OSCE Pediatrics CME (Dr.D.Y.Patil Medical College)

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PG CME at Dr.D.Y.Patil Medical College. 19.08.2012. Prepared by Dr.Ashwin Borade

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OSCE Pediatrics CME (Dr.D.Y.Patil Medical College)

  1. 1. OSCE MADE EASY CME, 19/8/2012 Dr. Ashwin Borade Consultant, Sant Dnyaneshwar Medical Education & Research Centre,Pune Consultant, Inamdar Multispecialty Hospital ,Pune8/19/2012 CME,Pune 1
  2. 2. Objective structured clinical examination (OSCE) 30 stations (4-5 rest stations) = 150 marksFive observed stations (50 marks = 1/3rd of OSCE) 8/19/2012 CME,Pune 2
  3. 3. OSCE is an skill assessment of your entire postgraduation.It attempts to assess candidates in all aspects.It’s an opportunity for student to make up marks. 8/19/2012 CME,Pune 3
  4. 4. • FOLLOWING ARE TYPES OF STATIONS (Based on memory of candidates)• 1.COUNSELLING 13.CLINICAL METHOD• 2.NATIONAL PROGRAMME 14.PSM 15.INSTRUMENT• 3.CLINICAL QUESTION 16.ECG• 4.PERIPHERAL SMEAR 17.X-RAY• 5.WASTE MANAGEMENT 18.HISTORY TAKING• 6.IMMUNIZATION PROGRAMME 19. GENETIC• 7.NUTRITION 20.CT/USG 21.PEDIGREE CHART• 8.PICTURE INTERPRETATION• 9.ABG 22.NEONATAL• 10.DRUG RESUCITATION/PALS• 11.STATISTICS 23.POISONING• 12.BIBILOGRAPHY 24.PROCEDURE 8/19/2012 CME,Pune 4
  5. 5. Format of questions• Q/A• Clinical scenarios• Match the following• Fill in the blanks• Photographs, charts, slides8/19/2012 CME,Pune 5
  6. 6. OBSERVED STATION OBSERVED STATION OBSERVED STATION OBSERVED REST STATION STATION REST STATIONSTATION 1 OBSERVED CME,Pune REST STATION 6 STATION
  7. 7. Question Blank OSCE Sheets8/19/2012 CME,Pune 7
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  13. 13. • The OSCE Questions & Answers are prepared by the faculty for the benefit of Post graduate students.• These Questions and answers are made for the students to understand the pattern of OSCE and not meant to completely cover the subject of Pediatrics.• Answer are checked from standard textbook in case of doubt plz email• ashwinborade@yahoo.com 8/19/2012 CME,Pune 13
  14. 14. Imaging• X ray (CVS, RS,GIT, CNS, NUT)• CT scan• MRI scan• USG ( neonatal)• Nuclear scan8/19/2012 CME,Pune 14
  15. 15. What you should Know• View , preparation, dye used• Normal structure seen in image• Abnormality/ problem• About disease and Treatment of disease8/19/2012 CME,Pune 15
  16. 16. • Describe the X ray findings .• What is the diagnosis?• What is the treatment of choice ?• Write 4 life threatening complications of Kawasaki disease.• 8/19/2012 4 side effects pertaining to CVS of Digitalis . Write CME,Pune 16
  17. 17. • X ray chest PA view with air trapped s/o Pneumopericrdium • Pneumopericrdium • O2 and monitoring if severe distress prompt evacuation. • MI, Coranry aneurusm, Thrombosis, DIC • Atrial, ventricular extrasystole, heart block,AV block, VT,VF8/19/2012 CME,Pune 17
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  19. 19. •1. Identify and describe the findings.•2.What is probable diagnosis ?•3. What is the treatment?•4. What is Indian contribution in treatment ofthis condition 8/19/2012 CME,Pune 19
  20. 20. Answers• CT scan showing Ventricular dilation• Hydrocephalus• Medical Acteazolamide, furosemide and surgical VP shunt• Chhabra Shunt /Upadhyaya VP shunt8/19/2012 CME,Pune 20
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  22. 22. • Interpret the MRI (1)• Interpret the EEG (1)• What is the most probable diagnosis (1)• Name the drug of choice (1)• What is the definition of Eosinophilic Meningitis (1) 8/19/2012 CME,Pune 22
  23. 23. Answer• Cortical damage seen in Bilateral temporal lobes• PLEDS Periodic lateralizing Epileptiform Discharges• HSV Encephalitis• Acyclovir• 10 or more eosinophils/mm3of CSF 8/19/2012 CME,Pune 23
  24. 24. • A premature baby was ventilated and on 2 ed day had convulsions. His investigation done which is shown here 8/19/2012 CME,Pune 24
  25. 25. • Identify and describe investigation• Spot the diagnosis with grade• What are preventive measures?• What is the commonest neurological sequel?• What is the commonest Opthlmoligical sequel? 8/19/2012 CME,Pune 25
  26. 26. Answers• Cranial USG showing cystic PVL• Grade 2 PVL• Early interventions , maintain normal cerebral perfusion• Spastic diparesis• Strabismus, nystagmus, ROP 8/19/2012 CME,Pune 26
  27. 27. • Peripheral Smears and slides and clinical photographs8/19/2012 CME,Pune 27
  28. 28. • What you should Know• Peripheral smear and B.M Picture,• Stain, method , Normal cells, abnormal cells, Parasite• Hematology and Oncology• Inheritance, clinical feature, Prognostic factor• Treatment, recent advance 8/19/2012 CME,Pune 28
  29. 29. Clinical Photo :-• Syndrome, disorder• Instrument, PFT,• Dermatology, Neurocutenous mark, Rash,• Clinical sign8/19/2012 CME,Pune 29
  30. 30. 8/19/2012 CME,Pune 30
  31. 31. • Identify this slide (1)• Name 2 drugs which can cause this state (2)• Name 2 non nutritional causes of this state (2) 8/19/2012 CME,Pune 31
  32. 32. Answers• Macrocytic anemia• Phenytoin / Sulfa group / Zidovudine / Phenobarbital• Hypohyroidism / orotic acid uria / Lesch Nyhan syndrome / Down syndrome / Marrow failure8/19/2012 CME,Pune 32
  33. 33. What is the organism ?What is the commonestpresentation ?What is the drug of choice byFDA ?What is incubation period? 8/19/2012 CME,Pune 33
  34. 34. • Giardia Lamblia• Mostly asymptomatic (but rarely Sudden onset explosive watery diarrhea with distension of abdomen)• Tinidazole ,Nizonide• 1-2 weeks8/19/2012 CME,Pune 34
  35. 35. An anxious mother of a day 5 neonate has brought her baby withhistory of following rash since birth.What is this condition 1What is the etiology 1How complications you can encounter1What is the management 1 8/19/2012 CME,Pune 35
  36. 36. • Klippel Trenaunay weber syndrome• cute nous cavernous vascular malformation• Cellulites, Thrombophelitits, Heart failure, Gangrne• corrective surgery and supportive care8/19/2012 CME,Pune 36
  37. 37. • ECGS8/19/2012 CME,Pune 37
  38. 38. What you should Know• Normal ECG / Various waves and duration calculation• ECG in CHD/ RHD/ electrolyte disorder• Atrial Flutter ,Wide Complex Tachycardia• Atrial Fibrillation ,Pericariditis- ,Sinus Tachycardia• Wolff Parkinson White ,Heart Block ,Electrolyte abnormalities 8/19/2012 CME,Pune 38
  39. 39. 8/19/2012 CME,Pune 39
  40. 40. • What does this EKG strip show (1)• Name 3 EKG findings that helped you in diagnosis (1)• Name 2 emergency pharmacological treatment options of a SVT. (1) 8/19/2012 CME,Pune 40
  41. 41. Answer• Wolff-Parkinson-White [WPW] syndrome)• short P-R interval, delta wave, and wide QRS• adenosine / phenylephrine / edrophonium / Verapamil8/19/2012 CME,Pune 41
  42. 42. • STATION 1:•1. Identify the ECG :•2. Name drugs causing this•3. Name Inherited conditions a/w this•4.What is the treatment?•5.what is common clinical presentation? 8/19/2012 CME,Pune 42
  43. 43. • Long Qt• Amidarone, cispride, Haloperidol• Jervell and Lange-Nielsen syndrome Romano-Ward syndrome• B blokers• Syncopal episodes by exercise , fright 8/19/2012 CME,Pune 43
  44. 44. EEGNormal waves , patternTypical EEG pattern in some disorders8/19/2012 CME,Pune 44
  45. 45. • 8 mts old female child with delayed development milestones flexor spasm EEG done.• Describe characteristic EEG findings• What is diagnosis?• What is T/t?• Which type having the good prognosis? 8/19/2012 CME,Pune 45
  46. 46. • Hppsarrythmia• Infartile spasms• ACTH and glucocorticoids• Cryptogenic infantile spasms8/19/2012 CME,Pune 46
  47. 47. • Clinical case scenarios8/19/2012 CME,Pune 47
  48. 48. • What you should Know• Case• Infection , CVS,RS, CNS,Endo.• HBsAg +ve, Chicken Pox,HIV, TB• Unimmunized child, Rabies• Infection :- Rash, clinical feature, incubation, Period drug of choice, isolation complications• Endocrinology• BMI, Target height, short stature, DKA, insulin dosage, Tanner staging 8/19/2012 CME,Pune 48
  49. 49. • A 10 day old infant male suddenly developed vomiting, lethargy, not feeding well on evaluation his CBC and sepsis work up was negative. His ABG showed PH 7.38 PCO2 -40• Plasma NH3 525 umol/L• What is Probable diagnosis?• Enlist drugs used to treat it?• What is commonest form of this disorder?• In this patient what form will be more severe?• What lab parameters are decreased in neonatal sepsis? 8/19/2012 CME,Pune 49
  50. 50. • Urea cycle defect• Sodium benzoate, Argenine, cetrulline• Carniline, Lactulose• Carbomoyl Phosphatan synthase deficiency• OTC deficiency• Platelet, WBC count8/19/2012 CME,Pune 50
  51. 51. Drugs and Vaccine8/19/2012 CME,Pune 51
  52. 52. • What you should Know• Drugs• Classification, dosage, route, uses, side effect, precaution. Eg.Adrenaline, sodabicarb, Ampo B, IVIG, Surfactant• Drug of choice,IV fluid constituents, ORS• Vaccine• UIP, IAP schedule, Newer vaccine• Vaccine dose, schedule side effects indications and contraindications, storage 8/19/2012 CME,Pune 52
  53. 53. Caffeine Citrate• Which group this drug belong ? (1)• What is mech of action (1)• What are indications? (1)• What is dosages ? (1)•8/19/2012 are side effects? (1) What CME,Pune 53
  54. 54. Answers• Methylxantine• Resp. centre stimulation, Antagonism of adenosine, Incr. Diaphragm contractility• Apnea of prematurity• Lading dose 20 mg/Kg IV followed by 5-12 mg/kg• Cardiac arrthymia, tachycardia, Irritability8/19/2012 CME,Pune 54
  55. 55. • What is dose of Leviractam and Lamotrigine?8/19/2012 CME,Pune 55
  56. 56. • Leviractam 20 mg/kg/day• Lamotrigine 2 MG/kg/24hrs → 5-10 mg/kg/day8/19/2012 CME,Pune 56
  57. 57. Chicken pox vaccine• What is the dose ?• What strain is used ?• Post exposure prophylaxis how vaccine can be given?• What are indications for varicella immunoglobin in neonate8/19/2012 CME,Pune 57
  58. 58. Answers• 0.5 ml S. C• Oka strain• Within 72 hrs ( 3-5 days)• If mother develops varicella 5 days before to 2 daysafter delivery 8/19/2012 CME,Pune 58
  59. 59. • Electrolyte/ ABG’s / Ventilators8/19/2012 CME,Pune 59
  60. 60. • What you should Know• Case study• Interpretation of ABG, calculation of PaO2, CaCo2• Formula for AaDo2, OI• Ventilator setting/modes/change as per ABG 8/19/2012 CME,Pune 60
  61. 61. A 4 yrs old male child with fever and AGE admitted in PICUwith cold extremities and respiratory distress . His ABG doneshowingpH -7.27 , PaCo2- 33 mmHg, PaO2- 84 mmHg, HCO3-17mMol/Land base excess- 7 mMol/L• What is ABG diagnosis• What is line of treatment?• What is formula to calculate AaDO2• What is formula to calculate OI• How u calculate anion gap8/19/2012 CME,Pune 61
  62. 62. Answer • Metabolic acidosis • IV fluid resuscitation • AaDO2 = PA02-PaO2 • OI= MAPX FiO2/ Postductal PO2 X 100 • Na- Cl – Hco38/19/2012 CME,Pune 62
  63. 63. • PSM / Statistics / Biomedical / Biblography8/19/2012 CME,Pune 63
  64. 64. • What you should Know• Health Programme – ICDS, CSSM, Mid Day Meal,RNTCP• Biomedical Waste – Infectious waste,Non infectious waste• Medical Stastics• Def. Mean, mode, meclian, 1st Quartile, 3rd Quartile incidence Prevalance, Specifically• Case Control, cohort study• TP, TN, RR, odd ratio 8/19/2012 CME,Pune 64
  65. 65. • What is RNTCP?• When was RNTCP was started ?• As per RNTCP aim is to achieve cure rate of• What is defaulter ?• What is treatment failure?8/19/2012 CME,Pune 65
  66. 66. Answer• Revised Natioanl Tuberculosis control program• 1992• 85%• Patient who return sputum smear + ve after having left t/t for 2 months• Patient who was smaer +ve and on t/t remain sputum smear + ve again at 5 months or later during t/t.8/19/2012 CME,Pune 66
  67. 67. Dispose the following waste• Wound dressing material• Needles• Plastic wraper• Indwelling Umbilical catheters• Discarded food8/19/2012 CME,Pune 67
  68. 68. • Wound dressing material – Yellow bag• Needles –Blue puncture proof container• Plastic wraper- Black Bags• Indwelling Umbilical catheters– Red bags• Discarded food- Black Bags8/19/2012 CME,Pune 68
  69. 69. Write following journal article in Vancouver style Article :Cardiogenic Shock With Hypereosinophilic SyndromeAuthors :Vinitha Prasad, L Rajam and Ashwin Borade Journal : Indian Pediatrics Year :2009 Volume 46 Page 801-8038/19/2012 CME,Pune 69
  70. 70. Authors surname Initials, Authors surname Initials. Title of article. Title of Journal. [abbreviated] Year of publication Month date;Volume Number(Issue number):page numbers.• Prasad V, Rajam L , Borade A.Cardiogenic Shock With Hypereosinophilic Syndrome. Indian Pediatr. 2009;46: 801-3.8/19/2012 CME,Pune 70
  71. 71. • During a study at hospital the PEFR of 100 adolescences boys follow a normal distribution with a mean of 280 lit/min, standard deviation 30 lit/min and standard error of 2 lit/min• What will be the range in which 95% of the boys PEFR will lie in the sample?• What will be the range in which mean PEFR of the population will lie from which the sample was taken?8/19/2012 CME,Pune 71
  72. 72. Range in which 95% of girls PEFR in the sample will lie: mean +/- 2SD = 280 +/-2(30)=220-340Range in which mean PEFR Value will lie: mean +/- 2SE( Standard error)-95% Confidence interval = 280+/- 2(2)= 276- 2848/19/2012 CME,Pune 72
  73. 73. • Determine the sample size to find out the Vitamin A requirement in the under five children of Pune district . From the existing literature the mean daily requirement of the same was documented as 930 I.U with a SD of 90 I.U. Consider the precision as 9. 8/19/2012 CME,Pune 73
  74. 74. Quantitative dataN = 4SD2/L24 x 90 x 90 /9 x9 = 400• Qualitative data N = 4pq/L2• P = positive factor /prevalence/proportion • Q = 100 – p • L = allowable error or precision or variability • 4 = 1.962(Alpha error) 2 8/19/2012 CME,Pune 74
  75. 75. Station• What is name of curve ? (1/2)• What are uses ? (1)8/19/2012 CME,Pune 75
  76. 76. Answer• A scatter plot chart• It displays series as a set of points specified by x and y coordinates. A scatter plot is useful for showing nonlinear relationships between variables. It requires at least one category and two series (representing the x and y coordinates).8/19/2012 CME,Pune 76
  77. 77. Instruments8/19/2012 CME,Pune 77
  78. 78. StationIdentify the instrument. (1/2)What are indications? (1/2)What are contraindications ?(1/2)What is size equipment to be used for child of 7 Kg?(1/2) 8/19/2012 CME,Pune 78
  79. 79. Answer• Larygneal mask airway• Elective surgical procedure where face mask are used or endotracheal intubation is not necessary.• Known or unexplained difficult airways, Profound unconscious patient, patient who resist LMA• 1 1/28/19/2012 CME,Pune 79
  80. 80. Identify instrument?What it measure ?What are uses?How u calculate PEFR using hight in OPD ?At which variability of PEF we garde as mild intermittent asthma? 8/19/2012 CME,Pune 80
  81. 81. Answers• Peak flow meter• It measure Peak expiratory flow rate• Used to assess severity of asthma and response• Diagnosis of asthma and monitoring• PEFR= ( Ht – 100 ) X 5 + 100• < 20 %8/19/2012 CME,Pune 81
  82. 82. • Emergencies and Poisoning8/19/2012 CME,Pune 82
  83. 83. ••1. Identify the ECG•2.What is the treatment if hemodynamic compromise?•Which cardiac condition it is assosiated ? 8/19/2012 CME,Pune 83
  84. 84. • VT• Defibrillation• Cardiomyopathy, ALCAPA, Intramyocardial tumors, Following corrective surgery for TGA, VSD8/19/2012 CME,Pune 84
  85. 85. A 4 yrs old child brought in ER at 10 AM with 12 kg and 45 % burn while playing at 8 AM , as a attending Pediatrician• Calculate his fluid requirement in 48 hr ( As Per Parkland Formula)• His 24 hr correction will be complete by which time?• What is the desired S. albumin level• In this patient how much 0.5 % albumin u will infuse8/19/2012 CME,Pune 85
  86. 86. Answers• 1st 24 hrs RL 4 ml X 12 ( wt) X 45 ( % of burn )• ½ in first 8 hrs and ½ in over 16 hrs (2160 ml)• 2 ed 24 hrs RL with 5 % D ( ½ of 1 st day fluid)• Next day 8 AM• 2 gm/dL• 30-50% burn 0.3 ml of 0.5 % alb/ Kg/ % of burn over 24 hr (0.3 X12X 45 = 162 ml)8/19/2012 CME,Pune 86
  87. 87. Match the following antidotes• Paracetamol Atropine/PAM• Dhatura BAL• Cyanide myl Nitrite• Mercury Physostigmine• OP N- Acetylcysteine• INH Naloxone hydrochloride• Opiods Pyridoxine8/19/2012 CME,Pune 87
  88. 88. Answers• Paracetamol N- Acetylcysteine• Dhatura Physostigmine• Cyanide Amyl Nitrite• Mercury BAL• OP Atropine/PAM• INH Pyridoxine• Opiods Naloxone hydrochloride8/19/2012 CME,Pune 88
  89. 89. Nutrition / Growth / Development8/19/2012 CME,Pune 89
  90. 90. Arrange following food items in descending order of calories content• 1 cup Tea• 1 TSF Sugar• 1 glass milk ( 200 ml)• 1 cup Cooked Rice• 1 egg• 1 TSF Ghee/ Butter• 1 TSF cooked dal8/19/2012 CME,Pune 90
  91. 91. • 1 cup Cooked Rice 175• 1 glass milk ( 200 ml) 120• 1 egg 80• 1 cup Tea 60• 1 TSF Ghee/ Butter 36• 1 TSF Sugar 20• 1 TSF cooked dal 10 8/19/2012 CME,Pune 91
  92. 92. Station Write average age of attainment in months for following milestone• Brings hands together in midline (1/2)• Builds tower of 6 cubes (1/2)• Follows one step command without gesture (1/2)• Speaks 10-15 words (1/2)• Stares at own hand (1/2)• Pretend play with doll (1/2) 8/19/2012 CME,Pune 92
  93. 93. • Answer• Brings hands together in midline -3• Builds tower of 6 cubes-22• Follows one step command without gesture-10• Speaks 10-15 words-18• Stares at own hand-4• Pretend play with doll-17 8/19/2012 CME,Pune 93
  94. 94. Write down the age at which following reflex appears• Palmer grasp• Rooting reflex• Moro reflex• Tonic neck reflex• Parachute reflex8/19/2012 CME,Pune 94
  95. 95. Answers• Palmer grasp 28 Wks• Rooting reflex 32 Wks• Moro reflex 28-32 Wks• Tonic neck reflex 35 Wks• Parachute reflex 7-8 months8/19/2012 CME,Pune 95
  96. 96. Genetics8/19/2012 CME,Pune 96
  97. 97. • What you should Know• Pedigree, Mechanism of inheritance• Example, Symbols, clinical photo• Associated anomalies• Karyotype, features, T/t 8/19/2012 CME,Pune 97
  98. 98. 1.Identify patter of inheritance2.What is the characteristic feature of this inheritance3.Give 2 examples4.In this disorder which organs are most affected 8/19/2012 CME,Pune 98
  99. 99. 1. A mitochondrial inheritance pedigree2 All the children of an affected female but none of the children of an affected male will inherit the disease.3.MERRFand MELAS4. Organ with greater energy requirement like brain, muscle and heart, liver 8/19/2012 CME,Pune 99
  100. 100. A neonate in LR with characteristic crying8/19/2012 CME,Pune 100
  101. 101. • What is the diagnosis• What is the defect• What is commonest presentation ?• What cardiac lesion can be seen with this?• What facial feature can be seen with this?8/19/2012 CME,Pune 101
  102. 102. Answers• Cri Du Chat syndrome• Micro deletion of short arm of chr, 5• Cat like cry ( hypotonic, SS, microcephaly)• VSD, ASD,PDA• Microcephaly, moon like face, hypertelorisum, epicantal fold, wide flat nasal bridge8/19/2012 CME,Pune 102
  103. 103. • Video / audio / Figures8/19/2012 CME,Pune 103
  104. 104. • Video of procedure , NRP• Audio heart sound• Figures- diagrammatic presentation of murmur, type of respiration, ophthalmic findings8/19/2012 CME,Pune 104
  105. 105. During intubation which is the correct position8/19/2012 CME,Pune 105
  106. 106. 8/19/2012 CME,Pune 106
  107. 107. What is the score is called ? What are uses ?8/19/2012 CME,Pune 107
  108. 108. • Silverman anderson score• Asses respiratory distress in newborn8/19/2012 CME,Pune 108
  109. 109. A 4 day old newborn delivered by LSCS with resiratory distress admitted in nicu brought with icterus, on evaluation s. bilirubin was 16.5. what ur plan of tretment8/19/2012 CME,Pune 109
  110. 110. Start PT8/19/2012 CME,Pune 110
  111. 111. Plot hight weight of the child and interpret age 4 yrs , Ht-100 cm, Wt-158/19/2012 CME,Pune 111
  112. 112. 8/19/2012 CME,Pune 112
  113. 113. Best of Luck Thank You8/19/2012 CME,Pune 113

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