1 station resus
TRANSCRIPT
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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 2A patient is admitted to the ICU with the following lab values:
BLOOD GASES under room air
pH: 7.199
PCO2: 32.2
HCO3: 12PO2: 86.6
ELECTROLYTES, BUN & CREATININENa: 136
K: 4Cl: 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)
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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
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Question 3 - PR interval in above picture is a), b), c),d)
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. c3. b
4.
a
b
c
d
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STATION 4
Q 1 Please match new unit for the older units of radiation measurement (2 marks)
OLD UNITS
1. Curie (C )
2. Rad
3. Rem
4. 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. Infectious waste
b. Non-infectious waste like paper/glass
c. Organic waste like discarded food/vegetables etc
d. 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
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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 andemergence 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 )
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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, protein2.9 g
Ans B - day1-7 for initial treatment and week 2-6 for rehabilitation
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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
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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. Oseltamivir is drug of choice to treat bird-flu
3. 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. EB virus is associated with more than half the cases of mixed cellularity Hodgkins disease.
6. HMPV ( Human Metapneumovirus) was identified in 2001
7. SARS outbreak in 2003 was the 1st global epidemic of the 21st century
8. 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 9ANSWERS
All or True (T)
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STATION 10
HISTORY TAKING
A 9 yr old child presents to emergency department withhematemesis . 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/False3. 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
Q 2 What is GAIN? ( 0.5 marks)
Q 3 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
Q4 Palivizumab ( monoclonal antibody) is used to treated infection with
which
virus ? 1 mark
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STATION 12
ANSWERS1. 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) Analyze results by country separately
b) Multivariate analysis
c) Patient Stratificationd) Prognostic factor analysis
e) 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
controlb) 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 groupse) It reduces the effects of sampling variations
Q 3 In a normal distribution the mean of the data will be similar to thea) Maximum
b) Medianc) Ranged) Standard deviation
e) Standard error
Q4 The table below shows the number of adverse effects reported in a randomized trialcomparing two treatments- A and B
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The Odds Ratio of having an adverse event in group A is
a) 4/16
b) 4/20c) 4/28
d) 4/32
e) 4/60
STATION 13
ANSWERS
1.E
2.D
3.B4.C
STATION 14
Q 1 Match the appropriate antidote to its corresponding drug overdose.
(a) Deferoxamine _____ 1)Acetaminophen(b) N-Acetylcysteine ____ 2)Benzodiazepine
(c) Pyridoxine _____ 3) Nitrates/Methemoglobinemia
(d) Vitamin K _____ 4)Isoniazid
(e) BAL _____ 5) Heavy metals (mercury, gold, arsenic)
(f) Methylene blue _____ 6)Organophosphate
(g) Atropine _____ 7) Iron
TreatmentGroup
Adverse Event?
Yes No Total
A 4 28 32
B 16 12 28
Total 20 40 60
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(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
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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
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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. Onexamination 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.
Q 1 Your most probable diagnosis? ( 1 mark)
Q2 What characteristic feature can be found in complete blood counts?
( 1 mark)
Q 3 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
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1 Kawasaki disease
2 Thrombocytosis
3 Congestive heart failure
4 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 andaxillae 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 manubrio-
sternal 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
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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 pre-
renal 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 Na x Serum Cr / serum Na x
Urine cr x 100
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Ans 3 Global tubular dysfunction - acidosis,
aminoaciduria,
glucosuria,phophaturia. Rickets
STATION 19
Question 1 Identify the condition
TWO CLINICAL PHOTOGRAPH S OF A PATIENT
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Question2 Name one association with this disease
STATION 19
Ans 1 hemihypertrophy
Ans 2 Wilms tumor, Beckweth-weildman syndrome,Sotossynmdrome
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. B
2. Thrombocypenia in smear A and presence of giant platelet
3. Fever/bleeding from any other site/pallor/ drug/HIV etc
4. CBC
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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 splenomegalythe 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
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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
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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 above-
mentioned disease
Ques 5 Intravenous immunoglobin has no role to play in mentioned disease
at any level
True / false
STATION 24
Answers
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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?
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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
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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 cell3. Bone marrow in sitting position, Pleural tap and
sending cells for immunophenotyping and malignant
cells