Pediatrics OSCE Observed Stations, Mock Exam, Oct 2013

1. Observed Stations

2. Station A
 Demonstrate putting INTRA OSSEOUS access with
materials provided. 10
 Dr. Rushikesh/ Dr . Niraj

3. Answer
 Informed consent of the parent if appropriate 0.5
 Looks for obvious contraindications like open fracture or skin infection
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at proposed insertion site 1
Palpates tibial tubercle 0.5
Aseptic precautions (hand wash cap mask gown, spirit betadine at the
site) 1
Gives local anesthesia 1
Opens IO needle puts index finger 1cm from tip of the needle 0.5
Inserts needle perpendicular to tibia advances till reach periosteum
Advances furthur with screwing movts till ‘GIVE’is felt 3
Watch the backflow, attach iv tubing secures with gauze and tape 1
BMW 1
Inform parents 0.5

4. Station B
HISTORY TAKING
 7yr old girl with early precocious puberty
development, take the relevant history to reach the
cause 10
 Dr Meghna/ Dr.Nivedita

5. Answer
 Introduces and rapport building 0.5
 Age of onset<4yr(organic cause),>6yr idiopathic CPP 1
 Differentiates betn puberty and pubertal variants like thelarchy
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pubarche menarche 1
Progression of puberty slow (idiopathic) fast (androgen producing
tumor,cns tumor,ovarian cyst) 1
h/o accelerated linear and physical growth1
h/o sympt suggestive of hypothyroidism0.5
h/o irregular vaginal bleed-ovarian tumor,hypothalmic hamartoma1
h/o past cns inf –headache,visual disturbance,behavior change seizure
dev delay2
Drug exposure-androgens,estrogen1
Family h/o precocious puberty ambiguus genitalia s/o CAH1/2
Thanks1/2

6. Station C
Counseling
 6year old boy presented to you with HYPERACTIVE
behavior. Counsel him/parent regarding management
and prognosis
 10 marks
 Dr.Ajit/ Dr. Parimal

7.  Introduces and rapport,ask language for communication 1
 Tells that this is commonest neurobehavioral problem most
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prevalent chronic health condition in school age children 1
Set the goals-education regarding learning,self esteem,social
skills, family function,dev study skills. decr disruptive behavior2
Tells domains of treatments psycho social treatment, behavioral
treatment and medications awares abt support gr 1
Urges parent and child both to follow the sessions with child
psychologist and be compliant with intervations taught and
medicines(METHYLPHENIDATE,ATMOXETIN) 1
Early t/t better outcome 1/2
60-80%hyperactives continue to exp sympt in adolescence 1
Hyperactivity reduces with age but impulsivity,inattention
disorganization becomes prominent1
If untreated these children can have risk taking
behaviors,delinquacy,sub abuse 1
Asks for question 1/2

8. Station D
Clinical examination
 Do the relevant clinical examination of a child who has
presented with hematuria
 Surface marking of rt kidney, tell the points to the
examiner 10
 Dr Neha/Dr .Preeta

9. Answer
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Asks for permission for examination 1/2
Gen exam-looks for pallor, rash joint pains,pitting oedema1/2
Looks for skin(petechiae,purpura) and mucosal bleeds2
BP 1
Looks for dysmorphism/facies,spinal abn 1
Syst exam per abd looks for suprapubic fullness,renal angle
tenderness,kidney ballotability,renal bruit2
SURF MARKING FROM BACK 3
Morris parallelogram
2 vertical lines first 2.5 cm,9.5cm from midline1
Two horizontal lines upper at T11 and lower at L3
Draw bean shape kidney with hilum opp tip of spinous process
of L1 on rt side2

10. Station E
 SHOW THE SIX STEPS OF HAND WASHING
8
 Dr.Preeti Lad

11. ANSWER
 Folding sleeves removing rings 1
 STEP1- wet hands and apply soap.rub palms together
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until soap is bubbly 1
STEP2-rub each palm over back of other hand 1
STEP3- rub betn yr fingers on each hand 1
STEP4- rub your hands with fingers together 1
STEP5-rub around each of your thumbs 1
STEP6-rub in circles on yr pal,rub wrist and elbows 1
At the end proper drying of hands 1

12. Station F
 During your night duty in postnatal ward, sister asked
to review baby, you found that baby is cyanosed ,not
breathing, HR 6in 6 sec. How will manage. You are
allowed to ask question.
 Total mark 12
 Dr.Sagar lad/Dr.Ashwin/Dr.Sandeep

13. Answer
 Initial steps of resuscitation
 Proper positioning of head
 MR SOPA
 Assessment of HR after 1 min
 Cardiac massage
 Drugs
 Counselling of parent
 Probable cause.

14. Station G
PALS OSCE
 A two year old child is brought to ER unresponsive,
gasping heart rate of 34 / min. How will you manage
and you are allowed to ask question
 Dr. Ashish dhongade/ Dr. Mayuri Dhongade/

15. Answer
 Categorise the physiologic status of the child.
 Initial steps give asses rhythm,Asystole/PEA
 C-A-B ET tube size ,legth to fix.
 Chest compressions- Position,depth,ratio with ventilation
 1. Number of times 2. Frequency of interruption
 ET sizt tube,depth of insertion..
 Administering epinephrine.
 1.Duration 2. Route.
PALS cardiac arrest algorythm

16. THANK YOU!!!
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