..

STATION- CW
1. Look at the photograph and write down your findings. 1

2. Write down 4 differential diagnosis of this case. 4

3. What are the major criteria to diagnose Rheumatic fever ? 3

4. Write down 4 differences between Rheumatic fever and JIA. 2

Answer:

1. Swelling of right knee joint.

2. D/D: RF, JIA, Haemophilia, Tuberculer arthritis, septic arthritis,
Traumatic arthritis. ( any 4)
3. Migratory polyarthritis, Carditis, Sydenham's chorea, Subcutaneous
nodule, Erythema marginetum.
4.
Trait RF JIA

Types of joint Large joints Both small and large joints

involved
Symmetry of Asymmetrical Symmetrical
Involvement
Characteristics Miratory polyarthritis with Not migratory & more
of arthritis severe pain & tenderness. marked in morning. J
· Chance of Not deforming disease High chance of deformity
deformity a
.
Other organ carditis, Chorea Lymphadenopathy,
involvement I 1 Hepatosplenomegaly J
 Station-&

Q. A six years old girl presented with fever and recurent bouts of cough for about six

weeks. sudenly her left Eye became red.

a) What is the mostly cause ? 2

b) What other complaint may arise in this disease? 3

c) How you can prevent this disease ? 3

d) How will you treat this patient? 2

QUESTION

1. Look at the photograph and write down your findings. 1

2. Write down 4 differential diagnosis of this case. 4

3. What are the major criteria to diagnose rheumatic fever? 3

4. Write down 4 differences between Rheumatic fever and JIA? 2

 . .
'' ~ ~ _.,. .- .
', ,. '. ·-.;:

•~ -; ,;r; ~ I _/ •
.· t~~-·
~~--~
. .
. .,.,~
+
...
~ ~

- .
 au~ st _____ _
st
CllSt

Calcium Oxalate NU
Cryatal Tnple P10s. NII
A. Phosphate Nil
Spcmnal.07oa Nil

QUESTION

1. Look at the report, give the positive findings.

z. What is your probable diagnosis?

I. Mention the specific treatment of this case?

I. Give the complications of this case?

 erase

'

4. look at the report, give the positive findings.

2
S. What Is your probable dla1nosis?
2

&. Give the causative organisms of this case less than 2 months of age?
3
7. Give the anti 811croblal therapy with duration?
3
 ..-ts in grat11. M
11-ltyefthis? 81
trote of glucose? 01
,eu correct some dehydration? 03
cEXam~om
unt 1.e1siiman s
No organism is Id
Acid Fest bacll I
 . Microinfusion set with buret.

• Perfurator

Buret

Counting chamber

Regulator

Connecting Tube

Adaptor

3. I/V fluids

1/V drugs

4. No chance of over hydration

Fluid can be given in micro drops.

LM at the object in the photograph and answer the following.

a. What is it? 1
b. Write its composition in grams. 2
c. What is its osmolality after being dissolved in water? 1.5
d. What the role of glucose in it? 1.5
e. Write 4 points to assess dehydration according to IMCI. 4
Slldtum chlorade/Nacl - 1.30 gn: O.U,tQ,2$
~ium chloride/Kc! - 0.75 gm 0.25'40~
Sodium citrate/tri sodium citrate - 1.45 gm G.2S+fJ25
Glucose anhydrous/glucose - 6.75 gm 0.25+0.25
sm/1 1.5
In absorption of sodium 1.5

SUnkeneyes 1
General condition of the patient 1
Reaction of the child when offered to drink 1
Elasticity of the skin 1
 body from post part of tongue.

li.M'lgttis/Oropharyngeal candidiasis l 1 ' ~Wnj

71'"':i~~
,, 7,,..i,; •·-J(J_,"
&
o.nomucleosis

Jeal abscess
a tnrusion set with buret. _ _ _ _ _ _ _ _ _ _ _ _1
b Burel:
Counting chamber
Regulator 1------ -- - - - - - - 0 0 = 3
Channel/Tube
C, I/V ftuids 1_ _ _ _ _ _ _ _ _ _ _ _ _ _ 1X2= 2
1/V drugs
TPN
d. No chance of over hydration _ _ _ _ _ _ _ _ _ _ IX2=2
Flutd can be given in micro drops.
a. Potassium containing fluid - _ _ _ _ _ _ _ 1X2=2
Cholera Saline
Hartman's SOiution
Ringer's lactate solution
Total score = 10
 1:onstituents in gram?

will you correct a case of some dehydration?

3
at is the role of glucose here? 1
 causative organisms that my cause

Us In age group 2 months to s years?

• Sterile Sec dysposable syringe • ltJt,bA'MMe- nuJJ.c. .

. Venous blood collection.

Application of parenteral (1/V or 1/M) drug ,use of P/ R drug.

NG sucction and NG feeding in Neonate

. Lumbar puncture for CSF study.

. Streptoco,cus pneumoniae

Haemophilus influenzae (type B)

Neisseria meningitidis.
 N~astric tube.
. a)~ding and medication
b) NG suction
c) Per-rectal diazepam
d) Umbilical catheterization
e) Urethral catheterization
. Ethelene oxide
. a) NG suction causes aspiration of gastric content
b. Introduce small amount of air through the NG tube will produce
gushing sound
if auscultate over the abdomen with stethoscope.
 you correct some dehydration?

rSheet

containing oral rehydration salts.

•• m chloride (1.30gm)

Atassium chloride (0.7Sgm)

Tt--sodium cytrate (1.45gm)

Glucose anhydrous (6.75gm)

3. Osmolarity is 245 mmol/L

4. Glucose enhance Na+ absorption

5. ~ of some dehydration with 75ml/kg of

 catflii!iiHWl•,
1 (one) la
•
¥)(18.
 rve the throat clearly.

oval of foreign body from post part of tongue.

• Fa.teal diptheria
Tonsillitis/Pharyngitis/Oropha n eal candidiasis 'i'~-,_~i
c1 7"'4i JJ;n}

Infectious monomucleosis

Agranulocytosis

Retropharyngeal abscess

Cleft palate
 / Haematology Report J
T-c,«mcaaftdoutbvsr:sH« KS-8991
RESULTS REFERENCE VALUE
0,71
2.2 /dl 12.20-16.50 G/dl
110 mm in 1st hour Weste reen 0.0-12.0 mm

6.5 37.70-53,70
91.5 76.00-96.00
31.0
27.00-32.00
33.8 32.00-36.00
30 150.00-400.00 l
Neutro hil .,Ofrto _ 40.0-70.0 %
171 %
DC 20.-0-4 .o %
02i % 2.0-8.0
E 00 I% %
Bia 1.0-'1.0 %
• _lS_l_o/o
%
 6,5 37.70·53.7
91,5 76.00-96.
31,0 27.00-32.
33.8
30

03 % 40.0-70.0 %
17 % • 20.0◄5.0 %
DC 02 _% 2.0-8,0 %
02 'o/o 1,0-4.0 %
/8 %
%
 Tubru:cu]jn Test kpptt

Dose : 0.1 ml (PPD) 10 TU

Route : lntradermal
Interval : 72 hrs.
:(£mm
Opinion : PssilOt / Ne!la,· .ae

Jax: 0821-719().$16, E-maDJnmclnfo@gmaU com We

 1000 cell cmm of fluid

n
i
Neutrophll .11._red,=-com'-'i'-'nacc;n"'t"-------------1
No organism is identified
~i_cells· Plenty/HPF.
'\ri'1 •ast bacilli not found

Dr. Md. Zakir Hossain

M88S OCP
Junior mnsldlant
Dept.<#Pllllalogy
1salabad ~ Medical Colloge,Sylllet.
·-

, - INl21719096 e-mail jml'ICOIIIMW

Nasopstric tube
MicRllnfuslon Ntwllll ..,_

.......
__
,..__
.....
(.ou..,.a-..

......
......
II!!·
. ......
.8malln
'"'
lto1~a1-i.n-
• ""6du-11a..,._. ............
 CSfstudy

02ml.
Tart>
Oear
Nil

300 eel anm of fluid

Neutrophd preoommantly
Back round shows RBC.

No O nlsm Is Found
Not Found

daRay
di)
ll!ldlll!llilomw
tr'ledleal c:oHege
 + ,.,
Nil
NH
Ml
cast NII
NII
NH
te NH
NII

9J!ffl'ON
1. look at the investigation report, what is your diagnosis. 2

2. What are the findings In favour of your diagnosis? 2

3. What are the clinical features of this condition? 3

4. Mention 3 complications of this case? 3

 P:•stwtr

0.5 ml.
:----------- - -,~N;Turbid.,__
; f l _ _ _ _ _ _ _ _ _ _ _--!
--- -----
99 mg/di. ____ _
/ 40 mgf_d,~I.___ _

!nation:

1000 eel cmm of fluid

Neutrophil predominantly
No organlsn 1s identified
Pus cells Ple!!h',IHPF
Not Found
flllllt-nl•I Oral rehydration Sah 5 cc dysposable syrln1e w~h hypodermic nlldle
(Q 5 D • wlli!Sv..,,. of ,tucou, how UI Q)rfi!CI:
IV; 1 r • ldoMIIJ
Y.w
VfflOUI blood ClOPK"llOn
~ft0IPlrente,-1&
pwrt<llldr"WS
NG tud;ICM'I & NG Ind "I I"
I\IOftlle

Sptcl■ I UN al hypodermic
needle In cNld word·
lumNrplM'IClu,. ,o,af

"""'

2
 400 mm
Neut II pr
No organism
----------+P~us~cells
_ _ _ _ _ _ _ _ _ . ..-1.:A Pie t
~icld Fast o
 sphates
em)
ucmg Substance)
(tt++}...

Pus cells
Hyahne cast N
_RSC casl NI
Granular casl Nil
Cast Cellular cast N
Candida I
p1thehal cast N
Ca c1um Oxalate N
Tnplc Phos. Nd
Crystal Nil
A. Phosphate
Spcrmato1oa Nd
 srze:•

1000c llld
N nantiy
No~n sm s l<1er,tmP<1
Pus Clllls- Plenty[HPF
=---------.-Add.::::;;;;Fast;::;-;bacllll not four,
 E ithellal cells
RBC
Pus cells
H line cast
RBCcast NII
Granular cast Nil
cast
Cellular cast Nil
WBCcast Nil
Nil
Nil
Crystal NII
NII

<;:;:. Hossain
, MPhll,

Medical COiiege,
 fftead1ng
:Diameter of lnduration

Marks:
01
What are the conditions that may give
03
•
Name the organism responsible
forthe disease. 01
4 Name five first line antitubercular drugs
With one side effect for each. 05
 l ~

~
'(
l
y.
 3-5 HPF
10-15 HPF
2-3 /HPF
llne cast NII
RBCcast +
Granular cast Nil
cast cellular cast Nil
dlda Nil
least NII
late Nil
Crystal NII
hate NII
NH

OutSTION

1. look at the investigation report, what Is your diagnosis. 2

z. What are the findings In favour of your diagnosis? 2

3. What are the clinical features of this condition? 3

4. Mutton 3 complications of this case? 3

Nil
-- ----- --------~

1000 cell/anm of fluid

Neutrophil predominantly
No organisn Is identified
Pus cells· Plenty/HPF
Not Found
 Station- 10
Instruction: Look at the picture and answer
the following questions

1. Mention two important findings notable in the

picture.
2. What is the most likely diagnosis?
3. Mention three relevant histories you want to take
from the attendant of this boy.
4. Mention the steps of immediate management plan
(Stabilization) of this child.
 Station- 08
Instruction: Look at the supplied photograph
and answer the following questions

1. Write down three prominent findin gs visible in

this photograph of the patient?

2. What is the most likely diagnosis?

3. If other siblings of this boy are also affected with

the sa me disease than what lvill be the type of this
disease? •

4. Mention four investigations you will do to

establish the diagnosis?
 STATION-8

Look at the photograph and answer the following questions.

a. What is your clinical diagnosis? l

b. Write down 4 important charts for treatment of this patient. 2
c. Write 4 important test & investigations. 4
d. Name 3 complications that may arise in this case. 3
 1. Look at the photograph and write down your
provisional diagnosis. 1

2. Write down 3 important causes of this condition. 3

3. What are the other clinical signs you look for? 3

4. What are the treatment options of this? 3

 Rickets || Rachitic Rosary
STATION -7

Look at the photograph and answer the following questions.

a. Identify the lesion and write your probable diagnosis. 2

b. Mention any two clinical findings other than this. 2
c. Write 4 important investigations with findings. 4
d. Write down the treatment of this condition. 2
 Statlon-7

Q.This 10 days old baby brought to you with a swelling in scalp.

a) What is the most likely diagnosis 7 2

b) What is the other possibilities? 3

c) How will you manage this baby? 3

2
d) How long it will take to resolve?
 8

pplied phot4

ilt findings visil

~nt?

~nosis?

disease?

4. Mention four investigations y

 STATION-7

Look at the photograph and answer the following questions.

a. Identify the photo and write your probable diagnosis. l

b. By which fluid and how can the baby be rehydrated
according to age? 4
c. What complications may arise if not rehydrated? 4
d. Name the rehydration solution for malnutrition. I
 ,
lVl
.+._ :r
J ""'"'
""-Y~·
I'\ U

Ft~~ 6r .Rflp~s.
f'y(>. ~ 't._(JY\}.. •
P1tvi ti.l -tr,.J vi CAY't¼:

tg. p,u,Wlt d l ~> . SU\Kvj

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~ - fu.,,;,. ~~ 1 -f,., dJ'.<oM... vt.r Q, J+·,.;.,,.,<['

~ · -l c..o~ {.jD 1 r~~an ·

~~, r~~, 1°"a) M&~ 1 ~ ~U>~.
 Station: ~
l ook at th e picture and answer the following questions

1. Mention important findings notable in the

picture.
2. What is the most likely diagnosis?
3. Mention relevant histories you want to take
from the attendant of this child.
4. Mention the steps of immediate management
plan of this child.
1 Whit 1r th f\nd\"I\
2 Whit m1v b th p \-- c.•m•t
3 Whit ls th dlaano ,, en·~.. mt& r cit
4. HOW m••'' an b pr••\ltl~~l
 --

Station -10
Instruction: Look at the haemoglobin electrophoresis of an 8-year-old
boy who presents with anemia and answer following questions.

Hb Capillary E1°~ophoresis

.. .. -
-
eone.:

a) Mention abnormalities present In the electrophoresis.

b) Write down the diagnosis.
c) Write down two important signs In the abdomen that you may
get during physical examination.
d) Write down three important abnormalltles that may be found In
the peripheral blood film of this patient.
• e) Write down five important complications that may arise If he Is
left untreated.
 '

Q.UESTION

1. Look at the photograph and write down your findings.

2. Write down 4 differential diagnosis of this case.

3. What are the major criteria to diagnose rheumatic te'ler?

4. Write down 4 differences between Rheumatic fever and 1\~1 1

guESTrON
1. look at the photograph and write down vour dinica\ diagnosis. l.

3
.2. Give the karyotype of this disease?

3. Write down facial findings of this picture.

4. Give the cardiovascular findings of this disease"?

 ,"•er

~n~

2. \Vhat is the most likely diagnosis.

3. J\1ention three relevant histories vou want to take
~

front the attendant of this bo)··

4. 1"1ention the steps of immediate management \)\an
t~t~hilization) of this cl1ild.
 Stu1ion - 118
l11 ,-,11 ·11c..•fiu11: f ~ook al the -,upplieU photot;ra1.'\h
a11,J an ,. .,wc,· lhc following, quc~tiun<.,

I. W1·ill' Chnvn three pro1nin<.:nt finding, vi..,ih\c in

flli-. pliolo~raph of the patient'!

2 . VVhai is lhc 1nost likely diagnosis'~

3. If other siblings or this boy are also affected ,,ith

the sa,ne disease than ,vhat will be the ty\)e of this
disease? .
4. Mention four investigations you ,vi\\ do to
establish the diagnosis?
 Station- 10
Instruction: Look at the picture and ans,ver
the following questions

1. Mention nvo important findings notable in the

picture.
2. \Vhat is the most likely diagnosis?
3. ;\,Je11tion three relevant histories you ,_.ant to ta\1.1!
from the attendant of this bo)'·
.J. •\lention the steps of immediate management 11\al\

(Stabilization) of this cl1ild.

 /
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F 'i,
F
£!... ::;
N.-.m. Of 0.se-~ Name of
Vaccine Amount Number-of
,-I ....,- <? ·
'
Dose ThTte ofV.icein ati on
Tubercul03,J5 Si\e. o1 \lac.c;.\na\\on 'l\ou\~ o\
BCG 00S mi \/.1.cc:.\"111'\\ol'\
l
JuM after Blrth Upper part ot ~h.
Diphtheria,. Pertus!;:·s,
A.rm \nu.-,d~tft\a\
Tetanus, Hepat.~tjs 8,
Neonataf tvteningitis PenravaJent 0.5ml 3 th
and Pneumonia 6 , 10th• 14 th week Outer part of m\d-d.le
of leit thigh lotf:)muscular
Pneurnococcal
Pneumonia PCV 0.5ml 3 6
th
, 10th, 18th week Outer part of middle
of right thigh \ntramu~t.u\ar

OPV 1-3 drops 3 6 1', 10"', 14 th week

Poliomyelitis Mouth Oral

IPV 0.5ml 1 14"'week Outer part of middle

of right thigh ln\rarnuscuta,

Measles and Rubella MR 0.5ml After completion of 9

\'ti 1 Outer pa rt of middle
months of right thlgh Subcutaneous
Measles MCV-2 0.5ml Aft,er completion of 15
1 Outer part of middle
months ~ of left th\_ih Subcutaneous

BCG ~ BacdJos Calme~~uenn, PCV =Pneumococcal ConJugate Vaccine, OPV =Oral Poho Vaccine, IPV =lnac\l\'e Polio Vaccine, MR., ~tes Ru~