What is the drug of choice?
2) Dosage and timing
Child 2: 2 years old male with VSD is to undergo
Cystocopy tomorrow.
1) What is the drug of choice?
2) Dosage and timing.
Child 3 :3 year old who has undergone PDA ligation
2 years back is to undergo dental extraction.
What is the appropriate advice?
Child4: 2 year old with TOF is to undergo circumcision.
What is the appropriate advice?

Answer for Question No : 32


1) Oral amoxycillin 50mg/kg 1hr before
surgery

(or)

Ampicillin IV/IM 50mg/kg hr before


surgery
2) IV Ampicillin 50mg/kg + gentamycin
1.5mg/kg
followed

30mins
6hrs

before
later

by

surgery
IV/oral

Ampicillin/amoxycillin 25mg/kg
3) No prophylaxis needed
4) No need for anti microbial prophylaxis.

Question No : 33
Pedigree chart:

1)

Identify the Mode of inheritance?

2)

Give 3 examples of clinical disorders?

3)

What is the significance of the pedigree symbols


used in this?

Answer for Question No : 33

1) Autosomal dominant
2) Neurofibromatosis, Huntingtons
chorea, Myotonic dystrophy.
3)

- Normal Male

- Normal female

- Affected male

- Affected female

- Proband

- Dead

Question No : 34
Pneumococcal 7 valent conjugate vaccine
1)

What is the protein conjugate?

2)

Route of administration?

3)

Youngest age for administration?

4)

Dosing interval?

5)

Primary immunization schedule for infants


< 6 months of age?

6)

Dose if started at 12 23 months of age?

7)

Dose if started > 24 months to 9 yrs of


age?

Answer for Question No : 34


1)

Diphtheria CRM 197 protein

2)

IM

3)

6 weeks

4)

4 to 8 weeks

5)

3 doses < 1 year


1 dose 12 to 15 months

6)

2 doses

7)

1 dose

Question No : 35
A study was carried out to assess the utility of IgM
Elisa test in the diagnosis of Leptospirosis. Blood culture
positive cases were considered the gold standard for
diagnosis.
A total of 100 cases were studied.
Leptospira were grown in blood culture in 40 of
these cases.
IgM Elisa was positive in 70 out of 100 cases. Out of
these 70 cases, Leptospira were cultured in 30.
IgM Elisa was negative in 30 cases, out of this 30,
Leptospira was grown in culture in 10 cases.
Calculate the following for IgM Elisa as a diagnostic
test for Leptospirosis.
1. Specificity
2. Sensitivity
3. Positive Predictive Value
4. Negative Predictive Value

Answer for Question No : 35

IgM elisa +
IgM elisa -

1)

2)

3)

4)

Blood c/s

Blood c/s

30 (a)
10 (c)
40

40 (b)
20 (d)
60

70
30
100

Specificity:
d
x 100
20
x 100 = 33.3%
d+b
20 + 40
Sensitivity:
a
x 100
30
x 100 = 75%
a+c
30 + 10
Positive predictive value:
a
x 100
30
x 100 = 42.85%
a+b
30 + 40
Negative Predictive value:
d
x 100
20
x 100 = 66.6%
c+d
10 + 20

Question No: 36

A 2 year old child presents with biphasic fever, severe


arthragia and rash tourniquet test is negative. Platelet
count is normal. Hb is 10.28gm.
1)

2)

What is the most probable diagnosis?


a)

Dengue hemorrhagic fever

b)

Measles

c)

Chikunguniya fever

d)

Roseola infantum

List 2 criteria for case definition of this probable


case and4 criteria for confirmed case

3)

What neurological complication can develop?

4)

What family does this virus belong to?

Answer for Question No : 36

1)

Chikunguniya

2)

Features of suspect case-Fever with chills


/

arthralgia

rash

rheumatic

manifestations.

Case definition features of suspect case


and positive serology in acute and convalesce
phase.

Confirmed case probable case with any of


the following :

a)

4 fold rise in antibodies in paired sera

b)

Positive IgM

c)

Virus isolation from serum

d)

Positive RT PCR in serum

e)

Positive RT PCR in serum

3)

Meningo encephalitis

4)

Toga viridiae

Question No : 37

A 10 year old female weighing 30kg; diagnosed case


of IDDM on insulin therapy as follows:
10 (regular)
Morning: 40 units
30 (lente)
7 (regular)
Evening: 20 units
13 (lente)
Her recent morning blood sugars are becoming
high. (Blood sugar at 7.00 am

280 mg%)

1)

What is Somogyi and Dawn phenomenon?

2)

How will you differentiate these two in this


case?

3)

How will you treat in either case?

Answer for Question No : 37

Somogyi phenomenon: Hyperglycemia begetting

1)

hypoglycemia due to counter regulating hormones


in response to insulin induced hypoglycemia.
Dawn phenomen: Hyperglycemia (early morning)
without preceding hypoglycemia due to decreased
availability of insulin and increased GH release.
2)

Measure blood sugar at 3 am, 4 am, and 7 am.

If blood sugar > 80mg/dl in 1st two sample, and


high in 3rd Diagnosis Dawn phenomenon

If blood sugar <60mg/dl in first two sample and


high in 3rd. Diagnosis Somogyi phenomenon

3)

Treatment Dawn phenomenon increased evening dose of


Lente insulin by 10 15%
Somogyi phenomenon decreased evening dose of
Lente insulin by 10-15%.

Question No : 38

Councell the mother of a child who is being discharged


from your hospital following acute severe asthma.

Answer for Question No : 38

1)

Introduces himself

2)

Clearly explains about asthma as hyperactive


airway disease and not infective.

3)

Explains that there is no curative treatment and


treatment reduces the severity and complications.

4)

Explains how to use MDI.

5)

Explains preventive strategies at home.

6)

Explains danger signs / warning signs of acute


attack.

7)

Tells the treatment at home and reach nearest


hospital. Tells difference between Rescue and
prophylactic inhalers.

8)

Explains other alternatives, and ask for any


doubts and clears it.

9)

Need for regular follow up.

10) Note of thanks and availability.

Question No : 39
1)

A child has massive GI bleed.

His clotting time is 12 mins. His PT test is 40 secs,


control 14secs and PTT test is 60 secs, control is 30
His Hb is 11gm and Platelet count is 2.5lakhs.
What blood product would you transfuse? And how
much?
2)

List 4 other indications for transfusion with this


blood product?

3)

List 4 clotting factors deficiencies, which will be


corrected by this transfusion?

4)

Name 2 parasitic disease transmitted by blood


transfusion?

Answer for Question No : 39


1)

Fresh Frozen Plasma - 15ml/kg

2)

a) Severe clotting factor deficiency and


bleeding

b) Severe clotting factor deficiency and invasive


procedure.
c)

Emergency reversal of warfarin effects

d)

Dilutional coagulopathy and bleeding.

e)

Anticoagulant protein (AT III, protein C,


Protein S, FTTP)

3)

II, V, X and XI

4)

Malaria / Chagas disease

Question No : 40
A 13 year old HIV positive boy is seen in OPD for
abrasions injuries over left thigh following RTA 2
days back. He was vaccinated with TT at age of 10
yrs.
1)

What

immunization

advice

is

appropriate?
2)

Mention the dose and route?

3)

What is the amount of Tetanus toxoid


present in DPT, DT and TT?

4)

What is the preservative in TT?

5)

What is the role of Aluminum Phosphate


in TT?

Answer for Question No : 40


1)

a) Clean the wound with soap and water.


b) Administer TT & TIG
c) Advice booster dose.

2)

a) TT 0.5ml IM on one buttock


b) TIG 500U IM on opposite buttock

3)

10 Lf of TT component.

4)

Thiomerosol 0.01% w/v

5)

TT is adsorbed on to aluminum compounds


and increases potency, by reaching high
titers. It also gives long lasting immunity.

Question No : 41
An infant is being evaluated for ambiguous
genitalia. You find clitoral hypertrophy and other
signs of virilization. On investigations Sr. cortisol
levels are low. ACTH & PRA are markedly elevated.
ACTH skin stimulation test reveals markedly
increased

17

OH

progesterone.

Serum

testosterone is also elevated. Child also has severe


hyponatremia.
1)

What is your diagnosis?

2)

What is the mode of inheritance?

3)

What is pre-natal diagnosis?

4)

What advice will you give her for the next


pregnancy?

5)

What treatment you offer for this baby?

Answer for Question No: 41


1)

Congenital adrenal hyperplasia due to 21


hydroxylase deficiency

2)

Autosomal recessive

3)

1sttrimesterCVS,2ndtrimester amniocentesis
for DNA common mutations or polymorphic
micro satellite markers if affected siblings
samples are available for comparison.

4)

Dexamethasone

20mg/kg

pre

pregnancy

maternal wt in two three divided doses.


Prefer CVS. continue treatment if female
child.
5)

Hydrocortisone 10 to 20mg/m2/day tds.


(Increase in stress situation)

Mineralo corticoids 0.1 0.3mg/day BD


Sodium supplements 1 3gm.
Surgical correction.

Question No : 42
Drug: Carbamzepine
1)

Mention 4 clinical indications?

2)

In which type of seizures it is avoided?

3)

What is therapeutic drug levels in blood and


recommended time to draw sample?

4)

Mention 4 common drugs, which increases its


toxicity?

5)

What dose adjustment is needed in ARF?

6)

What is the standard concentration in


suspension?

7)

Mention dosage of frequency of suspension?

8)

What & how frequent lab monitoring is


needed?

9)

Mention 4 life threatening complications?

10) What is treatment of toxicity?

Answer for Question No : 42


1)

GTCS,

partial

seizures,

trigeminal

neuralgia,

bipolar disorders.
2)

Myoclonic seizures

3)

4 12mg/L, 30min. before oral dose.

4)

Erythromycin, INH, TCA, clozapine, itraconazole,


cimetidine.

5)

Mild, mod forms - dose adjustment is not


necessary, severe (Creatnine clearance < 10;
decrease dose by 75%)

6)

5ml = 100mg

7)

10-20mg/kg/day, increased 100mg/day at 1 week


interval (BD/QD).

8)

CBC, SGOT, SGPT every monthly for first 3-4


months and then as needed.

9)

Hyper

sensitivity

reactions,

aplastic

anemia,

pancytopenia, hepatic toxicity, thrombocytopenia.


10) Gastric

lavage

repeated

dose

of

charcoal, hemoperfusion or hemodialysis.

activated

Question
1 year old male with acute gastroenteritis develops
anuria. His Hb is 8.9, Platelet count 90,000 & Pt
24/20, PTT 28/30. His PS is shown below.
1)

Describe PS

2)

Mention two MC D/D for it.

3)

Which single test will help differentiate your


D/B?

4)

This babys renal functions de--erated after 2


units of FFP. What would be the possibility?

5)

What are indications of steroids in this


scenario?

6)

Which

other

findings?

conditions

here

similar

PS

Answer
1)

Microangiopath--- hemolytic anemia with


helmetcells, burn cells, he------- RBCs

2)

HUS, RVT

3)

Doppler USG -------

4)

HUS due to strep pneumonia

5)

Seizures

6)

Malignment HTN, SLE

Question
A 10 year old male with acute onset progressive lower
limb weakness. On detailed CNS examination you find
he

is

cons---

alert

and

normal

cranial

nerve

examinations. No bowel / bladder involvement. His


knee and ankele re--- are brisk and has grade II
power on both lower limbs. You also notice abdominal
reglesses below ----- is absent alibbus sensory system
normal.
1)

what is your progressive diagnosis?

2)

Mention

conditions

where

you

get

hypotension and diminished referes in UMN


lesion?
3)

Mention 3 major points to differentiated extra


modular from intramedially lesions?

4)

Mention a congential conditions leading to non


compressive myelopathy?

Question No : 43
A 8 year old boy is brought because his mother
feels he is short for his age. His height is 80cm.
His fathers height is 160cm and mothers height is
148cm. His US/LS ratio is 1. 4: 1
1)

What type of short stature does this child


have?

2)

What is the mid parenteral height of this


child?

3)

Name 3 causes for the short stature in this


child?

4)

What is the normal US/LS ratio at this age?

5)

Name

conditions

advanced US/LS ratio?

in

which

there

is

Answer for Question No : 43


1)

Dysproportionate dwarfism

2)

160cm

3)

Achandroplasia,

cretinism,

short

limb

chandrodystrophy,

spinal

dwarfism.
4)

1.1:1

5)

Arachynodactyl,

deformity and eunochodism

Question No : 44
An infant with seizures is being investigated. The
following are the lab reports.
Serum Calcium: 6.6mg%
Po4: 9mg%
SAP: 500 units
Mg: 3mg%
1)

What is the probable diagnosis?

2)

What will be the levels of PTH & 1, 25(OH2)


D3?

3)

The same infant is also noted to be dark and


having mucocutaneous candidiasis.
What is your diagnosis?

4)

CT brain is carried out. What finding do you


expect?

Answer for Question No : 44


1) Hypoparathyroidism
2) Both are low
3) Type

polyendocrinopathiy

Addisons)
4) Basal ganglia calcification

(with

Question No : 45

16

week

developmental

infant

is

assessment.

examined
Write

for
what

patterns of behaviour will you expect in this


age?

Answer for Question No : 45


Prone : Lifts head and chest, arms extended.
Ventral suspension : head above plane of body
Supine : TNR and reaches toward and misses
objects.
Sitting : No head lag on pulling, head steady,
tipped forward, enjoys sitting with truncal
support.
Standing : when held erect, pushes with feet.
Adaptive : Sees pellet, makes no move to it
Social : Laughs out loud, excited at sight of food,
may show displeasure if social contact is broken.

Question No : 46
A child with meningoenclphalitis is comatose. His
serum sodium is 116 and you are contemplating
diagnosis of SIADH
1)

Which of the following lab values will be


present?

2)

a)

Urine OSM <100 mosm/l

b)

Plasma volume normal or increased

c)

Urine Na 200mg/L

d)

Serum uric acid 10mg%

Name 2 drugs which increases the vasopressin


levels?

3)

The fluid intake should be restricted to

4)

Which drug may be given?

5)

2 acute respiratory illnesses, which cause this?

6)

Anticonvulsant,

which

decreases

ADH

production?

Answer for Question No : 46


1) a) Urine OSM <100 mosm/l - Negative

b)

Plasma volume normal or increased Positive

c)

Urine Na 200mEq/L - Positive

d)

Serum uric acid 10mg% - Negative

2) CBZ, Vincristine, TCA


3)

1000ml/ m2 /24hr

4)

Demeclocycline

5)

Broncholitis, pneumonia

6)

Phenytoin

Question No : 47
1)

Identify this.

2)

What is the route of entry of this organism?

3)

Name 2 conditions that are high risk for this


infection?

4)

What hematological clue will occur?

5)

Drug of choice?

6)

1 complication

Answer for Question No : 47


1)

Strongyloides stercoralis Larvae

2)

Skin

3)

HIV/ Immunosuppression, PEM, MR,


Autoimmune disease

4) Eosinophilia
5)

Ivermectin 200mcg/kg OD for 1 2 days

6)

Hyperinfection syndrome

Question No : 48
A child with stroke is noted to have Ectopia Lentis,
arachinodactyly blue eyes and developmental delay.
1)

What is the likely diagnosis?

2)

What urine screening test will be positive?

3)

Estimation of plasma amino acids will show

cystine
Methionine
Homocystine
4)

Which vitamin is indicated?

5)

What other drug is needed?

6)

Mode of inheritance?

Answer for Question No : 48


1)

Homocystinuria

2)

Positive cyanide nitroprusside test

3) cystine - Negative
Methionine - Positive
Homocystine - Positive
4)

B6 200 1000mg/24hr

5)

Betaine

6)

AR

Question : 49
You are to meet a child with Thalassemia major
1)

When do you start transfusion?

2)

Optimum Hb

3)

Intervals for transfusion

4)

What is the risk in keeping Hb > 14?

5)

When will HbF be low?

6)

How

do

you

reduce

non-hemolytic

febrile

transfusion?
7)

What is the level of serum ferritin to be


maintained?

8)

Indications for splenectomy

9)

When to give vaccines before splenectomy?

10) Antenatal diagnosis How and When?

Answerfor Question No : 49
1)

< 7gm

2)

9 10gm

3)

2 4 weeks

4)

Thrombosis

5)

After repeated transfusions

6)

Leukocyte filter, pheneramine with paracetamol

7)

< 1000mg/L

8)

> 220ml/kg/yr of PRBCs, hypersplenism,


massive

spleen

discomfort.
9)

Atleast 4 weeks

with

prominent

abdominal

10)

CVS- mutation, 12to 14 weeks (MTP < 20weeks)

Question No : 50
Match the disease with the Urine Screening Test
1) Galactosemia

Nitroprusside test

2) PKU

CN PT

3) MPS

DNPH

4) HCU

Benedicts test

5) Organic aciduria

spot test
(Toludene blue test)

6) Cystinuria

Fecl2

Answer for Question No : 50


1) Galactosemia

Benedicts test

2) PKU

Fecl2

3) MPS

MPS spot test


(Toludene blue test)

4) HCU
5) Organic aciduria
6) Cystinuria

(Nitroprusside test)
DNPH
CNPT

Question : 51
DRUG: Vigabatrine
1) Mode of action?
2) Dosage
3) Important side effects
4) Mention important uses

Answer for Question No : 51


1) Y

aminobutyric

acid,

transaminase

inhibitor
2) 30mg/kg/d, od /bd upto 100mg/kg/d
3) Visual field constriction, Optic atrophy,
optic neuritis
4) Infantile spasms, Tuberous sclerosis
adjuvant for poorly controlled seizures.

Question No : 52

A 2 year old child is brought for Toe walking.


1) What is the commonest cause?
2) What is the Differential diagnosis?
3) Upto what age is it normal?

Answer for Question No: 52


1) Normal children
2) Cerebral

palsy,

Duchenne

muscular

dystrophy, tethered cord, congenital


tendo-achilles contracture, leg-length
discrepancy, CDH and habitual
3) 3 year

Question No : 53
1) What is premature thelarche?
2) Upto what age is it benign?
3) What

is

exaggerated

or

atypical

thelarche?
4) What will be the level of FSH, LH,
oestradiol

in

benign

premature

thelarche?
5) What will be the USG findings?

Answer for Question No : 53


1) Isolated breast development
2)

< 3 yrs

3) Associated with accelerated bone age


due to systemic ostrogen effects
4) Low
5) Small Ovanian cysts

Question No: 54
A child has chronic polyarthritis of 4 joints and is
ANA positive.
2)

What arthritis is it likely to be?

3)

What complication should we anticipate?

4)

In which type of JRA is HLA 27 positive ?

5)

A child with JRA presents with fever,


leuepenia

and

hepatosplenomegaly

and

lymphadenopathy. What is the diagnosis?


6)

What drug is indicated in treatment of Q4?

Answer for Question No: 54


1)

JIA pauciarticular type I

2) Chronic uveitis
3)

Pauciarticular type II

4) MAS
5) Cyclosporin

Question No :55
Oxygen therapy
1)

Below what blood O2 does WHO recommend


O2 therapy?

2)

What are the clinical indications for O2


therapy?

3)

O2 concentration with reference to FiO2


Nasal prongs @1-2 lit/min, Nasopharyngeal
catheter

Answer for Question No : 55


1)

<90%

2)

Central cyanosis, unable to drink due to


respiratory distress.
In those with pneumonia, Broncholitis and

asthma- severe lower chest in drawing, RR >70,


Grunting, Head nodding
3)

FiO2 30 35 %, 45 60 %

Question No : 56
A child is brought with snakebite.
1)

In which of the following is appropriate as


first aid.
a)

Splint the limb

b)

Apply ice

c)

Apply tourniquet to occlude venous flow

d)

Clean the wound

e)

Transport to hospital

2)

2 specific indication for ASV

3)

What is the dose of ASV to a 3 year old?

4)

What is the diluent for ASV?

Answer for Question No : 56


1) a)
b)

Splint the limb Clean the wound

c) Transport to hospital
2) Indications:
a) Systemic signs of envenomation
b) Local symptoms like severe necrosis, swelling
of > half of the limb
3) Same as adult
4)

Normal saline (2 to 3 volumes)

Question No: 59

1) What are the 4 types of lesions?


2) What bacteria cause this?
3) Which drug can induce this?
4) Name 4 drugs used?
5) What Dietary advice will you give?

Answer for Question No : 59


1)

Open Comedones blackhead


Closed comedones whitehead
Papules, pustules and nodulocystic lesions

2)

Propionibacterium acnes

3) Corticosteroid, androgens, INH, phenobarbital,


Phenytoin, B12 and lithium
4) Benzoyl Peroxide, Tretinoin, Adapalene,
Topical Erythromycin and clindamycin
Use for 4 to 8 weeks:
Systemic therapy: Tetracycline, Doxy, Minocycline
Isotretinoin (nodulocystic) (teratogenic)
Intradermal triamcinolone
5) Normal

Question No : 57
A child presents with muscle cramps. The serum
Magnesium is 1mg/dl, K is 1.6mg/dl and Hco3 is 40mg/dl.
There is no dehydration.
1)
2)
3)

What electrolyte in urine will you estimate?


Why?
The level of the urinary electrolyte estimated is
high BP is normal. List 3 possible diagnosis?

4)

There is no history of drug ingestion or failure to


thrive hypertension. What is the diagnosis?

5)

3 drugs for treatment

6)

What will be level of renin and aldosterone in


serum?

7)

What will be the urinary calcium level?

Answer for Question No : 57


1)

Calcium

2)

To distinguish low and high urine calcium


levels

3)

Barters, giltelmans and base administration

4)

Giltelman syndrome

5)

Na, mg and spiranolactone

6)

Normal

7)

Low

Question No : 58
A child is admitted with TCA poisoning.
1)

What are the 3 Cs in manifestations?

2)

What ECG findings do you anticipate? (3)

3)

Which of the following is correct?


a)

Emesis is indicated

b)

Activated charcoal to be given

c)

Na Hco3 must

d)

PH should be 7.45 to 7.55

e)

Lidocaine not be used for any time

f)

Quinidine & procainamide - to be used

g)

NaHco3 is used to prevent cardiac


arrhythmias

Answer for Question No : 58


1)

Coma, convulsion, cardiac toxicity

2) Widening of QRS, Q-T prolongation,-, flat


or inverted T , ST depression, RBB, CHB
3) A) No
b) Yes
c)

Yes

d) Yes
e) No
f)

No

g) Yes

Question No : 61

1)

What is the diagnosis?

2) Name 2 topical agents of use?


3) Duration and frequency?
4) 2 drugs for systemic therapy?
5) Commonest organisms?

Answer for Question No : 61


1)

Tinea corporis

2) Miconazole,

ketoconazole,

clotrimazole,

econazole, terbinafine, niftifine


3) Bd, 2 to 4 week
4) Griseofulvin several weeks
Itraconazole 1 2 week
5) T. Rubrum, T. Mentagrophytes

Question No : 60
Write the calorie value of
Rice 1 cup
Puri 1
Upma 1 cup
Idli 1
Dosa 1
Kichidi - 1 cup
Boiled egg - 1
Vada - 1
Pizza 1 slice
Oil 1 tbsp
Ice cream cup
Peanuts 50 nos
Banana 1
Cashew nuts 10
Milk chocolate 25gm

Answer for Question No : 60


Rice 1 cup - 170
Puri 1

- 100

Upma 1 cup - 270


Idlli 1

- 75

Dosa 1

- 125

Kichidi - 1 cup - 200


Boiled egg 1 - 90
Vada 1

- 70

Pizza 1 slice - 200


Oil 1 tbsp

- 60

Ice cream cup - 200


Peanuts 50 nos - 90
Banana 1

- 90

Cashew nuts 10 - 95
Milk chocolate 25gm - 140

Question No : 62
This girl has palpitation, diarrhea, and loss of
weight
1)

What is the diagnosis?

2)

The thyroid swelling is not tender, not


nodular. She has exophthalmos. What is the
cause?

3)

List 4 other causes?

4)

Investigations

5)

2 drugs used

Answer for Question No : 62


1)

Hyperthyroidism

2)

Graves Disease

3)

Toxic adenoma, toxic multinodular , subacute


thyroiditis, Lymphocytic thyroiditis, iodine
induce,

exogenous

hormone,

pituitary

adenoma and ovarian tumor.


4)

TSH is decreased, T4 increased. Thyroid


uptake increased

5)

blockers, methimazole (propylthiouracil)

Question No : 63
A spirometry is performed in an asthmatic child
1)

What will be abnormalities in the following:

FEV1
FEV1 / FVC
Improvement in FEV1
Exercise challenge
2)

What PEFR variation that is consistent with


a diagnosis of asthma?

Answer for Question No : 63


1)

FEV1 Low

FEV1 / FVC ration < 0.8


Improvement in FEV1 with inhaled 2 agonist
12%
Exercise challenge worsening in FEV1 15%
2) Morning to afternoon variation 20%

Question No : 64
The following is the ABG is an infant
PH - 7.2, Hco3 10, CO2 30
1)

What is the diagnosis?

2)

Why?

3)

Give an example of a common clinical setting


for this condition?

4)

Write the other compensation in acid bone


disorder. Which are appropriate?

Answer for Question No : 64


1)

Metabolic acidosis respiratory acidosis

2)

Expected Co2 = 1.5 X (10) + 8 2


= 21 to 25
Co2 >25

3)

Pneumonia with sepsis (lactic acidosis and respiratory


acidosis)

4)

Metabolic alkalosis Pco2 7mm for 10meq/L of Hco3


Respiratory acidosis Acute: Hco3 1 for 10mm in
Pco2
Chronic: Hco3 3.5 for 10mm in Pco2
Respiratory alkalosis Acute: Hco3 2 for 10mm
in Pco2
Chronic: Hco3 4 for 10mm in Pco2

Question No : 65
Serum Na - 136, Cl - 102 and Hco3 - 10
1)

What is the anion gap?

2)

What is the normal anion gap?

3)

In which of the following is anion gap normal or


increased?

Diarrhea
Lactic acidosis
DKA
ARF
RTA
Salicylate poisoning
Urinary tract diversion
IEM
Septic shock
Post hypocapnea

Answer for Question No : 65


1)

(136) (102 + 10) = 24

2)

8 16

3) Diarrhea - Normal
Lactic acidosis - increased
DKA - increased
ARF - increased
RTA - Normal
Salicylate - increased
Urinary tract diversion - Normal
IEM - increased
Septic shock - increased
Post hypocapnea - Normal

Question No : 66

1)

What is the mode of inheritance?

2)

2 examples

3)

Characteristics of the inheritance

4)

Plasma ammonia in this child is normal. What


is the likely diagnosis?

5)

There is no odor or skin lesion, but there is


ketosis. What is the likely diagnosis?

Answer for Question No : 66


1)

XLD

2)

VDRR

(Hypophosphotemia),

incontinentia

pigmenti
3)

Affected men

all
All

All

affected
normal

of affected have 50% inheritance

Rare XLD -

milder disease

Thrice as common as male


4) Organic acidemia
Urea cycle NH3 , anion gap normal
Amino acid defects
or

Galactosemia

NH3 normal, anion gap normal

5) MMA,
Propionic acidemia,
Ketothiolase deficiency
Odor + - MSUD / isovaleric
Skin + - Multiple carboxylase deficiency
Ketosis - Acyl CoA, 3Hydroxy 3HGA, HMG co synthetase deficiency

Question No : 67
1)

What is the clinical classification of leprosy


in India?

2)

What

are

the

differences

in

leprosy

constitution?
3)

What is the WHO recommended standard


treatment regime for children aged 10 14
yrs?

Answer for Question No : 67


1)

Indeterminate
Tuberculoid
Borderline
Lepromatous

Paucibacillary 1 to 5 lesions
in skin
Multi bacillary > 5 lesions

Pure neuritis
2) Case of leprosy clinical sign +

Bacilli in smear +
Not completed treatment
Paucibacillary 1 to 5 lesions
Multibacillary
Adequate treatment
Repeated treatment

Newly diagnosed case


Defaulter
Relapsed case
3) Multi Bacillary (completed in 12 months)
RMP 450mg once a month
Clofazamine 150mg once a month (supervised)
Clofazamine 50mgEod (self administered)
Dapsone 5omg once a month (supervised)
Dapsone 50mg daily dose ( domiciliary)
Pauci Bacillary (completed in 6 months)
Rifampicin 450mg once a month
Dapsone 50mg OD daily (domiciliary)

Question No : 68
Midday meal program
1) What are the principles?
2) Write a model menu?

Answer for Question No : 68


1)

Meal a supplement, not a substitute to


home diet

Should supply 1/3 of total energy, of protein


Cost low
Easily cookable in school
Use locally available foods
Change menu frequently
2)

Cereals & and millets 75gms


Pulses - 30
Oil & fat - 8
Leafy vegetable 30
Non-leafy - 30

Question No : 69
Answer the following questions with regard to
cold chain equipment:
1)

Which vaccines are stored in deep freezers?

2)

Which vaccines are stored in ILR?

3)

Which vaccines are kept in the basket of


ILR?

4)

What is the function of cold boxes?

5)

What are Day carriers used for?

6)

What are vaccine carriers used for?

7)

Which vaccines should not be frozen?

Answer for Question No : 69


1)

Measles & OPV

2)

All

3)

TT, DPT, DT and diluents (not in the floor


may be frozen)

4)

Transportation of vaccines

5)

Carry small quantities of vaccines to a nearly


session.

6)

Carry small quantities of vaccines to out of


reach session

7)

DPT, DT, TT, Typhoid, BCG, HBV, diluent

Question No :
A 11 year old boy is brought with a penetrating crush
injury with a compound fracture. His immunity and
immunization status for tetanus is unknown. Which of the
following action is correct with regard to tetanus
prevention?
a)

Nothing is required

b)

Toxoid 1 dose

c)

Toxoid 1 dose + TIG

d)

Toxoid complete course + TIG

His 8 year old sister has multiple clean abrasions. She


has earlier received 3 doses of DPT in the first year and
1 booster at 1 year and no other vaccines after that
What prevention will you carry out?

Answer for Question No :


All wounds surgical t------

< 6hr, clean, non

penetrating with negligible tissue damage


a)

Nothing

b)

TT 1

c)

TT 1

d)

TT complete course

All wounds surgical t------ other wounds

immunity

category.
a)

Nothing

b)

TT 1

c)

TT 1 + TIG

d)

TT complete course + TIG

a)

Complete course + Bon----- < 5 yrs

b)

Complete course + 5 to 10 yrs

c)

Complete course + > 10 yrs

d)

Immunity unknown + has not heel a complete


course of toxoid.

Question No : 70
The peak flow rates of 10 children of same age are
as follows:
250, 260, 290, 200, 240, 240, 260, 270, 270, 290
1)

What is the range?

2)

What is the mean deviation and Mean?

3)

What is the standard deviation?

Answer for Question No : 70


1)

90 (200 to 290)

2)

Mean Deviation = (x x)
N

Mean 257, Mean Deviation 19.8


3) Standard deviation = ( x x ) 2

(>30)

n
Standard Deviation = ( x x ) 2

(<30)

n-1 in this case (10-1)


Take the deviation of each value from Mean (x-x)
Square each (x x )2
Add and squared deviation ( x x ) 2
Divide by no. of observation or n-1 if <30
Then take square root

Answer No for Question No : 71


Resected tissue from OT Chemical disinfect ion
and discharge into drain
Waste from laboratory
culture

Chemical disinfect ion


/ autoclave /
microwave and mutilation
shredding

Needles and syringes

Disinfect ion / shredding

Discarded medicines

Autoclaving / microwaving
/ incineration

Linen contaminated

Incineration autoclaving

with Blood

/ Microwaving

Used IV set

Incineration and drug


disposal in secured land
fills

Liquid waste from house


keeping

Incineration / deep burial

Question No : 71
Write the correct method of treatment and disposable
of the following categories of biomedical work?
Resected tissue from OT

Incineration / deep burial

Waste from laboratory

Autoclaving / microwaving

culture

/ incineration

Needles and syringes

Disinfect ion / shredding

Discarded medicines

Incineration and drug


disposal in secured land
fills

Linen contaminated

Incineration, autoclaving

with Blood

/ Microwaving

Used IV set

Chemical disinfect ion /


Autoclaving / microwaving/
Multilation/ shredding

Liquid wask from house

Chemical disinfect ion

keeping

and discharge into drain

Question No : 72

This child also has joint hypermobility


1)

What is the diagnosis?

2)

What is the usual mode of inheritance?

3)

What is the defect?

4)

How many clinical forms?

5)

What cardiac among can occur?

6)

What surgical emergencies?

7)

Difference with Cutis Laxa

Answer for Question No: 72


1)

Ehlers Danlos

2)

AD

3)

Defect of fibrillar collagen quantitative

4)

10

5)

MVP, AR

6)

Rupture of great vessels, dissecting aneurysm,


stroke,

rupture

of

uterus

in

pregnancy,

echymoses, periodantitis.
7)

Cutis Laxa skin hangs in redundant folds AR

EDS hyperextensible snaps back into place when


stretched - AD
Cutis Laxa Bloodhound appearance, aged appearance
Hyperelasticity and hypermobility of joints, hoarse cry,
lax vocal cords

Question No : 73
A child is brought with a history of accidental
ingestion of Iron tablets.
1)

Which one of the following would be of


benefit?

Gastric Lavage
Activated charcoal
Whole bowel irrigation
2)

When would you measure serum Iron?

3)

What is the level of serum Iron which


indicate significant toxicity?

4)

If serum iron level reports were delayed,


how would you confirm iron ingestion?

5)

What are the 2 indications for giving


desferioxime?

6)

What system exhibits symptom first?


When?

Answer for Question No : 73


1)

Whole bowel irrigation

2)

4 8 hrs after ingestion

3)

>500g/dl

4)

X ray abdomen

5)

Level >500g/dl
Moderate to severe symptoms

6)

GI, 30 minutes to 6 hr

Question No : 74

1)

What is the diagnosis?

2)

What 2 findings are characteristics?

3)

What is the effect of treatment?

4)

List 4 drugs useful

5)

What physical therapy will help?

Answer for Question No : 74


1)
2)

Psoriasis
A) Plaques with yellowish white scale like
mica

b) Auspitz sign pinpoint bleed or removal


3)

Koebner phenomenon lesions appear

4)

Coal tar, topical steroid, salicylic acid,


calcipotriene (Vit.D analog), Methotrexate &
cyclosporine and retinoid

5)

UV light

Question No : 75
Assess the development of this 3 year
old

Answer for Question No : 75


Motor : Rides tricycle, stands on the foot
momentarily
Adaptive : Tower of 10 cubes, imitates bridge
construction of 3 cubes, copies a circle, imitates
a cross
Language : Knows age and sex, counts 3 objects
correctly, repeats 3 numbers or a sentence of 6
syllables
Social : Plays simple games with other children in
parallel, helps in dressing put on shoes,
unbuttons, washes hands.

Question No : 76

1) What is the diagnosis?


2) Commonest organism?
3) Treatment

Answer for Question No : 76


1)

Cutaneous larva migrans

2)

A. Braziliense (Hook worm of dogs and cats)

(other anky + & Strongyloides)


3)

Ivermectin 200mg/kg/one 1 to 2 days


Albendazole 1 OD X 3 days
Topical thiabendazole

Question No :
A mother says she has the following problems in breastfeeding
1)

A not enough milk

2)

The baby is reluctant to breast feed

Answer for Question No :


If not enough milk poor weight ----- <500/--<125gm/--< birth weight after 2 weeks
<6 times / day urine strong / smelling concentrated urine
Common reasons :
Poor breast feed p------- :
Poor attachment, no night feeds, delayed start, short feeds,
rigid schedule, broke, other feeds
Psychological strem, tired
Physical causes
Baby is illness / con---- among
Advice :
Refusal or reluctance to breast feed :
Baby is in pain, ill, sedation
Encourage to ---- and feed more often
Use EBM
Rooming in
Correct positioning
Clear ------ nose

Treat oral
sedation to mother

Question No : 77
Amniocentesis is brief contemplated for pregnant
woman for genetic counseling
1)

What is the ideal time?

2)

What is the most common indication?

3)

Name 4 other indications?

Answer for Question No : 77


1)

15 to 16 weeks

2)

Advanced maternal age > 35 yrs

3)

a) Previous child: chromosomal anmaly


b) Either parent - a translocation cause
c) History of genetic disorder diagnosed
by DNA analysis / biochemistry
d) Sex detection in XLD / XLR diseases
e) Maternal blood testing (triple screening)
indication

risk

f) Work up for fetal anomalies suggested by


USG

Question No : 79

1)

Identify the abnormality in RBC?

2)

This child has chronic diarrhea. What is


the diagnosis?

3)

Which vitamin deficiency in these children is


associated with neurological symptom?

4)

Which lipid abnormalities are


characteristics?

5)

What is the fundus finding?

6)

What is the mode of inheritance?

Answer for Question No : 79

1)

Acanthocytosis

2)

A Betalipoprotenemia

3)

Vit. E

4)

Cholesterol
TGL
Absent B Liproteins

5)

Retinitis pigmentosa

6)

Autosomal recessive

Question No : 78

An infant has cough and difficult breathing


The respiratory rate 70 / min
The infant has severe respiratory distress (head
nodding)
1)

What does the infant have as per ARI


programme?

2)

What are other criteria for this status?

3)

Will you treat this infant as OP or IP?

4)

What is the antibiotic therapy regimen?

Answer for Question No : 78


1)

Very severe pneumonia

2)

Central cyanosis
-------- to feed / drunk or vomited
everything
--------- / lethargy / -----------

3)

IP

4)

Ampi + Gentfor 5 days


Oral ------- for 5 days
Or
CM for 10 days
Or
Ceftriaxone

Question No: 80

1)

Identify the organism?

2)

What 4 stains are used?

3)

What is the treatment?

Answer for Question No : 80


1)

Pneumocystis carinii

2)

Grocott- Gomori

cyst

Toluidine blue
Polychrome Giemsa
Trophozoites and sporozoites
Fluorescent labeled MAB
3)

5mg/kg once daily 3 day a week


Cotrimoxazole
15 20mg in 4
3 weeks for AIDS
2 weeks for others
Pentamidine

Atovaquone, trimextrate + steroids

Answer for Question No . 82


1)

Giandia Lambia

2)

Acute Explosive fowl smelling watering


diarrhoea
Abd distusion / flatuluce / nansea anorara
and epigastic cramps

3)

FTT / Lactose Mal Absorbtion / Persistant


Steattorrhoea, E hystlylica diarrhoea
injection
Metronidayole 15 kg

4)