STATION 1

You are resuscitating a newborn at birth. The baby has gasping respiration at 30 seconds after birth. Demonstrate what steps you would take for the next 30 seconds.

STATION 2
A patient is admitted to the ICU with the following lab values:
BLOOD GASES under room air pH: 7.199 PCO2: 32.2 HCO3: 12 PO2: 86.6 ELECTROLYTES, BUN & CREATININE Na: 136 K: 4 Cl: 103

Ques 1 Describe metabolic condition (1) Ques 2 Describe compensation (calculate exact compensation) (1) Ques 3 Calculate anion gap (1) Ques 4 Name two conditions with similar anion gap as above (1)

STATION 2 ANSWERS Ans 1 Metabolic acidosis with partial compensation Ans 2 - 1 bicarb fall decreases Co2 1-1.5 Ans 3 Anion gap 25 Ans 4 Septic shock, Inborn error ( lactic acidosis), DKA etc
STATION 3

Question 1 Calculate the HR in the given ECG strip Question 2

One box is equal to =a) 1sec, b) 0.4 second c) 0.04 second d) 0.04mm

Question 3 - PR interval in above picture is a), b), c),d)

d

c a

STATION 3 ANSWERS 1. 50 /min If the distances are regular, count the number of "little boxes" from the beginning of one QRS to the beginning of the next QRS complex. Divide the number of "little boxes" (which each represent 0.04 seconds) into 1500 to obtain the heart rate in beats per minute. If the distances are irregular, count the number of QRS complexes, beginning at one QRS complex to the beginning of the last QRS complex within 30 large boxes (which each represent 0.2 seconds) and multiply by 10 to obtain the heart rate in beats/minute. 2. c
3. b

4.

STATION 4
Q 1 Please match new unit for the older units of radiation measurement (2 marks) OLD UNITS 1. 2. 3. 4. Curie (C ) Rad Rem Roentgen (R )

NEW UNITS a) Coulombs/kg b) Becquerel (Bq) c) Sievert (Sv) d) Gray (Gy) Q 2.Black bags/bins are meant for what type of waste? (1 mark) a. b. c. d. Infectious waste Non-infectious waste like paper/glass Organic waste like discarded food/vegetables etc Both b & c

Q3. Name 4 syndromes with increased sensitivity to X-rays (2 marks)

STATION 4 Ans 1 1-b 2 -d 3 -c 4-a Ans 2 d Ans 3 - Ataxia Telangectasia , Basal cell nevoid syndrome , Cockayne syndrome,Down syndrome,Fanconi Anemia, Gardner Syndrome,Nijmegan breakage syndrome, Usher syndrome , Bloom syndrome

STATION 5
DRUG - KETAMINE

Q 1. What is the dose for anesthesia for short procedure? (1 mark)

Q2. What are the adverse effects ? ( Atleast 4) ( 2 marks)

Q3. What type of anesthesia does it cause and which part of the brain does the drug act on? ( 2 mark)

Answers STATION 5 DRUG Ketamine

Ans 1. 0.5 2 mg/kg Ans 2 . Hypertension,tachycardia,hypotension,bradycardia,increased cerebral blood flow and intracranial pressure,hallucination,delirium,tonic clonic movement,increased metabolic rate,hypersalivation,nausea,vomiting, respiratory depression,apnea,increased airway resistance,cough and emergence reactions. Ans 3 - Dissociative anesthesia and direct action on cortex and limbic system

Station 6 Counseling session You have been called to see the parents of a child who has been recently diagnosed as a case of Diabetes Mellitus. Kindly counsel the parents about the disease . (10 marks )

Station 7
Q A. Provide ingredients and calories/100 ml and Protein/100 ml of following diet (4 marks) 1. F75 2. F100 Q B. What are the time frames for initial treatment and rehabilitation for the management of Severe malnutrition? ( 1 mark)

Answer station 7.
1. F75- dried skim milk 25 g, sugar 70g, cereal flour 35 g, vegetable oil 27 g, mineral mix 20 ml,vitamin MIX 140 MG, WATER TO MAKE 1000 ML . Calories 75 kcal, protein 0.9 g 2. F75- dried skim milk 80 g, sugar 50g, vegetable oil 60 g, mineral mix 20 ml,vitamin MIX 140 MG, WATER TO MAKE 1000 ML . Calories 100 kcal, protein 2.9 g

Ans B - day1-7 for initial treatment and week 2-6 for rehabilitation

STATION 8
Q1. Write age of eruption of secondary teeth . Q2. Write features of SMR stage 2 in girl and SMR stage 5 in boys.

STATION 8
Ans 1. central incisor - 9-10 yr,lateral incisor 10-11 yr,canines 12-15 yr,first premolar 12-13 yr,second premolar 12-14 yr,first molar 9-10 yr,second molar 14-16 yr,third molar 18-25 yr Ans 2. SMR 2 girl pubic hair are sparse,lightly pigmented,straight,medial border of labia and breast & papilla elevated as small mound,diameter of areola increased SMR5 in boy- pubic hair has adult distribution,spread medial surface of thighs,penis adult size and testes adult size

STATION 9
Give True (T) or False (F) response for the following statements ( 5 mark )

1.

Cidofovir used for treatment of adenovirus infection in immunocompromised patients is a nephrotoxic drug

2. 3.

Oseltamivir is drug of choice to treat bird-flu As of Feb 2006 , Nigeria is no longer considered endemic for wild polio virus (WPV) as it had no indigenous transmission during past 12 months

4.

Dose of Varicella Zoster Immunoglobulin (V ZIG) for post exposure prophylaxis is 1 vial (125 units) for each 10 kg increment (max 625 units) given intramuscularly as soon as possible but within 96 hr after exposure

5. 6. 7. 8.

EB virus is associated with more than half the cases of mixed cellularity Hodgkins disease. HMPV ( Human Metapneumovirus) was identified in 2001 SARS outbreak in 2003 was the 1st global epidemic of the 21st century A quadrivalent HPV vaccine against types 6,11,16 and 18 has been licensed for prevention of sqamous intraepithelial lesion

9.

In case of rat bite post exposure rabies prophylaxis is not required

10. Thrombocytopenia has been reported in 10-20% of HIV +ve patients

STATION 9
ANSWERS All or True (T)

STATION 10
HISTORY TAKING A 9 yr old child presents to emergency department with hematemesis . Take the history of the child from mother.
STATION 12 Q 1. Regarding COLD CHAIN SYSTEM ( 2.5 marks)

1. Preserve vaccines at a temperature between +8 to 24 C True/False 2. Equipments supplied at PHC are Ice Lined Refrigerators(ILR) and vaccine carriers True/False 3. Freezers with temperature monitoring at state level ( -20 C) True/False 4. Walk in freezers with temperature monitoring for district level storage ( -20 C) True/False 5. The quality of Cold chain is monitored by testing Measles vaccine samples selected randomly from the field True/False Q2 Q3 Q4 which What is GAIN? ( 0.5 marks) For AFP Surveillance a rate of >1/100,000 population in children aged less than 15 years is the best indicator for good surveillance system . ( True/False ) 0.5 marks Palivizumab ( monoclonal antibody) is used to treated infection with virus ? 1 mark

STATION 12 ANSWERS 1. 1 false,2 true,3 false,4false,5false 2. Global alliance for Improved Nutrition 3. true 4. RSV infection in children less than 24 months with chronic lung disease

STATION 13
Q 1 In an international clinical trial, two chemotherapy treatments are being compared. How are systematic differences between treatment groups best minimized? a) b) c) d) e) Analyze results by country separately Multivariate analysis Patient Stratification Prognostic factor analysis Randomization

Q 2. What is the rationale for conducting a clinical trial in a double blind manner? a) It effectively increases the size of the trial by suing each patient as their own control b) It increases comparability of patient characteristics in the treatment and control groups c) It increases the precision of the estimated effect d) It reduces systematic bias between the treatment and the control groups e) It reduces the effects of sampling variations Q 3 In a normal distribution the mean of the data will be similar to the a) Maximum b) Median c) Range d) Standard deviation e) Standard error Q4 The table below shows the number of adverse effects reported in a randomized trial comparing two treatments- A and B

Treatment Adverse Event? Group Yes A 4 B 16 Total 20

No 28 12 40

Total 32 28 60

The Odds Ratio of having an adverse event in group A is a) 4/16 b) 4/20 c) 4/28 d) 4/32 e) 4/60

STATION 13 ANSWERS 1.E 2.D 3.B 4.C

STATION 14 Q 1 Match the appropriate antidote to its corresponding drug overdose. (a) Deferoxamine _____ (b) N-Acetylcysteine ____ (c) Pyridoxine _____ (d) Vitamin K _____ (e) BAL _____ (f) Methylene blue _____ (g) Atropine _____ 1)Acetaminophen 2)Benzodiazepine 3) Nitrates/Methemoglobinemia 4)Isoniazid 5) Heavy metals (mercury, gold, arsenic) 6)Organophosphate 7) Iron

(h) Flumazenil _____

8) Coumarin

Q 2 List top ten causes of death worldwide of children under 5 yr of age.

STATION 14 Ans 1 A-7,B-1,C-4,D-8,E-5,F-3,G-6,H-2 Ans 2 1. LRTI 2. Diarrhoeal diseases 3. Childhood cluster diseases 4. low birth weight 5. malaria 6. birth asphyxia 7. HIV/AIDS 8. Congenital heart anomalies 9. PEM 10.STD excluding HIV 11.Drowning 12.Anenchephaly 13.Meningitis 14.RTA 15.Tuberculosis

STATION 15 Q 1 What does the following picture show?

Q2 What are the components of 1st Trimester screen done for detection of Downs syndrome? STATION 15

Answer 1 Microarray Ans 2-using maternal age and fetal nuchal translucency (NT) thickness along with maternal serum b-HCG,PAPP-A,unconjugated estriol and AFP level.

STATION 16 Case Scenario

5 Year old male child presents with fever for past 10 days. Fever is high grade, continuous in nature without chills and rigor. There is no associated loose motions, vomiting, headache, photophobia, cough, cold or rash. On examination child is conscious, febrile, normotensive , conjunctival congestion present with no apparent discharge . Two cervical lymph nodes (Right sided) palpable, 2 cm approx each. There is desquamation of skin around fingers. There is no hepatosplenomegaly . Rest of systemic examination is normal.

Q1

Your most probable diagnosis? ( 1 mark)

Q2 What characteristic feature can be found in complete blood counts? ( 1 mark) Q3 What is the most common cause of death in above-mentioned patient? ( 1 mark) Q4 What drug ( drug of choice ) you would like to give to this patient ( 1 mark)

STATION 16 Answers

1 Kawasaki disease 2 Thrombocytosis 3 4 Congestive heart failure Intravenous immunoglobin

STATION 17 This is a 5 minute station on volume assessment with a normal volunteer on a couch. Examiner: Please show me how you would assess this patient with renal failure for volume depletion or overload. STATION 17 Answer You are expected to examine the 'tissue', venous compartment and arterial compartment signs of volume. It would be inappropriate to ask the volunteer questions, not just because you have been asked to examine but also because symptoms are less sensitive and specific than signs in this situation. Assess tissue signs. Check if the tongue and axillae are moist; if they are, the patient is unlikely to be significantly volume depleted. Check the ankles and sacrum for oedema - its presence would suggest that the patient either is volume overloaded or has vascular leakage, which is allowing salt and water to escape into the tissues. Examine the jugular venous pressure: visible pulsation up to 2 cm above the manubriosternal angle suggests the patient is normovolaemic if you cannot see venous pulsation, lie the patient flat to see when it appears, and assess the degree of central venous hypotension if the pressure is raised, sit the patient up to see if you can identify the highest level of

pulsation, and assess the degree of central venous hypertension Examine the arterial compartment. Measure the pulse and blood pressure with the patient lying flat. Stand them up, then measure again after 2 minutes standing. STATION 18 Q 1. Indices used to distinguish between prerenal and established renal failure 3 Marks Q2 Formula for Fractional excretion of Sodium ( FENa) 1 mark Q3 What are laboratory findings in Fanconi syndrome ? 2 marks

STATION 18 Answer 1 * a urinary sodium * urinary osmolality * BUN /Cr ratio * urine osmolality/plasma osmolality * FENa Ans 2 Urine cr urine Na x Serum Cr / x 100 serum Na x

Ans 3 Global tubular dysfunction aminoaciduria, glucosuria,phophaturia.

acidosis, Rickets

STATION 19

TWO CLINICAL PHOTOGRAPH S OF A PATIENT

Question 1 Identify the condition

Question2 Name one association with this disease

STATION 19 Ans 1 hemihypertrophy Ans 2 Wilms tumor, Beckweth-weildman syndrome,Sotos synmdrome

STATION 20
Q 1 Which of these is normal smear ? Q 2 What is the noticeable difference between two smears ? Q 3 Important points to be asked in the history on the basis of the above abnormal smear. Q 4 What is the next investigation of choice?

STATION 20
Answer 1. 2. 3. 4. B Thrombocypenia in smear A and presence of giant platelet Fever/bleeding from any other site/pallor/ drug/HIV etc CBC

STATION 22
This is a 5 minute station with a normal volunteer on a couch. Examiner: This 13-year-boy has been found to have a mediastinal mass and lymphoma is suspected. Please examine him.
STATION 23 ANSWER

Do not waffle on about 'taking a history' because your instruction is clear and do not attempt to perform a 'general' physical examination. You must use your knowledge to focus the examination on examining: all possible sites of lymphadenopathy: the epitrochlear region of the elbow, neck, axillae, and groins the abdomen for para-aortic nodes (by deep palpation), hepatomegaly and splenomegaly the conjunctivae for anaemia. It is reasonable to examine the chest if you have time, but make less of a play of this than the parts of the examination listed above because chest examination may well be normal, and these other features will be much more informative, whether negative or positive. The character and distribution of the nodes are both important;
STATION 23

After you have examined

Patient on STATION 22

Q 1 What features of any lymph nodes found on examination would help your differential diagnosis? 2 marks Q2 What precautions you have to take prior to doing any diagnostic procedure? 2 marks Q3 What would be treatment of choice for urgent relief of superior vena caval syndrome? 2 marks

STATION 23 Answer: 1. Matted LN- TB, Rubbery LN - Hodgkins Lymphoma 2. NO SEDATION , Procedure in sitting position not in supine 3. Steroids with iv fluids with bicarb

STATION 24 Case scenario

15 year old female presents with fever for past 24 hours . Fever is high grade associated with sweating, loose motions (passed 10 large watery stools over past 6 hours ) . For past 2 hours patient is complaining of ghabrahat , chakkar . 5 days back (prior to fever ) patient had her menses which were of normal duration and normal blood loss On examination Toxic looking, drowsy with Glasgow coma scale of 10 Blood pressure systolic 70 mm Hg , pulse rate 140 min , capillary fill time 4 seconds , RR- 30/min . There is diffuse erythematous macular rash ( sun burn like ) all over body . Ques 1 Probable diagnosis Ques 2 First step in management other than airway & breathing Ques 3 What class (targeting particular bacteria) of antibiotic you would like to give to this patient Ques 4 Name common predisposing factor which can cause abovementioned disease Ques 5 Intravenous immunoglobin has no role to play in mentioned disease at any level True / false

STATION 24 Answers

Ans 1 Toxic shock syndrome Ans 2 Management of shock , fluid boluses Ans 3 Anti Staphloccocal Antibiotics

Ans 4 Use of tampons or vaginal device

Ans 5 false
Answer Following questions based on Xray seen on STATION 25 a. What is abnormal in this X ray? b. What is the ideal position of placement of umbilical arterial and umbilical venous line? c. After putting in a UA line, the right lower limb appears pale. What would you do? d. What is the level of the renal artery? e. How do you maintain a UA line?

STATION 25 ANSWER Abnormally placed umbilical arterial line in the subclavian artery Abnormally high placed endotracheal tube

For umbilical arterial line - High : Between T7-T10; Low: Between L2-L3 For umbilical vein - Just above the diaphragm

Warm the other limb ; If still pale >1/2 hour, remove the UA line

L-1

Use heparin infusion at rate of 0.5-1.0 Unit per hour

STATION 27
8yr old boy presented with bleathlessness on lying supine . Had pallor + ++ with liver 4 cm , spleen 5 cm below costal margin and axillary nodes bilateral 1x1 cm

STATION 28
Answer the following questions after seeing CXR on STATION 27

a. What are your findings on this CXR ? b. What is your likely diagnosis? c. How would you confirm?

STATION 28 1. Left sided opacity with trachea shifted to right with chest tube insitu 2. Mediastinal mass with left sided pleural effusion cause? Lymphoma T cell 3. Bone marrow in sitting position, Pleural tap and sending cells for immunophenotyping and malignant cells