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3 months.
Mother narrates that infant is not thriving well and remains irritable. Mother also feels that baby has
started becoming inattentive to sounds. He was admitted previously at 4 weeks of age with seizures
which were documented to be due to hypocalcaemia. O/E baby is pale with petechial spots over the
body. His weight is 4 kg, length 59 cm, HC 45 cm, and there is marked hepatosplenomegaly.
Investigations reveal Hb 6.5, TLC 32000, P 55%, L 35%, myelocytes 3%, metamyelocytes 4%. There are
also normoblasts 8/100 RBCs, Platelets 65000.
Mar 05 (2): A 6 years old boy is brought in a comatose condition. Parents narrates that he has had two
such episodes previously which didn’t last long. He however is described to be lethargic and unwell for
the last one year with h/o weight loss. O/E he is a thin lean boy with reduced muscle mass. He is
dehydrated with RR of 38/min, systolic BP 40. There is no visceromegaly.
His investigations reveal: serum Na 129, K 5.5, blood glucose 42 mg, TLC 9000, P 52%, chest x-ray-
decreased cardiac shadow.
Mar 05 (3): A 4 weeks old baby is noted to have increasing difficulties with feeding and cyanosis which
gets worse during crying and feeding. Chest x-ray shows cardiomegaly with oligaemic lungs. ECG
reveals an extreme left axis deviation. Arterial PO2 in air 35 mmHg. Arterial PO2 in 100% oxygen 55
mmHg.
Mar 05 (4): A 6 weeks old infant has h/o diarrhea since 5 days of life. He passes 20-25 stools a day.
Stools are watery and explosive. There is h/o polyhydramnios. Antenatal USG examination revealed
dilated intestinal loops. His ABGs reveal pH 7.49, PO2 102, PCO2 49.
Mar 05 (6): What advice will you give in a neonate who was detected to have unilateral
hydronephrosis on antenatal USG examination at 20 weeks of gestational age.
Mar 05 (7): A 1500 gm male preterm infant was asphyxiated at birth. He underwent successful
resuscitation and subsequently had a number of apnoeic spells on the neonatal unit. On the third day
of life the infant began to vomit and developed abdominal distension, with passage of bloody stools.
Mar 05 (8): A 41 days old male baby presents with vomiting and drowsiness for the last one day. O/E,
following findings were noted: weight 3.1 kg, length 50 cm, OFC 40 cm, pulse 92/min, RR 21, temp 98.6
F, GCS 6/15, fontanel full, pupils constricted, eyes sunken and skin turgor lost.
Mar 05 (9): A 3 year old boy has undergone surgery for inguinal hernia under general anesthesia. You
have been called to assess the child post operatively where he has been running high fever. Clinical
examination reveals a lethargic child with respiratory distress. Chest is clear on auscultation while the
temp is 105 F. There is rigidity of limbs. Investigations show blood pH 7.2, PCO 2 50, PO2 70, HCO3 11,
serum CK 20,000 u/l.
July 05 (2): A two months old male baby born to a primigravida, after an uneventful pregnancy and
delivery, is brought to you with FTT and recurrent episodes of vomiting. He weighs 2.9 kg where as the
birth weight was 3.0 kg. He has been exclusively breast fed with no feeding problems. There is no h/o
diarrhea or cough. O/E, the baby is emaciated with signs of dehydration. His RR is 52/min with clinically
clear chest and no visceromegaly. Other examination is unremarkable.
Investigations were: Na 130, K 3.1, HCO3 15, Cl 106.
July 05 (3): A 5 year old girl is admitted for evaluation of chronic diarrhea. She has been having
treatment from GP with no significant relief. She was hospitalized at 18 months of age for acute
bacterial meningitis. She has two younger male siblings. O/E she is found to be a thin girl with a weight
of 14 kg and height of 99 cm. she has sparse hair with scars of old healed lesion on one side of face.
Anterior and posterior cervical lymph nodes are palpable with discharging right ear.
Investigations Hb 9 g, TLC 11400, N 80%, L 15%.
July 05 (4): A baby is born to a mother who was diagnosed to have SLE and had been on treatment
during pregnancy.
A) What are the 4 possible problems which you would anticipate in the newborn?
B) What could be the possible effects on the fetus because of maternal drug intake during pregnancy?
C) Mother is very keen to breast feed. What advise would you like to give her?
July 05 (5): A full term infant was born after uncomplicated pregnancy by uneventful vaginal delivery.
Physical examination of the infant showed short arms with normal hands and ptechiae all over the
body. Rest of the examination was normal.
Lab investigations showed Hb 15.5 g, TLC 12500, platelet count 5000.
July 05 (6): A 3 hours old full term neonate is admitted in the neonatal unit with h/o delayed cry at
birth , followed by progressive cyanosis and associated respiratory distress. O/E, he is inactive and
listless having marked cyanosis all over the body, tachypnea, tachycardia and chest in drawing.
Abdomen is soft with no visceromegaly.
Investigations revealed: Hb 19 g, echocardiography shows no structural heart defect but shunting of
blood from right to left at foramen ovale.
July 05 (7): A 12 month old boy was brought for recurrent convulsions for the last 4 days. There was no
h/o head injury, fever and rash. He was born at home by normal vaginal delivery. He was breast fed
only for one month after which he was he was fed on artificial feeding. The water used for preparation
of feed was stored in a painted container. Motor mile stones were normal. O/E, his weight was 8 kg,
length 73 cm, OFC 46 cm, pallor ++, temp 99 F. Vital signs were stable. He was drowsy with boggy
anterior fontanel. His CSF examination was normal. Blood picture revealed Hb 5 g, MCV 55 fl.
Peripheral smear shows microcytic hypochromic anemia.
July 05 (8): An 8 months old child is seen because of vomiting for 24 hours. The child passed one soft
stool at the onset and has had no bowel movements since. The infant has had recurrent episodes of
agitation since the onset of vomiting. O/E child is listless and apathetic with soft and non tender
abdomen. A mass is palpable in right upper quadrant. Rectal examination is unremarkable. He has
severe dehydration.
July 05 (10): A 5 years old girl is brought to hospital with two days h/o hematuria. She had been well
previously except that she developed few pustules 3 weeks back which healed after local application of
antiseptic lotion. There is no h/o sore throat, medications, oliguria or dysuria. Her mother developed
high grade fever one week back, which was diagnosed as malaria. O/E the child was conscious, alert,
active and afebrile, rest of the systemic examination was normal. Urine report showed numerous RBCs
and proteinuria.
Nov 05 (2): A 9 months old girl presented with three days h/o increasing breathlessness. O/E, she
looked pale with RR of 55/min with marked intercostals recession. Her pulse is 155/min with normal
heart sounds and 3/6 pansystolic murmur at lower left sternal border. There was no hepatomegaly.
Investigations: Hb 7.5 g, TLC 8000. Chest X-ray: cardiomegaly with plethoric lung fields.
Echocardiogram: perimembranous VSD. Pulmonary: systemic blood flow 1.4:1.
Nov 05 (3): A10 year old boy has been having recurrent abdominal pain mostly confined to the left
flank for the past 2 years. Investigations show: urine RBCs 50/hpf, WBC 10-12/hpf, hexagonal crystals
present, albumin+, glucose-ve, urine metabolic screen reveals a positive cyanide nitroprusside test.
Nov 05 (4): A 12 year old boy has been admitted with coma in the ED. O/E, he has tachypnea with GCS
of 6/15. ABGs reveal the following results: pH 7.25, PCO2 25 mmHg, base excess -14, PO2 70 mmHg.
Urine examination shows: glucose is negative on glucostix. The lab result shows a positive Benedict’s
test.
Nov 05 (6): A 4 year old girl has been brought with vaginal bleeding and bilateral breast enlargement.
Clinical examination reveals her height > 97th centile. Rectal examination reveals a palpable mass to the
left of the uterus. Investigations reveal bone age 7 years, normal skull x-ray and serum oestradiol 160
p.mol/l (normal < 50).
Nov 05 (7): A 2 day old term female infant presents with fever, tachypnea, apnea, drowsiness and a
generalized seizure. She has been born by SVD with no h/o birth asphyxia or prolonged rupture of
membranes. Examination revealed a hypotonic obtunded infant weighing 3.6 kg with profuse serous
lacrimation. Investigations showed: Hb 15.1g, WBC 14500, platelets 360,000, glucose 90 mg, Ca 2.1
mmol, Mg 1.5 mg, Na 138, K 4.0, urea 16 mg, creatinine 0.9 mg. ABGs: pH 7.3, PCO2 45, PO2 60,
bicarbonate 20, base deficit 6.0, arterial lactate 5.3 mmol (normal), serum ammonia 20 mcg/dl (raised),
head CT diffuse cerebral edema.
Nov 05 (8): A baby girl was brought from home by her parents for passing black colored stools on 3 rd
day of life. She was born to primigravida mother at home uneventfully and started on mother’s milk
after 24 hours of plain water and ghutti. She was active, pink, jaundiced mildly and had no other
bleeding site.
Nov 05 (10): Two brothers 3 years and 5 years old presented to ED with h/o high grade fever and
persistent vomiting for 5 days, h/o epistaxis and hematemesis for one hour. O/E children were drowsy
with mild jaundice and hepatomegaly of 5 cm below costal margin and clinical ascites. There is h/o
contact with cattle and goats 14 days ago at Eid-ul-azha.