WADIA OSCE

NOTE: 

The OSCE Questions & Answers are prepared by the faculty of B.J.Wadia Hospital For Children , Parel , Mumbai for the benefit of Post graduate students. These Questions and answers are made for the students to understand the pattern of OSCE and not meant to completely cover the subject of Pediatrics. NOTE

One yr old child presented with fever, barking cough and breathing difficulties. Initially child was having only running nose . O/E: Tachypnoea, stridor, subcostal retractions, intercostal retractions. A] What is the diagnosis? B] What is the usual etiological agent? C] Which X ray sign is diagnostic of this condition?: 

One yr old child presented with fever, barking cough and breathing difficulties. Initially child was having only running nose . O/E: Tachypnoea, stridor, subcostal retractions, intercostal retractions. A] What is the diagnosis? B] What is the usual etiological agent? C] Which X ray sign is diagnostic of this condition?

Answers: A] Croup B] Parainfluenza A C] Steeple sign: 

Answers: A] Croup B] Parainfluenza A C] Steeple sign

4yr old child was followed by a paediatrician for a period of 1 year. He presented with haemoptysis, 1-2 episodes of malena. O/E: B/L wheeze and coarse crepts Gen. Exam: Severe pallor, clubbing, cyanosis. CBC showed Iron deficiency anaemia A] What is the diagnosis? B] What is the diagnostic investigation with findings? C] Which heart condition can give rise to this condition?: 

4yr old child was followed by a paediatrician for a period of 1 year. He presented with haemoptysis, 1-2 episodes of malena. O/E: B/L wheeze and coarse crepts Gen. Exam: Severe pallor, clubbing, cyanosis. CBC showed Iron deficiency anaemia A] What is the diagnosis? B] What is the diagnostic investigation with findings? C] Which heart condition can give rise to this condition?

Answers: A] Pulmonary haemosiderosis B] Bronchoalveolar lavage Haemosiderin laden macrophages C] Mitral stenosis.: 

Answers: A] Pulmonary haemosiderosis B] Bronchoalveolar lavage Haemosiderin laden macrophages C] Mitral stenosis.

Two yr old male child brought to a health care centre with c/o respiratory rate of 40/min without any chest indrawing. A] Classify the severity of the disease according to IMCI. B] What is the choice of antibiotics?: 

Two yr old male child brought to a health care centre with c/o respiratory rate of 40/min without any chest indrawing. A] Classify the severity of the disease according to IMCI. B] What is the choice of antibiotics?

Answers: A] Severe pneumonia B] Amoxycillin and Septran: 

Answers: A] Severe pneumonia B] Amoxycillin and Septran

35 weeks old newborn with BWt 2kg presented with episodes of coughing cyanosis and respiratory distress specially after feeding at 12 hours of age. O/E Tachypnoea, SCR, ICR P/A Scaphoid abdomen There was difficulty passing a nasogastric tube at birth. A] What is the diagnosis? B] Which associated anomalies should be looked for?: 

35 weeks old newborn with BWt 2kg presented with episodes of coughing cyanosis and respiratory distress specially after feeding at 12 hours of age. O/E Tachypnoea, SCR, ICR P/A Scaphoid abdomen There was difficulty passing a nasogastric tube at birth. A] What is the diagnosis? B] Which associated anomalies should be looked for?

Answers: A] Esophageal atresia B] VATER/ VACTRAL: 

Answers: A] Esophageal atresia B] VATER/ VACTRAL

6y old child after suffering from acute episodes of asthma suddenly started c/o stabbing pains in the chest radiating to neck O/E Decrease cardiac dullness to percussion. Mediastinal crunch on auscultation A] Identify the complication B] Name two conditions that can give rise to this complication. : 

6y old child after suffering from acute episodes of asthma suddenly started c/o stabbing pains in the chest radiating to neck O/E Decrease cardiac dullness to percussion. Mediastinal crunch on auscultation A] Identify the complication B] Name two conditions that can give rise to this complication.

Answers: A] Pneumomediastinum B] Trauma Dental extraction Esophageal perforation DKA: 

Answers: A] Pneumomediastinum B] Trauma Dental extraction Esophageal perforation DKA

Slide 13: 

A 3 year old girl presents with h/o vaginal bleeding( 2 episodes over the past 5 months). P/E Breasts TS I, Big café au lait spots over the face and abdomen. What Blood tests will you do in this child? What is the diagnosis? C) What is the cause of the bleeding? D) What are some other features you may see in this condition?

Slide 14: 

A) LH,FSH,Estradiol B)McCune Albright Syndrome C) Autonomous activation of gonads D) Autonomous activation of other glands like thyroid, parathyroids

Slide 15: 

A 3 year old boy presents with h/o progressive penile enlargement and pubic hair growth over the last 6 months.P/E PH TS III, SPL 6.5cms, Testicular volume= 8 ml bilaterally. Other exam normal. A) What is your diagnosis? B) What is the probable underlying cause? C) What tests will you do to diagnose this condition? D) What treatment will you offer?

Answer: 

Answer A) Central precocious puberty B) Hypothalamic hamartoma C)GnRH stimulation test and MRI Brain D) GnRH agonists

Slide 17: 

A 5 years old girl is admitted with fever polyuria ,polydipsia for 10 days and abdominal pain for 1 day. Her blood sugar is 480 mg%. On examination she looks sleepy,dehydrated and tachypneic. What is the likely diagnosis? The immediate treatment would be: 1. IV Normal Saline 2. 0.2% DNS 3. 1/3 NS 4. 1/3 NS with kesol c)What investigations from following list will guide you in immediate treatment? 1.Blood gas 2.Urine exam 3.Sr. Insulin 4. Sr electrolytes C-peptide levels d)What CNS complication can you encounter during treatment?

Slide 18: 

a) Diabetic ketoacidosis b)1 c)1,4 d) cerebral edema

Slide 19: 

Fill in the following Age Upper segment/ lower segment Birth 3 years 5 years 10 years

Slide 20: 

Age Upper segment/ lower segment Birth 1.7 3 years 1.4 5 years 1.3 10 years 0.98-1

Slide 21: 

Home monitoring of blood sugar in a diabetic child taking insulin prebreakfast and predinner ,mixed split regimen(regular and NPH) reveals following Pre breakfast Before lunch predinner Before sleeping(11pm) 3am Day1 250 168 300 100 60 Day 2 278 200 298 120 70 3 248 150 234 98 56 4 300 224 288 112 80 5 260 168 220 140 62 6 238 156 200 136 78 a)What changes would you make in insulin therapy b) What is the reason for morning hyperglycemia c)When should the parents test for urine ketones

Slide 22: 

Ans:a) Increase pre-breakfast Lente and decrease pre-dinner lente b) somogyi phenomenon due to production of counter regulatory hormones in the night due to hypoglycemia c) When the blood sugar is > 300 or during sick days.

Slide 23: 

The developmental age of a 3 year old child is 1 ½ years. a) What is his DQ? b) Which Indian developmental screening tests are available? c) Which aspects are considered while assessing development by Vojta technique? d) Which testing scheme is used in Bayley scales of infant development?

Slide 24: 

a)50 b)Baroda developmental screening test and Trivandrum Developmental Screening Chart c)Postural reactions and central coordination d)BSID administers 130 test items covering mental,motor and infant behaviour.

Slide 25: 

Fill in the following table regarding developmental reflexes in normal children Reflex Age of appearance Age of disappearance Rooting Moro Landau Parachute

Slide 26: 

Ans Reflex Age of appearance Age of disappearance Rooting Birth 3 months Moro Birth 5-6 months Landau 10 months 24 months Parachute 8-9 months Persists

Slide 27: 

At what age does child copy following figures: a)square b)circle c) diamond d) vertical stroke

Slide 28: 

a)4 years b)3 years c) 5 years d) 2 years

Match the following : 

Match the following Relationship between bone age(BA), Cause of abnormal growth Chronological age(CA)and height age(HA) 1) HA=BA>CA a)Familial short stature 2)HA=BA<CA b) Growth hormone deficiency 3) HA < BA= CA c )Constitutional delay in growth and puberty 4) HA<BA<CA d) Simple virilising CAH

Answer:: 

Answer: 1-d; 2- a; 3-c; 4-b

Slide 31: 

Match the following Physical finding Aetiology 1)Disproportionate short stature a)Growth hormone deficiency 2)Frontal bossing,small penis,depressed nasal bridge b)congenital hypothyroidism 3)Round face,short 4 th metacarpal,mental retardation c)Cushing syndrome 4)Central obesity,striae,proximal weakness d) pseudohypoparathyroidism

Answer: 

Answer 1-b; 2- a; 3-d; 4-c

This 5 year old boy was brought with learning disability and attention deficit. His examination revealed skin lesions Identify the skin lesions ? Give at least 2 features required for making the diagnosis What will the ophthalmic examination show? What is the inheritance pattern? : 

This 5 year old boy was brought with learning disability and attention deficit. His examination revealed skin lesions Identify the skin lesions ? Give at least 2 features required for making the diagnosis What will the ophthalmic examination show? What is the inheritance pattern?

Slide 34: 

Café au lait spots. Any two of the following 6 or more café- au –lait macules more than 5mm in prepubertal and over 15mm in post-pubertal individuals. Axillary or inguinal freckling. 2 or more lisch nodules. 2 or more neurofibromas. Optic gliomas. Opthal examination for lisch nodules Autosomal dominant.

Slide 35: 

4 yrs old, boy , FTND, Normal motor, mental and language milestones. Complaints from school – aggressive, can’t sit in one place, restless, forgetful and impatient, problems with friends, fights. Diagnosis? 3 cardinal features of this condition 2 treatment options

Slide 36: 

ADHD Inattention, hyperactivity and impulsivity Medications (methyl phenidate, amphetamines, fluoxitine, atomoxitine), Behavior therapy

Slide 37: 

4.A full term ,male child develops jaundice on day 3 of life, (S. bilirubin –34 mg%)and undergoes an exchange transfusion . What is the immediate complication likely to occur? Where is the anatomical abnormality? What are the long term complications? Name 1 investigation you would insist on after discharge?

Slide 38: 

Kernicterus Globus pallidus, dentate nucleus, cerebellar vermis, cochlear nuclei Choreoathetoid cerebral palsy, dystonic / dyskinetic CP, Sensorineural deafness, Audiometry testing

Slide 39: 

18) Name the sign 3 DDs 3 investigations in sequence of importance Inheritance/ locus

Slide 40: 

Gower’s Sign Duchenne, SMA III, Limb girdle dystrophy, BMD, myopathy Dystrophin gene study, EMG /NCV, CPK levels X linked recessive/ Xp 21

Slide 41: 

26 ) Label the parts shown

Slide 42: 

Corpus callosum Lateral ventricle 4 th ventrricle Pons medulla

Slide 43: 

10 months child with bacterial meningitis has hyponatremia. Sr .sodium 128 meq/l. sr k 4.5meq.urine output of child is 4.1 cc/kg/hr. urine sodium 102 meq/l child become hypotensive requiring fluid bolus . A) what is a cause of hyponatremia. B)what other steps help in diagnosis? C)How will you correct the electrolyte imbalance? D)Give two symptoms of hyponatremia.

Slide 44: 

A) cerebral salt wasting B) sr uric acid , sr vasopressin level C) 3% NaCl , 6 ml/ kg over 2 hrs. D)convulsion, irritability,alteration of sensorium.

Slide 45: 

4 years old male child with severe pneumonia, neurologically normal has folllowing investigations .Sr Na129 meq, Sr K 4.1, urine sodium31 meq, urine K 12 meq. His urine output is 1.2 cc/kg/hr. A) what is most likely diagnosis? B) how will you treat this condition? C) what are other 2 conditions causing similar conditions?

Slide 46: 

A) SIADH B) fluid restriction C) cns disease ,severe infections,respiratory tract infections, tumors. D) SIADH. URINE Na high. Sr. uric acid low. urine output low. Sr .vasopressin high ,.intravascular volume status normal or high.

Slide 47: 

A child with pneumonia on ventilator has following ABG report. Ph 7.29, pco2 60 ,po2 68, hco 330,spo2 92. A) what is acid base disorder B) whether it is ( mixed or simple) C) is it compensated? D) what is most like interversion.?

Slide 48: 

A ) respi acidosis B )simple C) uncompensated D) increase ventilator rate

Slide 49: 

Diagnose the X-ray. How will you manage this case?

Slide 50: 

Supracardiac TAPVC Decongestive therapy . Corrective repair on diagnosis.

Slide 51: 

This is lead II ECG of neonate who presented with excessive crying. Systolic NIBP is 80 mm HG What is the ECG diagnosis. DC shock available , is treatment of choice Y/N Is any treatment necessary , If yes mention doses .

Slide 52: 

(4) SVT(1) No (1) Vagal maneuvers , Ice filled packs on face, Carotid massage Adenosine with dose and method of administration Digoxin Ciplar

Slide 53: 

What is the dose and schedule of Indomethacin given for the closure of PDA in a newborn who is less than 48 hrs old? Name another condition which can be prevented by administration of indomethacin in a preterm newborn. What are the four main Contraindications to the use of indomethacin.

Slide 54: 

200 microgram stat foll by 100 microgram foll by 100 microgram at 12 to 24 hr interval. Intracranial Hemorrhage. Poor renal function, Thrombocytopenia, NEC, sepsis.

Slide 55: 

a)What is the Indication for the use of Sodium Nitroprusside? b) How does it act? c) What two specific precaution will you take while administering it?

Slide 56: 

a) Hypertensive Crisis. b) Vasodilator c) Protect from light and discard if colour changes from pale orange to dark brown or blue.

Slide 57: 

A 5 days neonate presents with abdominal distension. What is the diagnosis? What are the predisposing factors? What is the diagnostic triad of this condition?

a) The diagnosis is NEC b) Sepsis, Prematurity etc. c) Acidosis, Hyponatremia, Thrombocytopenia: 

a) The diagnosis is NEC b) Sepsis, Prematurity etc. c) Acidosis, Hyponatremia, Thrombocytopenia

Slide 59: 

A 8 day old baby was brought to PHC with C/O difficulty in feeding , crying excessively,& seizure. Parents of baby were 2 nd degree cousins & labourers by occupation. Mother had not received any ANC care. Baby was at home., had moderate cry , was well till D8 .His picture is shown HR-140/min RR-42/min AF-at level, sutures - normal Tone- Increased in all 4 limbs with neck retraction, intermittent seizures. , worsened with stimulus . What is the diagnosis of this baby ? What is the treatment? What is the usual cause of death in this condition?. What are the various types?

Slide 60: 

Neonatal tetanus Penicillin,tetglob,Musle relaxants- Diazepam, Baclofen. (c) Recurrent seizure causing airway obstruction. (d) Neonatal, Localized , Generalised, Cephalic

Slide 61: 

A 15 days old newborn was noticed to have sweating and poor feeding. On examination HR was >240/min with signs of poor perfusion. What are the diagnostic possibilities? What is the immediate management? Detail the emergency drug treatment?

ANSWER: 

ANSWER Supra-ventricular tachycardia. Vagal stimulation folowed by I.V.Adenosine. I.V. Adenosine 0.05mg/kg rapid bolus followed by increased bolus by 0.05mg/kg every 2 minutes until clinical response occurs or a max dose of 0.25mg/kg or 12mg is reached.

Slide 63: 

Answer the following regarding Child survival and Safe motherhood programme: When was it initiated? What are the child survival components of the programme? Which drug does CSSM drug kit supply and for what purpose?

Slide 64: 

Initiated in 1992 Neonatal care,immunization,vit A deficiency control and prophylaxis,diarrhea control and ORT, ARI control and therapy. The programme includes training of peripheral level health workers on recognition of pneumonia and treatment with Cotrimoxazole.

Slide 65: 

Yearly data ( for year 2000) pertaining to deliveries and their outcome in a community is as follows: No. of total births : 10000 No of still births : 80 No of preterm deliveries : 1500 No of newborn deaths In first week of life : 320 During 2-4 weeks of life: 180 No of deaths during first year of life : 500 Calculate perinatal and neonatal mortality rates for this community , demonstrating the steps taken to arrive at the results.

Slide 66: 

Perinatal mortality rate: =80 + 320/10,000 x 1000 =40 per 1000 live births. Neonatal mortality rate: = 320 + 180/10,000 x 1000 = 50 per 1000 live births.

Match the drug with the organism :: 

Match the drug with the organism : Ceftazidime Cotrimoxazole Crystalline penicillin Vancomycin Clarithromycin Mycoplasma Pneumocystis carini Cl. difficile Pseudomonas Diphtheria

Answers: 

Answers Ceftazidime Cotrimoxazole Crystalline penicillin Vancomycin Clarithromycin Pseudomonas Pneumocystis carini Diphtheria Cl. difficile Mycoplasma

Slide 69: 

Identify the pattern of inheritance Name 3 conditions with similar inheritance What is the degree of inheritance? Which sex is affected ?

Slide 70: 

Autosomal dominant NF1 , Polycystic kidney disease ,tuberous sclerosis , hereditory spherocytosis,marfans syndrome, osteogenesis imperfecta. 50% Either sex.

Slide 71: 

Male child with mental retardation identify the syndrome What is the exact locus? What is pattern of inheritance ? Mention any another syndrome with similar inheritance

Slide 72: 

Fragile X syndrome Xq 27.3 Allelic expansion-change in the increasing size of a particular DNA sequence from generations to generations Huntington disease, spinocerebellar ataxia, myotonic dystrophy, DRPLA[dentato rubro pallido luysian atrophy]

Slide 73: 

Identify the pattern of inheritance Name 3 conditions of similar inheritance Which is the affected sex ?what is the risk of getting affected in each pregnancy ?

Slide 74: 

X – linked recessive Hemophilia , color blindness , G6PD deficiency , DMD, menkes kinky hair disease, adrenoleukodystrophy Male ,the risk is 50% for male child in each pregnancy.

A mother was worried that her newborn baby did not receive polio drops along with BCG before discharge from hospital: 

A mother was worried that her newborn baby did not receive polio drops along with BCG before discharge from hospital What is the role of Zero dose polio? [1] What are the contents of OPV? [1] Unlike other live vaccines which are administered as single doses, why multiple doses of OPV are recommended? [1] What specific instruction has to be given to the mother after OPV administration? [1]

Answers: 

Answers Uptake is said to be better in neonatal period as there is no gut flora to interfere, so also transplacental transfer of maternal antibodies against poliomyelitis do not interfere with the seroconversion; also as it is the first contact period between the baby & the health care provider, it enables logistic ease of administration Each dose of OPV contains: Type 1: 10 6 TCID50 Type 2: 10 5 TCID50 Type 3: 10 5.5 TCID50 3. Multiple doses of OPV are needed for satisfactory seroconversion as poor seroconversion with OPV is related to poor antigenicity of the vaccine, thermal lability requiring stringent cold chain maintainance & interference by entero viruses in the gut for proper uptake of the oral vaccine 4. The mother need not be given any specific instructions after OPV, except that she has to report for subsequent immunizations regularly.

A pregnant lady found to be HBsAg positive, gives birth. [4 marks] : 

A pregnant lady found to be HBsAg positive, gives birth. [4 marks] What is the risk of the baby getting hepatitis B infection? [1] How do you protect the baby? [1] Is there a possibility for the baby to be infected in spite of proper management? [1] What is the prognosis in the infected newborns? [1]

Answers: 

Answers 1. Such a baby has a 30% chance of getting the infection. If the mother is also HBsAg positive, the risk rises to 80-90 % 2. The baby should be given the first dose of Hepatitis B vaccine within 12 hours of birth. Hepatitis B Immune Globulin (HBIG) preferably should also be given to the baby on the other thigh simultaneously. This is then followed by 2 more doses of the vaccine at 1 & 2 months of age and a booster at 1 year of age. 3. Yes, the baby can be found to be infected in spite of proper management if the baby has already acquired the infection in utero. 4. Once infected, 90% of the newborns become chronic carriers & 30% of them go on to develop complications like chronic hepatitis, cirrhosis & hepatocellular carcinoma.

All vaccines are susceptible to loss of potency when exposed to warm temperatures [4 marks]: 

All vaccines are susceptible to loss of potency when exposed to warm temperatures [4 marks] What is a cold chain? [1] What is a vaccine carrier? [1] How long can you keep vaccines in a vaccine carrier? [1] What are the other factors which damage vaccines? [1]

Answers: 

Answers 1. The system of transporting, distributing and storing vaccines under refrigeration using any convenient methods, from the manufacturer right up to the point of use is referred to as the cold chain. 2. A vaccine carrier is a thick walled, insulated box with a tight lid, used for carrying small quantities of vaccines to the peripheral clinics & fields for use. 3. Vaccines can be kept safely in the desired temperature, generally for 1 working day in vaccine carriers. 4. Heat, sunlight and freezing are other factors which damage vaccines.

A mother was worried that her newborn baby did not receive polio drops along with BCG before discharge from hospital [4 marks] : 

A mother was worried that her newborn baby did not receive polio drops along with BCG before discharge from hospital [4 marks] What is the role of Zero dose polio? [1] What are the contents of OPV? [1] Unlike other live vaccines which are administered as single doses, why multiple doses of OPV are recommended? [1] What specific instruction has to be given to the mother after OPV administration? [1]

Answers: 

Answers Uptake is said to be better in neonatal period as there is no gut flora to interfere, so also transplacental transfer of maternal antibodies against poliomyelitis do not interfere with the seroconversion; also as it is the first contact period between the baby & the health care provider, it enables logistic ease of administration Each dose of OPV contains: Type 1: 10 6 TCID50 Type 2: 10 5 TCID50 Type 3: 10 5.5 TCID50 3. Multiple doses of OPV are needed for satisfactory seroconversion as poor seroconversion with OPV is related to poor antigenicity of the vaccine, thermal lability requiring stringent cold chain maintainance & interference by entero viruses in the gut for proper uptake of the oral vaccine 4. The mother need not be given any specific instructions after OPV, except that she has to report for subsequent immunizations regularly.

Slide 83: 

8 month old boy brought to the clinic with failure to thrive, recurrent vomiting and polyuria. On examination, the child weighed 5.5 kg for a birth weight of 3 kg. He was normotensive, had no evidence of rickets, and systemic examination was normal. Investigations revealed Hb -12.1g%, BUN -8mg%, s. creatinine -0.4 mg%, s. Na -141mEq/l, s. potassium -2.5mEq/l, s. Cl -90mEq/l, blood gas pH -7.52, HCO3 -30mEq/l. Blood levels of renin and aldosterone are markedly increased. Urinary chlorides 35mEq/l. Questions (A) Diagnosis? (B) Differential diagnosis? (C) What is the treatment?

Slide 84: 

Bartter’s syndrome Gitelman’s syndrome presents at a later age and is milder in presentation. Hypomagnesemia and hypocalciuria are features of this syndrome. Potassium supplementation of 3 to 4 mEq/kg/day.& Indomethacin 1 to 4 mg/kg/day.

Slide 85: 

A 13 month old infant known case of collecting bilateral VUR and posterior urethral valves lost to follow up after initial diagnosis, came with the history of high grade fever and irritability. Urine routine revealed 50 WBC/hpf. Patient was admitted in view of persistence of fever inspite of starting appropriate antibiotic therapy. He was severely dehydrated. After infusing Ringer Lactate, he became more tachypneic and tachycardiac and less responsive. He went into shock . In the ICU, cardiac monitor showed marked arrhythmia, predominantly ventricular tachycardia. The lab results showed, ABG= pH -6.853, pO2 – 39.3 mm/Hg, HCO3 – 8.1mEq/l, S. Na- 145 mEq/l, S. K – 8.3mEq/l, BUN – 82 mg/dl, S. Creat – 4.9 mg/dl. Questions (A). What is the electrolyte disturbance causing the worsening of the condition? (B). What are ECG changes seen in order of severity? . ( C ).What is the treatment ?

Slide 86: 

A) Severe hyperkalemia. B) The T-waves become tall and peaked with prolongation of PR interval. The P wave becomes smaller and may eventually disappear. The QRS complex widens and becomes distorted and a “sine wave” pattern may appear. Ventricular fibrillation Cessation of electrical activity C) Cardiac and ventilatory support to be instituted Specific measures for hyperkalemia- Infusion of NaHCO3 and Ca gluconate. Infusion of glucose and insulin. Use of sodium polystyrene sulfonate retention enemas.. Dialysis.

Slide 87: 

4 year old child with nephrotic syndrome presents with severe abdominal pain Vomiting fever, and abdominal distension. What would you suspect How would you prove it Most likely organism responsible Drug of Choice of Treatment

Slide 88: 

a) SBP b) Ascitic tap c) Pneumococci d) Crystalline penicillin

Slide 89: 

1) Name different measures practised for ensuring enhanced child survival under the CSSM programme 2) Name prophylactic measures advocated under the national nutritional anemia control programme to reduce prevalance of anemia in children? 3) What measures are practised by health care workers to improve nutrition of children under the ICDS- integrated child development scheme?

Slide 90: 

Immunization, management of diarrhoea with ors, treatment of acute resp infections, vitamin a supplementation, essential newborn care Iron folic acid supplements for atleast 100 days of the year iron- 20mg and folic acid 100micro gram with use of iron rich foods Supplementary nutrition to provide extra calories and proteins vitamin a supplementation, use of iodized salt in the food prepared

Slide 91: 

Q ) What constitutes a case of relapse of tuberculosis as defined by the RNTCP? Q) Define a defaulter of treatment and a patient lost to follow up. Q)What is recommended management for each of these cases?

Slide 92: 

A)Relapse- signs/ symptoms of tuberculosis within 2 years of completing AKT B) Defaulter- one who discontinues treatment for > 1 week C) Lost to treatment – one who does defaults for > 1 month D) Category II of RNTCP with 2SHRZE, 1HRZE, 5 HRE

Slide 93: 

What is the definition of drug sensitive malaria? What are the grades of resistance? What are the indications for use of primaquine in the treatment of malaria?

Slide 94: 

Sensitive to drugs if absence of any form of malarial parasite in blood smear by day 6 and also by day 28 Resistance to drugs : R1 R2 R3 R1- absence of parasites by day 6 from blood smear but reappearance by day 28 R2-- clearance of parasites to less than 25 % of pretreatment levels but complete absence of parasites not achieved R3– clearance of parasites to a level of upto >/= 25% of pre treatment levels, but complete absence not achieved. C) Primaquine is used as a gametocidal for p falciparum – 0.75 mg/kg single dose and in p vivax to prevent recrudescence dose 0.25 mg/kg/day for 5 days

Slide 95: 

A one and a half year old infant presented with failure to thrive, recurrent diarrhea,irritability and pain abdomen. On Examination, he was found to be wasted with edema and finger clubbing. His tTG ELISA for both IgA and IgG was positive. What is this condition? Name other serological tests done to diagnose this condition. What will you do to confirm the diagnosis?

Slide 96: 

Celiac Disease Antigliadin and Antiendomyseal antibodies Small Bowel Biopsy

Slide 97: 

A 13 year old child came to the OPD with C/o gradual loss of vision. On Examination he had ataxia, intention tremors, loss of vibration and position sense. He had history of chronic Diarrhea with passage of bulky frothy stools. His plasma cholesterol was 28 mg/dl and his Serum triglycerides were 12 mg/dl. What is the diagnosis? What is the characterstic finding on peripheral smear of this patient? What is the visual problem?

Slide 98: 

a) Abetalipioproteinemia b) Acanthocytes. c) Retinitis pigmentosa

Counseling : 

Counseling Counsel the mother who has a 2 month old infant . She has to report to work next week and will be away from home bet 9.00 am to 4.00pm She feels she doesn’t have adq. Milk advice her about feeding the child regarding storage of BM .

Slide 100: 

Introduces rapport Enquires about urination , adq wt gain , about let down Reassures about adequacy of breast feeds Questions whether baby is feeding in correct position Explains that frequent sucking and confidence help breast feeding Counsels correctly regarding expression and storing of BM 8 hrs in room temp, 24 hrs in refrigerator

Slide 101: 

A term baby is born by normal vaginal delivery . Amniotic fluid was not stained with meconium. Resuscitate with the provided dummy and equipment You are free to ask vital signs of the baby whenever appropriate

Slide 102: 

1.Check the equpment 2.Perform all basic steps within 30 sec in correct order -Provide warmth, suction-clear airway,Dry and stimulate ,Give O2 if req.(0.5) 3. Evaluates and ask for vitals : Examiner says HR <100(0.5) 4.Bag and mask ventilatation Self inflating resuscitation bag, look for correct assembling of parts, position the baby correctly ,Selects proper size mask and positioning of mask and position appropriate ventilation ( rate and rise -40-60/min Evaluates vitals (HR<60 , HR > 60/min) 5.Chest compression – two finger technique , depth 1/3 of AP diameter of the chest , 1:3,check pulses 6.Evaluates HR decide about medication Epinephrine HR <60 after 30 sec of assisted ventilation and 30 secs of coordinated chest compression and ventilations.

A) Identify the abnormality on peripheral smear? B) Name 4 conditions where these cells can be seen.: 

A) Identify the abnormality on peripheral smear? B) Name 4 conditions where these cells can be seen.

Slide 104: 

2 A) Target cell B) Thalassemia Hemoglobinopathies Hb AC or CC Hb SS, SC, S-thal Liver Disease Post Splenectomy or Hyposplenic states Severe Iron deficiency HbE(Hetro and Homozygous) LCAT deficiency A betalipoprotenemia

A 10 yr old girl ,having ITP since 6 months has ecchymotic patch on her leg and has uncontrollable epistaxis. Her platelet count is 4000. : 

A 10 yr old girl ,having ITP since 6 months has ecchymotic patch on her leg and has uncontrollable epistaxis. Her platelet count is 4000. A) Which 3 invest. would you advice in her? B) What 4 measures either singly or in combination can be used to treat life threatening haemorrhage in ITP?

Slide 106: 

3A) ANA, ds DNA HIV, Ser. Immunoglobulin 3B) Platelet transfusion Methyl Prednisolone – 500mg/m2 IV /day x 3 days IV Ig 0.8 gm/kg Emergency splenectomy

A) Which 1 investn would you advice? B) What is the diagnosis? C) Which type would he be categorized as? D) What is the mode of inheritance? : 

A) Which 1 investn would you advice? B) What is the diagnosis? C) Which type would he be categorized as? D) What is the mode of inheritance? 1.5yr old boy with minor injury develops this swelling?

Slide 108: 

A) PT/PTTK B) hemophillia A or B C) moderate D) X linked Recessive

A) Identify the abnormality on peripheral smear? B) What is the inheritance pattern?: 

A) Identify the abnormality on peripheral smear? B) What is the inheritance pattern?

Slide 110: 

A 12 yr old boy is tested for sickle cell disease peroperatively.His father is known to have sickle cell trait. Results--- Hb 10.1g/dl,RBC—6 lacs,MCV--- 65fl, MCH---21.1pg,MCHC—30g/dl,Sickle test positive, HbS—71%,HbA---21.5%,HbA2---4.5%,HbF----3%,Serum Ferritin---19mcg/l. a) What haemoglobinopathy does the boy have? b) What haemoglobinopathy do you expect on testing the mother?

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ANSWERS 1) Sickle cell beta + thalassemia b) Beta+ thalassemia Sickle cell disease– HbS, no HbA,Hb F variable-15% Sickle trait----HbS 25-45%, HbA. B thal trait-----HbA,HbA2>3.5% +/- HbF. Bthal major----- HbA virtually absent, HbF majority, HbA2 vriable low/normal/raised. Sickle thal-----HbS,HbF+/- HbA.

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Match the clinical diagnosis with the haematological finding most appropriate to it from the list in the right hand column. kawasakis disease hydrops fetalis alpha thal major increased fetal Hb beta thal major hyposplenism in a 6 yr old sickle cell disease oxidant induc ed red cell damage G6PD def splenomegaly in a 6 yr old Hereditary spherocytosis Thromoc ytosis

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kawasakis------ thrombocytosis alpha thal major----- hydrops fetalis b thal major----increased Fetal Hb sickle cell disease---- hyposplenism in a 6 yr old G6PD----- oxidant induced red cell damage Hereditary spherocytosis------ splenomegaly in a 6 yr old

10 year male referred for autoimmune hemolytic anemia, frequent diarrhea, normal tonsils , father is a diagnosed case having low IgA levels. His immunoglobulin levels were low.: 

10 year male referred for autoimmune hemolytic anemia, frequent diarrhea, normal tonsils , father is a diagnosed case having low IgA levels. His immunoglobulin levels were low. What is the immunodeficiency type you will suspect? How will you treat the patient?

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COMMON VARIABLE IMMUNODEFICIENCY IVIG therapy, Septran Prophylaxis

A 6 year old child was admitted for treatment LRTI. This was his 6th episode of severe pneumonia apart from 4 episodes of severe diarrhea in past. He was transfused blood in view of anemia (Hb 8.5 gm%) but developed severe transfusion reactions.: 

A 6 year old child was admitted for treatment LRTI. This was his 6 th episode of severe pneumonia apart from 4 episodes of severe diarrhea in past. He was transfused blood in view of anemia (Hb 8.5 gm%) but developed severe transfusion reactions. What immunological defect is likely. How will you treat the same?

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SELECTIVE IgA DEFICIENCY Avoid Blood products, use product that has been depleted of Ig A

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10 months child with bacterial meningitis has hyponatremia. Sr .sodium 128 meq/l. sr k 4.5meq.urine output of child is 4.1 cc/kg/hr. urine sodium 102 meq/l child become hypotensive requiring fluid bolus . A) what is a cause of hyponatremia. B)what other step help in diagnosis?s C)How will correct electrolyte? D)Give two symptoms of hyponatremia.

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10 children having height respectively 101,98,98,99,102,101,100,98,101,101.calcalculate A) mean B) mode C) median.

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MEAN= SUM OF ALL/ TOTAL NO= 1000/10=100 MEDIAN= MIDDLE VALUE IN ASCENDING OR DESCENDING ORDER MODE= MAXIMUM TIME THE PARTICULAR VALUE COMING

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Screening test disease not diseased Positive a b Negative c d Calculate A) specificity B)sensivity C)Positive predictive value D) negative predictive value

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SPECIFICITY=TRUE POSITIVE=A/ A+C X100 SENSITIVITY=TRUE NEGATIVE=B/B+D X100 POSITIVE PREDICTIVE VALUE=TRUE POSITIVE AMONG ALL POSITIVE= A/ A+BX100 NEGATIVE PREDICTIVE VALUE=D/ C+D X100

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Out of 50 babies deliveried,10 were born still birth. out of this,5 were less than 1000 gm. 5 died in first month. Calculate A) still birth rate B)neonatal mortality rate. C) what is perinatal mortality rate D) tell significance of calculating perinatal mortality over neonatal mortality,.

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STILL BIRTH RATE=FETAL DEATHS OVER 1000 GM / TOTAL LIVE+STILL BIRTH WEIGHT MORE THAN 1000 GM. 5/ 40+5 X1000= 1000/9=111.1 NEONATAL MORTALITY RATE=NO OF DEATHS IN FIRST MONTH/ TOTAL LIVE BIRTH X 1000= 5/40 X1000=125

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Out of 5000 children population of a village,500 are cases already existing .newly diagnosed100 cases in a year. 20 children died of malnutrition. Calculate: A) prevalance rate. B) incidence rate C) case fatality rate D) what is advantage of calculating prevalance rate?

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PREVALENCE RATE= NO.OF EXISTING + NEW CASES/ TOTAL POPULATION.=500+100 / 5000 = 600/5000 X 1000=120 INCIDENCE RATE=NO. OF NEW CASES OF SPECIFIC DISEASE DURING A GIVEN PERIOD OF TIME/ POPULATION AT RISK X1000=100/ 5000 X 100=20 CASE FATALITY RATE=TOTAL NO OF DEATH DUE TO PARTICULAR DISEASE/ TOTAL NO OF CASES DUE TO SAME DISEASE.= 20/ [500+100] X100 =20/600X100=3.33 ADVANTAGE. TO ESTIMATE MAGNITUDE OF HEALTH DISEASE PROBLEM IN COUNTRY. TO IDENTIFY POTENTIAL RISK POPULATION. 4 ADMINASTRITIVE AND PLANNING PURPOSE.

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BEST OF LUCK