2. Station 1 – history taking
• 8 month old infant presents with history of
cough and wheezing
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3. • Introduce yourself
• Onset – acute / subacute Duration – hours / days
• Progress – better / worst / same
• Accompanying symptoms – fever, cold, vomiting,
skin rash, failure to thrive
• Past history of similar episode
• Feeding, growth, well being, immunisation
• Birth history
• Family history of atopy / contact with viral inf
• Drug history – relief if anydnbpaediatrics.blogspot.in
4. Station 2 – physical exam
• Examine respiratory system of this child
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5. • Introduce yourself and take permission from
mother or child
• Undress the child
• Examine from foot end or head end for
respiration
• Palpate for tracheal deviation
• Percuss gently and follow rules of
percussiion
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6. Station 3 – counseling
• 3 year old child has been diagnosed as
asthma – counsel the parents
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7. • Introduce yourself and find out what language
they would feel comfortable
• Describe in lay language about asthma
• Emphasise no one to blame and not to worry
• Tell them that it can be controlled
• Discuss preventive measures and drug therapy
• Inform advantages and safety of inhaled therapy
over oral medications
• Insist on diary record and periodic follow-up
• Explain end point of response and anticipated
period of time / end with “any questions?”/ thanks
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8. Station 4
• Draw surface anatomy of lungs
• Name all segments of left lung
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12. • What is the approximate normal value of
PEFR in a child whose height is 120 cms
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13. • 200 litres
• Formula to be used
PEFR in litres = (height in cms –80) x 5
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14. Station 6
• What are different types of devices used for
inhalation therapy?
• What is the advantage of a spacer?
• Describe maintenance of spacer
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15. • MDI with spacer, DPI, nebuliser
• Advantage of a spacer – no respiratory
coordination necessary / better deposition of
drug / no pharyngeal deposition of drug
thereby reducing chance of oropharyngeal
candidiasis and hoarseness of voice
• Wash with mild soap and water – drip dry
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16. Station 7
• In case of need for oxygen therapy, attempts
must be made to decrease oxygen
consumption. Name maneuvers to decrease
oxygen consumption
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17. • Control fever
• Adequate humidification
• Proper positioning
• Open airway
• Clear secretions
• Alleviate anxiety – child in mother’s lap
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18. Station 8
• What is low flow and high flow system of
oxygen delivery?
• Give examples of low flow and high flow
system
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19. • Low flow < pt’s inspiratory flow
achieves low oxygen concentration
Low flow systems – face mask, nasal canula
• High flow is adequate or > pt’s inspiratory flow
achieves high oxygen concentration
non-breathing mask - face mask and reservoir bag
with valve, oxygen hood, venturi mask
offers fixed FiO2 delivery
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20. Station 9
• Define following terms in relation to TB
Relapse
Defaulter
Lost to treatment
Treatment failure
• What treatment for each of them?
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21. • Relapse – signs and symptoms reappearing within
2 years of completion of ATT
• Defaulter – one who discontinues treatment for >
1 week
• Lost to treatment – one who defaults for > 1
month
• Treatment failure – no response or deterioration
after 12 weeks of intensive therapy
• Category 2 of RNTCP
2SHRZE / 1HRZE / 5HRE
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23. • Identify the condition
• Name three salient features
• Name type of inheritance
• What is the prognosis?
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24. • Ataxia-talengectesia
• Recurrent sino-pulmonary infections,
ataxia, immune deficiency, malignancy
• Autosomal recessive
• Poor – death due to chronic respiratory
failure by second decade
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25. What are the two most
important
abnormalities present?
• This healthy child
presented with
increasing
breathlessness over 12
hours. Name probable
diagnosis
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26. • Left pleural effusion and mediastinal shift
• Acute allergic pleural effusion of TB or
traumatic hemorrhagic effusion
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27. Station 12
• Name biochemical criteria for exudative
pleural fluid
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34. • This 7 year old child was diagnosed as
acute pneumonia on the basis of clinical
profile, neutrophilic leucocytosis and chest
x-ray – was treated with IV Ceftriaxone
• 4 days later, as fever continued, repeat CBC
and chest x-ray were ordered
• What is the problem?
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39. • What is the problem?
• How do you treat?
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40. • Paradoxical immune response
• Continue same ATT – in case of acute
symptoms such as breathlessness, consider
oral steroids
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41. Station 17
• What concentration of PPD is ideal for
Mantoux test?
• How do you measure test result?
• How do you interpret test result?
• What is the effect of BCG vaccine on Mt
test?
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42. • PPD 1 TU RT 23 with Tween 80 as a preservative
or PPD 2 TU without Tween 80 – PPD 5TU may
be an acceptable though inferior alternative
• Ball point method of measuring induration
• Induration > 10 mm is considered +ve indicative
of natural infection
• Previous BCG vaccine has minimal to none
influence on interpretation of Mantoux test
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