1) Study Notes / Revision Guide (High-Yield)

A. Case-taking format in paediatrics

1. Identification: name, age (months/years), sex, address
2. Informant and reliability
3. Chief complaints with duration
4. History of present illness (chronological)
5. Negative history relevant to system
6. Birth history
   • Antenatal, natal, postnatal events
   • Gestational age, birth weight, cry at birth, NICU stay
7. Developmental history
   • Gross motor, fine motor, language, social milestones
8. Immunization history (with card if possible)
9. Nutritional history
   • Breastfeeding, weaning, current diet, calorie/protein estimate
10. Past history, drug history, allergy history
11. Family history (TB, asthma, atopy, consanguinity, genetic disorders)
12. Socioeconomic/environmental history

B. Physical examination sequence

• General: built, nourishment, hydration, pallor, icterus, cyanosis, clubbing, edema, lymph nodes
• Vitals: temperature, RR, HR, BP, SpO2
• Anthropometry:
  • Weight for age
  • Height/length for age
  • Weight for height
  • Head circumference (<5 years)
  • MUAC
  • Plot on WHO/IAP charts
• Systemic examination:
  • RS
  • CVS
  • CNS
  • Abdomen

C. Growth and development quick sheet

• Red flags:
  • No social smile by 3 months
  • No head control by 4 months
  • Not sitting by 9 months
  • Not walking by 18 months
  • No meaningful words by 18 months
• Developmental delay: always mention domain-wise assessment and hearing/vision screening

D. Nutrition and PEM/SAM

• SAM criteria (6–59 months):
  • Weight-for-height/length < -3 SD or
  • MUAC < 11.5 cm or
  • Bilateral pedal edema
• Complicated SAM signs:
  • Anorexia, severe edema, hypoglycemia, hypothermia, severe infection, dehydration/shock
• Common deficiency signs:
  • Vit A: night blindness, Bitot spots
  • Vit D: rickets, wrist widening, rachitic rosary
  • Iron: pallor, pica, irritability

E. Common practical long cases

1. Severe acute malnutrition
2. Pneumonia / bronchiolitis
3. Tetralogy of Fallot / VSD
4. Cerebral palsy
5. Nephrotic syndrome
6. Acute glomerulonephritis
7. Thalassemia major
8. Acute leukemia (suspected)
9. Meningitis / encephalitis sequelae
10. Chronic liver disease with hepatosplenomegaly

F. Emergencies to memorize

• Shock (compensated vs decompensated)
• Acute severe asthma
• Status epilepticus
• Severe dehydration
• DKA basics
• Neonatal resuscitation initial steps

2) Viva Question Bank (with one-line model answers)

General

• Q: Normal respiratory rate in infant?
  A: ~30–40/min (varies with age).
• Q: Define low birth weight.
  A: Birth weight <2.5 kg.
• Q: Exclusive breastfeeding duration?
  A: First 6 months.

Nutrition

• Q: MUAC cutoff for SAM?
  A: <11.5 cm in 6–59 months.
• Q: Most common nutritional anemia in children?
  A: Iron deficiency anemia.

Immunization

• Q: At birth vaccines (India UIP)?
  A: BCG, OPV-0, Hepatitis B birth dose.
• Q: Route of BCG?
  A: Intradermal (left upper arm).

Respiratory

• Q: WHO fast breathing cutoff in 2–12 months?
  A: ≥50/min.
• Q: Commonest cause of bronchiolitis?
  A: RSV.

Cardiology

• Q: Common cyanotic congenital heart disease in practical exam?
  A: Tetralogy of Fallot.
• Q: Classic spell in TOF?
  A: Hypercyanotic (Tet) spell relieved by knee-chest position.

Nephrology

• Q: Triad of nephrotic syndrome?
  A: Edema, heavy proteinuria, hypoalbuminemia.
• Q: Cola-colored urine suggests?
  A: Acute glomerulonephritis.

CNS

• Q: First-line emergency drug in active seizure?
  A: Benzodiazepine (e.g., lorazepam/midazolam).
• Q: Earliest sign of meningeal irritation in older child?
  A: Neck stiffness (with fever/headache/vomiting context).

Hematology

• Q: Most common hereditary hemolytic anemia in India practicals?
  A: Thalassemia.
• Q: Peripheral smear in iron deficiency?
  A: Microcytic hypochromic RBCs.

Neonatology

• Q: Definition of prematurity?
  A: Birth before 37 completed weeks.
• Q: Common cause of neonatal jaundice in first 24 hours is pathological due to?
  A: Hemolysis/sepsis (needs urgent evaluation).

3) OSCE / Case Presentation Templates

A. Long case presentation template (2-3 min)

1. “This is X-year/month old child, brought by mother with complaints of … since …”
2. Key positives in HOPI
3. Relevant birth/development/immunization/nutrition history
4. Examination summary
5. Anthropometry interpretation
6. System findings
7. Provisional diagnosis
8. Differentials
9. Investigations to confirm + baseline tests
10. Initial management plan

B. Short case method (1 min)

• Identify key sign
• Elicit 2-3 supporting signs
• Give likely diagnosis
• Mention one differential
• Mention first-line investigation and management

C. Example: SAM short case

• Child appears wasted, bilateral pitting edema absent/present
• Weight-for-height below expected, MUAC low
• Diagnosis: Severe acute malnutrition
• Rule out: TB/HIV/congenital heart disease/chronic diarrhea
• Plan: Appetite test, classify complicated/uncomplicated, therapeutic feeding protocol

D. Example: Nephrotic syndrome short case

• Periorbital edema + pedal edema
• Urine albumin high, frothy urine history
• Likely nephrotic syndrome
• Investigations: urine protein, serum albumin, lipid profile, renal function
• Management: steroids (if first episode as per protocol), salt restriction, edema care, infection surveillance

4) Practical Exam “Must Not Miss” Checklist

• Wash hands, greet caregiver, gain consent
• Check age-appropriate interaction with child
• Count RR for full minute
• Plot anthropometry correctly (do not just state values)
• Mention developmental status in all under-5 cases
• Mention immunization catch-up if incomplete
• In every systemic case, give:
  • Provisional diagnosis
  • 2 differentials
  • 5 key investigations
  • Immediate management

5) Last 48-hour strategy

• Long case formats (nutrition, respiratory, CVS, CNS, renal)
• 100 viva questions rapid review
• Growth chart + vaccines + developmental milestones

• 10 mock case presentations aloud
• Emergency drug doses and algorithms
• Common X-ray/ABG/CSF pattern revision

• Only summary sheets, no new topic
• Sleep 6+ hours

1. A printable rapid-revision sheet (1-2 pages),
2. A 50 most expected viva questions booklet, and
3. 10 full model long-case presentations in exam language.