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  1. 1. OSCE PEDIATRICS Dr.Y.K.Amdekar dnbpaediatrics.blogspot. in
  2. 2. Station 1 – history taking • 8 month old infant presents with history of cough and wheezing dnbpaediatrics.blogspot.in
  3. 3. • Introduce yourself • Onset – acute / subacute Duration – hours / days • Progress – better / worst / same • Accompanying symptoms – fever, cold, vomiting, skin rash, failure to thrive • Past history of similar episode • Feeding, growth, well being, immunisation • Birth history • Family history of atopy / contact with viral inf • Drug history – relief if anydnbpaediatrics.blogspot.in
  4. 4. Station 2 – physical exam • Examine respiratory system of this child dnbpaediatrics.blogspot.in
  5. 5. • Introduce yourself and take permission from mother or child • Undress the child • Examine from foot end or head end for respiration • Palpate for tracheal deviation • Percuss gently and follow rules of percussiion dnbpaediatrics.blogspot.in
  6. 6. Station 3 – counseling • 3 year old child has been diagnosed as asthma – counsel the parents dnbpaediatrics.blogspot.in
  7. 7. • Introduce yourself and find out what language they would feel comfortable • Describe in lay language about asthma • Emphasise no one to blame and not to worry • Tell them that it can be controlled • Discuss preventive measures and drug therapy • Inform advantages and safety of inhaled therapy over oral medications • Insist on diary record and periodic follow-up • Explain end point of response and anticipated period of time / end with “any questions?”/ thanks dnbpaediatrics.blogspot.in
  8. 8. Station 4 • Draw surface anatomy of lungs • Name all segments of left lung dnbpaediatrics.blogspot.in
  9. 9. dnbpaediatrics.blogspot.in
  10. 10. • Left upper lobe – apical, anterior, posterior • Lingula – superior lingula, inferior lingula • Lower lobe – apical,anterior, posterior, lateral dnbpaediatrics.blogspot.in
  11. 11. Station 5 dnbpaediatrics.blogspot.in
  12. 12. • What is the approximate normal value of PEFR in a child whose height is 120 cms dnbpaediatrics.blogspot.in
  13. 13. • 200 litres • Formula to be used PEFR in litres = (height in cms –80) x 5 dnbpaediatrics.blogspot.in
  14. 14. Station 6 • What are different types of devices used for inhalation therapy? • What is the advantage of a spacer? • Describe maintenance of spacer dnbpaediatrics.blogspot.in
  15. 15. • MDI with spacer, DPI, nebuliser • Advantage of a spacer – no respiratory coordination necessary / better deposition of drug / no pharyngeal deposition of drug thereby reducing chance of oropharyngeal candidiasis and hoarseness of voice • Wash with mild soap and water – drip dry dnbpaediatrics.blogspot.in
  16. 16. Station 7 • In case of need for oxygen therapy, attempts must be made to decrease oxygen consumption. Name maneuvers to decrease oxygen consumption dnbpaediatrics.blogspot.in
  17. 17. • Control fever • Adequate humidification • Proper positioning • Open airway • Clear secretions • Alleviate anxiety – child in mother’s lap dnbpaediatrics.blogspot.in
  18. 18. Station 8 • What is low flow and high flow system of oxygen delivery? • Give examples of low flow and high flow system dnbpaediatrics.blogspot.in
  19. 19. • Low flow < pt’s inspiratory flow achieves low oxygen concentration Low flow systems – face mask, nasal canula • High flow is adequate or > pt’s inspiratory flow achieves high oxygen concentration non-breathing mask - face mask and reservoir bag with valve, oxygen hood, venturi mask offers fixed FiO2 delivery dnbpaediatrics.blogspot.in
  20. 20. Station 9 • Define following terms in relation to TB Relapse Defaulter Lost to treatment Treatment failure • What treatment for each of them? dnbpaediatrics.blogspot.in
  21. 21. • Relapse – signs and symptoms reappearing within 2 years of completion of ATT • Defaulter – one who discontinues treatment for > 1 week • Lost to treatment – one who defaults for > 1 month • Treatment failure – no response or deterioration after 12 weeks of intensive therapy • Category 2 of RNTCP 2SHRZE / 1HRZE / 5HRE dnbpaediatrics.blogspot.in
  22. 22. Station 10 dnbpaediatrics.blogspot.in
  23. 23. • Identify the condition • Name three salient features • Name type of inheritance • What is the prognosis? dnbpaediatrics.blogspot.in
  24. 24. • Ataxia-talengectesia • Recurrent sino-pulmonary infections, ataxia, immune deficiency, malignancy • Autosomal recessive • Poor – death due to chronic respiratory failure by second decade dnbpaediatrics.blogspot.in
  25. 25. What are the two most important abnormalities present? • This healthy child presented with increasing breathlessness over 12 hours. Name probable diagnosis dnbpaediatrics.blogspot.in
  26. 26. • Left pleural effusion and mediastinal shift • Acute allergic pleural effusion of TB or traumatic hemorrhagic effusion dnbpaediatrics.blogspot.in
  27. 27. Station 12 • Name biochemical criteria for exudative pleural fluid dnbpaediatrics.blogspot.in
  28. 28. • pH < 7.2 • Pleural fluid > 3 gm/l • Pleural LDH > 200 IU/l or Pleural fluid / serum LDH > 0.6 Pleural fluid / serum protein > 0.5 dnbpaediatrics.blogspot.in
  29. 29. Station 13 • How do you manage pleural effusion accompanying acute pneumonia? dnbpaediatrics.blogspot.in
  30. 30. • Uncomplicated para-pneumonic effusion – chest x-ray lateral decubitus < 10 mm fluid – antibiotics only • Complicated effusion – chest x-ray lateral decubitus - > 10 mm fluid / pH >7.2 / glucose > 40 / protein < 3 gm/l – antibiotic + thoracocentesis • Complicated effusion – chest x-ray lateral decubitus > 10 mm fluid / pH < 7.2 / glucose < 40 / protein > 3 gm/l – antibiotic + tube drainage • Multiple loculations – VAT / decortication dnbpaediatrics.blogspot.in
  31. 31. Station 14 dnbpaediatrics.blogspot.in
  32. 32. • Multiple fractures • Bilateral pneumothorax • Air in soft tissue • Scoliosis dnbpaediatrics.blogspot.in
  33. 33. Station 15 dnbpaediatrics.blogspot.in
  34. 34. • This 7 year old child was diagnosed as acute pneumonia on the basis of clinical profile, neutrophilic leucocytosis and chest x-ray – was treated with IV Ceftriaxone • 4 days later, as fever continued, repeat CBC and chest x-ray were ordered • What is the problem? dnbpaediatrics.blogspot.in
  35. 35. dnbpaediatrics.blogspot.in
  36. 36. • Immune mediated inflammatory disease Wagner’s granulomatosis dnbpaediatrics.blogspot.in
  37. 37. Station 16 dnbpaediatrics.blogspot.in
  38. 38. dnbpaediatrics.blogspot.in
  39. 39. • What is the problem? • How do you treat? dnbpaediatrics.blogspot.in
  40. 40. • Paradoxical immune response • Continue same ATT – in case of acute symptoms such as breathlessness, consider oral steroids dnbpaediatrics.blogspot.in
  41. 41. Station 17 • What concentration of PPD is ideal for Mantoux test? • How do you measure test result? • How do you interpret test result? • What is the effect of BCG vaccine on Mt test? dnbpaediatrics.blogspot.in
  42. 42. • PPD 1 TU RT 23 with Tween 80 as a preservative or PPD 2 TU without Tween 80 – PPD 5TU may be an acceptable though inferior alternative • Ball point method of measuring induration • Induration > 10 mm is considered +ve indicative of natural infection • Previous BCG vaccine has minimal to none influence on interpretation of Mantoux test dnbpaediatrics.blogspot.in

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