OSCE Pediatrics


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OSCE Pediatrics

  1. 1. DNBOSCE Pediatrics
  2. 2. 1Q1. Describe the findings in this photograph2. What is the nutritional status of this child3. What are the causes of abdominal distention in this child4. What are the life threatening emergencies associated with this condition 1
  3. 3. 1A 1. Generalized wasting, no edema, alert 2. Marasmus 3. Worm infestation, hypokalemia T.B. peritonitis (or) disseminated tuberculosis 4. Hypoglycemia Hypokalemia Hypothermia Fulminant sepsis 2
  4. 4. 2Q 1. W hat is the diagnosis 2. Two other congenital defects associated with this condition 3. Name four teratogenic drugs producing this defect 4. Ideal age for correcting this malformation 3
  5. 5. 2A 1. Cleft lip and palate 2. Congenital heart diseases, hypoplasia or agenesis of thymus and parathyroid, hypoplasia of auricle. 3. Phenytoin, carbamazepine, prednisolone and alcohol. 4. Lip – 3 months Palate – 12 months 4
  6. 6. 3Q An 8 year old boy was brought to the hospital with shallow respiration andaltered sensorium with a GCS of 5/15. The pupils were 3 mm in size and sluggishlyreacting to light. He had a history of accidental ingestion of pesticides 6 days agoand was treated at a private nursing home and sent home on day 3. He wasasymptomatic at home for the past 3 days. Now he is brought with the abovesymptoms. 1. What is the problem in this child 2. Briefly narrate the management 3. Name the blood investigation to confirm and prognosticate. 4. Name chronic sequelae associated with this poisoning3A 1. Intermediate syndrome of OPC poisoning (Neuro toxic) 2. Airway and breathing maintained by ventilatory support - Circulation by crystalloids, colloids, & Ionotropes - Pralidoxime continuous infusion 100mg –500mg/Hr - Antibiiotics to prevent sepsis. 3. Cholinestrase level < 10% very severe 10% – 20% - moderate 20% – 30% – Mild 4. Wrist drop, foot drop & Muscle paralysis 5
  7. 7. 4Q The following food substances, which contain Vit.A, need to be arrange d based on Vitamin A content from high to low.  Papaya,  Guava  Amaranth  Drumstick leaves  Egg  Human milk  Carrot 4A  Carrot 1167  Amaranth 515  Drumstick leaves 300  Egg 140  Papaya 118  Human Milk 38  Guava 0 6
  8. 8. 5. Q6 month old male infant brought to the emergency room for recurrent seizure sincebirth. Baby was macrosomic and had macroglossia at birth and there is no maternalhistory of diabetes. During each episode of fits, hypoglycemia was documented.Other base line investigations were found to be normal. 1. What is the diagnosis. Name one syndrome associated with this. 2. What is the dose of glucose, name the next drug that you will use to treat hypoglycemia. 3. How will you confirm the diagnosis 4. Name the Drugs used to treat this condition5. A 1 Hypoglycemia,beckwith wiedman syndrome 1. 2ml / kg 10% dextrose intravenous push followed by 6 to 8 mg/kg/min maintenance of glucose. If requirement of the glucose exceeds 12mg/kg/min think of hyperinsulinimic states. Probable diagnosis is recurrent Hypoglycemia due to hyperinsulinism. Hydrocortisone 10mg/kg/day 2. Plasma insulin level. 3. Diazoxide , stomatostatin and octreotide 7
  9. 9. 6QA Five-year-old female child was brought to the emergency department with ahistory of altered sensorium for 2 days and vomiting since afternoon. There was ahistory of fall 2 days back. Father had prolonged bleeding followingappendicectomy. Investigation revealed A normal Prothrombin time., normal APTT,normal Thrombin time and normal platelet count. 1. What is the probable diagnosis and what is the complication? 2. How will you confirm your diagnosis? 3. What is your immediate management? 4. Name the drug used to treat the minor complication6. A1. Bleeding disorder probably factor 13 deficiency now presenting with intracranial bleed2. Factor 13 assay (urea clot lysis) a. C.T. Scan brain to rule out intracranial hemorrhage3. FFP transfusion - Cryoprecipitate - Factor 13 concentrate b. Neurosurgical consultation to evacuate intracranial haematoma4. Tranexmic acid 8
  10. 10. 7QA 48 hrs old term baby was given respiratory support following neonatalconvulsions.His ABGPH – 7.6PCo2 – 18PO2 – 214BE--1Hco3 – 17.1 1. What is your diagnosis? 2. What is the cause? 3. How will you manage?7.A 1. Respiratory alkalosis 2. Hyperventilation 3. Reduce the ventilatory settings Primarily ventilatory rate 9
  11. 11. 8QA 3 year old boy is brought to the emergency room with history of fever for one day,sudden onset of stridor and dyspnoea. On examination the boy is toxic , anxious,febrile and has drooling of saliva pulse rate 150/minuteRespiratory rate 60/minute1) What is the diagnosis?2) What is the causative organism?3) What radiological sign in the X ray neck is observed?8A1. Acute epiglotitis2. H influenza3. Thumb sign 10
  12. 12. 9QIn a PHC area of population of 30,000 the total births in the year 2005 was 215 ofwhich 15 were stillbirths. 20 infants died in the same year of which 15 died in thefirst weeks of life. 1) Calculate infant mortality rate 2) Name the state with lowest and highest infant mortality rate. 3) Write 3 cost effective mechanism to bring down the infant mortality rate9. A1. Infant death = 20Neonatal death = 15Total live birth= total birth-still birth=200Infant mortality rate = No. of infants who died in the year x 1000 Total live births in the same year = 100/1000 live births2. Lowest mortality rate – Kerala Highest mortality rate - Bihar3. Exclusive breast feeding, KMC, and immunization 11
  13. 13. 10.QNational rural health mission (NRHM) 1. What is the ultimate goal of NRHM 2. What are its core strategies at the village level 3. Who is ASHA 4. What is the role of ASHA at the ground level10.A 1. The goal of the mission is to improve the availability of and access to quality health care by people, especially for those residing in rural areas, the poor, women and children 2. Train and enhance capacity of Panchayati Raj Institutiosn to own, control and manage public health services, promote access to improved health care at household level through a female health activist (ASHA), Health plan for each village through village health committee of the panchayat 3. ASHA is Accredited Social Health Activist – chosen to be accountable to panchayat to act as the interface between the community and the public health system 4. She will be honorary volunteer, receiving performance based compensation for promoting universal immunization, referral and escort services for RCH, construction of household toilets, facilitate village health plan and co – ordinate with the ANM’s and Anganwadi workers in all health activities. 12
  14. 14. 11Q12 yrs old male child is brought with history of poor growth1) Write two obvious abnormal physical findings2) What is the probable diagnosis?3) Give one differential diagnosis4) What is the inheritance pattern of this condition and write 4 diseases with similar inheritance?5) Mention 4 abnormal radiological findings in these children6) Write 2 neurological complications seen in these children 13
  15. 15. 11A1) Macrocephaly Disproportionate short stature Proximal shortening Bowing of legs2) Achondroplasia3) Hypochondroplasia4) Autosomal dominant Apert syndrome Crouzon syndrome Marfans syndrome Neurofibromatosis Osteogenesis imperfecta5) Short tubular bones Short vertebral pedicles through out the spine interpedicular distance decreases Iliac bones short and round with flat acetabular roof Calvarial bones are large6) Hydrocephalus Spinal cord compression at foramen magnum and lumbarspine 14
  16. 16. 12.Q6 years old boy admitted with 10 to 15 large quantity of watery stools in a day anddecreased urine output. Had an episode of convulsion just before coming to thehospital The weight was 10kgs previously now is 8.8kgs.O/E altered sensorium andno focal neurological deficit Investigation revealedNa-123 meq/litreK-3.8 meq/litreHco3-18meq/litre 1) What is the diagnosis 2) What is the probable cause for seizure and altered sensorium 3) How will you manage the above problem?12.A1.Acute watery diarrhoea with severe dehydration with hyponatremia2.hyponatremia3.Na deficit= (135-123) x10x.6 =72 meq/litre 1ml of 3% nacl = 0.5 meq/litre 144 ml of 3%Nacl to be infused to correct the Hyponatremia 15
  17. 17. 13.Q 1) What is the abnormality 2) List three biochemical abberations which will cause this abnormality 3) What are the common clinical presentation associated with this ECG abnormality 4) What is the drug which could cause this abnormality in early infancy 16
  18. 18. 13.A 1) Prolonged QT interval -It starts with the onset of Q or R to the end of T, in seconds 2) Hypokalemia Hypocalcemia Hypomagnesemia 3) Syncope, seizures 4) Cizapride 17
  19. 19. 14.Q1. What is the ideal schedule for this vaccination?2. What are the advantages over OPV3. What is the adverse effect?4. Where was the last outbreak in India?14.A1) 1st dose at 8 weeks of age 2 doses with 8 weeks interval + 1 booster optional /additive (AAP Schedule)2 a) Can be given to immunocomprimised individuals b) Vaccine induced paralytic polio is absent3. No adverse effect But if patient is allergic to neomycin, streptomycin and polymixin it can produce allergic manifestation4. Western U.P 18
  20. 20. FUNDUS PICTURE15.Q 1) What is the diagnosis 2) Mention 3 diseases with similar findings 3) Earliest clinical presentation of this condition 4) Name two treatable conditions with the same findings 19
  21. 21. 15.A 1) Retinitis pigmentosa 2) A. M.P.S. B. Late onset gangliosidosis C. Lawrence moon biedl syndrome D. Refsums disease E. Abetalipoprotenimia F. Ushers syndrome 3) Night blindness 4) Refsums disease and abetalipoprotenemia 20
  22. 22. 16Q. 1) What is your diagnosis 2) Name three risk factor for this diagnosis 3) What is the drug used to prevent this disease 4) What is the dose 21
  23. 23. 16A1. Respiratory distress syndrome2. Preterm, male, elective LSCS, gestational diabetes multiple gestation, asphyxia3. Antenatal corticosteriods-Betametasone4. Betametasone 12 mg 12hour interval I.M. 24 hours prior to delivery 22
  24. 24. 17.Q5 year old female child brought to the hospital for progressive difficulty inclimbing stairs and a positive gowers sign. Child also has wasting of the thenar,hypothenar and distal muscle. Tongue is thin and atrophic.1. What is the clinical diagnosis2. Name one clinical sign which will support your diagnosis3. Cardiac manifestation of this disease4. Name two drugs that will diminish the symptom of this disease17.A1) Mytonic muscular dystrophy2) Myotonic reflex3) Heart block and arythmias (other dystrophy will cause cardiomyopathy)4) Mexilitiene, phenytoin, carbamazepine,procainamide and quinidine sulphate 23
  25. 25. 18.Q1. What is the clinical diagnosis?2. Mention two points seen in this CT to justify your Diagnosis3. What is the immediate management?4. Name the complication seen in the CT. 24
  26. 26. 18.A1. Cerebral abscess – Right fronto parietal region2. Hypodense lesion measuring about 3cm x 2cm Ring enhancement – larger area differentiates this from granuloma and irregularity3. Surgical drain4. Ventriculitis right lateral ventricle 25
  27. 27. 19.QIn your hospital the following biomedical waste was generated from a patient withtyphoid. Indicate what colour code you will assign to dispose the waste.1. Torn under garment2. Plastic food box3. Cotton used to wipe blood from the site of venepuncture Slide containing smear4. Needle used to give IM injection.19.A1) Red2) Green3) Red4) Blue 26
  28. 28. 20.Q1. Report the smear2. Mention two features seen which give the diagnosis3. Mention any two preparations used to treat the condition4. Two important complications20.A1. Smear shows RBCs with trophozoites, gametocytes of P. falciparum.2. Banana shaped RBC with intracellular inclusion3. Chloroquine, quinine, artisunates.4. Cerebral malaria, backwater fever, algid malaria 27
  29. 29. 21Q1) What is this device?2) Mention 2 advantages and 2 disadvantages of this device?3) What is the flow rate of oxygen to be used in this device?4) What is the maximum fio2 this device can deliver?21A1) Oxygen Hood2) Two advantages – allows easy access to chest, trunk and extremities. - Permits control of improved oxygen Concentration and nebulization3) flow rate - > 10 to 15 L / min4) Fio2 – 80 – 90 % 28
  30. 30. 22Q1. Findings in this x ray2. What are the two important conditions which produce similar findings.3. How do you differentiate radiologically these two conditions.4. What hematological problems can occur in a child with such x-ray findings. 29
  31. 31. 22A1. - Increased density of bone - Changes suggestive of of rickets2. - Osteopetrosis - Pyknodysostosis3. (a) Angle of mandible normal in osteopetrosis Increased angle of mandible in pyknodysostosis (b) Distal phalanges normal in osteopetrosis Narrow distal phalanges in pyknodysostosis.4. Anemia 30
  32. 32. 23Q1) What is abnormal in this?2) What is the probable diagnosis?3) Write 4 conditions predisposing to this.4) Treatment of choice for this condition. 31
  33. 33. 23A1) Colon cut off sign is seen Paucity of distal bowel gas shadow2) Intussusception3) Gastroenteritis Upper respiratory tract infection Polyp HSP Hemangioma Rotavirus vaccine Meckels diverticulum Lymphoma4) Pneumatic reduction 32
  34. 34. 24.Palpation of Precordium1. a) Wish and introduce yourself and establish a rapport and get permission to remove the shirt to examine the precordium b) Warm up your hands2. Palpation for apex beat - Good light - Supine/sitting position - Palmar palpation and digital localization3. Parasternal heave - Supine position - To keep the ulnar aspect of hand over the right parasternal area4. Palpation of heart sounds by digit - Opening snap just inside the apex - P2 – pulmonary area5. Thrill over precordium - Supine position - To keep the palmar aspect of the hand over the precordium to locate the thrill (systolic thrill over parasternal area and diastolic thrill over the apex) 33
  35. 35. 25 Counseling3-month-old infant brought by the mother for NOT ENOUGH MILKCounsel the mother1. Introduce and establish rapport2. Questions to be asked regarding - Volume and frequency of urine output - Frequency of feeding - Artificial feeding/bottle feeding - Any chronic illness or acute illness in the mother3. See for the position and attachment -Weight gain 30 grams /day4.Tell about importance of giving feed continuously by demand -Weight gain and urine output are the good indicator of adequate feeding -Encourage to take adequate food and rest5.Buildup confidence in the mother Encourage night feeds Frequent and complete emptying the breast will help in lactation Tell about the dangers of artificial food like allergy/ diarrhea / recurrent respiratory infection 34
  36. 36. http://groups.yahoo.com/group/PediatricsDNB/ Theory: http://dnbpediatricstheory.blogspot.in/ OSCE: http://oscepediatrics.blogspot.in/ Clinical: http://clinicalpediatrics.blogspot.in/ Practicals: http://practicalpediatrics.blogspot.in/Download at: http://www.4shared.com/folder/t8E_yjDv/_online.html