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Batch of 2019 Profs

Paediatrics
(Vivas - pg 5 onwards)

1. Iron deficiency most likely in which child?

a. Preterm​ pg 399
b. post term infant
c. polycythemia
d. abo incompatibility

2. Child with rash, arthritis, abdominal pain. What is the most appropriate
treatment?
a. ffp
b. ivig
c. Steroid​ ​pg 494
d. plts

3. 2 month old child with 300 heart rate. Absent p waves.

a. Svt​ pg 320-21
b. v tach

4. Double bubble sign. Bilious vomiting?

a. duodenal atresia​ pg
b. pyloric stenosis

5. Most common cause of bacterial endocarditis?

a. strep pneumo
b. beta hemolytic strep
c. s aureus​ (according to medscape)
d. s epidermidis

6. Empyema most common complication of

a. Staph aureus​ pg 255
b. Strep group A
c. Strep B
d. H influ
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7. Infective endo most commonly caused by

a. Strep A
b. Staph
c. Strep B

8. What is not a cause of short stature?

a. Marfan's​ pg 588
b. Turners

9. What vaccine would you not give to an immunocompromised person?

a. Measles​ (live vaccines CI in immunocomp)
b. DPT
c. salk

10. 2 year old kid with 40 degrees fever for 7 weeks, multiple joints affected, pink
rash. ANA and double stranded DNA negative. Diagnosis?
a. system JIA​ pg 487
b. SLE

11. Child with umbilical hernia, coarse features, constipation, lethargy

a. congenital hypothyroidism​ pg454

12. Child with meningitis. Treated with anticonvulsants but not improving. What
complication of meningitis could be a cause?
a. SIADH
b. raised ICP
c. brain abscess pg 364

13. An 18 month old child. MAC 10.5, weight and height were less. Edema.
a. marasmic kwashiorkor
b. Kwashiorkor​ ​pg 95
c. marasmus

14. Boy with hx of flu comes with limp and pain in hip joint and discomfort. Lab ass (I
can’t remember)
a. Septic arthritis
b. Toxic synovitis
c. Slipped capitus
d. Sle
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15. Baby with episode of passage of blood from stool. Mother has svd. Mother on
anti epileptics but controlled. No complications with delivery.
a. Vit k def (??)​ pg 171-72
b. Swallowing of maternal blood
c. Haemophilia
d. (Can’t remember other options)

16. Moms scolding her kid. Kid screams, gets limp, and falls, weird movements on
the floor. What is it?
a. Breath holding
b. Epilepsy
c. Vasovagal syncope​??

17. Child with decreased PLT and and RBC, increased WBC. Bone pain,
hepatomegaly, lymphadenopathy, fever at night.
a. lymphoma
b. JIA
c. Leukemia​ pg 422

18. Mother is hep B positive. SVD, what will you give the child?
a. HBIG and vaccine in 12 hours​ pg 151
b. HBIG and vaccine in 24 hours
c. HBIG in 12 hours
d. HBIG in 24 hours

19. Kid with an increase in ALT and direct bilirubin. How will you investigate?
a. serum IgM for hep A​ pg 285
b. serum HBsAg
c. stool hep A
d. stool hep B

20. A 3 year old kid was previously fine but started experiencing progressive
weakness. Calf pseudohypertrophy and gower positive
a. Duschene’s​ ​pg 378

21. Young girl failure to thrive with hypertension, low posterior hairline and low set
ears
a. Down’s
b. Turner’s​ ​pg 501-502
c. Fragile x
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22. Infective endocarditis is most commonly caused by?

a. staph aureus
b. group A streptococcus
c. strep epidermis
d. h.influenza

23. Kid with ascending paralysis. What would be the most appropriate test?
a. EMG pg 389
b. stool test
c. nerve conduction velocity​ (confirmed by a neurologist)
d. MRI

24. Child on steroid medication. Which of the following vaccines is not given?
a. Dpt
b. Measles
c. IPV

25. Child with bedwetting. Has had a period of complete resolution. Parents want to
try some treatment. What will you offer?
a. desmopressin
b. alarm therapy​ pg 71
c. anticholinergics
d. imipramine

26. Who has the greatest risk of developing iron deficiency anaemia?
a. premature baby
b. ABO incompatibility
c. post term baby
d. polycythemia vera

27. A child drinks goat's milk. What deficiency will he have?

a. Folate​ pg 405
b. thiamine
c. vit E

28. Palpable purpura. HSP case. Treatment?

a. NSAIDS
b. IVIG
c. steroids
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SEQs:

1. A child who had recently undergone an elective hernia surgery came with
Hb - 8 MCV 63 and MCHC was also decreased
Hb electrophoresis showed hba 98% and hba2 2%
a. What kind of anemia is this? ​Microcytic hypochromic
b. what are the other causes for this kind of anemia
c. what is the cause of anemia in this child
d. other investigations which will help you with the diagnosis

2. Seq on celiac disease , diagnosis, what 3 conditions is it associated with,

investigations , management

Vivas

Do all exams well, they can make you do any exam, irrespective of case.
1. Cystic fibrosis. History, exam, other features, tests and treatment and newer
treatments.
2. TB meningitis - signs of meningeal irritation
3. Malnutrition - classification, growth charting, anthropometry, causes of iron deficiency
and food rich with iron.
4. Asthma - respiratory exam
5. Dr. Iqbal - EVERYTHING neuro. Causes of meningitis. Risk factors of meningitis.
6. Typhoid. Causes of hepatosplenomegaly.

Cf- types of breathing and what conditions they're present in.

Dr iqbal - differences between gbs and polio. How do you diagnose gbs, how do
you treat it? Causes of LMN symptoms. Motor exam. What is the cause of death
in gbs. What is Mallory something syndrome the subtype of gbs
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Dr shaista- facial nerve exam, bell’s palsy (causes and types and all), gbs, febrile
fits, status epilipticus, differences between different types of acute flaccid
paralysis, treatment of bells palsy

Lower limb motor exam, grades of power, management of status epilepticus, Child
presents to opd with drooping of side of face - what manoeuvres will you do, child
presents with headache and fever - what further qs will you ask in history, which
investigations, causative organisms
Causes of LMN lesions, findings in LMN lesions

Also asked about CP child. What is choreoathetosis, what are the difficulties faced by
them and treatment

One external spot who asked to take history of fever and vomiting and abdominal exam
and then random questions related to fever and vomiting

Differentials, exam findings, what all will you check for, where do you check for anemia,
grading of anemia

What is the normal span of liver, what is the significance of hepatomegaly

One spot with history of cough and then respiratory examinations, findings, treatment of
pneumonia, differentials for cough, causes of crepitations

Examination findings of consolidation

Prevention for family members, prevention for children under 2 years, causative
organisms, complications of pneumonia

Causes of decreased and increased vocal fremitus, treatment for pleural effusion and
pneumonia

Dr on CF spot: performance: respiratory exam

Questions: difference between vesicular and bronchial breathing what type of
breathing this child has what are the new advances in CF management how do u
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Dx CF other d/ds of case (child had cough and recurrent chest infections from
childhood)
Dr poker face on malnutrition /short stature spot:
Performance :GPE
Questions :causes of malnutrition types of short stature causes of ida foods rich
in iron foods not to give with iron plot weight and stature on growth chart tell the
centiles also where is your thermometer why didn't you bring it
Dr iqbal- cerebellar examination
Questions :causes of tremors (mention intention tremors and etc) what does
romberg test tells you what are the causes of cerebellar ataxia what are you
checking in gait (wanted to know different types festinating etc) perform reflexes
for lower limb

Also you had to take proper relevant history in the cystic fibrosis spot

Dr Iqbal: UMN lesions and LML causes. Presentation.

Rhombergs +ve in what?
Dr for malnutrition: when can you not give iron pills. Foods containing iron.
How to wean a child.
Causes of malnutrition
Dr for cystic fibrosis:
Breathing patterns, bronchial vs vesicular breathing. Relevant
examination.
Treat and diagnosis for CF

Dr Iqbal:
Complete motor exam of lower limbs
What is positive and negative babinksi
Name superficial reflexes
Perform abdominal reflex
What happens to superficial reflexes in UMNL
Examples of UMN diseases
Causes of acute pyogenic meningitis in older children
Cystic fibrosis-
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history and examination

Types of breathing
Describe bronchial and vesicular breathing
When do you hear bronchial breathing
What other sign would help you differentiate asthma from cf (clubbing)
Investigations
Management

Malnutrition-
Perform GPE on a 4 year old.
Normal pulse for a 4 year old
90 cm height- what does this mean?
Possible causes for short stature
Primary and secondary malnutrition
How do you classify
What are the drawbacks of WHO classification
What is a balanced diet
What are sources of iron rich foods
What do you avoid giving with iron rich food
What signs will you see in vit C deficiency
What is the normal weight for a 4 year old

Day 2
12 year old boy: high grade, fever, vomiting. Take relevant history. Do abdominal
exam
What tests will you order. My whole case was based around typhoid. Drugs.
Treatment. How will you treat interstinal perforation. Complications . What is XDR
typhoid
4 year old girl with respiratory distress. Subcostal recessions. Harsh vesicular
breathing. Amma was on the phone, couldn't take history. Do respiratory exam
and tell findings. Likely dx. Showed a CXR: with a consolidation. Treatment,
investigations for Pneumonia and asthma. Prevention you'll do. Questions you'll
ask in history if suspecting TB
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3rd case: 3 year old kid with delayed milestones. Take history. Examine. DDs.
Likely a cerebral palsy child. Inv, managament, counselling of CP child. What will
you see on CT of a CP child. Can this child live a normal life

Weird exam (everyone had poker face)

Case 1: told me to do abdominal examination. Tell findings, liver span. What is
normal. Causes of hepatomegaly, spleenomegaly, bleeding per rectum, how will
you treat dysentery. If patient had abdominal pain what other questions you want
to ask.
Case 2: child with bilateral lower limb weakness. Take history, do lower motor
exam. Asked dd. Differentiate btwn gbs and polio. How to diagnose gbs,
treatment.
Case 3: pateint with recurrent respiratory infection, cough, dyspnea. Take hx
from mother, do relevant examination. He had bilateral wheeze.
D/d. After I said asthma he said how will you confirm the diagnosis, classify his
asthma, treatment for asthma.

Dr shaista
Abdominal exam
History of abdominal pain
Causes of hepatomegaly
Blood in stool autoimmune cause?
What other examination
Gbs spot
Bilateral muscle weakness
Lowerlimb motor examination
D/D
Difference between gbs and duchenne
Investigations
Treatment
TB hx
Resp examination
Resp findings
Resp rate

Dr lubna- refuses to believe umn lesions have hyperreflexia.

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Cp child management.
Relevant exam on cp child- they wanted neuro or gpe- not happy with either-
hate them
Dr farahan- enteric fever hx taking, abdominal exam, diff between spleen and
kidney on palpation, how to palpate spleen ( diagonally from rif and then turning
the pt to the side and palpating.
External- pneumonia, vaccinations against pneumonia, dose, route, imnci