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Final Year Viva Questions - Pediatrics Professional Exam 2012

Final Year Viva Questions - Pediatrics Professional Exam

Compiled by Class of 2012





Marks Distribution
10 internal assessment
20 Osce
20+20 two short cases
30 long case

Questions by Class of 2013

OSCE
Day1
1)X-ray Pleural effusion.
Qs: 3 radiographic findings, diagnosis, treatment

2)Scenario from Pneumonia's IMCI table.
Qs: Diagnosis, most likely organism, treatment

3)Dengue fever scenario: 7 yr old girl with fever, petechial rash. Her labs showed thrombocytopenia and lymphocytosis. Hct was 40%.
Qs: Diagnosis, most useful investigation, treatment.

4) Neonatal rescusitation (Scenario: newborn with respiratory rate of 35/min, heart rate of 110/min and peripheral cyanosis.)

Day2
1. cardiomegaly x-ray
ques: radiological findings, 3 causes of this..

2. ITP scenario
diagnosis, confirmatory test, management
3. some dehydration scenario
diagnosis+ management
4. neonatal resuscitation
 

Day3
1.Xray wrist
Finding? (fraying, cupping, widening of epiphyseal ends)

Diagnosis? (Rickets)
Rx?

2.A photo was given
What's the lesion? Vesiculo-papular rash on anterior surface of abdomen)
Diagnosis? (Chicken pox)
Complications?

3.Scenario of cough with inability to take feed or drink.classification acc to IMNCI? (Severe pneumonia)
Rx?

4.On resuscitation table in unit 1, don't say we'll stimulate breathing by tapping the sole or rubbing the back.Baba adam ke zmany ke baten hain ye Sir says.When you clean n dry the baby, this very process stimulates breathing.And if scenario is a baby with apnea n blue color, begin by saying I'll call for help.Ye bolne ka bhi marks hain.
 

Day4
1. Consolidation X-Ray (D/D and Rx)
2. Nephrotic Syndrome (Labs and Rx)

3. Streptococcal Sore Throat (IMNCI classification and IMNCI Rx)
4. Neonatal Resuscitation (HR 100, RR 35, Cyanosed)

Day5
1.Consolidation & Tracheal Deviation Xray,
2.ORS types n uses (composition of both types was given),
3.IMNCI scenario: Some Dehydration (Persistent Diarrohea).

4.Resuscitation

Short Cases

Dnt forget to tell.patient's name, age n gender while describing. Sir Akmal asked for it in gpe n I think same goes for other commands as well...u can get it confirmed
.. Like my patient ___ age ___male/fmle sitting/lying in bed/ mother's lap comfortably etc n then continue with your examination findings...


short case with external of unit 1: command: examine facial nerve
viva: ur finding? what kind of lesion is this? what do u mean by supranuclear lesion?then what is infranuclear lesion? y they present so? how did u check them? what r the causes? where is its nucleus? investigations? what happens in bell's palsy...

short case with prof akmal laiq: command: examine motor system
viva: ur findings? what do u think then what is this?
causes of LMN lesion? what is the cause in this patient? y planter reflex is upgoing in this child if LMN lesion? normally present in children below 2 years... can hemiplegia occur in polio? investigations? which one investigation u can do in children bt not in adults n y???


short case1: hydrocephalus
( positive findings puchte hain methods nhe dekhte command was "examine the head n face n do the relevant" jis mein
motor sys krna tha with clonus, treatment?? shunt dala hua hai? yess it was already there will feel like something prominent behind the ear nt on the head)

Short Case 2:Fallot's tetrology "do GPE n relevant" (findings: clubbing grade? appearance n relevant ascultate chest murmur? (there's sys murmur due to pul stenosis) n then is mein vsd ka murmur kyun nhe hota)


Short Case 1:Down syndrome gpe..baby had no simion crease n creases appeared normal to me but facies were diagnostic....expects u to confirm findings of it on gpe...like heart ascultaion for congenital defects low set ear etc Related questions like how to confirm? Antenatal diagnosis?Councelling of parents for future etc delayed milestones or not et

Short case in unit 2 (ashraf sultan) hapatospleenomegaly n rickets? ask only about the positive findings. no other questions. methods koi nhe dekh rha if u had ur short cases in unit 2 to they ll tell u beforehand .

1st short case rheumatic fever pansystolic murmur, displaced apex beat, parasternal heave, and no one sees methods, external was on this case and he almost asks each and everything from cvs, all murmurs, causes of every abnormality, clinical difference b/w pansystolic murmur and ejection systolic murmur.

2nd short case was hypotonia, paralysis and absent reflexes on right side of body, sir akmal asks to do one or more methods like reflex or power etc , then asks diagnosis, then polio confirmation and he tells himself if u say something wrong.


Short Case: (Unit 2)
(The command in both cases was to do the relevant GPE in 5 minutes)

1) Rickets (5 month old boy. Positive findings were widened wrists and macrocephaly) Qs (external): Most likely diagnosis. Other possible findings with this Dx. What is Harrison's sulcus? Most likely cause of rickets in a patient of this age. Treatment options.

2)Tetrology of Fallot (7yr old girl with central cyanosis, bilateral clubbing and a murmur, which was probably systolic) Qs (Dr. Sultan): Positive findings. Likely diagnosis. Other cyanotic congenital heart diseases. Why would TGA be an unlikely Dx in this age-group? (TGA patients don't survive this long) Complications of pertussis.

1.Command :examine motor system of lower limb

1.5 year old boy with left sided hemiplegia, upgoing planter,absent tendon reflexes.
Question was narrate your findings,causes of hemiplegia (SOL, cerebral edema, intracerebral hemorrhage, meningitis...)
Name some brain tumors (astrocytoma, olignodendroma....)

2.command: examine abdomenPositive finding :Liver+spleen enlarged +pallor
Questions:D/D?(Leukemia,Hemolytic anemia,Thalasemia)
Investigation?
(CBC,Combs test,Retic count,Iron profile,Hb electrophoresis...
)

Short case 1 extrnl:hemiplegia,sir said examine motor system of lower limb,how wil u check bulk n'nutrition..causes of lower motor neuron lesion.how wil u investigate GBS.

Short Case 2 Sir akmal..GPE of patient n'child had involantry movements..sir.types of involant
ry movements..uni main sy 1 ko pakr lia n'said define chorea n'its causes,whthr its upper motr neuron or lower motr type.how wil u investigate rheumatic fever


Short Case 1
 Examine the precordium (VSD)
Dr. Ashraf Sultan - Positive findings, Diagnosis, Why it is not TOF? (no cyanosis, no clubbing), Signs of Heart Failure in Children.

Short Case 2. Examine motor system of all the four limbs (Monoplegia/Hemiplegia???)

Dr. Aisha - Positive Findings, Level of lesion in Brain in Monoplegia and Hemiplegia, Most Common Cause of Hemiplegia in Children.


Short case 1 Sir akmal : it was swelling on rt. Side of neck.. matted lymph nodes. .also check facial nerve . n then draining areas of lymph nodes..+ hepatospleenomegaly + other axillary n inguinal nodes.. questions on causes of cervical lymphadenopathy.. he was interested in infective ones..

Short case 2: chorea.. command was gpe.. difference from tremor.. chorea causes.. precordium must b examined for rheumatic fever..n viva on Wilson's disease..


Short Case 1: Rickets (Unit 1 External)... Do GPE... findings, investigations, xray findings n treatment of rickets.. head circumference n length of baby at birth n at 1 yr age......

Short Case 2: Nephrotic Syndrome (Prof Laeeq).. do GPE... Asked for positive findings... Periorbital n scrotal edema, baby had hirsutism as well on the face, caused by steroid therapy..


Short Case 1(external): enlarged Neck lymph nodes...examine neck...findings, D/D, diff b/w Hodgkin & TB, investigation of TB...

Short Case 2(Prof Akmal Laeeq): Nephrotic Syndrome...do GPE...positive findings,D/D,investigation


Long Cases

Every 2nd Long case z pneumonia positive findings? crepts?D/D, treat? clubbing hoti hai? causative org in this child (3m old) long case araam se prepare hojata hai wahan


long case unit 1 VSD : external: he is good asked about vsd , why pt has resp infections? epi schedule? why we give polio so frequent? manag of vsd? ecg changes in vsd? clinical difference b/w asd n vsd? murmurs in vsd n asd?

long case nephrotic... presentinh complaints, age, relevant history...weight...do u think its normal for age? examination positive findings, relapser, frequeny relapser, management in this patient, when to start cyclophosphamide( wen steroids toxicity develops I thnk) y bp is imp...( in addition to nephritis picture, also for steroids toxicity)... adverse effects of cyclophosphamide, prognosis, 5-10 yr duration in case of mcd...the only thing in that patient that could effect prognosis was his steroid depency... steroid dependent? etc

Long case recurrent diarrhea in 3.5 years old boy with weight of 22 kg. sir listened to history and asks positive finding in examination. he asked why weight of boy is more although he has recurrent diarrhea.

long case EPILEPSY d/ds? types? what is more common cause of fits in children? what do u mean by metabolic seizures? what is the most imp cause of matabolic fits in a child?investigations? treatment of partial seizure?

Long case (Unit 1) 4 month old girl with Pneumonia. Qs (external): Asked for case summary. Age when weaning should be started, and the foods used for it. Developmental milestones in this age group. Differential diagnosis for my case. Causative organisms of bronchiolitis and its treatment. (Supportive, except for RSV-caused bronciolitis when we use ribavarin) Specific indication for using ribavarin in bronchiolitis.

Long case : pneumonia
. . Difference from bronchiolitis ..vaccines given for prevention of pneumonia.. rest was general.


Long case unit 1 ,, akmal laeeq asks of pneumonia,, causes of cyanosis in the child,, vaccines to prevent pneumonia,, imnci k according case ko classify kro and treatment btao,, which is the drug of choice,, what is cause of death in pertussis,, cause of death in diphtheria,, when vaccines of measles are given,, positive findings on examination,, 2 most important signs on chest examination


                                                     ____The End_____
OSCE
(1). Resuscitate: 
 1. baby who is apnoeic,cyanosed,limp with a heart rate of 50/min
 2. apneic child at birth heart rate greater than 110, blue colour
3. resusitation table with dummy hving scenerio of periphrl cyanosis hr 110,resp rate 40.
4.Apneic and Cyanosed baby with 50/min heart rate.

(2). Pictures:   

1. Down's syndrome, Diagnosis,cytogenetics,antenatal diagnosis
2.  Meningomyelocoele complcations.
3. Chickenpox, types of rash, diagnosis, complications
4. measles pt diagnosis,type of lesion,complications.
5.marasmus..signs
6.meningoencephalocele..its complicwtions

(3). X-rayLabs:  
 1. Rickets radiological findings,diagnosis,treatment
2. Pneumonia , treatment n organisms
3. Pleural Effusion immediate management
4. Pneumothorax causes

(4). Instruments:  
1. ETT uses
2.Metered dose inhaler...drug used n one indication 4 it's use 
 (5). Lab Reports:   
 1. Microcytic hypochromic anemia, Diagnosis,causes,treatment
 2. Coagulation Profile
     APTT=N,PT=N,BT=Prolonged A (itp thrombocytopenia)
     APTT=prolonged BT=prolonged PT=N (von willebrand disease)
     another one C(hemophila)                                  
3. TB meningitis. Diagnosis and treatment plan
4. scenerio of respiratory acidosis...ph 7.1,pco2 60,hco3 28
5.hemophilia n pattern of inheritance
6.glomeruloneophritis...diagnosis n investigations
7.viral encephalitis scenario...list managemnts
8.nephrotic syndrome..tests ..treatment..management

(6). ORS hypo n hyper, whch one is better.Identify hypo osmolar and standard Ors(composition was given) which 1 is better and y?hypo osmolar is 1 havng osmolality 245..ths is beter than standard bcz (1)it is more absorbed n excretd les (2)it doesn't cause hypernatremia.

NEONATAL EXAMINATION...... take consent from mother, ask permission to wash ur hands or tell tht u have already washed em, take length of baby, weigh the baby, take head circumference, take brachial pulse, check respiratory rate and meanwhile put thermometer in his axilla for temp recording. now start from hands and look for single palmar crease and finger deformities of down or any other deformity, any canula passd, BCG scar, now move to head, palpate frontal fontanelle, occipital fontanelle, flattening of head, microcephaly etc.... now come to eyes and just see any gonococcal discharge or cataract (rubella). then look for abnormalities of lip or nose. do rooting reflex, moroz reflex and sucking reflex. take torch and look for any cleft palate, macroglossia etc. look for any mass or swelling or deformity of neck. probably its time to remove the thermometer. Now move to chest and look for any deformity there. specially intercostal recessions and chest indrawings. come down to abdomen and here u look for jaundice and anemia. look at umblicus and check for infection, umbilical hernia... open the nappy of baby and look for ambiguous genitalia and imperforate anus. again palmar crease and foot abnormality.. TURN THE BABY TO LOOK FOR ANY SPINE ETC PROBLEM AT BACK.
differnce of composiotion b/w breast and human milk.
 Vivas by Prof akmal laeeq
2 yrs gal undiagnosed case.. admitted 7 days back, a long list of investigations but still not diagnosed...may b some bleeding or clotting disorder but wo jo book mey ni hain... so dr akmal laek tooook viva on whole of bleeding n clotting disorders..... didnt leave even a single line of topic. 
short cases by PROF ashraf sultan sb...
1.examin motor system of lower limb (of chorea pt)
2.mother milk nd cow milk differences
3.external short case,,,GPE nd hv to tell finding nd my cases was neck diffuse soft swelling,,,,may b cytic hygroma...wht specific feature of cytic hygroma he asked..
4.Prof Laiq likes to ask site for taking bone marrow aspirate in children.i.e at what level of spinal cord?(site is different for epidural anesthesia).Also remember when intrathecal chemotherapy is administered and why?(It's the BBB and the recurrence).From hematology try to remember the drug regimens(names only).They might ask you which one is worse in terms prognosis.ALL or AML.Hodgin or Non-Hodgkin and why?


The preferred site for obtaining bone marrow in children is the posterior superior iliac crest because it contains the most cellular marrow, there are no vital organs in close proximity and it is a nonweight-bearing structure (3). The anterior iliac crest is preferable in very obese patients. In children younger than 18 months of age, the anteromedial face of the tibia is preferred for marrow aspiration (3); however, this site may fail to yield adequate samples when the procedure is performed by an inexperienced technician; there is also a risk of fracturing the bone. At The Hospital for Sick Children (Toronto, Ontario), the posterior superior iliac crests for all children, including small infants, is preferred.Trephine biopsies are usually taken from the posterior superior iliac crest in children; however, a technique using the tibia has been described for small neonates (5). Bone marrow aspiration (BMA) and bone marrow trephine biopsy (BMTB) must be performed only by experienced health care providers who have been well-trained in the technique 
Hodgkin's has a better prognosis than non-hodgkins i believe.

(B). Short Cases

 (a). GPE:

1.Marasmus

2. Cervical lymphadenopathy! Axkd abh its causes, diff b/w hodgkin n non-hodgkin. Non tender causes of L.N enlargement...short case wid ashraf sultan: was of lymph node enlargemnt in submandibular region d/d

3. Measles..its..how will u reach diagnosis...findings other than fever, and rash.Complications of measles...
drug used in measles and why?types of salivary glands, parts of submandibular gland,ducts n drainage,name any disease of this gland....i said sialadenitis...he said this is a vague term name some specific....i said neoplasms ... he said naa n asked if there is mumps of this gland.....i said yes...he said its very rare.....then is there any relation between this gland disease and DM...tukkaa Yes....he said ur rite but how....i was like Hmmmmmm....he said lets leave it ....can u prevent mumps...i said yes MMR....he said do we give it ...i said yes....he said no....its in EPI but why dont we give it....i had no idea whatsoever ....he said ur Government doesnt provide us this....I smiled and looked around... External , PGs and attendants all were smiling...thats how my worst ever viva experience went in the form of a Round table conference...even the baby girl said to me k uncle buhat buray hain....

4. Hodgkin's lymphoma:looked at methods n positive findings, asked d/d, relevant investigations, types of lymphomas

5. Nephrotic Syndrome: positive findings.anaemia and facial puffiness.asked causes of generalize edema.asked about other relevant findings.if hb is low and edema is present how do you co relate that
 6. Thyroid askd luk 4 proptosis. featres of hyprthyr . cardiac fndngs, ecg changes, inv, autoantibd n etc. Hypothyroidism as well.


7.Post-measles pneumonia asked about signs of measles(findings in that child were of healed rash). drug used in measles and why?,TB in measles and Mantoux test in it..

11.Rickets.. Anterior bowing of legs...he asked about rickets, its pathophysiology, features and treatment, causes of rickets. name any cause of ricket having higher level of Vit D in blood? how will u confirm the diagnosis ? treatment

12. Down's syndrome

(b). CNS:

 1. Meneingomyelocoele and q related to the examination, its associated features, why could there be unilateral leg weakness, what is imp of head circumference measurement in it, drug to prevent it.
spinal cord bahar pari hay to nerves to affect hon gee na with focal neurological symptoms....head circumference to see co related absence of brain anomalies as well and drug to wohee hoo gee folic acid before and during pregnancy to avoid all these neural tube defects
                                                                                                   

2. Menengitis...I was asked to do signs of meningeal irritation and cranial nerves on him...Was asked to
test rt. superior oblique,TBM,its complications,findings in eye in TBM... signs of meningitis. Diagnosis if there is associated (tb menigitis).nd if associated otitis media..(pyogenic.).trigeminal nerve.examination...sensory supply of face , organisms causing otitis media, complications of pyogenic menigitis.

3. Examine Lower limbs, questions abt localization of lesion, xplain ur findings, causes.. wat is CVA, causes of CVA in child. causes of upper motor neuron lesionshort case by prof akmal:examine motor system of lower limb, (hypertonia), causes of UMN & LMN, features of GB syndrome & polio, types of polio viruses. short case wid external: right sided hemiplagia tha comand was to examine lower limbs: mam ney findings suni and un ke interpretation. wat is CVA, causes of CVA in child. causes of upper motor neuron lesion.
Case of muscular dystrophy
decreased tone.hypertrophy and abnormal gait...mam asks the mode of inheritence of ducheenes muscular atrophy..x linked recessive diagnosis by muscle biopsy treatment physiotherapy


4. Cerebral Palsy Causes of upper and lower motor neuron lesions
Short case. Cerebral Palsy. Prof Laeeq: Causes of upper and lower motor neuron lesions.

5. Polio. CSF findings in polio. GB syndrome. CSF change in it.

6.febrile fits:
aeds long case (dr akmal laeeq)6 month old baby wid febrile fitshe listened to history. wat r ypes of fits? causes of fits in this age? (meningitism hypoglycemia hyponatremia) acute managemnt of febrile fits (do tell dat if diazepam cant b given iV thn giv rectal diazepam)when discharging wat will you advise mother? if baby develops fever do cold sponging n giv paracetamol for fever and baby gets a fit give rectal diazepam if condition doesnt improve bring to hospital.

7. epilepsy....sir asked me about d/d, features of epilepsy, precipitating factors, management and types..

8. TB meningitis. D/D. Positive findings. Cause of squint in it. What is diagnosis if a rash is present with meningitis. What is diagnosis if fixed dilated pupil with meningitis. What will be LP picture of TB meningits. When do we use steroids? How to diagnose miliary TB? Complications of TB Meningitis.

(c). Respiratory:

1.  Crepts

2. Pneumonia....looked at my methods, asked abt conditions causing change in percussion note and clinical findings in pneumoniae..by prof Akmal laiq...ARI WHO criteria nd management..prevetion of pnemonia by which vaccine e.g HIB,BCG.,danger signs eg ,,,persistant vomiiting fits,not feeding,sleepinessor drowsiness..hv to tell in history.....

2. Pleural Effusiƶn. Axkd abt d/d, wot findings favour ur diagnosis, causes of short stature in 5 yr old child, causes ov 2ndry malnutritn

(c). Blood & CVS:

1. Examine Chest  explain ur findings, dif.diag, patient had pansystolic murmur , causes of MR, causes of pansystolic murmur.
. tricuspid regurgitation and its clinical manifestations.
. apex beat and its types.
. vsd
2. Thalassemia. askd abt d/d of hepatosplm. cnfrmat tsts of malaria , thalasemia , leukamias, relevant gpe. Hepatosplenomegaly.

3.Rheumatic heart disease and its murmur


(d). GIT :

1. spleen and liver enlargement.cause of enlargement of both. asked findings of thalessmia.investigations and stuff.
(C).  Long Cases

(a). Respiratory System:

01. bronciolitis vs pneumonis, criteria for hospital admission, treatment in bronchiolitis.
pulm tb. tok by xtrnal inv, trtm , att, doses,
02. pnemonia with rickets(6 month old child) had frontal bossing! dvlopmental milestones, fine motor
movts, organisms of pnemonia in ths age grup

03. Pleural effusion. History n examination. check for vocal resonance . investigations, diff b/w plural effusion of pneumonia and tb. how u will do pleural tap.

04.Bronchopnemoniae


(b). GIT  & Renal:

1. Ent fever, MOA of penicillin resistance

2. Hematuria, listend to hstory,askd the weight n height of the child,is it appropriate fr the age?imp of bp in ths ch ild? D/d? Investigations,acute n chronic cmplications of uti.

3. Malnutrition and suspected TB wat is continuous and remittent fever?expected weight, height, mid arm circumfernce.no.of calories and protein requirement, what is your d/d, what is the degree of malnutrition, what is your management plan

4. Acute watery diarrhea with PCM....what u need to know is 1 ounce =30 ml n 1ounce of cows milk contains 20 kcal.n for correcting the calorie deficit u shouuld first calculate the expactant weight for age. n for 1 KG requiremant is 100kcal. after calculating the calorie requirement, calculate the ounces of milk required to fulfill that n divide it 3 hrly interval....

5. Splenomegaly

(c). CNS: Cerebral palsy


(c). Blood:

1. aplastic anaemia. D/d. Investigations, definition.treatment.why packed cell volume given, instead of whole blood...coz ccf can occur...y x-ray done, coz treatment includes steroids, so we have to rule out tb

2. Hodgkin Lymphoma, history positive findings,prognosis of NHL vs HL,diagnosis and treatment,complications of blood transfusion,other pancytopenia,aplastic anemia treatment,LP therapeutic uses,ALL drugs used in chemo 

2 yrs gal undiagnosed case.. admitted 7 days back, a long list of investigations but still not diagnosed...may b some bleeding or clotting disorder but wo jo book mey ni hain... so dr akmal laek tooook viva on whole of bleeding n clotting disorders..... didnt leave even a single line of topic. 

(d). CVS

VSD

(e). Endo

Rickets,hypothyroidism , malnutrition
  • 2012 VIVAS:
unit 1 osce:1.breast milk composition(values) were given identify which one?which one is better?prove scientifically.
2.paracentesis :uses n causes of ascites
3.pneumonia scenerio pt with cough n tacypnea 18 months old child with RR 45:outline management n do IMNCI grade
4.resusitate child with apnea n heart rate 50
short cases:external mam wat is cause of tense ascites n hepatomegaly
prof Dr Ashraf listen simple def n causes asked def of perebral palsy n is patient unconcious in it
long viva external:Aplastic Anemia dd how to differ it from leukemia n itp n management of aplastic anemia.....

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