Pediatrics mock OSCE Oct 2013
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Pediatrics mock OSCE Oct 2013

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Pediatrics OSCE - Mock exam, Pune, Oct 2012, Dr.Ashwin Borade.

Pediatrics OSCE - Mock exam, Pune, Oct 2012, Dr.Ashwin Borade.

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Pediatrics mock OSCE Oct 2013 Pediatrics mock OSCE Oct 2013 Presentation Transcript

  • Dr. Ashwin Borade 27TH Oct 2013
  • This is a PBS and photograph of a 10 year old boy who has presented with fatigue, fever, and malaise of > 1week in duration. On examination, he has generalized lymphadenopathy, splenomegaly and hepatomegaly. (1X5=5) 1) describe the main features in each picture 2) what is the diagnosis 3) Write 3 complications that may occur 4) What medication is contraindicated 5) what is the treatment
  • • Answer (1X5=5) • Picture 1 shows tonsillitis with membrane formation, picture 2 shows atypical mononuclear cells which are enlarged with irregular nuclei and basophilic pleomorphic cytoplasm • Infectious mononucleosis • Splenic hemorrhage/ splenic rupture/ airway obstruction causing drooling/ stridor and respiratory distress/ thrombocytopenia/ Coombs positive hemolytic anemia/ GBS/ Reyes syndrome • Ampicillin and amoxycillin • Rest and symptomatic treatment / avoidance of contact sports or strenuous athletic activities during the first 2-3 weeks of illness or while splenomegaly is present.
  • • A • • • • Name the Method used in slide 1/2 Enumerate the steps 1 Name two organisms which can be stained by this method 1 • B • Identify the PS 1/2 • Name 4 conditions in which it can be seen 2
  • • A • Zheil Neelson technique(1/2) • Steps: 1 Heat and dry, fix the smear Add carbol fuschin Heat for approx 5 minutes, do not boil Decolorize with 20% sulfuric acid Decolorize with ethanol Wash with water Counter stain with Methylene blue • Myco tuberculosis , M. Leprae, Nocardia
  • B • Eosinophilia • Allergic disorders/ Tissue invasive helminth infections/ Malignant disorders/ Rheumatological diseases/ Hyper – IgE syndrome
  • This is a picture of a 5 year old boy with a characteristic rash which was preceded by a prodromal phase consisting of low grade fever, headache and mild URTI. Describe the 2 pictures? 2 What is the diagnosis? 1 And the cause?1 Mention two immune mediated post infectious phenomena of the above organism 2
  • Answer • Erythema infectiosum/ Parvovirus B19 (1+1) • Picture-1- slapped cheek appearance (1) • Picture-2- lacy reticulated rash on the arm(1) • Rash and arthropathy are immune mediated, post infectious phenomenon(1+1)
  • VIDEO
  • Station • Identify the sign 1/2 • What is it used to detect? 1/2 • Name three conditions it can be associated with 2
  • answer • Trousseau’s sign 1 • Latent tetany 1 • Hypocalcemia/ hypomagnesemia/ metabolic alkalosis 3
  • Disorder DIC Hemophilia A Von Willebrand ITP Chronic liver disease Platelets PT APTT TT FDP
  • Disorder Platelets PT TT FDP Inc DIC APTT Inc Inc Dec Hemophilia A Inc N N inc N N N inc N N Von Willebrand N ITP Dec N N N N Chronic liver disease Dec/N Inc Inc N N
  • Identify inheritance A & B Give example of each and peculiarity of each • A • A
  • A • DIGENIC INHERITANCE. • Digenic inheritance explains the occurrence of retinitis pigmentosa (RP) in children of parents who each carry a different RP-associated gene. Both parents have normal vision, as would be expected, but the offspring who were double heterozygotes developed RP. • Digenic pedigrees exhibit characteristics of both autosomal dominant (vertical transmission) and autosomal recessive inheritance (1 in 4 recurrence risk). A couple in which the two partners are carriers for two different genes may have affected children. Any child, however, might transmit both mutations to an offspring, as in dominant inheritance.
  • B • Pseudodominant inheritance refers to the observation of apparent dominant (parent to child) transmission of a known autosomal recessive disorder • This occurs when a homozygous affected individual has a partner who is a heterozygous carrier, and it is most likely to occur for relatively common traits, such as sickle cell anemia or congenital deafness due to connexin26 gene mutation.
  • Milestone Follows moving object 180 Sustain social contact, listen to music Polysyllable vowel sound Creep or crawl Plays simple ball game Hope of feet Name 4 colors Make tower of 4 cubes Dress and undress Put 3 words together Age of attaining ( in months)
  • Milestone Age of attaining ( in months) Follows moving object 180 2 Sustain social contact, listen to music 3 Polysyllable vowel sound 7 Creep or crowl 10 Plays simple ball game 12 Hope of feet 48 Name 4 colours 60 Make tower of 4 cubes 18 Dress and undress 60 Put 3 words together 24
  • Write formula for • PA O 2 • VA • Ventilation index • OI • A-aO2 gradient
  • • • • • • PAO2=PI02- (PaCo2 /R) VA= (VT-VD) X RR Ventilation index= PIP X VR/1000XPaCO2 OI={(MAP X FIO2)/PaO2 } X100 A-aO2 gradient= PAO2-PaO2
  • • .A 12 yrs old female brought in general OPD with c/o fever, malaise, weight loss and recurrent headache since 3 months . On examination she had asymmetrical blood pressure and claudication • What is the diagnosis? • What are diagnostic criteria? • What are types of same? • What is drug of choice for new case, relapse case and refractory case
  • answer • • • • takayasu arteritis New case- steroid Relapse- methotrexate Refractory- cyclophosphamide
  • • What is the clinical condition called? • Which is the commonest malignancy associated with this? • Which chromosome is implicated in malignancy mentioned in question 2? • What other malignant disorders are associated with the malignancy being discussed?
  • answer • Leucocoria • Retinoblastoma • Rb1 gene Ch 13q 14 • Osteosarcoma Soft tissue sarcomas Malignant melanoma
  • • . A. What is PICOT study used for? • What it an acronym for …. • B Weight of 12 children of 2 yrs is as below • 10, 8, 9, 10, 12, 15, 10, 6, 9, 7, 11,8 • Calculate mean, mode, median
  • A. • PICOT is a technique medical researchers use to develop a clinical research question. • It may form part of a formal funding or research proposal, or medical staff may use it to carry out a small-scale experiment. • PICOT is an acronym for the five different areas the technique considers -- patient population, intervention or issue, comparison with another intervention or issue, outcome and time frame.
  • B. • Mean= 9.5 • Median= 8.5 • Mode= 10
  • • A patient is admitted to the ICU with the following lab values: • BLOOD GASES under room air • pH: 7.199 PCO2: 32.2 HCO3: 12 PO2: 86.6 • ELECTROLYTES, BUN & CREATININE • Na: 136 K: 4 Cl: 103 1 – Describe the metabolic condition (1) 2 – What is the expected compensation? (1) 3 – Calculate anion gap. What is the normal value? (2) 4 – Name two conditions with similar anion gap as above (1)
  • answer • 1- Metabolic acidosis with partial compensation • 2 - 1 bicarb fall decreases Co2 1-1.5 • 3 – Anion gap - [Na] – [Cl] – [HCO3] = 25 • 4 – Septic shock, Inborn error ( lactic acidosis), DKA etc
  • • 2yrs old child with seizure, behavioral problems, skin abnormalities, MRI done • What is diagnosis? • What are criteria? • What is inheritance? • What are chart eristic CNS presentation • How u follow up these cases?
  • answer • • • • • • • Tuberous sclerosis complex Major / minor criteria AD Epilepsy/ cognitive impairment F/u examination mRi 1-3 yrs USG/CT/MRI renal 1-3 yrs Neurodevelopment assessment
  •  An eight year old child presented with malaise, anorexia, vomiting, muscle weakness and orthostatic hypotension. He had H/o a febrile illness with purpuric rash a few days before.  What is the significant finding in the picture?  What is the cause of this finding?  What is the possible infection preceding it and what is it called  What are the possible electrolyte abnormalities ?  What is the definitive test for diagnosis of this condition.
  • Answer • Hyperpigmentation of the gingival and buccal mucosa. • Cortisol deficiency leading to increased ACTH production and Melanocyte stimulating hormone arising from the ACTH precursor POMC. • Meningococcemia – Waterhouse-Friderichsen syndrome • Hypoglycemia, ketosis, hyponatremia • ACTH Stimulation test
  • • • • • • A. What is diagnosis?1/2 What are predisposing factors for it? 1 What is t/t? 1/2 What are other manifestations? 1/2 • • • • B .Clarithromycin What group it belongs 1/2 What mechanism of action? 1 What organisms it act against 1
  • • • • • A. Guttate psoriasis Streptococcal infection, post viral, post steriod Topical steriod/PT Arthritis • B. Macrolide antibotic • By interfering with their protein synthesis. • Atypical pneumonias associated with Chlamydophila pneumoniae, skin and skin structure infections. In addition, it is sometimes used to treat legionellosis, Helicobacter pylori, and lyme disease.
  • • 1) Identify the condition in the CXR of an ELBW newborn • 2) Give the definition of this condition • 3) Mention the stages of this condition in a 34 wk old • 4) What are the pharmacological strategies in the management of this condition • 5) Expand INSURE
  • answer 1)Bronchopulmonary dysplasia (BPD) 2) Current definitions include 1. total duration of oxygen supplementation requirement for >28 days, 2. degree of prematurity (<32 weeks gestational age at birth), AND 3. Oxygen dependency at 36 weeks Postmenstrual Age.
  • answer 3) Stages: • Mild: Breathing room air at 56 days postnatal age or discharge* • Moderate: Need for <30% oxygen at 56 days postnatal age or discharge* • Severe: Need for > 30% oxygen and/or positive pressure (IMV/CPAP) at 56 days postnatal age or discharge* (* whichever comes first)
  • answer 4) Pharmacological strategies • -Vitamin A • -Postnatal steroids • -Superoxide dismutase • -Furosemide 5) INtubateSURfactantExtubate
  • 1) What is the radiological investigation 2) What sign is demonstrated? 3) What is the diagnosis? 4) What is the commonest age group in which the following condition occurs? 5) What are the other conditions associated with this abnormality?
  • answer • • • • • Upper GI barium meal study Corkscrew duodenum Malrotation with a midgut volvulus Usually newborns and young infants Duodenal atresia, duodenal stenosis, annular pancreas
  • • What are 4 categories of vaccines and explain them? • Fill the category below? VACCINE BCG CHICKEN POX MMR DTwP TYPHOID DTaP PPV23 RABIES
  • • Categories: Category 1: Vaccine covered under Expanded Program on Immunization (EPI) • Category 2: Vaccine recommended by IAP in addition to EPI • Category 3: Vaccine which are to be given after one to one discussion with parents. • Category 4: Vaccine to be given under special circumstances.
  • VACCINE CATEGORY BCG Category 1 CHICKEN POX Category 3 MMR Category 2 DTwP Category 1 TYPHOID Category 2 DTaP Category 3 PPV23 Category 4 RABIES Category 4
  • TESTS HBsAg anti-HBc anti-HBs HBsAg anti-HBc anti-HBs HBsAg anti-HBc anti-HBs HBsAg anti-HBc IgM anti- HBc anti-HBs HBsAg anti-HBc IgM anti- HBc anti-HBs RESULTS Negative Negative Negative Negative Negative Positive with >10mIU/mL Negative Positive Positive Positive Positive Positive Negative Positive Positive Negative Negative INTERPRETATION
  • TESTS HBsAg anti-HBc anti-HBs HBsAg anti-HBc anti-HBs HBsAg anti-HBc anti-HBs HBsAg anti-HBc IgM anti- HBc anti-HBs HBsAg anti-HBc IgM anti- HBc anti-HBs RESULTS Negative Negative Negative Negative Negative Positive with >10mIU/mL Negative Positive Positive Positive Positive Positive Negative Positive Positive Negative Negative INTERPRETATION Susceptible Immune due to vaccination Immune due to natural infection Acutely infected Chronically infected
  • • A .This is lead II ECG of neonate who presented with excessive crying. Systolic NIBP is 80 mm HG • 1) What is the ECG diagnosis? • 2) DC shock is available. Is DC shock treatment of choice Y/N? • 3) If any treatment necessary, if yes mention?
  • • B. Identify the ECG. What is the name of this condition? • Mention 4 causes for this.
  • A • SVT • No • Vagal maneuvers , Ice filled packs on face, Carotid massage Adenosine with dose and method of administration Digoxin Propanolol
  • B • • • • • • • 2nd degree AV block. Mobitz Type 1 Myocarditis Cardiomyopathy Myocardial infarction Congenital heart disease Digitalis toxicity Cardiac surgery
  • Match the following 1. Verapamil 2. Methemoglobinemia 3. TCA 4. Sulfonylureas 5. Propranalol 6. Anticholinergics 7. INH 8. Ethylene glycol 9. Diazepam 10. Morphine A. B. C. D. E. F. G. H. I. J. Fomepizole Octreotide Pyridoxine Methylene blue Insulin Sodium bicarbonate Glucagon Physostigmine Naloxone Flumazenil
  • • • • • • • • • • • 1-E 2-D 3-F 4-B 5-G 6-H 7-C 8-A 9-J 10-I
  • • A premature baby was ventilated and on 2nd day had convulsions. His investigation done which is shown here 11/3/2013 CME,Indore 55
  • • • • • • Identify and describe the investigation Spot the diagnosis with grade What are preventive measures? What is the commonest neurological sequel? What is the commonest Opthalmological sequel? 11/3/2013 CME,Indore 56
  • Answers • Cranial USG showing cystic PVL • Grade 2 PVL • Early interventions , maintain normal cerebral perfusion • Spastic diparesis • Strabismus, nystagmus, ROP 11/3/2013 CME,Indore 57
  • Write cardiac disorder for following syndrome (1/4 X 10=2 1/2) syndrome Apert Crouzon De lange Noonan william Down Digeorge Cong.Rubella Maternal PKA Carpenter Cardiac disoder
  • Answer syndrome Cardiac disoder Apert VSD Crouzon PDA/COA De lange VSD Noonan PS/ASD william AS Down ECD Digeorge Aortic arch anomalies Cong.Rubella PDA Maternal PKA VSD/ASD Carpenter PDA
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