http://www.dnbpediatrics.com/

1. Neonatology:
Spot No.1:
It’s a cranial sonography of a newborn (born at 30 wks of gestation with a birth wt. of 1.2 kg) taken at post natal age of 3 wks.
Q1. Identify the spot
Q2. Identify the plane in which this scan is depicted
Q3. Name the scientist who has given this grading/classification
Ans Spot 1:
Ans Q1. Multiple bilateral periventricular cysts are typical of periventricular leukomalacia (PVL).
Ans Q2. Coronal view
Ans Q3. De Vries
Spot no.2
Q1. Give the ACOG criteria for birth asphyxia (HIE)
Q2. Name the staging system commonly used for staging HIE clinically (Other than Sarnat and Sarnat) and name its
component
Ans Spot 2:

2. Ans Q1: Cord blood pH <7 with metabolic or mixed acidosis
APGAR <3 at ≥ 5 minutes
Seizures, Coma and hypotonia
Evidence of multiorgan dysfunction
Ans Q2: Levene staging
(Consciousness, Seizures, Sucking or Respiration and Tone)
Spot 3:
Q1. Give the Brazelton stages of neonatal consciousness
Q2. Name the stage in which neonatal examination should be started
Ans Q1: Stage 1- Baby in deep sleep
Stage 2- Baby in light sleep (REM)
Stage 3- Fully awake but quite (Not moving limbs)
Stage 4- Wakeful and moving limbs
Stage 5- Active, alert, moving limbs and
Crying (Consolabe)
Ans Q2: Stage 3
Spot 4:

3. A
Q1. Identify the stage of the ROP in given spot in ref to single long arrow (A)
Q2. What is stage 0 ROP?
Q3. Define rush disease
Ans Q1- Satge 2 ROP- Fundus photograph showing the ridge between vascularized and avascular retina
characteristic of stage 2 retinopathy of prematurity (single long arrow)
Ans Q2- Stage 0 ROP- Avascular retina
Ans Q3- PLUS disease that is associated with zone 1 ROP
Spot 5:
Q1. Give the do not resuscitate criteria as per the newer NALS guidelines
Q2. Define the T piece resuscitator
Q3. Give the FRC of a healthy term new born
Give the compliance of a newborn
Name of the scientist who has given the BPD classification
Ans Q1.
Ans Q2. Device which provide interrupted gas flow used to give PEEP and PIP non invasively and manually

4. Ans Q3. FRC- 30 ml/KG
Compliance- (4-6 ml/cm H2O or 1-2 ml/kg/cm H2O)
Northway’s classification
Spot 6-
Q1. Give the nutritional value (Calories & Protein) of following cooked items
One chapatti or One Bread
One Biscuit
One Egg
One TSF mashed potato
1 TSF cooked Dal
Q2. Answer the following question
Dextrose content of 1 liter Ringer lactate
Na+ content of one ml of 3% NaCl
Na+ content of one ml of 0.9% of NaCl
Elemental Ca in 1 ml of 10% calcium Gluconate
K+ content of 1 liter of Isolyte-P
Ans Q1-
One chapatti or One Bread- (70 calories and 2 Gms Protein)
One Biscuit- (20 calories and 0.5 Gms Protein)
One Egg- (80 calories and 6 Gms Protein)
One TSF mashed potato- (40 calories and No Protein)
1 TSF cooked Dal- (10 calories and 0.5 gm Protein )
Ans Q2-
Dextrose content of 1 liter Ringer lactate is ZERO
Na+ content of one ml of 3% NaCl is 0.5 mEq
Na+ content of one ml of 0.9% of NaCl is 0.15 mEq
Elemental Ca in 1 ml of 10% calcium Gluconate is 9 mg
K+ content of 1 liter of Isolyte-P is 20 mEq/L
Spot 7:

5. A
B
Q1. Name the spot
Q2. What are these chambers used for A & B (Blood cells)
Q3. If doing CSF cytology for WBCs, which chambers are used for this purpose?
Ans Q1-
Q1. Name the spot- Neubauer Chamber
Q2. What are these chambers used for A & B (Blood cells)
A- WBC and B for RBC’s and platelets
Q3. If doing CSF cytology for WBCs, which chambers are used for this purpose?- All 9 corners
Spot 8:
Q1. Identify the peripheral smear (from a febrile patient) including species with explaination
Q2. Define cerebral malaria

6. Ans Q1- Peripheral smear showing Plasmodium Falciparum
Numerous RBC infected, frequently 2 parasites (rings) per RBC
Infected RBC not enlarged.
Ring stage small, no large trophozoites or schizonts seen
Ans Q2- Cerebral malaria is defined as
Fever
Glasgow coma scale <8 or coma lasting >30 minutes after a seizure
Asexual parasite in blood
Spot 9:
Study this Arterial blood gas report of a 2 day old, 1400 gram neonate, treated with surfactant, on the ventilator for RDS. On
the following settings:
PIP 27cm H2O, PEEP 5cm H2O, Rate: 35/min, FiO2: 0.4, TI: 0.4 sec
ABG- pH 7.57, PaCO2 22 mmHg, PaO2 156mmHg, HCO3- 11mMol/L
Q1. Give the complete diagnosis
Q2. Name one ventilator setting which would normalize the blood gases
Q3. Name three long term complications that can occur in this neonate due to the blood gas abnormalities
Ans:
1. Uncompensated respiratory alkalosis with hyperoxia
2. Reduce PIP (Peak inspiratory pressure)
3. Retinopathy of prematurity, bronchopulmonary dysplasia, periventricular leukomalacia
Spot 10-
Study this arterial blood gas report of a 4 year old child in the ICU with feeble peripheral pulses.
pH- 7.28, PaCO2 32 mmHg, PaO2 87 mmHg, HCO3- 12 mMol/L,
Base excess: -8 mMol/L
Q1. Give the complete ABG diagnosis and possible cause of the abnormality
Q2. Name the most appropriate corrective measure for this child
Q3. Calculate the predicted carbon dioxide level for this level of bicarbonate

7. Ans:
1. a. Uncompensated metabolic acidosis
b. Shock
2. Fluid bolus
3. 12 x 1.5 + 8 + 2 = 24-28mmHg
Spot 11:
Q1. A patient with UMN type lesion of the lower limbs and normal upper limbs is found to have an abscess in x-ray
spine (Lateral) at first thoracic vertebrae what will be his level of lesion as per the spinal segments?
Q2. Define hemiplegia, Double hemiplegia, Quadriplegia, Diplegia and Pentaplegia
Ans:
Q1. Third thoracic spine injury (T1-6= Add two to the vertebral lesion)
Cervical- add 1, T7-9= Add 3
At T10= L1 and L2 are present
T11= L3 and L4
T12= L5 and sacral segments
Q2.
Hemiplegia- One half of body is involved (Arms >> Legs)
Double hemiplegia- All 4 limbs but difference in right and left side
Quadriplegia- Paralysis of all four limbs, both arms and both legs, as from a high spinal cord accident
Diplegia- Primarily affecting legs but may also involve arms
Pentaplegia- Four limbs involvement with neck involvement
Spot 12:

8. Q1. Identify the pattern of inheritance in the given Pedigree with explanation
Q2. Why does this happen like this?
Q3. Give 2 examples of this pattern
Ans:
Q1. Mitochondrial inheritance
All the offsprings born to an affected female are affected
Affected Males don’t pass on the disease
Q2. Because sperms doesn’t contain mitochondria
Q3. Leigh disease and MELAS (Mitochondrial Encephalopathy with Lactic Acidosis and Stroke like syndromes)
Spot 13:
This 2 yr old male child is residing in an over crowded slum and the lesions shown below are itching in nature. Lesions were
also there in the groins, male genetalia and between the buttocks.
Q1. Spot the diagnosis and name the etiological agent for this
Q2. Treatment for this
Ans:
Q1. Scabies and sarcoptes scabei (Mite)
Q2. 5% permethrin cream for local application x 10 hrs
All family members to be treated simultaneously
All linen and cloths to be boiled put out in the sun and subjected to hot iron
Tt May be repeated 2 wks later
(Oral ivermectin after 5 yrs of age)
Spot 14:
7 yr old male child presented with sudden onset explosive watery diarrhea with abdominal distension, flatulence and
epigastric cramps with out any blood or mucus in the stool. Stool examination of this child was consistent with the following

9. Q1. What is the diagnosis?
Q2. Schedule for stool microscopic examination
Q3. Source for diagnosis other than stool
Q4. Drug used in treatment (At least 3)
Ans:
Q1. Acute symptomatic Giardiasis (Asymptomatic carriage form is the most common form)
Q2. At least 3 stool specimen collected on alternate days (Detection rate up to 90%) because there is intermittent
shedding of giardial cyst
Q3. Duodenal aspirate or Biopsy/Fecal ELISA for antigen detection
Q4. Metronidazole, Albendazole, Tinidazole, Furazolidine and Quanicrine
Spot 15:
8 yr old male child presented to the emergency department with inability to get up from bed but once made to stand can stand
and even walk with an ataxic gait.
Q1. Spot the diagnosis; Give the criteria’s for diagnosis
Q2. Diagnostic modality
Q3. Treatment modalities
Ans:

10. Q1. Juvenile Dermatomyositis
Criteria- Bohan and Peter
Heliotrope discoloration of upper eyelid
Symmetrical proximal weakness
Elevated muscle enzyme levels- AST,ALT,CK and Aldolase
EMG evidence of myopathy
Muscle Biopsy showing myonecrosis
Q2. MRI, EMG and Muscle biopsy
Q3. IV Methyl prednisolone followed by oral steroids x 2 yrs
Unresponsive child may respond to Oral Methotrexate