FCPS Past Toacs
FCPS Past Toacs
FCPS Past Toacs
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
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
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
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
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)
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
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?
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
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
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)
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)
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
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??.
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.
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
Binge purge type: Intermitently overeating then atempt to rid themselves by induced vomiting and
laxative/enemas.
DMS-5 criterias.
Partial remision:
A/f full AN critetis met then A does not met while B and C still persists.
Full remission:
*S.S* :
Intermitently wt los
Fatigue
Hypothermia
Acrocyanosis
Orthostasis
DDs.
Hyperthyroidism
TIDM
Chronic illness
Malignancy.
Investigations
Derranged electrolytes
S.albumin decreased.
Rbs dec
UC Derrange.
S. Cortisol dec
Cholesterol dec
Complications.
Osteopenia
Osteoporosis
Hypothermia
Succidal atmepts
Tachyarrthmias.
*Treatment*
Decrease exercise
SSRI if depression
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.
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.
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).
*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.
*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*
*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
*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
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)
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)*
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.
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.
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?