Osce -neuro


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Osce -neuro

  1. 1. OSCE 1<br />NEURO(PAEDS)<br />
  2. 2. A 10 year old boy came with history of fever,chills and rigors,headache,vomiting and one episode of seizure.On physical examination,the patient was drowsy and has neck stiffness.Lumbar puncture was done.and the result of CSF analysis is as shown below.<br />CSF analysis<br />Appearance :cloudy/turbid<br />Mononuclear cells :30/mm3<br />Polymorph cells :200/mm3<br />Protein :1.5g/L<br />Glucose :<1/2 blood glucose<br />
  3. 3. What is the most likely diagnosis<br />BACTERIAL MENINGITIS<br />Typical history of meningitis in children<br />Symptoms precipitated by history of infection and complicated with neck stiffness<br />Other PE: Kernig’s sign, Brudzinki sign<br />What is the most common organism causing this type of pathology<br />Virus:enterovirus-coxsackieviruses<br />Fungi:cryptococcus<br />Bacteria:depends on the age<br />< 3/12 : GBS,e.coli,<br />1/12-6 years:streppneumoniae,H.influenza,Neisseriameningitidis<br />>6 years: Neisseriameningitidis,H.influenza<br />
  4. 4. How to differentiate it from other types<br />
  5. 5. Outline the management of this patient <br />Supportive<br /><ul><li>Monitor vital signs
  6. 6. Stict I/O chart
  7. 7. Complication of SIADH
  8. 8. Fit chart
  9. 9. Fluid maintenance  if a/w SIADH,2/3 maintenance/24 hours only
  10. 10. Daily CNS assessment</li></ul>Therapeutic<br /><ul><li>Antibiotics:
  11. 11. Ampicillin + ceftriaxone/cefotaxime
  12. 12. Steroid –dexamethasone
  13. 13. Prevent hearing deafness
  14. 14. Antiviral-aciclovir
  15. 15. Herpes simplex encephalitis</li></li></ul><li>Complications<br />Early<br />SIADH<br />Seizure-infarction<br />Abscess<br />Late<br />Hearing loss<br />Learning disabilities<br />Mental retardation<br />Visual impairment<br />Hydrocephalus <br />
  16. 16. Describe the skill assessed<br /><ul><li>Fine motor activity</li></ul>Pincer grip as patiemt use his thumb and the 2nd fingers to pick the stuff<br />Pincer grip<br />Mature<br />Immature <br />
  17. 17. What is the developmental age<br />10 months<br />Name another group of motor skills of that age<br />Gross motor activity<br />Sit without support<br />Stand with support<br />Name 2 conditions with defect in that skill (c )<br />Cerebral palsy<br />Congenital myopathy- Duschen<br />Spinal cord lesion<br />