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This document summarizes the stations and tasks involved in an OSCE (Objective Structured Clinical Examination) in pediatrics. It describes the history taking, physical exam, counseling, and diagnostic skills that would be evaluated at each station, including assessing a child with cough and wheezing, examining respiratory system, counseling parents of a child with asthma, evaluating lung anatomy and function, interpreting tests, and diagnosing and managing various respiratory conditions.
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- 2. Station 1 –history taking • 8 month old infant presents with history of cough and wheezing dnbpaediatrics.blogspot.in
- 3. • Introduce yourself •Onset – acute / subacute Duration – hours / days • Progress – better / worst / same • Accompanying symptoms – fever, cold, vomiting, skin rash, failure to thrive • Past history of similar episode • Feeding, growth, well being, immunisation • Birth history • Family history of atopy / contact with viral inf • Drug history – relief if anydnbpaediatrics.blogspot.in
- 4. Station 2 –physical exam • Examine respiratory system of this child dnbpaediatrics.blogspot.in
- 5. • Introduce yourselfand take permission from mother or child • Undress the child • Examine from foot end or head end for respiration • Palpate for tracheal deviation • Percuss gently and follow rules of percussiion dnbpaediatrics.blogspot.in
- 6. Station 3 –counseling • 3 year old child has been diagnosed as asthma – counsel the parents dnbpaediatrics.blogspot.in
- 7. • Introduce yourselfand find out what language they would feel comfortable • Describe in lay language about asthma • Emphasise no one to blame and not to worry • Tell them that it can be controlled • Discuss preventive measures and drug therapy • Inform advantages and safety of inhaled therapy over oral medications • Insist on diary record and periodic follow-up • Explain end point of response and anticipated period of time / end with “any questions?”/ thanks dnbpaediatrics.blogspot.in
- 8. Station 4 • Drawsurface anatomy of lungs • Name all segments of left lung dnbpaediatrics.blogspot.in
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- 10. • Left upperlobe – apical, anterior, posterior • Lingula – superior lingula, inferior lingula • Lower lobe – apical,anterior, posterior, lateral dnbpaediatrics.blogspot.in
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- 12. • What isthe approximate normal value of PEFR in a child whose height is 120 cms dnbpaediatrics.blogspot.in
- 13. • 200 litres •Formula to be used PEFR in litres = (height in cms –80) x 5 dnbpaediatrics.blogspot.in
- 14. Station 6 • Whatare different types of devices used for inhalation therapy? • What is the advantage of a spacer? • Describe maintenance of spacer dnbpaediatrics.blogspot.in
- 15. • MDI withspacer, DPI, nebuliser • Advantage of a spacer – no respiratory coordination necessary / better deposition of drug / no pharyngeal deposition of drug thereby reducing chance of oropharyngeal candidiasis and hoarseness of voice • Wash with mild soap and water – drip dry dnbpaediatrics.blogspot.in
- 16. Station 7 • Incase of need for oxygen therapy, attempts must be made to decrease oxygen consumption. Name maneuvers to decrease oxygen consumption dnbpaediatrics.blogspot.in
- 17. • Control fever •Adequate humidification • Proper positioning • Open airway • Clear secretions • Alleviate anxiety – child in mother’s lap dnbpaediatrics.blogspot.in
- 18. Station 8 • Whatis low flow and high flow system of oxygen delivery? • Give examples of low flow and high flow system dnbpaediatrics.blogspot.in
- 19. • Low flow< pt’s inspiratory flow achieves low oxygen concentration Low flow systems – face mask, nasal canula • High flow is adequate or > pt’s inspiratory flow achieves high oxygen concentration non-breathing mask - face mask and reservoir bag with valve, oxygen hood, venturi mask offers fixed FiO2 delivery dnbpaediatrics.blogspot.in
- 20. Station 9 • Definefollowing terms in relation to TB Relapse Defaulter Lost to treatment Treatment failure • What treatment for each of them? dnbpaediatrics.blogspot.in
- 21. • Relapse –signs and symptoms reappearing within 2 years of completion of ATT • Defaulter – one who discontinues treatment for > 1 week • Lost to treatment – one who defaults for > 1 month • Treatment failure – no response or deterioration after 12 weeks of intensive therapy • Category 2 of RNTCP 2SHRZE / 1HRZE / 5HRE dnbpaediatrics.blogspot.in
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- 23. • Identify thecondition • Name three salient features • Name type of inheritance • What is the prognosis? dnbpaediatrics.blogspot.in
- 24. • Ataxia-talengectesia • Recurrentsino-pulmonary infections, ataxia, immune deficiency, malignancy • Autosomal recessive • Poor – death due to chronic respiratory failure by second decade dnbpaediatrics.blogspot.in
- 25. What are thetwo most important abnormalities present? • This healthy child presented with increasing breathlessness over 12 hours. Name probable diagnosis dnbpaediatrics.blogspot.in
- 26. • Left pleuraleffusion and mediastinal shift • Acute allergic pleural effusion of TB or traumatic hemorrhagic effusion dnbpaediatrics.blogspot.in
- 27. Station 12 • Namebiochemical criteria for exudative pleural fluid dnbpaediatrics.blogspot.in
- 28. • pH <7.2 • Pleural fluid > 3 gm/l • Pleural LDH > 200 IU/l or Pleural fluid / serum LDH > 0.6 Pleural fluid / serum protein > 0.5 dnbpaediatrics.blogspot.in
- 29. Station 13 • Howdo you manage pleural effusion accompanying acute pneumonia? dnbpaediatrics.blogspot.in
- 30. • Uncomplicated para-pneumoniceffusion – chest x-ray lateral decubitus < 10 mm fluid – antibiotics only • Complicated effusion – chest x-ray lateral decubitus - > 10 mm fluid / pH >7.2 / glucose > 40 / protein < 3 gm/l – antibiotic + thoracocentesis • Complicated effusion – chest x-ray lateral decubitus > 10 mm fluid / pH < 7.2 / glucose < 40 / protein > 3 gm/l – antibiotic + tube drainage • Multiple loculations – VAT / decortication dnbpaediatrics.blogspot.in
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- 32. • Multiple fractures •Bilateral pneumothorax • Air in soft tissue • Scoliosis dnbpaediatrics.blogspot.in
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- 34. • This 7year old child was diagnosed as acute pneumonia on the basis of clinical profile, neutrophilic leucocytosis and chest x-ray – was treated with IV Ceftriaxone • 4 days later, as fever continued, repeat CBC and chest x-ray were ordered • What is the problem? dnbpaediatrics.blogspot.in
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- 36. • Immune mediatedinflammatory disease Wagner’s granulomatosis dnbpaediatrics.blogspot.in
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- 39. • What isthe problem? • How do you treat? dnbpaediatrics.blogspot.in
- 40. • Paradoxical immuneresponse • Continue same ATT – in case of acute symptoms such as breathlessness, consider oral steroids dnbpaediatrics.blogspot.in
- 41. Station 17 • Whatconcentration of PPD is ideal for Mantoux test? • How do you measure test result? • How do you interpret test result? • What is the effect of BCG vaccine on Mt test? dnbpaediatrics.blogspot.in
- 42. • PPD 1TU RT 23 with Tween 80 as a preservative or PPD 2 TU without Tween 80 – PPD 5TU may be an acceptable though inferior alternative • Ball point method of measuring induration • Induration > 10 mm is considered +ve indicative of natural infection • Previous BCG vaccine has minimal to none influence on interpretation of Mantoux test dnbpaediatrics.blogspot.in