LAB & OTHER INV
OSCE IN PEDIATRICS
FOR DNB PEDIATRICS PRACTICAL EXAMINATION
dnbpaediatrics.blogspot.in
Lab – 1(Blood)
• Age – 4 yrs
• Hb – 7 g%
• RBCs – Polychromatophilic
reticulocytosis, many spherocytes,
central pallor les...
Lab – 2 (Blood)
• Age – 3yrs
• Hb – 6 gm%
• TLC – 1500/cmm
• Platelets – 20,000/cmm
• Bone marrow – Cellularity reduced
• ...
Lab – 3 (Urine)
• Age – 9yrs
• Appearance - Turbid
• Sp Gr – 1019
• Proteins – 4 +
• RBCs – 6 to 10 per HPF, occasional RB...
Lab – 4 (CSF)
• Age – 3 days term neonate
• CSF –
– Appearance – clear
– Proteins – 10 mg/dl
– Glucose – 45 mg/dl ( Blood ...
Lab - 5 Peritoneal fluid
• AGE 10 yrs
• Peritoneal fluid
– Protein 4.5g/dl
– LDH 750 IU (90u/L)
– WBC 7500/cmm
– GLUCOSE 5...
1. What is the diagnosis?
2. What is the mutation that results in this
disease?
3. What are the three main categories of c...
Questions
1. Describe the cells
seen.
2. Name one condition
each from following
category in which these
cells are seen
a. ...
• What is this modality of investigation?
• Name three common indications .dnbpaediatrics.blogspot.in
• What is this modality of investigation?
• Name one common indication . dnbpaediatrics.blogspot.in
• What is the diagnosis ?
• What are the cardiac conditions associated ?
• What are the endocrinal conditions associated
?...
Questions
1. What is the
diagnosis?
2. Give two sexual
characters in this
condition
3. Give one cardiac
condition that
may...
psvt
dnbpaediatrics.blogspot.in
Questions
• a. Diagnosis
• b. Commonest differential how do you
distinguish between two?
• c. Give 3 Steps of management
d...
ECG
dnbpaediatrics.blogspot.in
Questions
• Abnormalities
• Management
• Which drug eliminates the causative agent
dnbpaediatrics.blogspot.in
• What disease does this PBS picture
suggest ? dnbpaediatrics.blogspot.in
ANSWERS
dnbpaediatrics.blogspot.in
Lab – 1(Blood)
• Age – 4 yrs
• Hb – 7 g%
• RBCs – Polychromatophilic
reticulocytosis, many spherocytes,
central pallor les...
Answers: Lab – 1(Blood)
• Anemia
• Increased retic count – Hemolysis
• PBS – spherocytes, other series normal
• Bone marro...
Lab – 2 (Blood)
• Age – 3yrs
• Hb – 6 gm%
• TLC – 1500/cmm
• Platelets – 20,000/cmm
• Bone marrow – Cellularity reduced
• ...
Answers: Lab – 2 (Blood)
• All three cell lines are depressed
• Bone marrow depression
Diagnosis- Aplastic anemia
Causes
–...
Lab – 3 (Urine)
• Age – 9yrs
• Appearance - Turbid
• Sp Gr – 1019
• Proteins – 4 +
• RBCs – 6 to 10 per HPF, occasional RB...
Answers: Lab – 3 (Urine)
• Sp Gr – normal
• Nephrotic range proteinuria
• Microscopic hematuria with RBC casts –
glomerula...
Lab – 4 (CSF)
• Age – 3 days term neonate
• CSF –
– Appearance – clear
– Proteins – 10 mg/dl
– Glucose – 45 mg/dl ( Blood ...
Answers: Lab – 4 (CSF)
• Normal CSF in a neonate
WBC 11+/-10 (90th centile-22)
• polys 2.2+/-3.8 % (90th centile- 6)
• Pro...
Lab - 5 Peritoneal fluid
• AGE 10 yrs
• Peritoneal fluid
– Protein 4.5g/dl
– LDH 750 IU (90u/L)
– WBC 7500/cmm
– GLUCOSE 5...
Answer : Lab - 5 Peritoneal fluid
• Normal value
Transudate Exudate
Sp Gr <1.016 >1.106
Protein <3gm/dl >3gm/dl
WBCs <1000...
1. What is the diagnosis?
2. What is the mutation that results in this
disease?
3. What are the three main categories of c...
Answers
1. Sickle cell disease
2. On the beta chain, valine is substituted
for glutamic acid at position 6
3. Aplastic cri...
Questions
1. Describe the cells
seen.
2. Name one condition
each from following
category in which these
cells are seen
a. ...
Answers
1. Acanthocytosis
2. Conditions
a. Neurological Neuroacantocytosis
b. Metabolic Abetalipoproteinemia
c. Hepatic Se...
• What is this modality of investigation?
• Name three common indications .dnbpaediatrics.blogspot.in
Answer: Spots: 1
• Radionuclide bone scan
• Indication
–Metastasis
–Osteomyelitis
–Stress fracture
Total 2 marksdnbpaediat...
• What is this modality of investigation?
• Name one common indication . dnbpaediatrics.blogspot.in
Answer : Spots: 2
• Hepatobiliary scintigraphy
• Indication
–Biliary atresia
Total 2 marksdnbpaediatrics.blogspot.in
• What is the diagnosis ?
• What are the cardiac conditions associated ?
• What are the endocrinal conditions associated
?...
Turner’s Syndrome
1.Bicuspid aortic valve
2.Co of aorta
3.AS
4.MVP
5.TAPVR
• Hypogonadism
• Hypothyroidism
• Type-II DM
To...
Questions
1. What is the
diagnosis?
2. Give two sexual
characters in this
condition
3. Give one cardiac
condition that
may...
Answers
1. Klinefelter Syndrome (47 XXY)
2. Any two
Lack secondary sexual characteristics
Infertility, azoospermia
Gynecom...
psvt
dnbpaediatrics.blogspot.in
Questions
• a. Diagnosis
• b. Commonest differential how do you
distinguish between two?
• c. Give 3 Steps of management
d...
Answers
• PSVT
• Sinus tachycardia - there is beat to beat
variability.
• Vagal manoeuvres:
– Carotid Massage
– Ice packs ...
ECG
dnbpaediatrics.blogspot.in
Questions
• Abnormalities
• Management
• Which drug eliminates the causative agent
dnbpaediatrics.blogspot.in
Answers
• ECG changes of hyperkalemia
• Calcium gluconate, sodabicarb, asthalin
nebulisation, insulin
• Kayexelate resin.
...
• What disease does this PBS picture
suggest ? dnbpaediatrics.blogspot.in
• Spherocytosis
1
dnbpaediatrics.blogspot.in
THANK YOU
dnbpaediatrics.blogspot.in
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Lab

  1. 1. LAB & OTHER INV OSCE IN PEDIATRICS FOR DNB PEDIATRICS PRACTICAL EXAMINATION dnbpaediatrics.blogspot.in
  2. 2. Lab – 1(Blood) • Age – 4 yrs • Hb – 7 g% • RBCs – Polychromatophilic reticulocytosis, many spherocytes, central pallor less conspicuous • WBC and platelet series- normal • Bone Marrow – Erythroid Hyperplasia • Questions – Differential diagnosis – Confirmatory test dnbpaediatrics.blogspot.in
  3. 3. Lab – 2 (Blood) • Age – 3yrs • Hb – 6 gm% • TLC – 1500/cmm • Platelets – 20,000/cmm • Bone marrow – Cellularity reduced • Questions –Diagnosis? –Name 2 infectious causes dnbpaediatrics.blogspot.in
  4. 4. Lab – 3 (Urine) • Age – 9yrs • Appearance - Turbid • Sp Gr – 1019 • Proteins – 4 + • RBCs – 6 to 10 per HPF, occasional RBC casts seen Questions – Diagnosis? – Causes? dnbpaediatrics.blogspot.in
  5. 5. Lab – 4 (CSF) • Age – 3 days term neonate • CSF – – Appearance – clear – Proteins – 10 mg/dl – Glucose – 45 mg/dl ( Blood sugar – 80 mg/dl) – Cells – WBC – 6/cmm pred neutros • Questions –What is your interpretation dnbpaediatrics.blogspot.in
  6. 6. Lab - 5 Peritoneal fluid • AGE 10 yrs • Peritoneal fluid – Protein 4.5g/dl – LDH 750 IU (90u/L) – WBC 7500/cmm – GLUCOSE 56mg/dl (Blood sugar 80mg/dl) Question – Diagnosis? – Treatment? dnbpaediatrics.blogspot.in
  7. 7. 1. What is the diagnosis? 2. What is the mutation that results in this disease? 3. What are the three main categories of crises in patients with sickle cell disease? dnbpaediatrics.blogspot.in
  8. 8. Questions 1. Describe the cells seen. 2. Name one condition each from following category in which these cells are seen a. Neurological b. Metabolic c. Hepatic d. Endocrinal dnbpaediatrics.blogspot.in
  9. 9. • What is this modality of investigation? • Name three common indications .dnbpaediatrics.blogspot.in
  10. 10. • What is this modality of investigation? • Name one common indication . dnbpaediatrics.blogspot.in
  11. 11. • What is the diagnosis ? • What are the cardiac conditions associated ? • What are the endocrinal conditions associated ? dnbpaediatrics.blogspot.in
  12. 12. Questions 1. What is the diagnosis? 2. Give two sexual characters in this condition 3. Give one cardiac condition that may be associated with this condition 4. What would be the plasma levels of a. FSH b. LH c. Testosteronednbpaediatrics.blogspot.in
  13. 13. psvt dnbpaediatrics.blogspot.in
  14. 14. Questions • a. Diagnosis • b. Commonest differential how do you distinguish between two? • c. Give 3 Steps of management dnbpaediatrics.blogspot.in
  15. 15. ECG dnbpaediatrics.blogspot.in
  16. 16. Questions • Abnormalities • Management • Which drug eliminates the causative agent dnbpaediatrics.blogspot.in
  17. 17. • What disease does this PBS picture suggest ? dnbpaediatrics.blogspot.in
  18. 18. ANSWERS dnbpaediatrics.blogspot.in
  19. 19. Lab – 1(Blood) • Age – 4 yrs • Hb – 7 g% • RBCs – Polychromatophilic reticulocytosis, many spherocytes, central pallor less conspicuous • WBC and platelet series- normal • Bone Marrow – Erythroid Hyperplasia • Questions – Differential diagnosis – Confirmatory test dnbpaediatrics.blogspot.in
  20. 20. Answers: Lab – 1(Blood) • Anemia • Increased retic count – Hemolysis • PBS – spherocytes, other series normal • Bone marrow – hyperplastic – hemolysis • D/D of hemolytic anemia with spherocytes – Hereditary spherocytosis – osmotic fragility – Autoimmune hemolytic anemia – coombs test – Wilsons disease – serum ceruloplasmin – Burns - History Total 2 marksdnbpaediatrics.blogspot.in
  21. 21. Lab – 2 (Blood) • Age – 3yrs • Hb – 6 gm% • TLC – 1500/cmm • Platelets – 20,000/cmm • Bone marrow – Cellularity reduced • Questions –Diagnosis? –Name 2 infectious causes dnbpaediatrics.blogspot.in
  22. 22. Answers: Lab – 2 (Blood) • All three cell lines are depressed • Bone marrow depression Diagnosis- Aplastic anemia Causes –CMV –Hepatitis B –HIV Total 2 marksdnbpaediatrics.blogspot.in
  23. 23. Lab – 3 (Urine) • Age – 9yrs • Appearance - Turbid • Sp Gr – 1019 • Proteins – 4 + • RBCs – 6 to 10 per HPF, occasional RBC casts seen Questions – Diagnosis? – Causes? dnbpaediatrics.blogspot.in
  24. 24. Answers: Lab – 3 (Urine) • Sp Gr – normal • Nephrotic range proteinuria • Microscopic hematuria with RBC casts – glomerular pathology • Nephrotic syndrome with hematuria – Nephritic onset Nephrotic syndrome • Common causes – Idiopathic, SLE, Malaria, HSP, Hepatitis B Total 3 marksdnbpaediatrics.blogspot.in
  25. 25. Lab – 4 (CSF) • Age – 3 days term neonate • CSF – – Appearance – clear – Proteins – 10 mg/dl – Glucose – 45 mg/dl ( Blood sugar – 80 mg/dl) – Cells – WBC – 6/cmm pred neutros • Questions –What is your interpretation dnbpaediatrics.blogspot.in
  26. 26. Answers: Lab – 4 (CSF) • Normal CSF in a neonate WBC 11+/-10 (90th centile-22) • polys 2.2+/-3.8 % (90th centile- 6) • Protein 84+/-45 mg/dl • Glucose 46+/-10 mg/dl Interpretation – normal CSF report Total 3 marks dnbpaediatrics.blogspot.in
  27. 27. Lab - 5 Peritoneal fluid • AGE 10 yrs • Peritoneal fluid – Protein 4.5g/dl – LDH 750 IU (90u/L) – WBC 7500/cmm – GLUCOSE 56mg/dl (Blood sugar 80mg/dl) Question – Diagnosis? – Treatment? dnbpaediatrics.blogspot.in
  28. 28. Answer : Lab - 5 Peritoneal fluid • Normal value Transudate Exudate Sp Gr <1.016 >1.106 Protein <3gm/dl >3gm/dl WBCs <1000/cmm >1000/cmm RBCs <10,000/cmm Variable Glucose = serum <serum pH 7.4 to 7.5 <7.4 • Diagnosis Tuberculosis • Treatment- ATT as per IAP consensus Total 2 marks dnbpaediatrics.blogspot.in
  29. 29. 1. What is the diagnosis? 2. What is the mutation that results in this disease? 3. What are the three main categories of crises in patients with sickle cell disease? dnbpaediatrics.blogspot.in
  30. 30. Answers 1. Sickle cell disease 2. On the beta chain, valine is substituted for glutamic acid at position 6 3. Aplastic crisis Vaso-occlusive crisis Acute splenic sequestration 1 1 1 1 1 Nathan and Oski's Hematology of Infancy and Childhood, 6th ed. 2003, pp 802-811 dnbpaediatrics.blogspot.in
  31. 31. Questions 1. Describe the cells seen. 2. Name one condition each from following category in which these cells are seen a. Neurological b. Metabolic c. Hepatic d. Endocrinal dnbpaediatrics.blogspot.in
  32. 32. Answers 1. Acanthocytosis 2. Conditions a. Neurological Neuroacantocytosis b. Metabolic Abetalipoproteinemia c. Hepatic Severe liver dysfunction d. Endocrinal Hypothyroidism 1 1 1 1 1 dnbpaediatrics.blogspot.in
  33. 33. • What is this modality of investigation? • Name three common indications .dnbpaediatrics.blogspot.in
  34. 34. Answer: Spots: 1 • Radionuclide bone scan • Indication –Metastasis –Osteomyelitis –Stress fracture Total 2 marksdnbpaediatrics.blogspot.in
  35. 35. • What is this modality of investigation? • Name one common indication . dnbpaediatrics.blogspot.in
  36. 36. Answer : Spots: 2 • Hepatobiliary scintigraphy • Indication –Biliary atresia Total 2 marksdnbpaediatrics.blogspot.in
  37. 37. • What is the diagnosis ? • What are the cardiac conditions associated ? • What are the endocrinal conditions associated ? dnbpaediatrics.blogspot.in
  38. 38. Turner’s Syndrome 1.Bicuspid aortic valve 2.Co of aorta 3.AS 4.MVP 5.TAPVR • Hypogonadism • Hypothyroidism • Type-II DM Total 4 marksdnbpaediatrics.blogspot.in
  39. 39. Questions 1. What is the diagnosis? 2. Give two sexual characters in this condition 3. Give one cardiac condition that may be associated with this condition 4. What would be the plasma levels of a. FSH b. LHdnbpaediatrics.blogspot.in
  40. 40. Answers 1. Klinefelter Syndrome (47 XXY) 2. Any two Lack secondary sexual characteristics Infertility, azoospermia Gynecomastia Testicular dysgenesis 3. Any one Mitral valve prolapse (55%) Varicose veins (20-40%) 4. Plasma levels of a. FSH Increased b. LH Increased c. Testosterone Decreased 1 2 0.5 0.5 0.5 0.5 dnbpaediatrics.blogspot.in
  41. 41. psvt dnbpaediatrics.blogspot.in
  42. 42. Questions • a. Diagnosis • b. Commonest differential how do you distinguish between two? • c. Give 3 Steps of management dnbpaediatrics.blogspot.in
  43. 43. Answers • PSVT • Sinus tachycardia - there is beat to beat variability. • Vagal manoeuvres: – Carotid Massage – Ice packs over face – Valsalva manouver • Adenosine drug of choice. 4 marks 4 marks dnbpaediatrics.blogspot.in
  44. 44. ECG dnbpaediatrics.blogspot.in
  45. 45. Questions • Abnormalities • Management • Which drug eliminates the causative agent dnbpaediatrics.blogspot.in
  46. 46. Answers • ECG changes of hyperkalemia • Calcium gluconate, sodabicarb, asthalin nebulisation, insulin • Kayexelate resin. 4 marks dnbpaediatrics.blogspot.in
  47. 47. • What disease does this PBS picture suggest ? dnbpaediatrics.blogspot.in
  48. 48. • Spherocytosis 1 dnbpaediatrics.blogspot.in
  49. 49. THANK YOU dnbpaediatrics.blogspot.in

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