slides of objective structured clinical examination in pediatrics

1. OSCE QUESTIONS AND
ANSWERS-APR 2022-PART 2
Dr Gururaja R
MD,DNB

2. Station -1
• Diagnosis?
• Write 4 imporntant
causes in infants
• How do you screen for
this condition during
bedside examination of a
neonate?
• Name the important
complication in case of no
treatment or delayed
treatment

3. Station - 1
• Congenital cataract
• Trisomy syndromes
• Lowe syndrome
• Congenital rubella
• Alport syndrome
• Galactosemia
• Exaination of red reflex with ophthalmoscope
• Amblyopia

4. Station - 2
• mention the abnormalities
seen in the picture?
• Mention the syndrome
• Mention the genetic defect

5. Station 2
• Polydactyly, hypogonadism,obesity
• Retinitis pigmentosa
• Bordet-Biedel syndrome (Laurence –Moon-
Biedel syndrome)
• Autosomal recessive – 16q13,11q13

6. Station - 3
• Diagnosis?
• Medical management
• Curative treatment

7. Station - 3
• Osteopetrosis
• Calcitriol
• Human Interferon beta
• Bone marrow transplantation

9. Station - 4

10. Station - 5
• Mention the important
findings in this
neuroimaging
• Diagnosis?
• What is the clinical
presentation in this
child?

11. Station -5
• Aplasia of the vermis
• Cystic enlargement of the fourth ventricle
• Dandy Walker syndrome
• Hydrocephalus
• Rounded protuberance or exaggeration of
cranial occiput

12. Station - 6
• 4 yr old boy referred for evaluation of short stature. He
has crowding of teeth, depressed nasal bridge, obesity,
micropenis and undescended testis. His bone age is
less than 2 years. US:LS – 1:1.3. You plan for growth
hormone study after ruling out other causes.
• What are the methods of growth hormone testing?
• Why should we stimulate the secretion of growth
hormone?
• Which is the most preferred method?
• What are the pre requisites of growth hormone
testing?

13. Station - 6
• Clonidine/insulin hypoglycemia/glucagon
• Growth hormone secreted in pulses
• We may miss the pulse
• clonidine
• Euthyroid state (T4/FT4 and TSH not just TSH as
we miss central hypothyroidism
• Priming with sex steroids if the child is in pubertal
age
• Two basal samples at 30 minute intervals before
stimulation

14. Station - 7
• In this trace of jugular
venous pulse write the
cause of different waves

15. Station - 7
• a – wave is due to right atrial contraction
• x –wave is due to downward displacement of
tricuspid valve during ventricular systole
• c-wave retrograde transmission of positive wave
produced by bulging of tricuspid valve in to right
atrium
• v – wave is due to right atrial filling with tricuspid
valve closed
• y- wave is due to opening of tricuspid valve and
subsequent rapid flow of blood from right atrium
to right ventricle

16. Station 8
• important Finding in x-
ray
• Diagnosis?
• List 2 important clinical
features
• Important
investigations

17. Station - 8
• Deposition of calcium in skin –dense calcium
nodules
• Calcinosis Cutis – part of juvenile
dermatomyositis
• Late complication of juvenile dermatomyositis
• Muscle weakness – proximal
• Grottons papules
• CRP,ESR,CPK,ANA,EMG,Anti-Mi-2, Anti-Jo-1

18. Station 9
• Diagnosis/DD
• Mention at least 2
etiological factors
• Important clinical
features
• Mention at least 2 poor
prognostic markers

19. Station - 9
• Medulloblastoma
• Medulloepithelioma
• Anaplastic ependydoma
• Sporadic
• Loss of chromosome 17p
• Myc amplification
• Features of raised ICT, Ataxia, Hydrocephalus
• Age<3 yrs, metastasis, anaplastic type, myc
amplification

20. Station 10
• Diagnosis?
• Write 2 etiological
factors in children
• Important 2 clinical
features
• Definitive management
step

21. Station -10
• Complete heart block
• Congenital-SLE, Congenital heart disease
(operated), myocarditis, electrolyte imbalance
• Bradycardia, heart failure, syncope, sudden
death
• Pacemaker

22. Station -11
• 16 yr old boy brought to
emergency room by
parents
• What is your clinical
impression?
• Management

23. Station -11
• Self inflicted wounds
• Wound management
• Counselling

24. Station -12
• VVM- Vaccine Vial Monitor
• What does VVM indicate?
• What does site of VVM
indicate?
• What are the limitations ?
• What is the difference
between VVM in OPV and
Hepatitis B?

25. Station -12

26. Station 12
• VVM does not indicate potency of vaccine
• Irreversible
• Cumulative time temperature indicator
• Open vial/multidose –body
• Freeze dried /single use - top

27. Station -13
• Identify the abnormality
in the smear
• Give 2 differential
diagnosis for this
condition
• Describe porter index

28. Station 13
• Basophilic stippling
• Thalassemia, Lead poisioning
• Porter index or desferal therapeutic index
• Mean daily dose of desferoxamine in mg/kg
divided by serum ferritin
• This is calculated in every 6 months in patients
receiving desferoxamine
• Porter index should not exceed 0.025 in order to
minimize sensorineuronal hearing loss

29. Station - 14
• 12 yr old boy is brought to the clinic with recurrent
cramps. On examination, his growth is normal. He is
normotensive and has no evidence of rickets. His lab
reports are as follows:
• Hb – 12.1g/dl, BUN 8 mg/dl, s creatinine 0.4mg/dl, s
sodium 141 meq/l, s potassium 2.5 meq/l, s chloride 90
meq/l, s magnesium 0.5 mmol/l, urinary chloride 35
meq/l, ph – 7.52, HCO3 – 30 meq/l
• What is the most probable diagnosis?
• What is the mode of inheritance?
• What is the treatment?

30. Station -14
• Gitelman’s syndrome
• Autosomal recessive
• Potassium and magnesium supplements

31. Station 15
• What is dermatoglyphics?
• What are ulnar loops and what is its
significance?
• What is triradius and where it is formed?
• What is normal “atd”angle? What happens to
the angle in down syndrome?
• What is sydney line and kennedy crease?

32. Station 15
• Dermatoglyphics are configuration formed by
fine ridges on palmar surface of hands and
fingures
• Ulnar loop is formed by ridges entering and
leaving the skin surface over the finger tip on
the ulnar side

33. Station 15

34. Station 15

35. Station 15

36. Station 16
• What is this plot used for?
• Explain the plot

37. Station 16
• Used to display a statistical
summary of a variable :
median, quartiles, range and
extreme values
• The central box represents the
values from the lower to
upper quartile (25 to 75
centile)
• The midline refers to median
• The horizontal line extends
from minimum to maximum
value, excluding outside and
far out values which are
displayed as separate points.

38. Station 17
• Name this device
• What would be the
approximate normal
value of PEFR of a
subject standing 120
cm tall
• What does spirometer
measure

39. Station 17
• Peak flow meter
• 200 litres/min
• Formula for approximate normal PEFR for a
given height:
• PEFR (L/Min) = (ht(cm) – 80) x 5.

40. Station 17

41. Station 18
• Name one species of probiotics used for
prevention of NEC
• What are the potential benefits of probiotic
use in preterm neonates?
• What may be potential problem with routine
use of probiotics?
• What are the relative contraindication for use
of probiotics?

42. Station 18
• Bifidobacteria and lactobacillus
• Reduced incidence of NEC
• Decreased mortality and early time to reach full
feeds
• Sepsis, lack of standardization of products
• Cross contamination within NICU with probiotic
strains
• Development of antibiotic resistance
• Malfunctioning gut, NEC, Sepsis, Ileus

43. Station 19
• Answer the following questions.
• A. Dextrose content of 1 litre of RL
• B. Na content of one ml of 3% NaCl
• C. Na content of 100 ml of 0.9% NaCl
• D. elemental Ca in 1 ml of 10% calcium
gluconate
• E. K content of 1 litre of Isolyte-P

44. Station -19
• A. zero
• B. 0.5 mEq
• C. 15.4 mEq
• D. 9 mg
• E. 20 mEq/L

45. Station 20
• What is shown in colour
window of echo?
• What is 2D view shown
known as?
• What is medical
management in this
scenario?

46. Station -20
• PDA
• Ductal view, tripod sign
• Indomethacin, Brufen, Paracetamol

47. •THANK YOU