OSCE Pediatrics question and answers

1. OSCE QUESTION & ANSWERS –
APRIL 2022 – PART 3
Dr Gururaja MD,DNB(Paed)

2. Station-1
• Write the lobe and segment of Lung involved
shown in diagrams of chest physiotherapy (A )
to (K)

3. Station -1
• A. Upper lobe apical bronchus
• B. Upper lobe posterior bronchus left
• C. Upper lobe apical bronchus
• D. Middle lobe – right
• E. Lingula
• F. Upper lobe posterior bronchus right
• G. Lower lobe apical basal
• H. Lower lobe anterior basal
• I. Lower lobe posterior basal
• J. Lower lobe lateral basal
• K. Lower lobe medial basal

4. • Identify the chart
• Till what age can it be
used?
• Till what age do you use
corrected age?
• When to administer to
the high risk
newborn(at what age?)

5. Station 2
• DDST II
• 0-6 yrs
• 2 years
• Corrected age
4mo,6mo,1yr,
• Yerarly till 6 yrs

6. Station - 3
• 8 yr old girl brought with unsteady gait of 2 years
duration and progressive in nature. She also has
dysarthria, loss of proprioception. She has no DTR
with upgoing Babinski reflex B/L. She also has
scoliosis and on insulin treatment for diabetes.
• Name the disease?
• What is the genetic defect?
• What is the most common cause of death in such
cases?

7. Station 3

8. Station - 4
• A 9 month old infant being fed a
complimentary feed for the first time. He was
crying while mother was trying to feed the
semisolid diet. He suddenly vomited and
became unresponsive.
• Is this anaphylaxis?
• Specific management?

9. Station - 4
• Abrupt onset
• Cow milk protein induced, peanut, egg protein, wheat
• Epiephrine – 0.01 mg/kg – 1:1000
• i.m ---0.5mg max in adults, 0.3 mg in children
• Antihistamine(?)
• Steroids (late onset action)
• Iv saline bolus
• Recumbent position
• Salbutamol nebulisation
• Advanced airway
• Epinephrine infusion

10. Station - 5
• 2 yr old boy with lower limb
weakness and difficulty in walking
since last 2 weeks.
• Normal past and development
history
• Weight and length -60 th centile
• Irritable
• Oral cavity, skin -NAD
• Bones and joint -no swelling
• Screaming on touching the lower
limb
• Unable to walk with out assistance
• Neurological exmn –NAD
• Mention the findings of x –ray.
• Diagnosis
• Treatment

11. Station - 5
• Pseudoparalysis
• Scurvy
• 200 mg daily Vitamin C-
1 Month
• Dietary modifications

12. Station -6
• Study the arterial blood gas report and answer the
questions.
• pH– 7.343
• PaCO2 – 60
• PaO2 – 47.8
• HCO3 – 32
• Interpret the blood gas.
• What is the normal PaO2 level expected if a child is
breathing at room air with normal lungs?
• Above mentioned ABG was taken when patient was
inspiring 60% FiO2. Calculate AaDO2 assuming R as 1.

13. Station - 6
• Uncompensated respiratory acidosis
• 80-100 mmHg
• AaDO2 = PAO2-PaO2
• PAO2 = (760- 47)FiO2-PCO2/RQ
• = 713X 0.6 – 60
• = 367.8- 47.8 = 320

14. Station - 7
You are doing a study “ Is Zinc better than
racecadotril for diarrhoea” and results are like
this.
Zinc – improvement – 12
no improvement – 27
Racecadotril – improvement – 6
no improvement- 20
Calculate the relative risk.
What does it signify?

15. Station - 7
• RR = N(Exposed)/N(non exposed)
• 12/39 divided by 6/26 = 1.52
• It means that out come variable is more in
zinc group than in racecadotril group

16. Station - 8
• Mechanism of action
• Indications
• Dose
• Adverse effects

17. Station -8

18. Station - 8

19. Station - 9
• A 9 yr old boy presents with 6 month h/o worsening
cough and dyspnoea, associated with limiting physical
activity and weight loss. He has also had recurrent
fevers and was diagnosed with pneumonia based on
increased cough, haemoptysis and bilateral pulmonary
infiltrates on two occasions over past 6 months. He
was given inhaled steroids and bronchodilators with no
improvement. Work up for TB – Negative. No infectious
etiology proven. Past h/o skin rash and joint pain
elicited.
• What is diagnosis/DD
• How will you investigate this case?

20. Station -9
• Pulmonary vasculitis syndrome,MPA,HSP,SLE,GPA
• Lung – rich vascular network, antigen reach easily
• Large number active immune mediators
• Acute – immune complex
• Chronic – Cell mediated immunity alteration
• CBC, CRP, CT–Chest, BAL
• Ophthalmology evaluation for uveitis
• ANA, ANCA

21. Station -10
• 4 yr old boy
• 3 episodes of
pneumonia
• 2 episodes of ear
discharge
• absent tonsils
• Diagnosis?/DD
• Investigations
• Genetic defect

22. Station -10
• CHD
• Aspiartion syndromes
• Cystic fibrosis
• Anatomical defects
• X linked
agammaglobulinemia
• Reduced IgG,IgM,IgA
• Reduced B cells
• Btk gene mutation

23. Station 11
• 6 yr old girl
• Fever, seizures of 7 days
duration
• Altered sensorium
• Unable to stand or walk
• h/o URTI 15 days back
• Findings in MRI?
• Diagnosis/DD
• Important investigations
• Specific management

24. Station 11
• Diffuse poorly demarcated hyperintense lesions
in T2
• Thalamus and basal ganglia are involved
• ADEM
• DD- Pediatric MS –points against
• CSF – Oligoclonal bands, elevated protein
content, pleocytosis
• Vision assessment
• IV Methyl prednisolone

25. Station 12
• 16 old old boy born in a Guajarati
Jain family,
• h/o giddiness, easy fatigability,
vomiting and yellowish
discoloration eyes and fever of 2
weeks duration
• Severe pallor,
• Hb- 4, TLC – 2300, Platelets –
60,000, MCH -38, MCV – 110,
MCHC – 37, LDH – 3300, S Bil –
2.7
• Findings in PBS
• Diagnosis?
• Treatment?
• How do you explain jaundice and
raised LDH in this case?

26. Station 12
• Megaloblastic anaemia
• Hyper segmented neutrophil
• Macro-macro ovalocytes
• Vitamin – B12 with folic acid
• Ineffective erythropoiesis

27. Station - 13
• Mark is a 14 yr old child who is brought to your office
because of parental concerns about his development. His
mother describes a typical birth history with no significant
medical problem. she says that mark has always seems “a
little behind” other kids his age. His language is delayed
and he has trouble in making eye contact with no friends in
school. He has stereotyped behavior.
• Why this case is not Asperger syndrome?
• What is the typical genetic defect in Rett’s syndrome?
• What is role of Gluten free diet in a child with Autism?
• What is “Refrigerator mother” regarding etiology of
autism?

28. Station -13
• Language delay not present in Asperger
syndrome
• MECP2 gene defect
• No proven role
• Distant, over intellectual, unable to express
appropriate affect with an infant – not proven.

29. Station 14
• 2 yr old girl
• Weight – 5.5 kg
• Recurrent diarrhoea from 6 months of age
• Hospitalized multiple times
• IgM -2960, IgG – 34, Ig A- 11
• What is the diagnosis?
• What is the pathophysiology?
• What is the treatment?

30. Station 14
• Hyper IgM syndrome
• Ig G – (345-1236)
• IgA – (14-159)
• IgM – (43-259)
• Class switching defect
• B cells and T cells talk to each other through
CD40 and CD40L(activated T cells)---
• Ig M producing B cells -- ----Ig G producing B cells
• IvIg

31. Station - 15
• Ravi received 1nd dose of DPT on 25 Mar 2022
and reported for 2 nd dose on 19 April,
• Can he be offered the vaccine?
• A 4 month old Rahul brought with no BCG Scar.
• What does this mean?
• What if no scar?
• Do you advice BCG in a Mantoux is positive
healthy infant?

32. Station 15
• Minimal interval -4 weeks---no augmentation of
memory cells
• Second dose is invalid if interval is > 4 days before 4
weeks
• Antigen – effector cells , memory cells—primary
response---augmentation --- secondary cells
• Vaccine give sc, vaccine not efficacious
• If documented BCG vaccination – nothing need to be
done
• Wait till 6 months of age
• No, infant already sensitized.

33. Station 16
• An 8 month old male child brought with complaints of
dry scaly skin around the oral cavity and on palms
along with reddish tint of the hairs for the last 2
months. Lesions are increasing in severity since then.
He was exclusively breast fed up to 6 months of life,
now he is on cows milk. His weight is 6 kg (BW -3.2 kg)
and length is 68 cm. on examination he is found to
have conjunctivitis, blepharitis, glossitis and stomatitis.
• What is the most probable diagnosis?
• What is the mode of inheritance?
• What lab investigation will clinch the diagnosis?
• What treatment will you advise to this child?

34. Station 16
• Acrodermatitis enteropathica
• Autosomal recessive
• Plasma Zinc – low levels
• 25- 50 mg of zinc / day in 2-3 divided doses till
clinical improvement

35. Station 17
• What is the pattern of
inheritance?
• Name three conditions
with similar pattern of
inheritance.
• Draw a pedigree chart
showing parents with a
pair of identical twins

36. Station 17
• Autosomal dominant
• Neurofibromatosis
• Polycystic kidney
disease
• Marfans
• OI

37. Station 18
• 5 day old male
• neonate with
persistent
respiratory distress
• Diagnosis?
• Treatment?

38. Station 18
• Congenital lobar
emphysema
• Surgical

39. Station 19
• A 1- month old born to HIV positive parents at
term is on exclusive breast feeds and nevirapine
prophylaxis.
• Parents are anxious to know if the infant is
infected or not.
• Which is the preferred test and why?
• How long they should wait?
• Are repeat tests needed? If so,when?
• When can the baby be confirmed to be HIV
negative?

40. Station 19
• HIV DNA PCR at 6 weeks
• 98% Sensitive
• Two serial tests if confirmative
• Negative – followed up by antibody tests at 6,12
months
• If antibody test positive – DNA PCR will be sent
• At 18 months of age by a negative antibody test

41. Station 20
• Answer the following questions regarding
prevention of rheumatic fever – secondary
prophylaxis.
• What is the dose of Benzathine penicillin in a
10 kg child?
• What is the duration of prophylaxis in patients
with no proven carditis
• With mild MR
• With mitral valve replacement surgery

42. Station 20
• 6,00,000 units
• 5 yrs after last episode or until 18 yrs of age
which is ever is longer
• 10 yrs or till 25 yrs of age
• Life long
• ?till 40 yrs of age