Systemic Examination Q&A COUNT: 20* CVS Examination: 05 (Q) What is apical impulse? Lowermost and Outermost point of definite cardiac impulse, which gives maximum thrust to the palpating finger (Q) How apical impulse position varies with age? INFANCY - In the left 4th Intercostal space, just "lateral" to the midclavicular line (then) UPTO 5 YEARS - In the left 5th Intercostal space, along the midclavicular line (then) AFTER 5 YEARS & ADULTS - In the left 5th Intercostal space, just "medial" the midclavicular line Types of Apical Impulse Tapping  - MS Heaving - AS Hyperdynamic - MR Diffuse apical impulse - left ventricular aneurysm Double apical impulse - AS + AR Triple apical impulse - HOCM Quadruple apical impulse - HOCM Difference between Tapping, Heaving and Hyperdynamic apical impulse  Tapping - confined to one Intercostal space Hyperdynamic - diffused over more than Intercostal space, ill sustained (for du...

Q&A COUNT: 28* GENERAL EXAMINATION: (1) Pallor Pallor - Grading according to IMNCI No Palmar Pallor Some Palmar Pallor Severe Palmar Pallor WHO classification of anemia Based on Hb% levels Mild anemia 9-11 g% Moderate anemia 7-9 g% Severe anemia <7 g% (2) Clubbing and Cyanosis Age to develop clubbing 4-6 months Which finger usually develops clubbing? Only thumb usually develops clubbing Cause for Pandigital clubbing TETRALOGY OF FALLOT Grades of Clubbing Grade 1 - Fluctuation Grade 2- Obliteration of nail bed angle Grade 3 - Parrot Beak appearance Grade 4 - Hypertrophic Osteo-arthropathy Causes of Clubbing RS - Bronchogenic carcinoma, Cystic Fibrosis, Suppurative lung diseases, Lung carcinoma, Pulmonary AV malformation Abdomen - Primary Biliary cirrhosis, Inflammatory bowel disease CNS - Hemiplegia, Syringomyelia CVS - Congenital cyanotic heart disease, Infective endocarditis, Eisenmenger's syndrome Causes of Hypertrophic Osteoa...

RICKETS : Q&A COUNT: 16* Clinical Features of Rickets This picture is taken from Aruchamy textbook of Paediatrics Reason for Recurrent Respiratory Tract infection in Rickets HYPOTONIA What is recurrent Respiratory Tract infection? (or) Tell criteria to say it is recurrent RTI 6-8 episodes of Respiratory Infection in every year What is Bad CRP (Child Rearing Practices)? Mention them Bad CRP are those socio-cultural practices which are harmful to baby. Bottle feeds and prelacteal feeds are examples of Bad CRP This picture is taken from Aruchamy textbook of Paediatrics EXAMINATION : Fontanelles, Bossing, Craniotabes: Fontanelles - age of closure? AF by 7-19 months PF by 2 months Since delayed closure of AF is seen in Rickets, normal closure age can be asked Method of measuring Anterior Fontanelle Normally it would be around 2 x 2 cm approximately Significance of Bulging of Anterior Fontanelle other than Rickets It is a Cl...

PAEDIATRIC EXAMINATION Q&A COUNT: 39* (1) External Markers: Name the external markers of Congenital Heart disease This picture is taken from Aruchamy textbook of Paediatrics External markers of cardiac failure This picture is taken from OP Ghai textbook of Paediatrics Neuro cutaneous markers This picture is taken from Aruchamy textbook of Paediatrics External Markers of Tuberculosis TUBERCULOSIS : a) Scrufuloderma (side of neck) b) Phlyctens (eyes) c) Lupus vulgaris (face/neck) d) Tinea versicolor e) Erythema nodosum (shin) f) Coroid tubercle (fundus) g) Nimbus (spine) h) Epididymo orchitis External Markers of Liver cell failure 1. Alopecia 2. Hepatic facies - sunken cheeks/ eyes with malar prominence, enlarged parotids 3. Bitot spots 4. KF ring 5. Conjuctival hemorrhage 6. Xanthalesma 7. Icterus 8. Loss of buccal pad of fat 9. Parotid enlargement 10. Foetor hepaticus 11. Spider nevi 12. Gynecomastia 13. Palmar eryth...

Q&A COUNT: 30* FEBRILE SEIZURES: Q&A count: 30* Note: This case doesn't have any clinical findings other than fever and history of seizures, so this case won't be kept for exams for sure! Model case sheet is given in the end! Questions related to Febrile Seizures:  HISTORY: (10) Criteria , Definition for Febrile Seizures: 3 criteria: Febrile seizure is a seizure which: 1. Occurs between 6 months to 5 years of age 2. Accompanied by fever and 3. Not associated with any CNS infection What are the Types of Febrile seizures? Simple and Complex types Simple seizure is a generalised seizure , occurs only once in 24 hours and lasts for less than 15 minutes If any of these three features are opposite, then it is said to be complex febrile seizure That is.. A complex febrile seizure should have any 1 of the following: 1. Focal seizure 2. Recurrence within 24 hours 3. Lasts for more than 15 minutes Other types: 1. Febrile seizure + 2. Statu...

ANTHROPOMETRY Q&A: 26* Difference between growth and development Growth denotes a net increase in size or mass of tissues , while development denotes maturation of functions and acquisition of skills. Growth is due to multiplication of cells while development is due to maturation and myelination of nervous system. Growth is measured by Anthropometry and Growth charts, while Development is measured by Developmental milestones ANTHROPOMETRY (GROWTH): When to plot a growth chart for preterm baby? First allow the baby till it attains term age. Then start to plot growth chart from term age What is significant weight loss? More than 10% in last 6 months Tell Weight calculation formula (Weech formula) Weech formula for weight Difference between length and height? For baby less than 2 yrs - we call it length, since baby cannot stand and vertical height cannot be measured. Instead, we will use "INFANTOMETER" to measure length of the baby Fo...

NEPHROTIC SYNDROME Q&A COUNT: 33* Relevant Findings to this case: History: 1) C/C: Facial puffiness/swollen legs and decreased urine output 2) Facial puffiness is more prominent when child gets up in morning 3) Decreased urine output - Number of times/day, no hematuria* (rule out Nephritic syndrome which has hematuria) 4) H/O orthopnea, dyspnea, PND (in case of complication - CCF) 5) H/O recurrent respiratory tract infections (complication) 6) No H/O sore throat, No H/O skin infections 7) No H/O seizures or blurred vision or headache (ruled out hypertensive encephalopathy due to Glomerulonephritis) 8) H/O abdominal pain or distension (in Nephrotic syndrome) Examination : Bilateral pitting pedal edema Normal BP* (BP elevated in Nephritic syndrome) Anasarca Penile/scrotal edema Abdomen: Distended, Fluid thrill positive, Shifting dullness negative Normal liver span No renal angle tenderness QUESTIONS : Definition of Nephrotic Syndrome 1) Heavy proteinu...