This OSCE document describes 12 clinical spots or cases presented to a pediatric resident. For each spot, key details are provided such as the patient's history, examination findings, and any relevant investigations. The resident is asked to identify diagnoses, interpretations, treatment plans, and other clinical information. This OSCE evaluates the resident's ability to synthesize clinical data and demonstrate sound medical knowledge and reasoning for various common and important pediatric presentations.
Dnb pediatrics osce 2 for PGS in Southern Railway HospitalNibedita Mitra
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
Dnb pediatrics osce 2 for PGS in Southern Railway HospitalNibedita Mitra
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
SSPE, dr. amit vatkar, pediatric neurologistDr Amit Vatkar
Subacute sclerosing pan encephalitis (SSPE) also known as Dawson Disease, Dawson encephalitis, and measles encephalitis is a rare and chronic form of progressive brain inflammation caused by a persistent infection with measles virus.
In this presentaion i will a case a sspe and give u some information regarding daignosis and treatment
Diagnosis and Management of Special Populations 2010Dominick Maino
Diagnosis and Management of Special Populations presents the latest in the assessment and treatment of those with physical, cognitive, and behavioral abnormalities. Up to date information concerning the etiology, prevalence/incidence and physical/cognitive findings of individuals with developmental/acauired disabilities (Cerebral palsy, Down syndrome, Fragile X syndrome, autism, acquired/traumatic brain injury) will be discussed. New diagnostic and treatment techniques are reviewed. The eye care practitioner will be able to confidently provide eye and vision care for those with disability at the end of this presentation.
Blood Group Selection in Newborn Transfusion - Dr Padmesh - NeonatologyDr Padmesh Vadakepat
Before transfusing blood in a newborn, we have to understand the basic physiology and unique features of newborn blood groups. This presentation aims to simplify the same.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
2. Spot 1
10 yr old male
child presented
with multiple
cranial nerve
palsies of 2 wks
duration. MRI
done is shown
here
• Spot the diagnosis with type
• Views of picture A and B and what does
the MRI depicts
• Early important clinical clue for
hydrocephalus after 1st month of life
3. • Severe communicating hydrocephalus
• Contrast-enhanced axial (A) and coronal
(B) T1- weighted MR images depict
diffuse leptomeningeal enhancement in
the basal cistern. Strong enhancement
of the bilateral thickened third nerves
(arrowheads in A)
• Open squamo parietal suture beyond
first month of life
4. Spot 2
Prematurely (28 wks)
born SGA baby,
ventilated for 18 days,
hemodynamically was
unstable and had
neonatal seizures. USG
cranium done at 6 wks of
age is shown here…
• Name the investigation with view
• Spot the diagnosis with grade
• Significance of the diagnosis and
intervention
• Protective antenatal factors
5. • Sonogram cranium (coronal view)
showing cystic periventricular
leukomalacia
• Cystic Periventricular Leukomalacia,
Grade III (De Veries classification)
• C-PVL strongest indicator of cerebral
palsy, especially spastic diplegia so
palsy
early stimulation programme with
occupational therapy
• Antenatal steroids and Anemia
6. Spot 3
3 yr old male child from Utter
Pradesh admitted with high
grade fever x 4-5 days and
generalized seizures for 1 day.
There were (B/L)6th and 7th CN
palsy with dystonias. Similar
cases are being reported from
the same area. His most
important investigation is given
here….
Name of the investigation and identify the Spot
Main transmitter to man
Subclinical cases, what %
Preventive strategy
7. • T2-weighted MRI of the brain
showing Panda sign
• Female Culex mosquito (Culex
tritanirhynchus and Vishnui)
Vishnui
• 99% cases are sub clinical
• Vaccine in the inter epidemic
period and Fogging with
malathion sprayed in 3 km range
from the infected cases
8. Spot 4
EEG of a 60 hrs old
newborn who required
resuscitation at Birth
with a 5 minute APGAR
of 5. Child had seizures
in first 12 hrs of life
Identify the spot
Its significance
Name of the staging system other than Sarnat and Sarnat
and give its component
9. • EEG showing Burst Suppression
pattern
• It indicates serious outcome in HIE
patients
• Levene’s staging system (Mild,
Moderate and Severe)
– Consciousness
– Tone
– Seizures
– Sucking/Respiration
10. Spot 5
11 yrs old male child
admitted with slurring of
speech, ataxia and
dystonias. On inv.he found
to have renal tubular
acidosis and active rickets.
Give the most possible diagnosis
Pattern of inheritance
Most specific investigation
Specific treatment and advise to family
members
11. • Wilson disease with lenticular
degeneration
• Autosomal recessive
• Hepatic copper content (µg/gm dry wt. of
liver- it exceeds >250 µg/gm dry wt.)
• D-Penicillamine with Pyridoxine and Zinc
and all family members should be screen
with slit lamp examination
12. Spot 6 4 yrs old male child
brought with a history of
developmental delay. He
found to have mild
mental retardation and
Sensory neuropathy. He
is from low SE group
and his father is a
laborer. X-ray is shown
here…..
Most probable diagnosis
Treatment options
Indication for treatment
Urine investigation
13. • Lead posioning
• CaNa2EDTA (Calcium Versanate) and BAL
in symptomatic child
• If lead levels >45 µgm% (N <10 µgm%)
• Urine – Increased Zinc protoporphyrin
14. Spot 7 6 yrs old male child
presented with seizures,
delayed development, some
problem in vision and
fainting attack which are
not due to seizures. He had
myoclonic seizures during
the infancy. His only clinical
finding is given here
Possible diagnosis and spot the arrowed structure
Pattern of inheritance
Investigation you would ask for and what do you expect
One eye finding
Treatment of choice for seizures and its important ocular
S?E
15. • Tuberous Sclerosis, Ash leaf
Sclerosis
macule
• Autosomal Dominant trait
• CT head for subependymal nodes
• Retinal hamartoma
• Vigabatrin and loss of peripheral
vision
16. Spot 8
• Identify the Spot
• Main Uses
• Normal test indicates what?
17. • BERA- Brainstem Evoked
BERA
Response Audiometry
• Post meningitis/Bilirubin induced
neurotoxity
• Normal test – normal retro
cochlear nervous pathway
18. Spot 9
Six days after undergoing liver
transplantation, a 12 yr old patient's levels
of gamma-glutamyl transferase (GGT),
alkaline phosphatase, and bilirubin begin
to rise.
•Which is the most appropriate next step
in diagnosis?
•What if kidneys were transplanted and
BUN/Cr used to be increased and why?
19. • Ultrasound of biliary tract and Doppler studies of the
anastomosed vessels
• In all other solid organ transplants, deterioration of
function 5-6 days out would suggest an acute
rejection episode, and appropriate biopsies would
be done to confirm the diagnosis.
In the case of the liver, however, antigenic reactions
liver
are less common, whereas technical problems with
the biliary and vascular anastomosis are the most
common cause of early functional deterioration.
20. Spot 10
A 3-year old boy presented with FTT. The
child was apparently fine for the first
couple of years. He began to have
diarrhea with light colored stools. Although
stool examinations were performed, it was
unclear what the report is. The child was
placed on a high protein, high calorie diet
with vitamins and supplements. However,
he showed very little improvement over a
•Identify the spot
4 month period. Barium exam showed
"large dilated loops of hypotonic bowel"), •Best diagnostic
the child was admitted with a diagnosis of possibility
celiac disease. Stool examinations has
•Treatment ?
shown in the picture
21. • This image contains a Giardia lamblia
trophozoite
• Three stool examinations on altrenate
days detects around 90%
• Metronidazole is the treatment of
Choice x 5 days and Others are
Albendazole, Furazolidine
22. Spot 11
• A 13-year-old, obese boy complains of persistent knee pain
for several weeks. The family brings him in because he has
been limping. He sits in the examining table with the sole of
limping
the foot on the affected side pointing to the other leg.
Physical examination is normal for the knee, but shows
limited hip motion. As the hip is flexed, the leg goes into
motion
external rotation and cannot be rotated internally.
internally
Which of the following is the
most likely diagnosis?
23. • Slipped capital femoral epiphysis is an
orthopedic emergency.
– The clinical picture is classic: a chubby male
in his early teens who is limping and cannot
rotate his leg internally.
24. Spot 12
• A 14-year-old boy dives into the shallow end of a
swimming pool and hits his head against the
bottom. When he is rescued, he shows a complete
lack of neurologic function below the neck. He is
neck
still breathing on his own, but he cannot move or
own
feel his arms and legs. The paramedics carefully
legs
immobilize his neck for transportation to the
hospital, and they alert the emergency department
to his impending arrival.
– Once there, which treatment would most likely have an
immediate benefit for this patient? (other than ABC)
25. • There is some evidence that high-
dose corticosteroids administered as
soon as possible after the injury will
result in a better ultimate outcome
26. Spot 13
• 8 yrs old child resident of Delhi is admitted with
fever x 5-6 days, loss of appetite x 6 days and
hepato splenomegaly. His peripheral smear is
shown above
– Spot the picture (name the form of parasite)
– Name of the culture media
– Drugs used to treat resistant cases
27. • Kala Azar (LD bodies-Amastigote form,
form
non flagelated form)
• NNN media (Novy, MacNeil & Nicolle)
• AMB, Pentamidine, Aminosidine,
Miltefosine, Recombinant INF gamma,
Allopurinol and adjunct splenectomy
28. Spot 14
2 month old male, "fussy", diarrhea and vomiting;
flatulence. Breast-fed. He had Viral gastroenteritis
10 days previously. Before the infection, mother's
milk was well tolerated. Body weight within normal
limits. Moderately dehydrated. Urine shows
presence of reducing sugars. No reaction for
glucose. You make a diagnosis of lactose
intolerance and start him on reduced lactose diet..
• Indications for changing diet in case
of non or poor response
• What are diet A, B and C
29. • Indications
– Stool frequency >10 watery stool/day even
after 48 hrs of starting diet
– Return of the signs of dehydration any time
after staring diet
– Failure to establish wt,gain by 7th day of
dietary management
• Types of diet
– Diet A (reduced lactose)
– Diet B (lactose free)
– Diet C (Monosaccharide diet)
30. Spot 15
2 yr old male child presented with diarrhea of 3 wks
duration with failure to thrive. He was started with
nutrition rich feeds (Simyl-MCT drops, HMF
sachet and pedia sure) and antibiotics at a
sure
peripheral health center 7 fays back. Since then
diarrhoea has even increased and patient is
loosing weight. He was Moderately dehydrated at
admission. His daily stool output comes around
185 ml and his stool Na+ 42 mEq/L and K+ 3.8
mEq/L. Sister didn’t sent the stool pH and
mEq/L
reducing substance.
What is the diagnosis based on these investigations
Calculate the osmotic Gap
What is the treatment next
31. • Chronic diarrhoea (Secondary
lactose intolerance- Osmotic
diarrhoea)
diarrhoea
• Osmotic Gap : 290-(2 x Stool Na+K)
If Gap >100 its osmotic diarrhoea
• Remove the osmotic load from the
diet and stop feeding for 24 hrs and
then restart the lactose free diet
without adding any nutritional stuff