PAEDIATRICS SOLVED OSPE 9TH & 10TH SEMESTER

STATION NO: 01 (MALNUTRITION)

- SCENARIO:
 A 05-year old boy is admitted in pediatrics ward 02 since 15 days. He has features of PCM
& is edematous. There is hepatomegaly & dermatitis.

1. What is your most likely diagnosis?



2. How will you make resomal?

 01 pack of ORS in 02 L of water, 50gms of sugar & 40mEq of KCl
(with other minerals)

3. For severe malnutrition, without edema which solution is preferred?

 F75 130 ml/kg 02 hourly.

4. Give any 02 differences between F75 & F100.

 F100 has increased osmolarity & has more proteins & fats.

5. Which screening test is done for SAM?

 MUAC (Mid-upper arm circumference).

6. How will you classify acute malnutrition according to CMAM?

 On the basis of MUAC.

STATION NO: 02 (HEPATITIS A)

- SCENARIO:
 A 08-year old boy has presented with acute onset of jaundice & fever since 02 days. He has
nausea & loss of appetite & tender hepatomegaly, pale stools & dark urine.

1. What is the most likely diagnosis?

 Hepatitis-A.

2. What percentage of children are affected in this?

 30 to 35%.

3. How this condition can be prevented?

 Vaccination, proper hygiene & counselling on hand washing.
4. Give any 03 investigations for this condition?
 HAV in blood & antibodies like IgG & IgA, LFTs, CBC, viral screening

5. What specific treatment can be given in this condition?

 No any specific treatment only supportive treatment is given.

STATION NO: 03 (PNEUMONIA)

- SCENARIO:
 A 03-year old child has presented with cough since 05 days with fever & dyspnea. On
examination stridor is positive & chest indrawing is also seen.

1. What is the most likely diagnosis?

 Pneumonia.

2. Name any 03 diseases which are associated with your diagnosis?

 Measles, otitis media, congenital heart disease, malnutrition.

3. What investigations would you go for in this condition?

 X-ray chest, blood culture, sputum culture, WBC count, pleural fluid examination.

4. Give any 04 complications of this condition.

 Empyema, lung abscess, pneumatocele, pleural effusion.

5. What is the treatment of this condition?

 ABs like benzyle penicillin, erythromycin or chloramphenicol for 07 to 10 days & 02 to 03
weeks in case of staphylococcus aureas.

STATION NO: 04 (TUBERCULOSIS)

- SCENARIO:
 A 03-years old child is seen in OPD with history of low grade fever, cough,
lymphadenopathy & weakness. There is history of TB in grandmother.

1. What is your most likely diagnosis?

 Tuberculosis.

2. What investigations would you go for in this condition?

 Tuberculin skin test, X-ray chest, AFB smear & culture of body secretions,
biopsy, PCR, gene expert (new test).

3. Give the first line drugs of this condition.

 Isoniazid, rifampicin, ethambutol, streptomycin & pyrazinamide.
4. Give any 02 differential diagnosis of this condition.
 Pneumonia, bronchitis etc.

STATION NO: 05 (ASTHMA)

- SCENARIO:
 A 03-years old Asif has cough, dyspnea, tachypnea & wheezing since 03 days. He had
similar complains last year in the same season. He also has history of allergic rhinitis in
his family.

1. What is your most likely diagnosis?

 Asthma.

2. Give the management of the acute attack of this condition.

 O2, nebulized salbutamol, adrenaline, terbutaline, aminophylline,
hydrocortisone, adequate hydration, antibiotic cover, ventilatory support.

3. Give any 03 conditions in which wheezing may occur.

 Asthma, pneumonia, bronchitis.

4. What is shown in the diagram?

 Nebulizer machine.

5. Name the different parts of this machine.

 Mask, tubes, machine with pluck.

6. Which drugs can be used in this machine?

 Salbutamol, corticosteroids, ipratropium.

7. Give the dose of Ventoline given by this machine.

 0.5% diluted in 1.5ml normal saline

STATION NO: 06 (DIARRHEA)

- SCENARIO:
 A 04-years old boy has presented with diarrhea with severe dehydration.

1. What are the signs of severe dehydration?

 Sunken eyes, unable to drink, skin pinch going back very slowly, lethargic
or unconscious.

2. What will be plan of management of this case according to IMNCI?

 Plan C.
3. According to plan C, 100 ml/kg is to be given in how much time?
 Since this baby is 04 years old so it should be given in 3 hours.

4. At what time will you re-access the child & classify?

 After 03 hours & classify the hydration status accordingly.

STATION NO: 07 (NEPHROTIC SYNDROME)

- SCENARIO:
 A 04-years old boy has presented with edema first seen on the face in the morning & later
involving whole body. Child is lethargic & anorexic. Urine volume is decreased & shows
proteinurea & no hematuria.

1. What is the most likely diagnosis?

 Nephrotic syndrome.

2. What investigations would you go for in this condition?

 Urine analysis for proteins, serum cholesterol, serum albumin, calcium,
complement levels, RFTs.

3. Which type is most common in children?

 Minimal change disease.

4. What is the treatment of this condition?

 Salt & protein restriction, salt free albumin, furosemide, steroids (prednisolone).

5. What do you mean by steroid dependent?

 A responder who relapses frequently when steroid dose is being decreased or discontinued for
at least 02 weeks.

STATION NO: 08 (JAUNDICE)

- SCENARIO:
 A 03-week old baby is brought by the parents with complains of yellow discoloration of
skin, sclera & mucous membrane.

1. What is the most likely diagnosis?

 Neonatal jaundice.

2. What investigations would you go for in this condition?

 LFTs, CBC (Hb reticulocyte count especially), culture of blood urine
& spinal fluid, TORCH antibody titer, HbsAg, HIDA scan.

3. At what level of bilirubin jaundice becomes manifested in newborn?

 04 to 06 mg/dl.
4. What type of jaundice occurs in newborn?
 Physiological jaundice, breast milk jaundice, pathological jaundice due to hemolysis.

5. What is the treatment of this condition?

 Phototherapy, exchange transfusion, drugs, phenobarbital.

STATION NO: 09 (BREAST FEEDING)

- LOOK AT THE PICTURE AND ANSWER THE FOLLOWING QUESTIONS

1. What is shown in this picture?

 Good breastfeeding attachment.

2. What are the signs of good attachment?

 Baby's chin should touch the breast,
 Mouth should be widely opened,
 Lower lip turned outward,
 More areola visible above than below.

3. What are the signs of good position?

 Head & body should be in a line (straight),
 Head & whole body should be supported,
 Baby should lie close to mother,
 Baby facing the breast & nose should be opposite to the nipple.

STATION NO: 10 (ITP)

- SCENARIO:
 A 03-years old baby has presented with multiple petechial rashes & ecchymosis over the
limbs & bruises very easily. On examination there is no splenomegaly or lymphadenopathy
& child appears to be nontoxic.

1. What is the most likely diagnosis?

 ITP (idiopathic thrombocytopenic purpura).

2. What are investigations for confirming the diagnosis?

 Platelet count, bleeding time, bone marrow examination.

3. Give any 03 differential diagnosis of this condition.

 Hemophilia, von willebrand disease, aplastic anemia, leukemia.

4. Give pharmacological treatment of this condition.

 IVIG (intravenous immunoglobulin), steroids, anti-Rh D.
 STATION NO: 11 (VSD)
- SCENARIO:
 A young child has presented with shortness of breath & failure to thrive. He has repeated
chest infections & has pansystolic murmur over the sternal border on left side.

1. What is the diagnosis?

 Ventricular septal defect (VSD).

2. Give any 03 clinical features of this condition.

 Cyanosis, tachypnea, loud P2, feeding difficulty, growth retardation.

3. What investigations would you go for in this condition?

 Chest X-ray, echocardiography, cardiac catheterization.

4. The prognosis of this condition depends on what?

 Size of VSD.

5. What are the complications of this condition?

 CCF, repeated respiratory tract infections, pulmonary hypertension, infective endocarditis,
growth failure, eisenmenger’s syndrome.

6. What is the treatment of this condition?

 Digoxin for CCF & surgical closure of large ventricular septal defect.

STATION NO: 12 (DOWN SYNDROME)

- SCENARIO:
 There is a 03 month old boy presenting in pediatric ward 01 with complains of fever &
jaundice. He has characteristic facial appearance with flat occipital and low set ears &
hands shows a single crease.

1. What is the most likely diagnosis?

 Down’s syndrome.

2. What is the karyotype of this condition?

 47XY (in 90% cases).

3. Give any 02 characteristic features of this condition?

 Simians crease, severe mental retardation.

4. Give any 02 risk factors of this condition.

 Increased maternal age, parental karyotype.

5. How screening is done during pregnancy?

 By checking alpha fetoprotein levels, unconjugated estradiol levels, CGH levels, nuchal
translucency in ultrasound in 1st trimester.
 STATION NO: 13 (CHICKEN POX)
- SCENARIO:
 A 13-years old child has presented with fever, back ache & maculopapular rash crops like
rash on whole body except palms & soles. There is itching & pain.

1. What is the most likely diagnosis?

 Chickenpox.

2. What is the route of transmission of this condition?

 Respiratory droplets.

3. Give any 03 complications of this condition.

 Bacterial infection, Reye's syndrome, puerperal fulminants.

4. How will you diagnose this condition?

 By viral identification in the blood, by measuring antibodies against antigens, by ELISA &
FAMA test.

5. How will you treat this condition?

 Maintaining hydration, calamine solution for pruritis, acyclovir.

6. How this condition can be prevented?

 Vaccination after 1st year of life.

STATION NO: 14 (TETANUS)

- SCENARIO:
 A newborn baby of 10 days is brought to ER with H/O refusal to feed, lethargy, lock jaw &
high temperature. He has arching back

1. What is the most likely diagnosis?

 Neonatal tetanus.

2. Give any 03 differential diagnosis of this condition.

 Encephalitis, meningitis, birth trauma.

3. Give any 03 complications of this condition.

 Aspiration pneumonia, lacerations, seizures, vertebral fractures.

4. What is the main site from where infection can spread?

 Umbilicus.

5. Give any 02 steps of prevention of this condition.

 TT in mother when pregnant, sterilization while delivering the baby.
 STATION NO: 15 (MENINGITIS)
- SCENARIO:
 A child has presented with fever & fits.

1. Give any 04 differential diagnosis of this condition

 Bacterial meningitis, viral meningitis, viral encephalitis, cerebral malaria,
brain abscess, TB meningitis.

2. What important investigations would you go for in this condition?

 LP, CSF culture, blood CP, blood culture, X-ray chest.

3. Name any 03 antibiotics that you would like to give in this condition.
 Ampicillin, cefotaxime, ceftriaxone, gentamicin.

4. Give any 04 complications of this condition.

 Cerebral edema, cranial nerve palsies, subdural effusion, water house friederichson syndrome.

STATION NO: 16 (HYPOTHYROIDISM)

- SCENARIO:
 A mother has brought her 03 years boy for flu & cough for 02 days. On anthropometry his
height is below 3rd centile. She is also complaining of constipation & increasing laziness in
her son.

1. What is the most likely diagnosis?

 Hypothyroidism.

2. What investigations you will advise to confirm your diagnosis?

 Thyroid function test including T3, T4 & TSH
 X-ray wrist for bone age.

3. Write down the steps of management.

 Thyroid replacement therapy.
 STATION NO: 17 (DOWN SYNDROME)
- SCENARIO:
 A 08-months old Salim brought in emergency because he is not yet holding his neck. His
mother’s age was 40 years at time of his birth. On examination he is microcephalic with
flat occipit, epicanthic folds & upward slanting of eyes, face is mongoloid, chubby hands
with single palmer crease with incurving of little anger.

1. What is your diagnosis?

 Down syndrome.

2. What is the cause of this abnormality?

 Trisomy 21 non-disjunction type, translocation type and mosaicism.

3. Is antenatal diagnosis possible? If yes, how?

 Yes.
 By triple test, karyotyping, amniocentesis or chorionic villous sampling and ultrasound of
back of neck.

STATION NO: 18 (SORE THROAT)

- SCENARIO:

 Sajjid is a 04 years old has fever & sore throat for 03 days. On examination weight 13 kg,
temperature 39.4 ˚C. Finding on throat examination is shown in photograph.

1. What is the most likely diagnosis according to IMNCI?

 Streptococcal sore throat

2. What other clinical sign you will see?

 Tender enlarged lymph node on neck.
 Red enlarge tonsils
 White exudates on throat.

3. What late complication can occur if condition is not treated?

 Acute rheumatic fever
 Post-streptococcal glomerulonephritis.

4. What is the treatment of this condition?

 I/M benzathiazine penicillin, I/V amoxicillin, paracetamol, sooth remedy for sore throat.

5. If child has no fever but he is unable to drink, it is due to?

 Throat abscess.
 STATION NO: 19 (VACCINATION)
- SCENARIO:
 A mother brought her 01 year old child for vaccination. She inquired about diseases &
vaccine schedule of this child.

1. Name the diseases that are preventable by vaccines of EPI.

 Tuberculosis, poliomyelitis, diphtheria, pertussis, tetanus, measles, hepatitis-B, H-influenza
type-B serious infection.

2. Name three live vaccines of EPI.

 BCG, polio vaccine, measles.

3. How many doses are required for measles vaccine and when?
 Two doses, nine months & fifteen months.

STATION NO: 20 (TOF)

- SCENARIO:
 Naseema is a 04 years old girl presented to emergency department with complaints of
breathlessness on exertion and plays only for a short time and then sits down in squatting
position. On examination she has central cyanosis & clubbing of nails.

1. What is the most likely diagnosis?

 Fallot’s tetralogy.

2. What are the common complications of this disease?

 Growth retardation, brain abscess, endocarditis, thromboembolic phenomena.

3. Write two other common cyanotic heart diseases.

 TGA, tricuspid atresia, hypoplastic left heart, anomalous pulmonary venous return.

STATION NO: 21 (MENINGITIS)

- SCENARIO:
 A 04-years old Ahmed brought in emergency with high grade fever for 03 days, projectile
vomiting & fits. On examination he has neck stiffness.

1. What is your diagnosis?

 Meningitis.

2. Write three common causative organisms responsible for this disease.

 H-influenza, streptococcus pneumonia, Neisseria meningitides.
3. Give two other differential diagnosis.
 Encephalitis, cerebral malaria.

4. Write down the investigations in this case.

 Lumbar puncture, CSF culture, blood count, blood culture, CT scan.

5. Write down the complications in this case.

 Increased ICP, cranial nerve palsy, seizures, stroke, ataxia, hydrocephalus, ventriculitis,
cerebritis, hearing loss (deafness).

STATION NO: 22 (INSTRUMENT)

- LOOK AT THE INSTRUMENT PRESENT INFRONT OF YOU AND ANSWER THE
QUESTIONS.

1. Name the instrument.

 Three way aspiration needle

2. Why it is used in neonates.

 In neonatal jaundice for exchange transfusion.

STATION NO: 23 (IMNCI)

- SCENARIO:
 A 04-years old Saad presented with fever, headache for 02 days. One hour before coming
to hospital he acquire posture shown in photograph. On examination weight 14 kg,
temperature 39.4˚C. Saad belong to area with high malaria.

1. What is shown in the photograph?

 Patient is convulsing with ophisthotonic posturing.

2. Classify illness according to IMNCI.

 Very severe febrile disease.

3. What is the treatment of this?

 Take slide of MP & send it with patient
 Give 1st dose of IM quinine
 Give 1st dose of antibiotic
 One dose of paracetamol
 Refer urgently to hospital.
 STATION NO: 24 (IMNCI)
- SCENARIO:
 One day old baby presented with refusal to feed since birth, baby delivered normally with
gestational age 30 weeks & weighing 1.2 kg.

1. How will you classify this baby according to ENCC?

 Very small baby.

2. What problems the baby could develop?

 Hypoglycemia, hypothermia, feeding problems, infections.

STATION NO: 25 (NEONATOLOGY)

- SCENARIO:
 A full term neonate born to a primigravida mother with difficult & prolonged labor. On the
same day he developed fits & admitted in nursery.

1. Write three main causes of seizures during first 24 hours of life.

 Birth asphyxia, birth trauma, meningitis, hypoglycemia.

2. What investigations will help in diagnosis?

 Blood sugar, ultrasound brain, CT scan brain, CSF examination.

STATION NO: 26 (INSTRUMENT)

- LOOK AT THE INSTRUMENT PRESENT INFRONT OF YOU AND ANSWER THE
QUESTIONS.

1. Name the instrument.

 Lumbar puncture needle

2. What landmarks are used to perform the procedure?

 At the level of iliac crest & between L4 & L5

3. What examination will you perform before the procedure?

 Bulge fontanelle in infants, fundus in older children & local infection.
 STATION NO: 27 (HEPATITIS)
- SCENARIO:
 A 06-years old Akhtar brought in emergency with yellow discoloration of eyes, fever,
nausea & pain abdomen for four days. On examination his liver is palpable 03 cm below
costal margin.

1. What is your diagnosis?

 Acute viral hepatitis

2. Name the causative agents of this problem.

 Hepatitis A,B,C,D,E,F,G

3. Write two preventive measures of this disease.

 Improving sanitation & providing education to hygienic measures. Vaccines.

STATION NO: 28 (GB SYNDROME)

- SCENARIO:
 A 07-years old boy presented with weakness of both lower limbs after 02 days history of
low grade fever & flu. The weakness worsens after 02 days & involve upper limbs. On
examination he has respiratory rate 45/min with increased work of breathing. On
abdominal examination there was mass in lower abdomen.

1. What is your diagnosis?

 Guillian Barre syndrome.

2. What investigation you will order to confirm the diagnosis?

 CSF analysis with increased protein > twice normal with no pleocytosis & normal glucose.
 EMG acute denervation of muscle.
 Nerve conduction velocity decreased.

STATION NO: 29 (HYPOTHYROIDISM)

- SCENARIO:
 A 02-years old Amna brought due to growth retardation, inactivity, poor feeding &
constipation. On examination she has dull facial expressions, protruding tongue, umbilical
hernia, dry skin & feels cold on touch.

1. What is your most likely diagnosis?

 Hypothyroidism.

2. How you manage this patient?

 L-thyroxin for long life.
3. What are the investigations in this case?
 Linear growth, TFT, X-ray, thyroid scan, ECG.

STATION NO: 30 (TETANUS)

- SCENARIO:
 A 10-days old term neonate brought in nursery with inability to suck & open mouth. On
examination he has redness around umbilicus & developed severe muscular spasms on
touching the body. Baby born at home & mother was unvaccinated.

1. What is your diagnosis?

 Possible neonatal tetanus.

2. Is it preventable disease? If yes, how?

 Yes, by tetanus vaccination to mother & childbearing age women.

3. Is this baby required vaccination when recovered from this disease?

 Yes because this disease does not produce lifelong immunity.

STATION NO: 31 (UTI)

- SCENARIO:
 A 04-years old Fatima brought in emergency because of pain abdomen, vomiting, increase
urinary frequency, urgency, dysuria & high grade fever with shivering.

1. What is your most likely diagnosis?

 Urinary tract infection.

2. Write common causative organisms for this problem.

 E. coli, klebsiella, proteus, pseudomonas.

3. How will you treat this patient?

 High fluid intake, antipyretic for fever & antibiotic for 10-14 days.

4. What are the investigations in this case?

 Complete urine examination, urine culture, nitrite sticks, renal function test.

5. What are the complications of this case?

 Hypertension, renal scarring, severe vesico-ureteral reflux, chronic renal failure.
 STATION NO: 32 (MEASLES)
- SCENARIO:
 Look at the photograph of 02 year old Saima who presented with fever, runny nose, cough
for 03 days & skin rashes since 01 day.

1. What clinical findings are shown in photograph?

 Red eyes, macular rashes on skin.

2. What is the IMNCI classification of illness?

 Measles.

3. What other clinical signs you will look?

 Mouth for ulcer
 Eye for corneal clouding
 Pus drainage.

4. Write down the treatment options for this.

 Chloramphenicol eye ointment, vitamin A, gentianviolent, prevent low blood sugar level,
refer urgently to hospital.

STATION NO: 33 (DIARRHEA)

- SCENARIO:
 A 08-months old Suraish presented with history of loose watery stools for two days. On
examination he is lethargic with sunken eyes.

1. How you classify for dehydration?

 Severe dehydration.

2. What is the most common organism causing diarrhea in this age group?
 Rotavirus.

3. What are the complications of diarrhea?

 Shock, metabolic acidosis, convulsions, renal shutdown, paralytic ileus, acute renal failure,
persistent diarrhea, death.

4. What is the treatment of this?

 100 ml/kg ringer lactate solution
 ORS 5 ml/kg/day.
 STATION NO: 34 (ANEMIA)
- SCENARIO:
 A 07-months old Sajid was seen at OPD with blood CP report. Blood picture shows
decreased RBC count, hypochromic microcytic anemia with increased red cell distribution
width, Hb% is 6.7 gm/dl, no history of blood transfusion in the past.

1. What is most likely diagnosis?

 Iron deficiency anemia.

2. Write any 02 differential diagnosis.

 Thalassemia
 Lead poisoning.

3. Write name of drugs which can treat the patient according to IMNCI.
 Ferrous sulphate, mebendazole, antimalarial.

STATION NO: 35 (HEPATITIS)

- LOOK AT THE PICTURE & ANSWER THE FOLLOWING QUESTIONS.

1. What is the most likely diagnosis?

 Viral hepatitis A.

2. Write any 02 important investigations of this.

 Antibody for HAV or IgM, LFT.

3. How will you treat & prevent other siblings in family?

 Supportive fluids
 Hepatitis-A vaccine & immunoglobulin.

STATION NO: 36 (ANEMIA)

- SCENARIO:
 A 10-months old Imran presented with pallor, anorexia, irritability & failure to thrive.
Blood CP report shows hemoglobin 7gm/dl & hypochromic microcytic picture on blood
film.

1. What is your most likely diagnosis?

 Iron deficiency anemia.

2. How shall you proceed to examine the patient?

 Vitals, pallor on skin, palms, conjunctiva, mucous membrane, nails for koilonychias,
tongue for glossitis & angular stomatitis.
3. How will you treat this patient & for how long?
 Iron therapy (6mg/kg/day elemental iron) for one month then follow patient.
 Dietary counselling
 Blood transfusion if he has cardiac problem.

STATION NO: 37 (ALL)

- SCENARIO:
 A 04-years old Ameen admitted in ward with complain of fever, weakness, weight loss for
last 20 days. Child developed bruises & petechial from last 10 days. On examination
anemia +ve, purpuric spot on skin, having generalized lymphadenopathy &
hepatosplenomegaly. Initially treated by different antibiotics & antimalarial but not
improved.

1. What investigations would you like to order?

 Complete blood count, peripheral blood smear & bone marrow examination.

2. What are two most likely diagnosis?

 Acute lymphoblastic leukemia
 Lymphoma.

3. What are the complications of disease?

 Thrombocytopenia, sepsis, DIC, severe anemia, pneumocystis carini pneumonia.

STATION NO: 38 (NEONATAL JAUNDICE)

- SCENARIO:
 This is the picture of a 05 days old baby.

1. What is shown in the photograph?

 Severe jaundice.

2. How will you investigate this baby?

 Serum bilirubin total & direct
 Blood CP with peripheral smear
 Reticulocyte count
 Blood group of baby & mother, coombs test.
 STATION NO: 39 (NEONATOLOGY)
- SCENARIO:
 A 05-days old neonate comes to you with stiffness of body & umbilical redness.

1. Classify the illness according to IMNCI.

 Very severe disease & local bacterial infection.

2. Mention immediate treatment needed by this neonate.

 Give rectal diazepam, treat to prevent low blood sugar.
 Give first dose of I/M antibiotic
 Advise mother to keep infant warm
 Refer urgently to hospital.

STATION NO: 40 (DEHYDRATION)

- SCENARIO:
 A 04-years old child has loose motions for 03 days. His weight is 14 kg. He is eager to
drink & has sunken eyes.

1. What is the status of dehydration?

 Some dehydration.

2. Calculate the amount & type of fluid he needs.

 1050 ml of ORS in 4-6 hrs.

STATION NO: 41 (VSD)

- SCENARIO:
 A 06-months old girl presented with dyspnea. On examination respiratory rate is 40/min
with heart rate 150/min. On auscultation there was grade-II systolic murmur at lower left
sternal border. Liver was palpable 06 cm below right costal border. There was no
cyanosis.

1. What is the most likely diagnosis?

 Ventricular septal defect.

2. What investigations you will advise to confirm your diagnosis?

 Echocardiography.

3. What findings you will expect on chest radiograph?

 Cardiomegaly with plethoric lung fields.
 STATION NO: 42 (INSTRUMENT)
- LOOK AT THE INSTRUMENT AND ANSWER THE QUESTIONS.

1. What is the name of the instrument?



2. Name two indications for the use of the instrument.



3. Name any three complications of the instrument.



4. Name any two contraindications of the instrument.



STATION NO: 43 (REPIRATORY SYSTEM)

- SCENARIO:
 Chest X-ray of 03 years old child presented with breathlessness for 02 days.

1. What abnormality is shown in this X-ray?



2. What two most important clinical signs in this child on inspection

of respiratory system you will look for?


3. What will be two most important clinical signs on auscultation of chest?



STATION NO: 44 (NG TUBE)

- LOOK AT THE INSTRUMENT AND ANSWER THE QUESTIONS.

1. Identify the instrument.

 Nasogastric tube.

2. Write any 03 uses of this instrument in IMNCI.

 Treatment plan C
 Per rectal diazepam to control convulsions
 To treat hypoglycemia in unconscious child.
3. Write other uses of this instrument.
 For feeding purpose
 Management of poisoning
 Aspiration of gastric juice
 Gastric decompression.

4. Write down the complications of this instrument.

 Epistaxis, sinusitis, sore throat, erosion of nasal cavity, aspiration, gastritis.

5. Write down the contraindications of this instrument.

 Esophageal varices, coagulation abnormalities, cleft palate, fracture of base of skull, etc.

STATION NO: 45 (MANAGEMENT)

- SCENARIO:
 You are called to labour room to see a full term newborn baby boy with fits. He was born
15 minutes ago to 20 years old first time mother. Baby delivered by C-section due to his
breech position. Baby cries weak, has decrease tone & heart rate >100 beats/min. On
examination baby looks appropriate size, not dysmorphic, his lips & tongue appears
slightly blue during fits. R/R 70/min, he transferred urgently to neonatal ward.

1. What are the important at least 05 cause of neonatal fits?

 Birth asphyxia, intracranial hemorrhage, hypoglycemia, hypocalcaemia, bacterial
meningitis & sepsis.

2. What investigations you look for?

 Blood glucose, serum calcium, serum electrolytes, blood urea, lumbar puncture, blood
culture.

3. Give 03 important steps for management.

 ABC
 Short acting anticonvulsant such as I/V diazepam, phenytoin
 Specific treatment according to cause
 Antibiotic
 I/V glucose & I/V calcium.
 STATION NO: 46 (MICRONUTRIENTS)
- LOOK AT THESE PICTURES AND ANSWER THE QUESTIONS

1. Which micronutrient deficiency is seen in picture

marked by A?
 Iron.

2. Which micronutrient deficiency is seen in picture

marked by B?
 Niacin.

3. Which micronutrient deficiency is seen in picture marked by C?

 Vitamin C.

4. Which micronutrient deficiency is seen in picture marked by D?

 Vitamin A.

5. Which micronutrient deficiency is seen in picture marked by E?

 Iodine.

6. Which micronutrient deficiency is seen in picture marked by F?

 Vitamin D.

STATION NO: 47 (INSTRUMENT)

- LOOK AT THE INSTRUMENT AND ANSWER THE QUESTIONS.

1. Name the instrument in front of you.

 Lumbar puncture needle.

2. Write down conditions in which it is used.

 Meningitis, encephalitis, GBS, seizures, stroke, subarachnoid hemorrhage.

3. Write down the complications of this instrument.

 Pain, infections, hemorrhage.

4. Write down the contraindications of this instrument.

 Increased ICP, bulging on occipit, infections at site, meningomyelocele, hydrocephalus,
bleeding disorders, brain abscess, tumor etc.
 STATION NO: 48 (VACCINATION)
- SCENARIO:
 A 48-days old infant has received BCG & OPV at birth. He received pentavalent-2 & OPV-
2 at 6th week.

1. When should he return for his next immunization?

 At 10th week of age.

2. Which vaccine is recommended for next immunization?

 Pentavalent-2, IPV-2, PCV-2.

STATION NO: 49 (NEPHROTIC SYNDROME)

- SCENARIO:
 A child presents with oliguria, abdomen distension. He had flue like symptoms two weeks
back.

1. What is the most likely diagnosis?

 Idiopathic nephrotic syndrome.

2. Write laboratory investigations of this condition.

 Urinalysis  proteinuria 3+/4+, 24hr protein excretion/ microscopic hematuria.
 Serum albumin, serum cholesterol, decrease calcium level, increased ESR etc.

3. What are the complications of this condition?

 Infection (peritonitis), atrial & venous thrombosis, acute renal failure, hypertension.

STATION NO: 50 (RICKETS DISEASE)

- SCENARIO:
- A child’s picture is shown having rickets disease.

1. What is your diagnosis?

 Rickets disease.

2. What physical findings you will find in this patient?

 Head larger, frontal bossing, craniotabes, delayed closure of fontanelle, caput quadratum.

3. What findings are present on chest?

 Rachitic rosary, Harrison’s sulcus, pigeon chest deformity.
4. How will you manage this patient?
 Vitamin D & adequate nutritional intake of calcium & phosphorus.

5. How will you prevent this condition?

 Exposure to sunlight (ultraviolet)
 Oral vitamin D 10µg daily
 Vitamin D given to pregnant & lactating mother.

STATION NO: 51 (BITOT SPOT)

- LOOK AT THE PICTURE AND ANSWER THE QUESTIONS.

1. Identify the condition shown in the slide.

 Bitot’s spot.

2. What are the causes of this condition?

 Deficiency of vitamin A.

3. How will you prevent this condition?

 Vitamin A 1500 I/V / day
 Protecting & promoting breastfeeding
 Vegetable oil, wheat flour, nutritional education etc.

4. What is the management of this condition?

 Vitamin A supplements
 Food rich in vitamin A.

5. What are the other clinical features of vitamin A deficiency?

 Conjunctivitis, xerosis, night blindness, corneal xerosis, keratomalacia, corneal scar,
anemia etc.

STATION NO: 52 (IMNCI)

- SCENARIO:
 You are posted in nursery ward. A child brought & he is cyanosed.

1. How will you manage this child?

 Prevent hypothermia, prevent blood glucose level, hemoglobin maintain, oxygenation,
propranolol 1mg/kg/orally.

2. What are the causes of neonate mortality in Pakistan?

 Preterm birth complications, birth asphyxia, intrapartum complications, neonatal sepsis,
pneumonia.
3. What are the causes of child mortality in Pakistan?
 Pneumonia, diarrhea, malnutrition

STATION NO: 53 (TOF)

- SCENARIO:
 Chest X-ray showed boot shaped heart.

1. What is the most likely diagnosis?

 Tetralogy of fallot.

2. What are the X-ray findings in this condition?

 Diminish pulmonary vascularity (oligemic lung field)
 Right sided aortic arch
 Heart size normal
 Boot shaped heart.

3. How will you manage acute episodes of cyanosis?

 Propranolol 1mg/kg x 6hr
 Oxygen inhalation.

4. Which X-ray findings you find in TGA?

 An egg placed on its site.