1 Station Resus

download 1 Station Resus

of 24

Embed Size (px)

Transcript of 1 Station Resus

  • 7/31/2019 1 Station Resus

    1/24

    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)

  • 7/31/2019 1 Station Resus

    2/24

    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

  • 7/31/2019 1 Station Resus

    3/24

    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

  • 7/31/2019 1 Station Resus

    4/24

    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

  • 7/31/2019 1 Station Resus

    5/24

    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 )

  • 7/31/2019 1 Station Resus

    6/24

    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

  • 7/31/2019 1 Station Resus

    7/24

    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

  • 7/31/2019 1 Station Resus

    8/24

    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)

  • 7/31/2019 1 Station Resus

    9/24

    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

  • 7/31/2019 1 Station Resus

    10/24

    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

  • 7/31/2019 1 Station Resus

    11/24

    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

  • 7/31/2019 1 Station Resus

    12/24

    (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

  • 7/31/2019 1 Station Resus

    13/24

    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

  • 7/31/2019 1 Station Resus

    14/24

    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

  • 7/31/2019 1 Station Resus

    15/24

    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

  • 7/31/2019 1 Station Resus

    16/24

    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

  • 7/31/2019 1 Station Resus

    17/24

    Ans 3 Global tubular dysfunction - acidosis,

    aminoaciduria,

    glucosuria,phophaturia. Rickets

    STATION 19

    Question 1 Identify the condition

    TWO CLINICAL PHOTOGRAPH S OF A PATIENT

  • 7/31/2019 1 Station Resus

    18/24

    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

  • 7/31/2019 1 Station Resus

    19/24

    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

  • 7/31/2019 1 Station Resus

    20/24

    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

  • 7/31/2019 1 Station Resus

    21/24

    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

  • 7/31/2019 1 Station Resus

    22/24

    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?

  • 7/31/2019 1 Station Resus

    23/24

    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

  • 7/31/2019 1 Station Resus

    24/24

    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