Toacs imm january.2015

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STATION NO.1 (Silent) 1 A. a child presented to general practitioner with URTI and child was given cephradine. After 1 day he developed rashes (Two pictures were shown 1.rashes on face with involvement of mouth and eyes 2.rashes on buttock and trunk) Q1. Describe lesion? Q2.Diagnosis? Q3. Treatment? (Steven Johnson syndrome) 1 B. X-ray of IVP shown on illuminator. Q1. Describe findings. And name the investigation performed? Q2. Further investigations? Q3. Treatment? (Bilateral stag horn stones)

Transcript of Toacs imm january.2015

Page 1: Toacs imm january.2015

STATION NO.1

(Silent)

1 A. a child presented to general practitioner with URTI and child was given

cephradine. After 1 day he developed rashes

(Two pictures were shown 1.rashes on face with involvement of mouth and eyes

2.rashes on buttock and trunk)

Q1. Describe lesion?

Q2.Diagnosis?

Q3. Treatment?

(Steven Johnson syndrome)

1 B. X-ray of IVP shown on illuminator.

Q1. Describe findings. And name the investigation performed?

Q2. Further investigations?

Q3. Treatment?

(Bilateral stag horn stones)

Page 2: Toacs imm january.2015

STATION NO. 2

(Silent)

A child presented with you and has following investigations.

HBSAg Positive

Anti-HBS Ag Negative

Anti-HBe Ag Negative

HBc IgM Positive

Q1.Diagnosis?

Q2. Further Investigations?

Q3. Treatment?

Page 3: Toacs imm january.2015

STATION NO. 3

(Interactive)

A mother brought a 10 year old boy with H/O bed wetting.

(Mother was sitting with the examiner)

Q1. Diagnosis?

Q2. What questions will you ask from the mother?

Q3. Investigations?

Q4. Treatment?

Q5. What counselling message will you give to the mother?

Page 4: Toacs imm january.2015

STATION NO. 4

(Silent)

ECG

Q1. Describe the ECG?

Q2. Give 3 causes of the findings?

Q3. What further investigations will you order?

(HR 75/min, sinus rhythm, bifid p waves, left axis deviation, LVH)

Page 5: Toacs imm january.2015

STATION NO. 5

(Interactive)

A 2 year old child, wt.8kg, is having fever and runny nose, presented with rashes

on the body. There is also a family member with similar complaints.

Q1. If the child has mouth ulcers how will you classify?

Q2. When will you refer the child?

Q3. Give the treatment?

Page 6: Toacs imm january.2015

STATION NO. 5

(Interactive)

A 12 years old boy diagnosed case of IDDM for last 3 years. For the last one year he

is injecting insulin himself. Now his BSR is 450mg/dl. His previous week reading was

same.

(cpsp servant was there as a patient)

Q1. Ask the questions from the boy for his poor control of sugar level?

Q2. Counsel about the complications of DM if he controls blood sugar ?

Page 7: Toacs imm january.2015

STATION NO. 7

(Interactive)

Mother has a 15 days old neonate. She wants to add some top feeding because her

baby cries frequently due to insufficient feeding.

Q1. What questions will you ask about insufficient feeding?

Q2. How will you counsel the mother for breast feeding?

Page 8: Toacs imm january.2015

STATION NO. 8

(Interactive)

A 7 years old child is diagnosed as a case of pulmonary T.B. He is taking ATT

(isoniazid, Rifampicin, Pyrazinamide) for 4 weeks. Now he presented in OPD for

yellow discoloration of eyes and anorexia.

Q1. Diagnosis?

Q2. How will you investigate?

Patient has bilirubin 4mg/dl, SGPT 254 IU/L, SGOT 312 IU/L and negative viral

markers.

Q3. How will you proceed?

After 8 weeks LFTs are improving and enzymes are decreasing.

Q4. How will you proceed further?

(will you stop one or all drugs, will you restart one drug or all drugs, will you

replace 1st line drugs with 2nd line drugs )

Page 9: Toacs imm january.2015

STATION NO. 9

(Interactive)

A 3 years old child is a known case of Cerebral Palsy. Mother is concerned about

child’s recurrent chest infection and seizures.

(Mother was sitting with examiner)

Q1.How will you counsel the mother about recurrent chest infection?

(why this occurs, what is cure, what is prevention)

Q2. How will you counsel the mother about recurrent fits?

(why fits occur, what is cure, what other causes can cause fits)

Q3. Name antiepileptic drugs?

Page 10: Toacs imm january.2015

STATION NO. 10

(Interactive)

A child is a diagnosed case of meningitis and is given cefotaxime and mannitol.

Investigations are

Serum Sodium 115 mmol

Serum potassium 4.5 mmol

Plasma osmolality 60

Urine osmolality 280

Q1 Diagnosis?

Q2. What are different causes of this condition?

Q3. How will you manage?

Q4. How will you control seizures?

( name ADH antagonist)

Page 11: Toacs imm january.2015

STATION NO. 11

(Interactive)

( CT scan Brain plain was on illuminator)

A 10 years old child previously normal presented with 1 day H/O GTC seizures and

became unconscious. Now his GCS is 9/15.

Q1.Describe findings?

Q2.What is likely neurological cause of this condition?

Q3. Further investigations?

( bilateral occipital infarct)

Page 12: Toacs imm january.2015

STATION NO. 12

(Interactive)

A child is having progressive pallor for 6 months. CBC shows

Hb. 7 g/dl

TLC 2800

Platelets 25000

Q1. Differential diagnosis?

Q2. Explain bone marrow aspiration procedure on child sitting there.

Q3. What are different points at which bone marrow aspiration can be done

according to different age group?

( bone marrow biopsy needle was there on the table with some other

instruments)

Page 13: Toacs imm january.2015

STATION NO. 13

(Interactive)

(A child was sitting there, Age was told by the examiner 4 years, Growth charts were

available on the table of the examiner)

Q1. Do the head circumference, weight, MUAC, Length / Weight of the child

and plot on the Growth Charts.

Q2. At what MUAC child is classified as severely malnourished?

(Check zero error, >2years height is taken, <2years Length is taken)

Page 14: Toacs imm january.2015

STATION NO. 14

(Interactive)

A 2 ½ years old child previously well, started having sudden onset of

shortness of breath and cough for 2 hours. Previous night child also attended

birthday party with his mother. O/E child has tachypnea, breath sounds are

diminished on right side, liver is palpable by 3 cm, heart sounds are normal.

Q1. Diagnosis?

Q2. What other findings will you find on examination?

Q3. What findings will you expect on X-ray?

Q4. What 1st treatment step will you take if you see sudden choking?

Q5. What is the treatment of choice?

Page 15: Toacs imm january.2015

STATION NO. 15

(Interactive)

A 3 days old neonate presented to you with jaundice which started in first

24 hours of age. Mother also has H/O 2 episodes of jaundice in her life. Now

the investigations show

S. Bilirubin 22.2mg/dl

Indirect bilirubin 1.8 mg/dl

Direct bilirubin 21.4 mg/dl

Q1. Diagnosis?

Q2. What will you see on PBP?

Q3. How will you confirm you diagnosis?

Q4. Treatment steps for baby?

Page 16: Toacs imm january.2015

1. There is no need of any instrument like stethoscope or hammer

2. Overall is optional

3. There may be one or two scenario at each station

4. Time allowed at each station is 7 minute but they announce 6 minute

5. Examiners have positive mindset

6. Only ball point is needed

7. There are 4 silent stations and 11 are interactive stations

8. Rest stations may or may not be there depending upon no. of candidates

9. Response sheet you have to put in the drop box at the same station (silent

station)

10. You have to write your roll no. date, subject and answer on response

sheet

Dr.ZAHID MAHMOOD

Pgr pediatrics

SZMC/H, Rahim Yar Khan

[email protected]