TOACS FCPS

TOACS FCPS 2010

1. Xray of bifid thumb with pancytopenia and dds
2. Mri brain post fossa tumor(medulloblastoma)
3. Xray perthes disease
4. Respiratory alkalosis
5. Rash in newborn(syphillis)
6. Nnr
7. Fb aspiration cxray findings and its manahgement
8. Imnci
9. Senario of ckd
10. Turner syndrome
11. Senario of vit d resistant rickets

TOACS FCPS 2011

1. Senario of hypernatremic dehydration
2. Cxray of double bubble sign
3. Ct brain with port wine sign(sws)
4. Procedure of exchange tx
5. Senario of iex(organic acedimia)
6. Tension pnuemothorax
7. Pedigree of xld
8. Genetic counselling of william syndrome
9. Cah with shock
10. Pic of bull neck diphthatia, collar stud abcess of tb
11. Ecg down syndrome with r superior axis
12. Counselling of dm
13. Counselling of all
14. Asthma classification and method of inhaler
15. Cleft palate and mother feed

TOACS FCPS 2012

1. Senario of pseudohypoparathyroidism
2. Imnci(ear d/c and diarrhea)
3. Hie & its management
4. Develop assessment of 2 yrs old
5. Child neglect> counsell the mother
6. Mag scan of renal.
7. Cxray of brochiectasis causes and its investigations
8. Pic of hypothyroidism
9. Procedure of suprapubic aspiration
10. Ecg>>wpw syndrome
11. Pic of mysthenia gravis
12. Hydronephrosis approach>>>2days old baby with hydronephrosis and its approach
13. Counsilling of celiac
14. Earth quake and ur approach

TOACS FCPS 2013

1. Eeg(sspe)
2. Ecg(hyperkalemia)
3. Procedure liver biopsy
4. Target joint(hemophillia)
5. Pic of constrictive pericarditis(large liver with raised jvp)
6. Turner syndrome, karyotyping and inheritance
7. Cardiac achlasia
8. Xray shoulder osteomyelitis
9. Mri brain>> meduloblastoma
10. Cxray rds
11. Xray kub stag horn stone
12. Simple obesity senario
13. Pics>> Hypothyroidism
14. Pic>>> Hemangioma

TOACS FCPS 2014

1. Counselling of DM
2. NNR
3. Senario of DHF
4. Peak flow meter
5. Xray horse shoe kidney and its associations and complications
6. Xray struge weber syndrome
7. Pic lingual tonsil;/cleidoclavical dystosis/papiledema/TS
8. Procedure pericardiocentesis
9. ECG heart block
10. Road to health charts and how to plot
11. Pic of portal HTN/Budd chairi syndrome
12. Cxray bronchiectasis, causes and its management
13. New vaccines in epi, what criteria required to add in epi

TOACS FCPS 2014

1. Hus
2. Xray tef
3. Opp
4. Procedure of needle aspiration
5. Pic of mps/hypothyroidism
6. Pathological gynecomastia
7. Ecg bbb and svt
8. Adhd
9. Iron poisoning and chelation
10. Counselling of dmd
11. Senario of neurowilson
12. Flood diaster and management
13. Ct scan icb
TOACS FCPS MARCH 2015
1. Xlinked dominant
2. Hemangioma
3. Scurvy(caffeys but seems more likely to be scurvy,i asked one of the examiners according to the
key it was rickets, it was caffey,in scurvy there is white line of franklin,it is most probably caffey
disease).
4. CXray chest with right basal opacity
5. Renal ostepdystrophy
6. Autism
7. Pseudotumor cerebri
8. Obesity
9. DDH
10. Breastfeeding
11. Myocarditis
12. Fanconis anemia(picture of chromosomal fragility and dd of chromosomal breaks)
13. Glycogen storage disease
14. Exchange transfusion
15. NEC
16. Nephritic syndrome

TOACS FCPS OCT 2015

1. Abgs data + cyanosis>>> hyperoxia test interpretation and imediate step of management --> tga
2. Delayed puberty male
3. Opv and newly introduced ipv (polio k recent advance ipv in epi k elawa poch rahy thy 2 eridct
ho gay bt wat r new)
4. Procedure Liver biopsy
5. A child with dehydration develops intracerebral thrombosis (sagital/dural sinus)
6. A child with tuberous sclerosis develops fits while on proper aed dose and good compliance.
7. Child with hemophilia develops inhibitors and its rx.
8. Hepatitis b – definitions, hep b k treatment monitring markers, after 6 m how to investigate and
followup.
9. Glyogen storage disease (interactive) 12 month with dirhae devolp fits 2nd day exam stuprious
lethargic csf clear electrolyte normal rbs normal
10. Vur grade 5 .. Puv mcug.
11. IEM --> urea cycle defect.. Otc def ..scenario.. Urea cycle men spesific konsa hy aur amonia ko
dec k liay na benz k elawa kia kia de sakty.(specific meaning ???)(orotic argnase ya otc sh said there
is hint in senirio only male afected(xlinked disease?)
12. Child with bas develops adrenal haemorrhage.
13. Child with lumbar meningomyelocele – counselling.
14. Ct scan chest --> Bronchiectasis
15. Pictures
a. Pierre robin sequence
b. Natal tooth

TOACS FCPS2 2016

1. SWS
2. Xray NEC
3. Malnutrition
4. DM-1
5. Asthma Counseling
6. HIV
7. Maternal TB
8. Pericardiocentesis
9. Intraosseous
10. Herliquen baby
11. Organic acidemia
12. Hemophillia inhibitors formation

TOACS FCPS2 MAY2017

1. Ventricular tachycardia ecg
2. Polio vaccination and questions
3. Exchange transfusion
4. Peritoneal dialysis
5. Tumor lysis syndrome
6. .Delayed puberty and questions
7. Raised icp management
8. Xray hypothyroid and diaphragmatic hernia
9. Jia counseling
10. Psychogenic polydipsia
11. Spirometry obstructive lung disease
12. Picture of torch and pautezjegher sydrome.

TOACS FCPS DEC 2017

1. Cxray congenital lobar emphysema
2. Hiv +ve mother, management of baby.
3. Famlial hyper triglyceridemia
4. Procedure liver biopy
5. Procedure intubation>Asthma patient needed ett.
6. Varicella in 10 weeks pregnant mother with 2 live issues. Management of mother and children.
Counselling for current pregnancy.
7. Mcug VUR
8. Cp child with feeding problems.
9. Barium meal of gastric outlet obstruction(pyloric stenosis 6 signs)
10. Cxray showing pnuemopericardium.
11. Ecg showing Long qt syndrome
12. Hemophillia with inhibitors formation.
13. Jdm pic calcinosis and xray
14. Pic Andgiofibroma face (tuberous sclerosis).
TOACS FCPS MARCH 2018

1. HYPOTHYROID
2. WT HT PLOT CHART
3. PNUEMOTHORAX NEEDLE ASPIRATION PROCEDURE.
4. WORM INFESTATION
5. OTOSCOPY
6. CHILD ABUSE
7. ALD PEDGREE
8. URTICARIA AND ITS DDS
9. HDN/MATERNAL SWALLOWED BLOOD
10. STROKE
11. HOCM
12. MUMPS ENCEPH
13. B/L RENAL STONES
14. ALL WID TLS
15. COW MILK PROTEIN ALLERGY

TOACS FCPS AUG 2018

1. Luekemia counselling
2. Scorpion sting
3. ARDS with xray
4. Renal calculi with xray kub
5. Scabies
6. Bening rolandic epilepsy
7. Ischemic hemiplegic stroke
8. Partial exchange transfusion for neonatal polycythemia
9. MCTD/scleroderma
10. Septic shock
11. Heart block with myocarditis ecg
12. NNJ with hypopituitarism and hypothyroidism

TOACS FCSP FEB 2019

1. VT
 Read ecg and interpretation
 History and examination
 Treatment
 Counseling
 Mainly was asked that child has urti symptoms(tookclarithromycin and developed vt the rscore
stop clarithromycin)

2. Mushroom poisoning
 Treatment
 No one knew about it
 Main question was specific treatment and type of liver transplantation

3. Asthma
 PEFR was asked
 Child was on salbutamol and steroids
 Child is had frequent attacks now how to proceed
 First complaint was asked the n doses and then stepup
 Then counselling

4. Sickle cell anaemia with crisis

 Xray was given and scenario of abdominal pain with anaemia
 Family history was positive
 Diagnostic approach and treatment was asked
 Hissibling also had similar complaint what to give him

5. Scenario of ulcerative colitis

 Diagnosis was asked
 Then history and examination question
 What you will ask in history and what you will look on examination(ask specific
 Questions for that patient
 Then how will you diagnose findings of each test you tell
 Then treatment

6. Counselling for brain death

 Final question was whom you will in volve in decision making
 Emphasis was on ethical community

7. Procedure of CVP line

 Told everything from video seen in youtube
 Main question was site of insertion and tell name of procedure when you insert guidewire
 Complications?

8. Senario of baby born to hiv mother

 Accoriding to the imnci
 Questions were which vaccine will you give
 When will you give influenzavaccine how many cd counts should be?
 Everything was about cd count
 Treatment

9. A 3day old child presented with complaint of afebrile fits home delivery
 Differential diagnosis
 Metabolic fit
 Hemmorhagic disease of newborn
 Sepsis/hie
 Iem
 Questions of history and examination points
 In family history he said to me that uncle died with same problem others told that examiner said
his sibling died with same died
 Treatment

10. Picture of swollen leg with bruise/ecchymosis

 Scenario of infection then developed this condition
 Diagnosis(dvt)
 What question will be asked and examination
 Diagnostic tests
 Treatment option
 How will you monitor your treatment

11. thin lean tall child came in opd

 No previous history
 Mainly scenario was of hyperthyroidism

12. Senario of UTI and MCUG was given

 What will you ask in history and examination
 Main point was question of constipation
 Then how will you treat
 Treatment of UTI and then treatment of constipation
 Counselling question

TOACS FCPS2 SEP2019

1.PCMQ
 Plot on chart sd
 Acute or chronic
 Tell m4 reliable signs of shock in pcm
 Tell me who unrelible sign of shock in pcm
 Tell me3 types of fluid used in pcm shock
 Tell me difference resomal and ors
 How will u treat shock
 How many bolus will u give and in what time
 If no improvement than what will u do

1. Child e uncontrolled seizure abnormal jerky movement

 Ct shows calcification
 Diagnosis tuberous sclerosis
 Tell me neurophsyctric manifestations of ts
 Hw will u treat seizure in this patient tell me drugs
 Tell me other option to control seizure
 Tell me cardiac renal and pulmonary manifestations of ts
 When will u do f/u eccho?
 When will u do f/u ct
 Hw will u follow renal problem
 Tell me hw will u follow this patient

2. Leukemia e warm shock

 Diagnosis
 Hw will u manage
 Hw many bolus will u give
 No improvement then
 Mechanism of action of nor epi
 Dose of nor epi
 If no response on nor epi than
 Dose and duration of hydrocortisone in this patient
 No improvement on hydrocortisone
 No improvement on 2nd inotropthan
 No improvement on correction of 5hand6 tthan

3. ckd senario
 Diagnosis
 Labs
 Why plt dec inckd
 Why anemia in ckd
 Dose of erythropoiten
 Why short stature in ckd
 Why ultrasound
 Hw will u correct acidosis and in what timeframe
 At whath b level u will start erythropitein
 Hw will u treat hyperkalemia
 Hw will u give kaxylate

4. PPHN
 Portal hyper eessimenger
 Tell me expected ecg findings in patient
 Why hypertension occured
 Tell me rx options

5. Portal hypertension
 Tell me other dd
 Tell me whyportal hypertension
 Tell me labz
 Findings on u/s
 Tell me other labs
 Hw will u manage
 Dose of octreotide
 Tell me other option if noresponse

6. Sle e cva
 Tell me specific reason of cva in sle
 Hw will u investigate
 Hw will u manage
 Which drug is preferred in thrombos in cva
 Causes of cva

7. Cow v/s breastmilk

 Tell me reason of failure to thrive in patient given in scenerio
 Counsel mother about composition diffrence of cow and mothermilk
 How to dilute cowmilk tell ratio
 Which fats are healthy saturated or unsaturated
 What about vitamins in mothermilk
 What is solute-load
 Tell me expected problem due to cow milk protein and fats in this child
 Counsell mother for diet
 At what age u can give cowmilk

8. Bloodydiarhea
 Tellme causes of bloody diarhea
 Complication
 Hw will u treat salmonella diarrhea
 Which strain of ecoli cause bloodydiarhea
 Hw shigella present
 Tellme chronic complication of campylobactrrjujeni

9. Vwd/pltfunctiondisoredr
 Tellme diagnosis
 Labs
 Dd
 Rx
 D/fin bernald and glanzman

10. Pneumothorax(tensionpneumothorax)
 Why pneumo why not simple lungt issue
 How will u manage to distrect chest tube bottle was on table
 (needlethoracotomy)
 Do the procedure
 Than what will u do after procedure(xray)

11. Neonate e distress xray was there

 Abgs shows acidosis oxygen60
 How will u manage (ventsupport)
 U r consultant what parameters u will ask your junior to set
 Tellme rate
 Tellme pip
 Tellme peep
 Patient is detoriate what will udo(dope)
 No improvement than(eccho)
 This is eccho report what is suggest
 Pda e shunting right to left
 Pphtn
 Tell me treatment option

TOACS FCPS JAN 20.

1. Sma
2. Puv
3. Approach to metabolic disorder (chart in nelson metabolic start)
4. Hereditary spherocytosis but approach to hemolytic anemia
5. Liver biopsy procedure
6. Lead poisoning(harriate lane chart)
7. Precocious puberty in male investigations approach
8. Aids transmission via breast feed hiv imnci & transmission rates (all modes)
9. Micronutrients supplementation in malnourished (Folic Acid, Vit D Zinc,Vit A,Iron)
10. Cleft lip cleft palate ki counselling kb karwate hen surgery tb tak feeding issues.
11. Lung abcess
12. Autism

TOACS FCPS JAN 20.

Station: 01
A.Plot ht and wt on growth charts.
B. What will you ask in the history and examination findings?
C. How will you treat micro and macro nutrients deficiency.

Station: 2
A.Identify the picture.
B. How will you manage cleft lip and palate. Time for surgery?
C. What are the early and late complications?

Station 3.
Senario (Precocious puberty)
A. Diagnosis
B.How will you diferentiate central and peripheral?
C. How will you investigate?
D. How will u manage?
E. Side effcts of GnRH?.

Station: 4
Senario (Lead Poisoning)
A. Dx?
B. How will u investigate qith interpretation?
C. What are xray skull findings?
D. How will u manage?
What are complications?
E.Counselling for lead.

Station: 5
Senario (Autism)
A.Dx
B. How will u approach and investigate?
C. What is DSM criteria?
D. How will u manage? ( drugs and other options.).
How will u prognosis and counsel?

Station: 6
Liver biopsy procedure.
A. Indocations?
B. Needle direction? *Perpendicular*
C. Complications?
D. Needle size??
E. Important investigations before procedure? *BT CT PT APTT PLT COUNT.*

Station: 7
Senario (HS)
A. Dx?
B. Dds?
C. Investigations wid interpretation?
D. Management?
E. Spleenectomy indications?
F. How to perform flow cytometry.?

Station: 8
A. Abgs results were shown and interpret the ABGs (Respiratory Alkalosis)
B. How to calculate the anion gap?
C. 3 DDs?
D. Most likely diganosis?
D. Investigations?
E. Managemnet of hyperamonia?

Station: 9
A. Read the chest xray and interpret the findings?
B. Ct scan findings?
C. Dx?
D. Investigations other than Cxray AND CT?
E. Management and what is VATS?

Station: 10
Senario abou AKI with PUV.
A.what will u ask in the history?
B. What could be the findings in the antenatal US?
C. Read the MCUG and tell the dindings?
D. How will you further investigate?
E. Manage?

Station: 11
Senario SMA/ Pompe disease?
A. How will u approach to tje case?
B. How will u further investigate?
C. Management?
D. Prognosis and counselling??

Station: 12
HIV +ve Mother with neonate..
A. How many % of the infection risk from untreated and how many % if mother is on treatment?
B. % of the infection transmission through BF, intrauterine, intrapartum and peripartun?
C. What are prophylaxis drugs and duration?
D. How will u investigate the baby at birth?
E. Vaccines at birth?
F. When will u vaccinate the baby for other vaccines?

TOACS FCPS NOV 20

1. Std apparoach
2. Squint
3. Rvt
4. Growth charts e short stature
5. Covid e dds
6. Att induces hepatitis e dds
7. Hyperamonia in neonate e dds
8. Mr e rhd
9. Moderate asthma classification
10. Neopuff e nrp
11. Nf e scoliosis
12. SCA wid ACS

TOACS FCPS DEC 20.

1. Methemoglobulinemia
2. Hypercholestrolemia
3. Complete androgen insensitivity syndrome.
4. Cong: chloride diarrhea
5. Laryngeal mask airway(lma)
6. Megaloblastic anemia
7. Coa
8. Candidiasis vaginalis
9. Bronchiolitis
10. Breath holding spells
11. Puv e vur
12. Congenital ichthyosis

TOACS FCPS2 MARCH 2021

1. celiac disease counselling.. How u counsel the parents, which foods to give n what should
avoid, how u investigate, what are the biopsy findings, how u monitor the disease n its associated
diseases n follow up.Child presented with chronic diarrhea ,tissue transglutaminase positives

2. What is diagnosis 2. How will you counselling 3. What are associations

3. Liver biopsy procedure... How u perform each n every step from intro to end

4. Autism scenario ( child didn't speak a word till 2.5 yrs otherwise normal)... What u ask in
history, n how u manage thi child, aba therapy(2 and half year old child present unable to
speak.Which question ask in history 2. Which examine you ll do 3. How treat non pharmological)

5. Ear examination with otoscope (right ear)

otoscopy n they ask what u have seen, what are the boundaries of eardrum anatomically, is it movable
or not if yes then when, if it has 2 tubes in ear drum what will u think, any other examination related
to ear i said throat n behind the air for mastoiditis.

6. A child presented sever abdominal pain,urine d/r normal,and treated for uti,but child not
improved, send to surgical ward for rule out.
1. Which question you ll ask in history to reach diagnosis.
2. Which investigation you ll do
3. How many types Acute intermittent porphyria... Scenario was generalised abd pain n 4 months
back abd pain n hematuria but no rbc in urine dr n surgical cause ruled out no other findings.

7. 35day old baby delivered admitted in nicu surfactant given also pda
1. What is treatment/risk factor/complication/prophylaxis
• key bpd/risk of developing bpd is inversely related to gestational age and birth weight.
(prematurity /pphn/dexamethasone )
Bpd scenario of preterm 28 wks with prolonged ventilation n cxr was given frst she ask diagnosis
then why bpd, what are the other causes of bpd other than ventilation, how u manage bpd treatment
other than o2, how many calories wil u give to a baby with bpd, complications of bpd i said pphn then
she said how u manage pphn.

8. Child diagnosed case of diabetes type 1 weight 20kg prescription of insulin asparte n glargine in
child
1. What is called this regime
2. How you calculate dose which is started from 0.6iu
3. Write down prescription at page
Diabetes type 1 pt.. Frst she ask what is bolus n basal regime, asparte n glargine me se kon sa bolus n
knsa basal, then calculte dose of 20kg child by 0.6 unit per kg n how u prescribed these 2 injections
shw gave a slip n it was all about to write a proper prescription with name age weight date dose of inj
asparte n glargine, how u give divided dose, route, urdu me bhi likhna sath n also rbs monitoring
mentioned on prescription slip.
Key
1. Bbr
2. 20 multiply 0.6 =12 units 50%then bolus regime 50% basal regime,6units asparte 6 units glargine
then asparte ko 2 units each with meal s. C)

9. Chest tube placement procedure.

A child presented with respiratory distress, needle thoracotomy was done, but child not improving.
1. Describe x ray
2. How you ll treat chest intubation
3. After chest intubation what you ll do

10. Supra pubic blader aspiration procedure of a child with phimosis scenari
6month old child abdominal pain doctor wants to take urine specimen,but child having phimosis, and
difficult to pass urine.
1. Procedure of suprapubic
2. Complications)

11. 5years old sudden collapsed how ll you proceed.( bls to perform)
BLS.Sudden collapse 5 yrs child on a road what u do.. As in work shops we did all was abt that then
he ask how many compression in 1 min, 1 rescuer n 2 rescuer diff, infant n child resuscitation
difference, method of compression in infant, which pulses in infants we should check.
Child presented sudden collapsed 1. Ecg given (lqt) 2. What is treatment)
Ecg with scenario of child who suddenly collapse.. Long qt syndrome.. Tell ecg findings it was torso
de (polymorphic vt) , diagnosis, management, which drugs to avoid.

12. 37 ga week pregnant mother diagnosed case of hiv ,come to you for advice(hiv +ve mother n
baby... What u sak in history frst.. Then he said mother is taking no treatment what will u do how u
manage baby n what treatment will u give to mother name drugs.. What tests will u do in baby, which
vaccine will u give in epi schedule to a baby with hiv, what drugs will u give to baby what are thr side
effects how will u monitor these side effects which test will u do for these, breastfeeding continue
krey mother ya nh)
1. What is prophylaxis of baby
2. If pcr positive then??
3. Name antiviral drugs/vaccine
4. Should mother breast feed
1. Start ziduvudine (azt), po, within 12 hours of birth.
2. At24-48hrs, hiv pcr, hep. Screen, cmv urine analysis.
3. At6 weeks, repeat hiv pcr.
4. Stop azt, start septran prophylaxis.
5. At3-4 months, repeat hiv pcr
6. If all 3 pcrs negative: stop septran>95% chance that baby is not infected continue f.up until hiv ab–
ve.
7. If any of the 3 pcrs +ve, than decide for pcp prophylaxis and haart
8. Haart: protease inhibitors nucleoside reverse transcriptase inhibitors non nucleoside ( reverse
transcriptase inhibitors
9. Developing country not contraindicated/developed country contraindicated.
10. Indications of immunizations in hiv patients:
• • live vaccine should not receive
• • immune globulin after exposure to measles.
• can receive varicella vaccine if thecd4+lymphocyte count is≥15% of expected for age.
• ipv instead of opv

TOACS FCPS JUNE 21

1. Cxray Ards e covid>> ventilator setting(5 yrs old wid fever 104 sudden cough anf sc
retractions, b/l crepts SPO2 80%, wid 4L/min. What will u do, how will u investigate.CXRAY
showing B/L infiltrates/ haziness. Abgs on demand showing resp acidosis. PH 7.3, PCO2 50, PaO2
48 HCO3 28.Type of resp failure and Vent setting.
2. Renal osteodystrophy(12 yr old girl wid pallor and easy fatiguablty, bone pain. Labs showing
Na 130, K 5.6, Ca 1.6, PO4 2.8, Cr 3.5, Alk pho 1136. Dx?, how will u investigate and manage?)
3. Cah(3 hrs old neonate look at the pic>> ambiguity>> clitomegal nd bifid scrotum)1.how wil u
proced>> gonads palpation>>absent, usg>> overies and uterus present,karyotyping xx, uretheral
opening>>single, Na 128, K 6.5, 17Oh progesteron increased) 2.what is dx, 3.how will u
manage.After 6 months of treatment came wid increased ht 98 and wt at 95centil. how will u aproach
this?
4. Ct scan of chronic pancreatitis(7 yrs old wid uper abdominal pain wid nauasea vomiting for 6
weeks. look at the ct contrast, what are findings( clacification in pancrease), wht is dx, how will u
manage and what are chronic complications)
5. Beta blocker toxicity( 3yrs old baby took grandfathers tablets he is on antihypertensive. Ecg
shown bradycardia wid av blok what will u do, whts dx, how will u investigate and manage?.
Beta blocker toxicity...
*Occures after 6hrs of ingestion.
*Decreases cardaic contractlity and cardiac heart rate.
*Bradycardia hypotension hypoglycemia bronchospasm. unconsiousness coma death
*Investigations.
*Ecg... Bradycardia
PR prolong
Prolong QT interval
*UCE
RBS

*DDs..
Ca blockers
Management.
Admit iv line
Fluids electrolyte corection
Correct hypoglycemia with 10% D/w.
*Specific
1.Glucagon bolus 0.15mg/kg then infusion 0.05ug/kg/hr
Others.... Ca suplements, vasopresors and insulin.
B agonits for bronchospasm.

Ca blocker toxicity...
Occures soon after ingestion.
Blocks ca channels and decreases cardiac contractility.
Hypotenstion with bradycardia
Arythmias
Hyper/normoglycemia
*Investigations
ECG.. Bradycardia/tachycardia
UEC
MANAGEMENT.
Admit iv line
Gastric wash
Whole bowel irigation
Charcoal
Corect fluid electrolytes
Specific
Ca suplements(calcium gluconate)
Vasopresors
Insulin with euglycemia
Lipid emulsion therapy
Cardiac pacing
Intra-aortic ballon pump
ECMO
Cardiac monitoring and rbs monitoring.
6. Cvp line (indications, technique and site of insertion and tell name of procedure when you insert
guidewire, Complications & contraindications)

7. Exchange tx( how will u perform, why hypokale, why hypocal, why hypothermia nd
hypogkycemia, what will u do wid blood aspirated, why o negative blood u want why not babiez
own). Pre requisties
8. Vt in unstable child>>>a rescue team is doing cpr, u arrive at scene what will u do( intorduction
and brief sumry about case,aspetic protocol gloves and then ask about ecg which was showing VT
widout puls). Now what u do?## Defib unsynch shok cont:cpr then shok then cpr and epi then again
shok cpr wid amiodrone again shok cpr and look dor Hs nd Ts. Everytim increas dose. Dose of epi
and amiodrone.
9. Corona ward donning and dofing(ppe) u apointed as duty in covid ward what will u do first.
10. Tethered sp cord. Look at the pic(pes cavus), causes Chronic gbs, CMTD, tethered cord. Then
spine pic showing dimple and hairs, spina bifida then investigation? Then showed MRI showing
tethered cord at conus medularis. what is dx? Tethered cord and spina bifida. How will u manage?
MDT suportive with bowel blader care. Micro surgical dissectiion(release of overlying dura and soft
tissues) orthopedic opinion physio therapy.
Prognosis: Outcome depends upon complexity. If diastematonyelia good and low chances of
reccurence.If MMC/Lipomemingomyelocele poor outcome wid increase chances of reccurences of
tethered cord.
What are complications? Neurologic motor sensory deficits, ankle jerk absent, calf atrophy,
orthopedic asymetry of feets, smaller or high arched foot(pes cavus) laong wid clawing of toes and
scoliosis. Bowel baldder dysfunctioning. Generalized back pain radiating to lower limbs.
Investigations. Mri, yrodynamic studies and mcug for vur.
11. Cxray wide mediastinum(hodgkin lymphoma>>3weks cough, nd fever for 2weeks).
12. Leg calf perthes disease.( 7 yrs old boy e limping and unable to bear wt on leg. O/E abduction
and internal roatation dificulty. Look at the xray. Dx? Dds, points to ask in history, management and
counselling regarding disease and which drug to avoid and why? Steriod??.

TOACS FCPS NOV 21

Station 01
neonate 7 day old with hypoglycemic fits
questions asked
immediate management>10 dw
labs septic profile/baseline labs/insulin/c peptide
definitive critical sample
how will u mange hyperinsulinemia bsr 25 insulim 2.2(raised)

Station 02
12 year old with jaundice frm 9 mnth.liver 3 cm speen 2 cm.hbsag positive
diagnpsis
furthur labs were asked
then bilirubin 9 alt 90 liver biosy inflamation with fibrosis
will u treat>yes
what trearment
1st line treatmnt duration and when will u stop
seroconversion

Station 03.

Fev1 1.31 fvc 3.9

what is the test spirometry
what are the finding> obstructive lung dis
diagnosis>asthma
then he show one year back reafing that was fev1 3.7 fvc 3.4 then asked for treatment step up aproach
curently pt on medium dose inhaled>LABA high dose ics then theophyline and systemic steroids
home monitrong for asthma PEFR
any other way of monitoring

Station 04
scnarion of myocarditis attended a gathring now tachycardia crt 4sec bp was low
immediate managemnt
labs..cbc crp esr ecg echo cxr covid pcr ferritin d dimer
then he told the lab parameters there was lymphopenia raised d dimer and ferritin
now how will u manage>supportive plus steroids ramdisivir and tociluzumab

Station 05
Scenario of anorexia nervosa
asked for criteria of anorexia nervosa
complications
cause of death> arrythmias suicide
how will u evaluate.

Anorexia nervosa

Overstimation of body shape and size.

Types

Restrictive: Excessive dieting and exercise

Binge purge type: Intermitently overeating then atempt to rid themselves by induced vomiting and
laxative/enemas.

DMS-5 criterias.

1. Low body wt by decreasing energy in relation to requirement.A

2. Intense fear of gaining wt to become fatty.B

3. Distrubances in self perception of wt nd shape.C

4. Exclusion of other pschyatric causes.

Partial remision:

A/f full AN critetis met then A does not met while B and C still persists.

Full remission:

A/f full criteria then no one met.

*S.S* :

Intermitently wt los

Fatigue

Hypothermia

Acrocyanosis

Dec body mass

Orthostasis

DDs.

Hyperthyroidism

TIDM

Chronic illness

Malabsorption syndrome IBD

Malignancy.
Investigations

CBC: Anemia wbc dec or inc

Derranged electrolytes

Ecg: nonspecific st changes and QT prolong

Gonadotrophin level decreased

S.albumin decreased.

Rbs dec

UC Derrange.

S. Cortisol dec

Cholesterol dec

Complications.

Gonadal failure: Amenorrohea/ erectile dysfunctioning.

Osteopenia

Osteoporosis

Hypothermia

Succidal atmepts

Tachyarrthmias.

*Treatment*

Counselling Primary care diet

Decrease exercise

Refer to.memtal health servoces if any other psychatric issues

SSRI if depression

Congnitive behavioural therapy.

Dilactical behavipural therapy.

Cause of death
Sucide

Tachyarhthmias.

Station 06
12 yr old male with breast enlargmnt
what u will ask in history> drug intake/CLD
examination >smr anthropometry neurological testicular exam
labs lh/fsh/usg/testosterone/estradiol
from where estrogen is produced in male
i said Dheas and frm testostrene
treatment>reassurance/tamoxifen/surgical excision

*Gynecomastia* .
Proliferation of mammary glandular tissue in the male atleast 0.5cn centrally beneath niples and
aerolar region.
*Pseudogynecomastia* :
Accumulation of adispose tissue in breast.
Physiological imbalance between estradiol and testoesterone action at breast tissues with normal level
in serum. Estrogen is preoduced by testes(20%), brain, adipose tissues,skin nd bone.
Neonatal gynecomastia is mostly physiological which is due to increased maternal estrogen and it is
unilateral and transient. Resolve widin few months of life
Pathological associated with below conditions.
*H/o*
Drugs.
Cimetidine
Ketoconazole
Spirnolactone
Androgen inhibitors
Estrogen
Anabolic steriods
Opiates
Cosmetic creams/herbal exposure
Alcohol
*Syndrome*
Klinefelter
CAH
Hyperprlactinoma
Hyperthyroidism
Malnourished/Refeeding syndorme.
H/o renal or liver disease
F.hx
*Exam*
Breast examination(overlying skin changes fixation local Lymph nodes, Niple discharge.)
Testicular volume for klinefelter.
Exam for ckd and cld
Anthropometry and bp
SMR stagging.
*Investigations*
Thyroid profile
S.testoestrone, estradiol,hcg, LH, Prolactin
Karyotyping For syndrome
DHEA
LFTS
RFTS
GONADOTROPHIN LEVEL FOR KLINEFELTOR
17-OH for CAH.
*TREATMENT*
Benign pubertal Reassure bcz physiological in nature.
If Persistent for 12months or pshcyological issues .
Estrogen inhibitora
Raloxifen(60mg/day) and tamoxifen(10-20mg) for 3-9 months
If execessive 3-5 stage wid pshcyological issues and medical treatment fail to regress in 18-24
months then go for surgery in nearly or comlpeted pubertal male.

Station 07
Secenario of hereditry angioedema
labs
specific test
treatment
how will u councel parents

Station 08
mcug was shown e grade 4 vur
what other findings on mcug..there was some mass
then he asked examination
and treatmnt options>intermitent catherization/antibiotic/surgery
what surgery
what other treatmnt opetion?

Station 09
Procedure interossius line

Station 10
road side accident with head injury
how will u maintain and position airway
>head tilt chin lift suction/other airway options
ambu baging ett
perform ett how will u asses ett in place
what will happen if ett is more inside than normal i said collapse of contralateral lung
size off ett in 4 year old child > 5

Station 11
scenario of sickle cell with severe abd.pain and limb swelling hb 7 wbc 1400 plat 19500
immediate step> rehydrate/analgesic/antipyretic
examination points of sickle cell patient>
neurological heart limbs kidney eyes
treatment at discharge> hydtoxy urea
vaccination
prophylactic antibiotics.

An 18 mnth old girl brought to opd with complaints of rt eye protrusion. Acc to mother the child was
fine about a mnth back when she noted her daughter was seeing outwards with her left eye and at
times sparkling glow from rt eye in dark. O/e her ht and wt were on 50th cantile. Rt eye has proptosis
with absent red eye reflex. Cranial nerves are grossly intact. Rest of axamination is unremarkable.
Q1...d/ds of leukocoria at this age.
2..most likely diagnosis
3...inx
4...mode of inheritance
5...treatment options.
Retinoblastoma..
Torch
Persistent hyperplastic primory viterous
coats disease
Diagnosis. Retinoblastoma.

Mode of inheritance autosmoal dominant and sproadic

Postive family hx
Do gentetic testing n eye examination .if genetic testing positive do serial eye monitoring till age of 5
year
Opthalomical finding would b grey chalky whitish mass
Investigations
U/s orbit
CT,MRI brain
RB1 gene mutations
Tx
Enucleation
Focal therapy
Chemo with VEC ( carboplatin, vincristine ,etoposide,)
External beam irradiation
Brachy therapy.
enucleation for unilateral
chemoreduction and focal therapy for bilateral
prognosis95% cured
with congenital form risk of 2nd malignacy
soft tissue tumors
osteosarcoma
melanoma.
12.Retinoblastoma with preseptal cellulitis with fundoscopy pic and mri orbit hypointense area left
Orbit.
Genetics
Treatment
Eye examination.

TOACS FCPS DEC 21

Station 1:
Çhest xray showing cardiomegaly and obliterated costophrenic angles. Describe cxr, then ecg was
shown, asked to describe ecg. Showed low voltage complexes. (Constrictive pericarditis)
What investigations will you do further?
Possible diagnosis?
In the end echo report was shown, showing pericarditis, now how will you manage?

Station 2:
Scenario of a pregnant female, her u/s showing hydrops fetalis.
What are causes of this condition? Not hemolytic causes
What further investigations will you advise to find out cause?
They wanted to hear karyotyp13and amniocentesis in answer and cardiac causes of hydrops. After
that karyotyping report was shared showing trisomy 13, and asked what is this condition and which
cardiac defects common in it.

Station 3:
Picture of peritoneal dialysis. Page was given to you and you were asked how will you make an input
and output record chart and how will you monitor and which investigations will you do meanwhile?
Three different circuits were shown and asked which one is correct.
If patient became edematous after PD what could be the reason ? How will you manage

Station 4:
Child with recurrent episodes of respiratory tract infections and nasal polyp. What are your 3 dds.
Top dd was cystic fibrosis. How will you confirm your diagnosis?
Diagnostic criteria?
Treatment?
Which antibiotic is given via nebulizer?

Station 5:
Child in far off village, presented with hepatosplenomegaly, nystagmus.
How will you investigate further?
Cbc report was shown with decreased Hb
Later on xray was shown with bone in bone appearance suggestive of osteopetrosis
Station 6:
Child had nephrotic presentation with hematuria which initially responded to steroids but did not
respond for the next time. Diagnosis was asked (atypical N.S, PSGN, and SLE nephritis).
How will u further investigate. .?
Renal biopsy report was shown which showed FSGN?
How will you manage. ?

Station 7:
Neonate with Bilateral cataract, hepatomegaly, sepsis.
What are your two DDs? Torch and galactosemia. Which of the torch most probable and justify your
answer. Rubela as there is b/l catarct and HSM along wid sepsis. How will you manage torch or
galactosemia? Investigation
Torch profile
GALT1 activity in rbcs. Glucose 1phosphate uridyltransferase.
Rbs
Usg abdomen
Mri ct brain
Eye examination
If rubela no specific treatment. Suportive only
Prevention Vacination
Avoid pregnancy for 28days after imunization.

Station 8:
A mother came with complaint of child stammering which started two months back?
What will you ask in history.
Child abuse

Station 9:
A young girl presented with pain abdomen, vomiting, in ER. How will you investigate and how will
you manage.
Dds.
Some were given hint that young girl so consider ovarian torsion. However, general outline was
asked for acute abdomen.

Station 10:
Picture of unilateral ptosis. Asked causes. Further viva in myasthenia gravis.

Unilateral ptosis causes

3rd nerve palsy
Horner syndrome
Mystehnia gravis
Myopathy.

Station 11:
A young girl with headache, raised b.p, hematuria, pain abdomen, recurrent fits. It was a long
scenario with some lab reports. There was hyponatremia.
Give 3 dds.
Further viva was in acute intermittent porphyria.

Station 12:
A child after having electric shock is on ventilator for 3 weeks, now was given trial but could not be
weaned off from ventilator. How will you counsel the parents regarding this?
They wanted to hear tracheostomy as answer. Further viva was on care of tracheostomy.

Tracheostomy
*Indications*
Emergency: Upper resp tract obstruction,
Anaphylaxis.
Angioedema
Tumors of upper Resp tract
Prolonged Ventilation

*Contraindications*
Absolute neck cellulitis
Cervical instability
Tumor
Skin infection
Prior surgery (neck).

*Complications and Risks of Tracheostomy*

Bleeding.
Air trapped around the lungs (pneumothorax)
Air trapped in the deeper layers of the chest(pneumomediastinum)
Air trapped underneath the skin around the tracheostomy (subcutaneous emphysema)
Damage to the swallowing tube (esophagus)

*Site*
crocoid cartilage at 2nd 3rd ring.
*Postoperative care* .
Adequate warmed humidity.
Maintain cuff pressure.
Suction as needed.
Ascultate sounds ett can be lodged into rt bronchus.
Monitor vitals and O2sat.
Maintaina hydration.
Care of stoma and neck.

*Routine home care*

*How will u check Patency?*
Cotton ya koi b chez samne rakhn g tube k agar expiration k Doran move kar rh to patent
*Duartion*
It depnds upon condition it can be prolong.

*IMPERFORATE ANUS
New born no anus opening*
*What examination*
Examine for presence of any fistula, vertebral anomalies, cardiac, chest, limb defects

*Investigation*
cross tab lat view xray
Xray spine
Renal u/s
Echo
Esophagoscopy

*Treatment*

Treatment depends upon level of imperforated anus.

if low level then perinal anoplasty.
if high level then colostomy and posterior saggital colostomy repair..

*Long term menagment*

*SYPHILIS*

*Primary syphilis* ... genital chancre

*Secondary syphilis* ...2to 10 weeks after chancre heals, condyloma lata ,gen lymphadenopathy

*Tertiary syphilis* ... gummatous lesion and cardiovascular and cns involmement

*Congenital syphilis* ... untreated syphilis during pregnancy results in vertical transmission rate
approaching 100%
60% are asymptomatic at time of birth, hepatomegaly skeletal abnormalities periositi, osteositis, gen
lymphadenopathy, maculopapular rash , vesicular rash , bullae, rashes are highly contagious,
Rhinitis, sniffles, anemia thrombocytopenia neurosyphilis

*Diagnosis* :
1. Non trponemal serological screening test RPR/VDRL

2.Treponema specific test

FTA ABS
TPPA
TPI
Remain positive for life and do not correlate disease activity

*Treatment*
Aqueous crystalline penicillin G 2-300000u/kg/day iv for 10 days
*PRUNE BELLY SYNDROME*

*Associations*
-Lung Hypoplasia
-TOF/VSD
-Malrotation of intestine
-DDH
-Urinary tract defects (Large ureters, distended bladder, megaurethra, patent urachus)

*C)Labs*
-U/C/E
-ABGS
-U/S abdomen and pelvis
-XRAY chest/Echo
-XRAY Hip
Complications
Undecend testes
Renal pulmonary gut mrotation chd DDH
Us kub mcug xray hips echo

*D)Prognosis*
-depends on degree of Pulmonary Hypoplasia and Renal dysplasia
*1/3rd Still birth
*Survival went to CKD

Senario of osteopetrosis questions..

Why there is deafness and vision problems?
because of thick bones nerves get impinged
Coz of defective osteoclastic activity bone deposition continues n nerve foramen became narrow.
D/ds???
Pykinodysyosis
Storage disorder/guacher.
D/Ds HSM and Pancytopenia.
Invsgs me,X-ray,cBC. Aur genetic studies.
Rx .. Interferon Calcitriol Bisphosphate and supportive .. Transfusion and BMT

Atypical nephrotic syndrome

Child had nephrotic presentation with hematuria which initially responded to steroids but did not
respond for the next time. Diagnosis was asked (atypical N.S, PSGN, and SLE nephritis).
How will u further investigate. .?
Renal biopsy report was shown which showed FSGN?
How will you manage. ?
what firther questions will u ask..? Ask regarding dose Duration complianc, hx of HTN.
Then further investig… renal biopsy was showed
There was focal sclerosis.
Rx..Teatment of steroid resistant nephrotic syndrome
DsDNA ANA compliments level
Biopsy
Bp
Edema
Poor prognosis
Progressve renl insufncy and ESRD 50%.
15-20 response karte
30-50/ Recurnt nephrotic after transplant..
Patau syndrome

Scenario of a pregnant female, her u/s showing hydrops fetalis.

What are causes of this condition? Not hemolytic causes
What further investigations will you advise to find out cause?
They wanted to hear karyotyp13and amniocentesis in answer and cardiac causes of hydrops. After
that karyotyping report was shared showing trisomy 13, and asked what is this condition and which
cardiac defects common in it.

Ans:
Causes....cvs...arrhythmia, malformations
Chest...cams, dh
Infections...torch,parvo
Chromosomal...trisomy.. 18,13,21
Skeletal dysplasia...OSTEOGENISIS IMPERFECTA
kidney...congenital NS
Alfa thalassemia and IEOM
Inx
Detailed Fh
Serology for torch n parvo
Amniocentesis
Karyotyping for trisomy
Genome sequencing for dysplasia and IEOM
Us
CBC
Torch
Fetal echo
Amniocentesis fetoscopy
Chromosomal analysis shows an extra chromosome 13

2. DIAGNOSIS
Patau syndrome (trisomy 13)

3. S/S
Cutis aplasia
Microphthalmia
Cleft lip and palate 60-80%
Microcephaly
Capillary hemangioma
Deafness
CHD (VSD, PDA, ASD)
Clinodactyly
Polydactyly
Severe dev delay
Renal abnormalities

4. DIFFERENTIALS
Trisomy 18
5. INVESTIGATIONS
Karyotyping
Rapid test by FISH
Echocardiogram
Usg abdomen
Skeletal survey

6. ETIOLOGY
Trisomy 13
Mosaicism

7. ASSOCIATION
Female gender 60% (Current)

8. COMPLICATIONS
Failure to thrive
Cognitive disabilities
Apneic spells
Seizures
Deafness

9. MANAGEMENT
General supportive care
Join support groups
Genetic counseling

10. PROGNOSIS
Death occurs in early infancy or by 2nd yr of life due to heart failure or infection (Current)

Median survival 12 days

80% die by 1 yr

10 yr survival 13%.
Station 4:
Child with recurrent episodes of respiratory tract infections and nasal polyp. What are your 3 dds.
Top dd was cystic fibrosis. How will you confirm your diagnosis?
Diagnostic criteria?
Treatment?
Which antibiotic is given via nebulizer?
D/d
Cf
Kertegeners
Immunodeficiency??
How will you investigate CF in neontal life? Hx. And investigation??
Investigation m swt chloride test
Cftr mutation
Nasal potential difference
Nasal scrpng biopsy
X-ray
Hrct
Fecal elastase (supportive)
Sweat Cl test. CFTR mutation. Nasal potential difference, CXR, HRCT. Fecal Elastase... Stool for fat
globules...
What symptoms the child will have in neonatal period
Meconium ileus,prolong jauindice
Treatment MDT
Nutritional
Physiotherapy
Nebulization
Broad spectrum antibiotics
panceatic enzyme replacement.
>>Colistin,Aztreonam, tobramycin can be given Via Nebs

7yrs old girl has been unwell for six wks with lethargy, fever, and joint pains. O/E she has temp
38.5oc , erythmatous rash on trunk and both wrists are warm and painful
1..what other findings you would ke to check to make diagnosis.
2..give 3 differentials
3...what inx you would like to perform.
Lymphadenopathy visceromegaly
Bone temderness
joint ivolvement kb se hy, kitny joints involve hain
fever kb se hy,record
h/o sore throat 2-4 weaks back
any other rash on face
photosensitivity urinary complaint hematuria etc
Yes pattern of fever ,joint involvement, pattern n timing of rash plus d/ds k liye previous sore throat,
oral ulcer, alopecia, photosensitivity,
2. DDs
SoJIA
SLE
Leukemia
Rheumatic fever
3.p smear ,blood c/s
Esr
Crp
ANA
Antids DNA
Urine analysis

7yrs old girl has been unwell for six wks with lethargy, fever, and joint pains. O/E she has temp
38.5oc , erythmatous rash on trunk and both wrists are warm and painful
1..what other findings you would ke to check to make diagnosis.
2..give 3 differentials
3...what inx you would like to perform.
Lymphadenopathy visceromegaly
Bone temderness
joint ivolvement kb se hy, kitny joints involve hain
fever kb se hy,record
h/o sore throat 2-4 weaks back
any other rash on face
photosensitivity urinary complaint hematuria etc
Yes pattern of fever ,joint involvement, pattern n timing of rash plus d/ds k liye previous sore throat,
oral ulcer, alopecia, photosensitivity,
2. DDs
SoJIA
SLE
Leukemia
Rheumatic fever
3.p smear ,blood c/s
Esr
Crp
ANA
Anti ccp
Antids DNA
Urine analysis
*FCPS part 2 toacs(15/11/2021)*

1.neonate 7 day old with hypoglycemic fits

questions asked
immediate management>10 dw
labs septic profile/baseline labs/insulin/c peptide
definitive critical sample
how will u mange hyperinsulinemia bsr 25 insulim 2.2(raised).
Ist of all what is neonatal hypoglycemia. <55mgldl in infant of upto 28 days.
Transient
Rebound
Persistent hypoglycemia.

Transient occures in infant of diabetic mother due to compensatory response to hyperglycemia in

mother (increase insulin).
Rebound in response to exogenous glucose
transient resolves within 3day.
persistant persist beyond 3days after birth.
and rebound is after dextrose infusion more insulin is secreted and again pt goes to hypo
*Causes of persistent hypoglycemia...
Hyperinsulinemia
Fattyacid oxidation deffect
Carnitine defficiency

Labs.
At the time of hypoglycemia blood sample and urine sample was taken
Insulin more than 2
Ketone less than 2
Fatty acids less than 1.5.>>>>hyperinsulinemia
Treatment..
If pt is asymptomatic...
Start oral/ NG feeding n check rbs frequently with GFR Upto 8 or more.
Iv glucose initially starts 10%D/W then increase its concen. After 12.5% give thru cvline.
Then
Diazoxide then
Octeotride plus glucagon
partial/total pancreatectomy.

chronic active hep B

12 year old with jaundice frm 9 mnth.liver 3 cm speen 2 cm.hbsag positive
diagnosis
furthur labs were asked
then bilirubin 9 alt 90 liver biosy inflamation with fibrosis
will u treat>yes
what trearment
1st line treatmnt duration and when will u stop
seroconversion.
chronic active hepatitis
HbS ag, HbS ab, Hbe ag /ab, hbc ab, LFTs, u/S,
Cbc,lfts, inr,hep b serology, hbv dna, usg, biopsy
bilirubin
lfts
pt aptt
albumin
hep b serology usg
Immuneactive
Viral load more than 20,000,serology positive,derranged lots,cirrhosis on biopsy
Yes will treat
Interferon alfa 2b ....on alternate day for 6 mnths
Lamivudine oral for 52 wks n 6 wks after clearance of virus.

Pericarditis
Senario and cxray was pericarditis.
Globular flask shape silhouette with obliteration of cp angles.
Dx.. Pericarditis.
Investigations?
Ecg....low voltage ecg with wide spread st elevations
further investigations?
Echo,cardiac MRIand invs for the cause.
In constrictive there is calcification in cxray ct mri.
what will be the signs if its pericardial effusion?
Pain ,sob,oedema,Raised jvp
Pulses paradoxes ,basal crepts
Y not myocarditis? Low voltage ecg is also In myocarditis?
Admit iv line
O2 suport
 Monitor attach
Iv hydration and antipyretics and painkillers.
If there is p.effusion i will do pericardiocentesis or
pericardial window if reccurent.
Antibiotics
Steroids with att if tb
Antifungal.
In case of prevention of recurrnce colchicine ad anakinara.
Heart transplantation.

senario of baby born to hiv mother

accoriding to the imnci
questions were which vaccine will you give
when will you give influenzavaccine how many cd counts should be?
everything was about cd count
treatment

24yrs old lady diagnosed as hiv+ at 36wks of preg. counsel her regarding perinatal transmission and
followup?
what is incidence of perinatal & breastfeeding transmission?
what are modalities of reducing rate of transmission?
how to decrease transmission during breastfeeding and how much these measures are effective?
how will you diagnose that infant is infected with hiv?
how will you manage infant?
answers:
in the absence of any interventions, 15–25% of hiv-positive mothers will infect their infants during
pregnancy or delivery; if they breastfeed, there is an additional absolute risk of 5–20%.
art to mother and child, lscs
art to mother and infant; the risk for transmission is reduced to 2% or 4% if she breastfeeds for 6 or 12
months, respectively
hiv dna/rna by pcr; ultrasensitive p24 antigen detection in plasma
one positive virological test at 4–8 weeks is sufficient to diagnose hiv infection in a young infant.
Start zdv (birth) untill neonatal disease excluded by pcr
Also start pcp prophylaxis (tmp-smz) until disease excluded
When symptoms or immune dysfunction treat with art regardless of age and viral load
HIV +ve Mother with neonate..
A. How many % of the infection risk from untreated and how many % if mother is on treatment?
B. % of the infection transmission through BF, intrauterine, intrapartum and peripartun?
C. What are prophylaxis drugs and duration?
D. How will u investigate the baby at birth?
E. Vaccines at birth?
F. When will u vaccinate the baby for other vaccines?

11 yrs old female on ventilator for last many days for encephalitis with nonreative dilated pupils.
Criteria to declare brain death and to remove from ventilator in this patient. Absence of brain stem
reflexes. What is apnoea test and how is it performed? What are the steps? Who do you involve in your
decision to remove from ventilator besides parents short of court? (hospital dnr committee made of
experts) what do you counsel the parents after confirming brain death. What is dnr?