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Exam Recall Series (INI-CET Nov '24) - Paediatrics — Transcript

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0:00so hello everyone this is Dr singaram
0:02your Pediatrics faculty we are going to
0:03discuss about the recall question
0:05discussion in the subject of Pediatrics
0:07asked in this recently conducted inct
0:09November 2024 exam before I start the
0:12discussion let me just uh give you my
0:14insights about this particular exam uh
0:16standard number of questions were asked
0:18from the Pediatrics part and also the
0:20topics which were covered were the ones
0:22which we usually emphasize in the
0:24classes like the previous year topics as
0:26well as the most important topics for
0:28any subject like milestone SC gental
0:30heart disease and those topics okay and
0:32regarding the pattern of questions it
0:34was a standard pattern according to inct
0:37however it was more of direct question
0:40this time compared to lengthy question
0:42that means the clinical scenarios were
0:44comparatively lesser uh in comparison to
0:46the previous in exams but of course the
0:49topics covered were almost the usual
0:51topics which we expect in an inac exam
0:54level so with that introduction we will
0:56start the discussion now now coming to
0:58the first question it is a question
1:00about Milestone a child is able to copy
1:02a cross tell stories and goes to toilet
1:04alone what is the probable age of the
1:06child as per the development attain this
1:08is a very straightforward question if
1:09you look at the Milestone copying a
1:11cross telling a story and going to
1:14toilet alone all will be fitting into
1:16the age of 4 years okay this is a very
1:19direct question so I'm going to put up
1:21some information about the key
1:23milestones attained at the age of four
1:24years this is from Nelson textbook of
1:26Pediatrics look at the first one motor
1:29milestone it is hopping on one foot
1:32there is also one more motor Milestone
1:34able to go downstairs child is able to
1:37go downstairs with one
1:40foot per step this is also one more
1:43Milestone attained at the age of 4 years
1:45this is for the motor domain next is
1:47about the fine motor domain imitates
1:49construction of a gate of five cubes and
1:52also able to copy a cross which was
1:54given in the question then about
1:56language child is able to count four
1:58pennies accurately and also able to tell
2:00a story which was again given in this
2:02particular question and the last one is
2:04about the social domain Milestone where
2:06the child is able to play interactively
2:08with other kids so this is more of a
2:11interactive play Happening by the age of
2:144 years and also role play and along
2:16with that child is able to go to the
2:18toilet alone which is also asked in this
2:20particular question okay so everything
2:23fitting into the age of 4 years which
2:25would be the answer for this particular
2:27question moving on to the second
2:29question all of the following are
2:31included under diagnostic criteria of C
2:34recruit mantion also called as
2:37Sam except okay which is not height for
2:40age weight for height P edema muac means
2:44mid uper arm circumference less than
2:4611.5 CM let us look at the options from
2:49the last mid appam circumference less
2:51than 11.5 cm is definitely included
2:54under Sam and cannot be the answer for
2:55the question please remember the age
2:57group in which we apply this criteria
2:59for Sam children is from 6
3:02months to 5 years 6 months to 5 years
3:07presence of pedal edema of course
3:09bipedal edema or both Leg Edema is also
3:12included under the criteria for Sam and
3:14cannot be the answer for this question
3:16then weight for height that is also
3:19included in the criteria and what does
3:20the criteria say weight for height less
3:23than or below minus three standard
3:26deviation is what is called severe acute
3:29Mal neutri
3:30so that is also included and cannot be
3:31the answer so the obvious answer for
3:33this question is height for age when the
3:35height for age is low we call it as
3:37chronic malnutrition and not as acute
3:39malnutrition that would be the obvious
3:41answer for this particular question so
3:44these three things I have told for Sam
3:46and out of the three how many should be
3:47present to be called as Sam any one of
3:51this present itself will be sufficient
3:53to make a diagnosis of severe equid
3:55management that is also one of your
3:57previous year questions so this question
3:59and answer is very clear it is height
4:01for age is not included under the
4:03criteria for Sam children okay so that
4:05is something very clear moving on to the
4:08third question this is a clinical
4:10scenario question where we have to
4:11analyze the question in terms of
4:13clinical findings as well as the uh lab
4:16findings also this is a two-e old baby
4:19who is presenting the history of
4:21epistaxis and recurrent rectal beding so
4:23something like repeated bleeding
4:25manifestations are noted and one more is
4:27there is also parents complaining of the
4:29history that there is a bleeding from
4:31the amus since birth so multiple areas
4:34there is bleeding epistaxis recurrent
4:37rectal bleeding as well as Amal bleeding
4:40so whenever you have a child with
4:41repeated bleeding manifestation you have
4:43to perform the coagulation testing here
4:46also we have done that and lab
4:48investigation reveal normal Pro thrombin
4:51time normal thrin time normal partial
4:53thromboplastin time normal platelet
4:55count as well as normal function of the
4:57platelet so that means the basic workup
4:59of the coagulation or bleeding disorder
5:02is actually normal platelet functions
5:04are normal PT AP is normal and platelet
5:07count is also normal now what would be
5:09the answer for the question for that
5:11only a very important clue is given at
5:13the end what is that look at the test
5:16which is turned out to be positive in
5:18this child what is that UA clot
5:21solubility testing is positive this one
5:25finding is sufficient to conclude the
5:28diagnosis as what factor deficiency yes
5:32it is a fibrin stabilizing factor or
5:34clot stabilizing Factor what is that
5:37factor 13 that is the likely deficiency
5:41in this particular child first of all
5:44what is this Factor 13 as I already told
5:46you it is a fibrin stabilizing Factor
5:47also called clot stabilizing Factor so
5:51the role of this Factor starts after the
5:53formation of clot that is why till the
5:56formation of the clot or till the
5:57production of fibrine everything thing
5:59is not affected so that is why PT aptt
6:02is normal in this particular condition
6:05so see this PT and aptt reflect only
6:07till fiber formation which is actually
6:09normal in this child that is why they
6:12are normal in this particular child and
6:14PT AP never measures crosslinking which
6:18is actually done by factor eight this
6:20cross linking is a mechanism for
6:22stabilization of the clot which is done
6:24by the factor 13 that is not assessed by
6:27PT or aptt that's what you can make a
6:30note of so for this particular uh Factor
6:33deficiency we have performed the test
6:35itself what is the name of the test clot
6:37solubility testing is performed to
6:39identify the affected individuals okay
6:42right so that is how we come to the
6:44answer for this particular question now
6:46a quick note about this Factor 13
6:48deficiency it's a rare clotting Factor
6:50disorder and it is inherited in an
6:52autosomal recessive manner okay the
6:55usual bleeding sites are actually given
6:57in the question also and I will just
6:58read it uh bleeding from the Amicus
7:01which is already given in the question
7:02the other sites of bleeding are soft
7:04tissue bleeding surgical bleeds joint
7:06bleeds as well as sometimes sometimes
7:09dangerous intracranial bleeds can occur
7:11and out of all this Amal beding in an
7:13infant small baby should make you think
7:16about the possibility of factor 13
7:19deficiency and of course the treatment
7:21for this condition is a replacement of
7:22the factor 13 in the form of factor 13
7:25concentrates so that was about Factor 13
7:28deficiency which was asked asked as a
7:29clinical scenario question in this inac
7:32exam moving on to the next question it
7:35was one more question about severe
7:37accute malnutrition but this time
7:39related to primary failure of recovery
7:43or primary failure of treatment in an
7:45admitted child with severe acute
7:47malnutrition there were some criterias
7:49given in the question and that was
7:51matched with the day of the treatment
7:53can you see day 4 10 and all is
7:54something related to day of treatment in
7:57s okay failure to regain appetite by day
8:00four failure to start losing edema by
8:03day four complete absence of Edema by T
8:0510 weight gain of less than 5 G per day
8:08from day 20 okay 5 G per kg per day
8:11sorry for that 5 G per kg per day from
8:14day 20 now this is purely purely a
8:17factual question where you have to know
8:19the facts which will be for primary
8:21failure of treatment in case of Sam and
8:23this is the standard criteria we use
8:26when you call the patient failing to
8:28respond to treatment okay there is
8:29something called primary failure to
8:31respond and secondary failure to respond
8:33in this question we'll focus on the
8:34primary failure to respond to treatment
8:36which is in the first phase or what we
8:39called as the stabilization phase okay
8:42right failure to regain appetite by day
8:44four failure to lose edema this is
8:47starting to lose edema this is what you
8:49have to remember by day four edema still
8:52present by day 10 that means what
8:54completely edema is not resolved by day
8:5710 please make a note of this and last
8:58one failure to enter the phase four
9:01phase two that means the uh
9:03Rehabilitation phase or not gaining more
9:05than 5 gram per kg per day by day 10 so
9:08you can see two criterias related to day
9:10four and two criterias related to day 10
9:13day four failure to regain appetite
9:15failure to start losing edema day 10
9:17complete absence of Edema and not
9:19gaining adequate weight this is what we
9:21call primary failure of treatment please
9:23remember Day Zero is the starting day of
9:26treatment and it is subsequently
9:28numbered after that okay right so going
9:31by this you can see failure to regain
9:34appetite by day four is in fact a
9:36criteria for primary failure to respond
9:38to treatment failing to start to lose
9:40edema by day 4 that is also included
9:43complete absence of Edema by day 10 that
9:45is also included but weight gain of less
9:48than 5 G per kg per day not from day 20
9:51it was from day 10 you saw that very
9:54clearly which was given in that picture
9:56which I was displaying before so uh a b
10:00and c indicate the failure to respond to
10:02treatment so option A would be the
10:04answer for this particular question okay
10:07right so that was about criteria for
10:09primary failure of recovery one more
10:11point I want to remember is the reason
10:13for failure of uh um response to
10:16treatment is basically due to some
10:18untreated or unrecognized infection that
10:21is what should be looked for in this
10:22particular child whenever that's a
10:24primary failure of treatment uh response
10:27okay right failure to respond to
10:28treatment okay okay so that's about this
10:30particular question moving on to the
10:33next question a very usual question
10:36asked about jaundice which is breast
10:38milk jaundice okay breast milk jaundice
10:40you have to find which is true statement
10:43about this condition okay see breast M
10:46jaundice is mainly a benign Condition
10:48it's not very dangerous condition so
10:50that is why most of the times treatment
10:52may not be required and if you look at
10:54the options most of the children require
10:56phototherapy is obviously a wrong
10:57statement okay right
10:59and uh breastfeeding should not be
11:01continued is also wrong because I told
11:03you it's mostly a benign condition and
11:05it's a very transient or a self
11:07resolving condition so that is what is
11:09the textbook lines which are given
11:11breastfeeding is should be seldom
11:14stopped that means it should not be
11:15stopped in case of a breast milk
11:18jaundice so that is also out now the
11:20reason for this breast milk jaundice is
11:22due to some substances in the breast
11:24milk which will deconjugate the B Rubin
11:27thereby converting the conjugated B
11:28Rubin back to unconjugated bin thereby
11:31increasing the unconjugated B Rubin
11:35levels in the body right so that is why
11:38the last option in this particular
11:39question conjugated hyper bmia is also
11:42wrong so by excluding the option where
11:45have already arrived at the answer for
11:46the question what is it it's a condition
11:49due to exclusive breastfeeding the total
11:51B Rubin exceeding 10 milligram P dtive
11:54after 3 to 4 weeks of birth okay right I
11:57have uh come to this answer by by
11:59excluding the other option and if you go
12:01by the textbook references from op
12:03textbook the first line under breastman
12:06jaundice itself can you see what is
12:07written approximately seen in 3 to 4
12:11percentage of exclusively breastfed
12:13babies having TSB what is TSB totem
12:17serum serum B Rubin of more than 10 migr
12:20per decil Beyond third to fourth week of
12:23Life exact same line from Opa textbook
12:26the first line given under breast
12:28jaundice which is the correct statement
12:29for this particular question okay now as
12:32I told you there are some substances in
12:33the breast milk which will contribute to
12:35this and one of the substance is beta
12:38glucuronidase which causes
12:44deconjugation of the conjugatable Rubin
12:47that means it converts the conjugable
12:48Rubin back into UNC conjugable Rubin
12:50thereby increasing the levels of UNC
12:52conjugable Rubin and contributing to
12:54jaundice and please remember
12:56Interruption of breastfeeding is seldom
12:58required that means you you will never
13:00stop breastfeeding this condition will
13:02settle on its own that is what you need
13:04to remember so it's a transient and a
13:07benign condition of neonatal jaundice so
13:10you should not stop breastfeeding the
13:12clear answer is option C for this
13:15particular question okay right so that's
13:18about this question moving on to the
13:19next one which of the following is not a
13:21feature of cystic fibrosis cystic
13:23fibrosis is one of the most often
13:27repeated Topics in your npg as well as
13:30in exam every year after year there is
13:34one question definitely asked about 65
13:37bres so you should know thoroughly for
13:39all your upcoming exams please make a
13:41note of this okay right so this time it
13:44was a very direct one they asked which
13:46is not a manifestation of cystic
13:47fibrosis nasal polyps are a definite
13:50feature of cystic fibrosis in fact
13:52bilateral n and fips are associated with
13:55cystic fibrosis so that cannot be the
13:57answer for the question B is a cental
14:00anomaly situation causing Neal quasis
14:02and is not a feature of cystic fibrosis
14:06right okay meconium inav is one of the
14:08early manifestation of cystic fibrosis
14:11characterized by thick meconium not
14:13getting exted and the baby classically
14:16present with delayed passage of meconium
14:18as well as abdominal distension of after
14:21birth so that's a true uh finding in
14:23cystic fibrosis bleeding di thesis of
14:26course we know it's a correct statement
14:28but can you re note why it can occur in
14:30cystic fibrosis remember in cystic
14:32fibrosis there is pancreatic
14:34insufficiency correct there is
14:36pancreatic
14:41insufficiency and as a part of
14:43pancreatic insufficiency there is a fat
14:45malabsorption occurs also called
14:48Storia
14:50Storia and also there is a deficiency of
14:53fat soluble vitamins what are they
14:55vitamin A d e and K this
15:01vitamin K deficiency as we all know is
15:04going to be associated with bleeding
15:07manifestations only due to inactivation
15:08of clotting factors 2 7 9 and 10 so that
15:12is why bleeding diathesis can be an
15:15association for Cystic Fibrosis also
15:18okay so the clear answer for this
15:20particular question is option b delri is
15:23not a feature of cystic fibrosis that's
15:25a very straightforward question moving
15:27on to the next one this was asked in a
15:30recent previous inct exam what is that
15:33in a child with a congenital heart
15:36disease nada's criteria includes all of
15:38the following except okay right now I
15:41have discussed this in the previous uh
15:43recall sessions also during that time
15:45the question was asking about Minor
15:47criteria nadas criteria here they have
15:49generally included the criterias you
15:51should know that nadas criteria has
15:53major criteria and minor
15:56criteria first let me solve the question
15:59and then I'll go to the details of this
16:01major and minor criteria diastolic
16:03murmur any grade is definitely included
16:05under Nas's criteria increase tronent T
16:09is for what it is for helping in the
16:11diagnosis of myard infection and that
16:13cannot be something related to
16:15congenital heart disease so that is out
16:17and is not included in the nadas
16:18criteria abnormal x-ray is definitely a
16:21feature under nadas criteria comes under
16:23the minor criteria congest cardiac filia
16:25features also Point towards the
16:27possibility of heart disease and that
16:28that is also included under nadas
16:30criteria this is a quick recap of the
16:33nadas criteria which I have discussed in
16:35my previous recall videos also major
16:38criterias include systolic murmur of
16:39grade three or more any diastolic murmur
16:42which was given in this question and
16:44also sinosis of course it's a central
16:47sinosis and congestive cardiac failure
16:50which is again given in the question
16:52when we move to the minor criteria it is
16:54holic M less than grade three and all
16:56the abnormal ones what is it abnormal S2
16:58AB abnormal ECG abnormal chest x-ray and
17:01abnormal uh BP sorry this is blood
17:04pressure abnormal blood pressure so all
17:06these are included under minor criterias
17:09okay right so that was about the quick
17:11recap of minor criterias and major
17:13criterias in Nas criteria now tell me
17:15how many major and minor should be
17:17present to make a diagnosis of
17:19congenital heart disease clinically yes
17:22it is one major criteria or two minor
17:25criterias are essential for indicating
17:27the presence of congenital heart disease
17:30right so the answer for this question is
17:32very clear proponent is not included
17:34under nand's criteria that's it so
17:37moving on to the next question this was
17:38a question about GBS or gillberry
17:41syndrome all of the following are true
17:43statement except we all know that
17:45gillberry syndrome is a condition of
17:47poly neuropathy and it is following an
17:50infection po infectious condition
17:52usually preceding infection is 10 days
17:54before a episode of gastritis caused by
17:58Campo back J right that is what we all
18:00know about now as a part of this poly
18:02neuropathy what will happen to the Deep
18:04tendent reflexes it will be absent or
18:06decreased so look at the first option a
18:09reflexive of the affected limb is a
18:10mandatory diagnostic criteria that is
18:12true only and cannot be the answer for
18:14the question second option plasma feris
18:17is not preferred in refractory cases
18:19please remember the first treatment we
18:21give is ivag for a progressive weakness
18:24in gillberry syndrome but if IV is not
18:26effective plasma feris is this next
18:29treatment option so saying plasma feris
18:31is not preferred is a wrong option and
18:34will be the a wrong statement and will
18:35be the answer for this particular
18:37question IB is definitely the first line
18:40of treatment that's a correct statement
18:42and in fact aluo cytological
18:43dissociation CSF is characteristic we
18:45all know that when you do the lumbar
18:47puncture and the CSF analysis there is a
18:49discrepancy between albumin and cell
18:51count what is that high albumin or high
18:53protein but cell count are normal that
18:56is what is called albuminocytological
18:57dissociation that is in fact
18:59characteristic of gillberry syndrome so
19:01all the things are correct statement and
19:03B is a wrong statement and will be the
19:05answer for the question now I'll just
19:07take you through some points from Nelson
19:09textbook of Pediatrics to give you more
19:11uh information about this particular
19:14topic with relevant to the options given
19:15in the question number one is features
19:18needed for diagnosis of gillberry
19:19syndrome remember it's a neuropathy so
19:22it is characterized by muscle weakness
19:24and this weakness is usually involving
19:27the legs and the arms limb muscles and
19:30where does it start it starts from the
19:31legs and goes upwards to the upper part
19:34of the body that's why it's called
19:37ascending paralysis or ascending
19:39weakness that is what you have to
19:41remember okay right it's a ascending
19:43weakness okay second thing I've already
19:45explained that in the question itself
19:47absent deep Trend reflex a reflex here
19:49or at least decreased deep Trend reflex
19:51is very very important for making a
19:53diagnosis of Gan Berry syndrome that is
19:55also correct now moving on to the uh
19:58next next one that is CSF analysis
20:00finding see the line from the textbook
20:02the dissociation between High CSF
20:05protein and lack of cytological respon
20:07that means what cell count are normal
20:09that is what is called
20:11albuminocytological dissociation also
20:13called cytoalbuminologic
20:14dissociation in a patient with acute or
20:17Subacute poly neuropathy is essentially
20:20diagnostic of gillberry syndrome which
20:22was again given in the options in this
20:24question now talking about the
20:26management or treatment of glenberry
20:27syndrome I told you
20:29for any rapidly Progressive weakness
20:32ivag is a first line treatment of choice
20:35that is intravenous imunoglobulin if
20:37that is not effective then we can go for
20:39the other treatment which includes
20:41plasma feris and or immunosuppressive
20:43medication we all know that
20:45immunosuppressive drugs are a big group
20:47and in that immunosuppressive drugs
20:49please keep in mind steroids are not
20:52actually effective for improving the
20:54weakness instead they will improve the
20:57pain in a patient with Gill ber syndrome
20:59so this is an important Point among the
21:01immunosuppressive medications steroids
21:02are not that helpful to improve the
21:04weakness please keep that in mind so
21:07with all this discussion the answer for
21:09the question is very clear it is plasma
21:11feris is not preferred in refractory
21:13cases is a wrong statement and that
21:15would be the answer for this question
21:17moving on to the next question it's a
21:19very uh straightforward question a
21:21four-year-old child was diagnosed with
21:24cou which of the following is the most
21:26common CA to organism remember cou is an
21:29upper respiratory infection okay with an
21:31extension to the larynx and tro also
21:33that is why it's called lingo tro
21:36bronchitis okay and this is the typical
21:39age group for the cou also basically cou
21:41is a viral infection and we all know
21:44that the most common cause for the cou
21:47is a par influenza virus par influenza
21:52virus now if you look at the options par
21:55influen is not given that means you have
21:56to choose the next to common virus
21:58associated with the c what is that it's
22:00a straightforward one which is influenza
22:03virus that would be the answer for this
22:05particular question because par
22:07influenza is not given in the options
22:09now just a quick recap of the important
22:11points I told you the age group given in
22:13the question was actually typical age
22:15group it is from a range of 6 months to
22:183 years and CW being a viral illness is
22:20characterized by low grade fever
22:23generally the child is not very sick and
22:25due to involvement of the larynx you get
22:27Strider and what is the characteristic
22:29cough in cou barking cough please
22:32remember Strider barking cough and low
22:35grade fever are characteristic findings
22:37of group clinically and if you do the
22:40X-ray you will see the characteristic
22:42sign what is the name of that sign
22:43steeple sign which represent the
22:47subotic
22:50narrowing okay seen in cases of group
22:53the maximum area of narrowing the
22:55subcloud is region which is what we see
22:57as a Ste sign in case of kro okay so
23:01that was a clear answer for the question
23:03influenza virus moving on to the next
23:05question this is a very factual question
23:08which of the following causes the
23:10closure of ductus osis we all know that
23:12ductus atosis is something like a
23:14structure connecting the art two
23:16arteries namely the Iota and pulmonary
23:18artery in the fetal circulation and
23:20after birth it is going to close what is
23:23the chief factor for the closure is it
23:25increase in oxygen levels decrease in
23:27the carbon oxide levels increase in the
23:30pulmonary vascular resistance or fall in
23:31the concentration of camines what do you
23:34think is the answer please remember that
23:37the main main factor for the closure
23:39ductus osis is increase in oxygen we all
23:42know that once the baby starts crying or
23:45breathing where the lungs get the oxygen
23:47and give it to the body there's an
23:48increase in the oxygen concentration in
23:50the body this increase in the oxygen
23:52concentration causes
23:55constriction of the smooth muscles in in
23:58the wall of the ductus osis and this
24:00constition of the smooth muscles will
24:02result in the closure of the ductus osis
24:06this is the main factor for closure of
24:09ductor arteriosis after birth please
24:12remember there is also one more Factor
24:15two key factors one is already given
24:17rise in the oxygen concentration divin
24:19second is decrease in the levels of
24:21prandin because prandin is the one which
24:24is responsible for maintaining the
24:26patency of ductors in fetal circulation
24:28and after birth the Prine level
24:29decreases and that will also contribute
24:31to the closure of ductors but that is a
24:33second Factor first factor is always
24:36always increase in oxygen concentration
24:38and that would be the answer for this
24:40particular question moving on to the
24:43next question this was about
24:45cardiopulmonary resist pediatric CPR
24:48okay is always always an important topic
24:51for your exam purposes okay right the
24:54question was which is a true
24:56statement just compression
24:59at the rate of 30 is2 whenever you
25:01maintain a ratio or a rate it is justest
25:04compression with ventilation ratio that
25:05is what they asking about 30 is to2 with
25:09two Rescuers 30 is to2 is okay but it is
25:12not for two rescuer it is for a single
25:15rescuer that means one person and
25:18actually what is the correct version if
25:21there are two Rescuers then the ratio
25:23should be 15 is to2 please remember this
25:27that is right so it's a wrong one and
25:29cannot be the answer for the question
25:31right so single rescuer it is 302 two
25:34Rescuers it is 15 is2 right adenosin is
25:38via intra oous is preferred over other
25:40method first of all adenosin is not even
25:42used in the management of pediatric CPR
25:45adenosin is for paroxysmal
25:47supraventricular takic cardia in the
25:49intravenous route we all know about it
25:51so anyway that is wrong and cannot be
25:53the answer for the question look at the
25:55third option while test compression
25:57depth be at least 1/3 of the AP diameter
26:01of the child's chest this is a correct
26:04statement and that would be the answer
26:05for this question we always say the
26:07depth of compression should be at least
26:091/3 of the diameter of the chest in
26:11terms of AP diameter that is what so
26:13that's a correct statement only
26:15adrenaline is given in the dose of 0.01
26:19mgram per kg IV or IO in 1,000
26:23concentration up to this part everything
26:25is okay adrenaline is given 0. 0 1 mg
26:28per kg IV or IO that is all okay but it
26:31is not one in 1,000 concentration how
26:35much it is one in 10,000 concentration
26:38always always we have to dilute the
26:40adrenaline to this concentration and
26:42then only you have to use it during this
26:44hesitation so that is what is wrong and
26:46cannot be the answer for the question so
26:48the very clear answer for this question
26:49is option C only now let me take you
26:53quickly through some important points
26:55regarding uh this pediatric CPR with
26:57relevant to the the options given in the
26:59question first is about chest
27:00compression what is the usual rate of
27:02chest compression we' maintain it is
27:03approximately 100 to 120 per minute
27:07that's what you need to know about okay
27:09next is the depth of compression I told
27:11you it is at least 1/3 of the AP
27:14diameter of the chest please remember
27:16this is approximately 4 cm in an infant
27:20and after infancy it is 5 cm in
27:24children approximate depth of
27:26compression okay right then third one
27:30after you do one chest compression you
27:32should allow some time for the chest to
27:33fully recoil because full recoil of the
27:36chest only facilitates the Venus return
27:38to the heart for the next compression so
27:41please remember this okay right you
27:42should always allow full recoil after
27:46each chest compression okay right next
27:49is about adrenaline pediatric
27:50resistration we all know that it's one
27:52of the life-saving medications so you
27:53have to know all details about
27:55adrenaline which was also asked in this
27:56exam number one is a dose as I already
27:59told you is
28:010.01 mgram per kilog or you can also
28:05remember in terms of ml per kg
28:080.1 ml per kg but always remember it is
28:12one in 10,000 dilution please make a
28:16note of this and every dose maximum dose
28:19of adrenalin is 1 mgram don't forget
28:22this maximum dose of adrenaline is 1
28:25mgram and strength I I've already told
28:27you it is 1 in 10,000 will be the
28:29strength and you can give it by either
28:32root IV is a preferred one or intra oous
28:35root okay IV or
28:37IO however you can give it through endot
28:40tral tube that is ET root if there is no
28:44IV or IV access which could be obtained
28:46that is a alternative route but least
28:49preferred in fact why because eratic
28:51absorption of the adrenaline occurs
28:53through endoral route so we don't
28:55usually prefer but as a last chance as a
28:58last result we can give that root if no
29:00IV or IV access is available okay right
29:05and also you can repeat the do Adine
29:06every 3 to 5 minutes as needed okay
29:09suppose the heart rate is not increasing
29:11then you can repeat every 3 to 5 minutes
29:13so these are the must know points about
29:15adrenaline in pediatric resistration so
29:17with that the question answer is
29:19completed there in option C just
29:22compression definitely should be at
29:23least 1/3 of the AP diameter of the
29:25chest so with that we have come to the
29:27discussion
29:28of conclusion of the discussion of inct
29:31questions in November 2024 session in
29:33the subject of pediatric I hope this
29:35discussion was useful if you have any
29:37comments uh or any modifications in the
29:39question or any clarifications to be
29:42addressed please put it up in the
29:43comment section below thank you and all
29:45the best

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