DNB pediatrics Osce for Post graduates in southern Railway Head Quarter Hospital. This includes a video Station. Click on the picture to play the video

1. DR. NIBEDITA MITRA
SOUTHERN RAILWAYS
DNB PEDIATRICS OSCE-2
For PGs at Southern Railway Head Quarter Hospital

2. OSCE STATION -1
1. Enumerate the clinical findings.
2. What is the diagnosis?
3. Enumerate the ocular manifestations
4. A. What is the cause of the ophthalmopathy
B. what is the risk factor for ophthalmopathy.
5. Treatment of choice in- a. Pediatric patients
b. Pregnant and lactating
woman
6. Name four conditions that may be assosciated.

3. OSCE STATION -1 ANSWER
1. Goitre , Exophthalmos. 2
2. Graves Disease 1
3. Exophthalmos, Lid lag ( Von graffe sign), Impairment of convergence(Mobius sign), retraction of
upper eyelids(Darlymple’s sign), Infrequent blinking(stellwag sign), decreased visual acuity , absent
creases in the forehead on superior gaze (Joffrey sign) 4
4 a.Antibodies against antigens shared by thyroid and the eye muscles. TSH receptors have been
identified in retroorbital fibroblasts, leads to synthesis of glycosaminoglycans and cytotoxic effect on
muscle cells.1
b. Smoking 1
5. a. Methimazole b. Propylthiouracil. 2
6. Type I Diabetes Mellitus, Addison Disease, Vitiligo, Pernicious Anaemia, Myasthenia gravis,
Alopecia Areata, Celiac Disease 4

4. 1. Identify the ECG changes.
2. Enumerate the toxins that can cause this changes.
3. Name the antidote and its dose.
OSCE- 2A

5. OSCE-2 AANSWER
1.Takycardia, wide QRS complex, prominent R waves in aVR 3
2.TCA, Diphenhydramine, Cocaine 3
3.Sodium bicarbonate, repeated bolus of 1-2meq/kg till QRS <110 msec
(2)

6. OSCE- 2B

7. OSCE-2B
This ECG is of a 10 years old girl diagnosed to have cyanotic congenital heart
disease on the 9th day of life. She was operated at 7 months of age and was then
lost to follow up. She has come now with recent increase of cyanosis and
symptoms.
1. What is the diagnosis?
2. Enumerate two ECG findings?
3. Name the surgery done.
4. What can be the cause of increasing surgery.

8. Answer-2B
1. Tricuspid Atresia
2. Tall P waves, Left axis deviation
3. Bidirectional Glenn shunt which has reduced the load on the left
ventricle.
4. Either VSD is becoming smaller or pulmonary outflow is becoming
narrower

9. Identify the following in stool microscopy-
1.
2.
3.
4.
5.
6.
7.
8.
OSCE- 3( A)

10. OSCE- 3 (A) ANSWER
1. Hook worm
2. Whipworm ( Trichuris Trichura)
3. Taenia egg
4. Entamoeba Histolytica cyst.
5. Giardia
6. Infertile Ascaris lumbricoides
7. Red blood cell
8. Schistosoma mansoni egg

11. 1. 2
3
4
5
Identify the following in Urine Microscopy-
1.
2.
3.
4.
5.
OSCE-3 (B)

12. ANSWER-3b
1. Granular cast
2. Calcium oxalate crystal
3. Hyaline cast
4. Uric acid crystal
5. Yeast cells

13. OSCE-4 (A)
10 years, Ravi has been bitten by a
street dog with open wound on the
face.
1. Classify the wound.
2. Write the steps of management.

14. OSCE- 4(B)
After going through his medical record
you see that he has received one course
of Rabies vaccine two years back.
How will you manage?

15. Answer 4 (A)
1.Class III bite 1
2.
Step 1.- thorough cleansing of the wound with soap and flushing under running
water for 10 minutes. 1
Step 2. irrigation with a virucidal agent such as 70% alcohol or povidone iodine. 1
Step 3. RIG should be infiltrated in and around the wound (HRIG-20U/Kg, ERIG-
40U/Kg) 1
Step 4. rabies vaccine post exposure prophylaxis 5 doses-days
0,3,7 ,14 and 28 days. 1

16. Answer 4(B)
Step 1 and 2 remains the same.
RIG not to be given if an individual has received Rabies Vaccination in
the past. 2
Two doses of Rabies vaccine on day 0 and day 3 to be given.1

17. 111 1
OSCE STATION-5
1.a.Identify the picture
1.b. Identify the view
2. Label 1. 2. 3. 4. 5. 6. 7. 8
2
3
4
5
6
7
8

18. Answer-5
1. A Ultrasonography Cranium .5
1.B Coronal view .5
2-
1. Interhemispheric fissure .5
2. Corpus Callosum .5
3. Septum pellucidum .5
4. Third Ventricle .5
5. Body of lateral ventricle .5
6. Caudate nucleus .5
7. Sylvian fissure .5
8. Thalamus .5

19. One and a half month old male child Nishanth developed inconsolable cry for 4
hours and fever of 40.5 º C one day after receiving DPT vaccine from a PHC.
a. Can he receive the second dose of DPT vaccine? (1)
b. Give reasons to substantiate your answer. (1)
c. Will you advice DTaP for the next dose and if so why? (1)
d. What are the absolute contraindications for DPT vaccine? (1)
e. Can DTaP be used if DTwP is contraindicated? (0.5)
f. Is progressive neurological disease a contraindication to DTwP? (0.5)
OSCE -6

20. a. Yes
b. Inconsolable cry for > 3 hours,
fever > 40.5 º C,
HHE within 48 hours and
seizures with or without fever within 72 hours of DTwP vaccine are considered as
precautions but not contraindications for future doses.
c. Yes if parents can afford,
as both minor and major side effects are less with DTaP
d. Anaphylaxis and
encephalopathy within 7 days of DTwP vaccine
e. No. Absolute contraindications are same for both
f. Progressive neurological illness is a relative contraindication for DTwP.
ANSWER-6

21. OSCE-7
1.Toxic dose of Acetaminophen- Acute----,Subacute---
2.Toxic dose of Iron ---
3. Toxic dose of Salicylates___
4. ______ is the most toxic β blocker.
5.Life threatening toxicity in toddlers can occur with _____ no.of
pills of opioid, and even if asymptomatic, they should be
hospitalised for ______ hours for monitoring.
6. In toddlers, ingestion of _____ sulfonylurea tablet can lead to
significant toxicity.
7.Alkalanization of urine is most useful in managing ____,
____,________ toxicity.

22. 1. Toxic dose of Acetaminophen- Acute—more than 200mg/kg--,Subcute-
90mg/kg/day for consecutive days-- 2
2. Toxic dose of Iron ---60mg/kg 0.5
3. Toxic dose of Salicylates__more than 150 mg/kg/_ 0.5
4. prpranolol______ is the most toxic β blocker. 0.5
5. Life threatening toxicity in toddlers can occur with __single___ no.of pills of
opioid, and even if asymptomatic, they should be hospitalised for 24______
hours for monitoring. 1
6. In toddlers, ingestion of _single____ sulfonylurea tablet can lead to
significant toxicity. 1
7.Alkalanization of urine is most useful in managing _salicylate,TCA,
barbiturate,betablockers ,methotrxate, toxicity. 3
ANSWER-7

23. 1.What is the diagnosis?
2.List one further
investigation to aid
diagnosis.
3. Name one syndrome
frequently associated.
4.What other anomalies
may be associated?
OSCE-8

24. 1. Hirschsprung disease 1
2. Rectal manometry and rectal suction biopsy are the most reliable
indicators. The
radiographic diagnosis is based on the presence of a transition
zone between normal dilated proximal colon and a small caliber
obstructed distal coon caused by the non relaxation of the
ganglionic bowel. 2
3. Down’s syndrome 1
4. Microcephaly, mental retardation, abnormal facies, with autism,
cleft palate, hydrocephalus and micrognathia 2
ANSWER- 8

25. 1. Identify the abnormality in RBC.
2. This child has chronic diarrhea. What is the diagnosis?
3. Which deficiency in this children is associated with neurological symptoms?
4. Which lipid abnormality is characteristic?
5. What is the fundus picture?
6. What is the mode of inheritance?
OSCE- 9

26. 1. Acanthocytosis. 1
2. A-Betalipoproteinemia 1
3. Vit E 1
4. Decreased cholestrol, decreased triglycerides, absent betalipoprteins 3
5. Retinitis pigmentosa 1
6. Autosomal recessive 1
ANSWER- 9

27. OSCE -10 (A)
Consider the following list of research techniques:
A. Cross sectional study
B. Cohort study
C. Randomized control trial
D. Case control study
E. Case series
F. Case report
1. Arrange the study design from strong to
weak according to relative strength of
evidence
2. Select ONE answer for each situation:
a) Evaluation of a new drug in comparison
with an existing one
b) Calculation of prevalence
c)Estimation of incidence
d)Calculation of relative risk of a disease
related to risk factors
e) The study of cause in a rare disease
f) Establishing a temporal sequence

28. OSCE- 10 (A)
2 a) C : RCT
b) A : Cross sectional study
c) B : Cohort study
d) B : Cohort Study
e) D : Case control study
f) B: Cohort study
• Randomised Clinial Trial
• Cohort Study
• Case control Study
• Cross sectional study
• Case series
• Case Report
Marks .5 each

29. OSCE -10(B)
• Enumerate four search engines for literature search

30. OSCE-10 (b)
• PUBMED
• Embase
• Cochrane central register of controlled trials
• Regional/national data base: Ind med, WHO
• General search engines : Google scholar, TRIP
Total marks-4

31. OSCE- 11
1. What is the diagnosis?
2. What are the characteristic features of the
disease
3. What is the treatment
4. What is the long term sequeale?

32. ANSWER -II
1. Infantile Tremor Syndrome
2. Classical features are- Mental and Psychomotor regression, - Pallor
- pigmentary changes in hair and skin , - tremors
3. Treatment is nutritional Support. Vitamin B 12 injection, Iron, Calcium and Magnesium
supplement.
Propranolol for Tremors
4. Suboptimal intelligence is the only long term sequeale

33. Staion 12
•What is the diagnosis?(1/2)
• 4 diagnostic radiological findings
(2)
• Risk of recurrence(1/2)
•5 complications (2)

34. Answer-1
•Achondroplasia
•X-ray findings-
-Inter pedicular distance decreases from L1 to L5
- iliac bones are short and round
- acetabular roofs are flat
-tubular bones are short
-flaring of metaphysis
- fibula longer than tibia
•Complications- hydrocephalus, spinal stenosis at foramen magnum and lumbar
spine, quadriparesis, bowel and bladder, dental, hearing
• mutation, autosomal dominant

35. Staion 13
What is the diagnosis? (1/2)
Describe 4 diagnostic radiological finding.
(2)
Prevention .(2)
Treatment.(1/2)

36. Answer-3
• Congenital syphillis
•X-ray findings
- Periosteal new bone formation
-serrations at the distal metaphysis
-destructive foci at the medial aspect of prowimal tibial epiphysis (wimberger sign)
-epiphysis classically spared.
•Antenatal screening- non treponemal test, confirmation- treponemal test
•Treatment- crystalline penicillin for 10 days