slides of objective and structured clinical examination in pediatrics

1. OSCE ANSWERS
Dr Gururaja R
MD,DNB(Paed)

2. Station 1
Interpret the aEEG from (a) to (f)

3. Station 1
• (a) normal pattern
• (b) moderately abnormal- discontinuous
normal voltage
• © Burst suppression
• (d) severely abnormal
• (e) seizure activity
• (f) status epilepticus

4. Station-2
• X-ray of a newborn who
died immediately after
birth
• Parents are reluctant to
give consent for post
mortem investigation
• What is the likely
diagnosis?
• What investigations can
help in diagnosis?

5. Station -2
• Thanatotrophic dysplasia
• Genetic studies for mutations of FGFR3
located on chromosome 4p16.3

6. Station -3
• 12 yr old boy presented
with history of fever,
headache and generalized
tonic clonic seizures.
• His MRI scan as shown in
picture
• (a) most likely diagnosis?
• (b) how can you confirm
diagnosis?
• ©what is the treatment
of choice?

7. Station-3
• HSV Encephalitis
• CSF viral studies for HSV – DNA PCR
• IV Acyclovir – 20mg/kg – 8hrly

8. Station - 4
• What is the diagnosis?
• What is the name given
to this typical chest X-
ray presentation?
• What is the clinical
presentation of the
infant with this
diagnosis?

9. Station 4
• Supra cardiac type of TAPVD
• “Snow man sign”
• Cyanosis, CCF, Recurrent chest infections
• Pulmonary HTN

10. Station-5
• Write the complete
composition per 1g
sachet

11. Station - 5

12. Station 6
• Write 4 uses in
paediatric practice
• Dose in Nephrotic
syndrome
• Name 4 adverse effects
• Contraindications

13. Station - 6
• Steoid dependent and resistant Nephrotic
syndrome
• ITP
• SLE
• NHL
• Dose – 375 mg/M^2
• Back pain,oedema,chills,allergic rash
• Arrhythmia, ongoing infection, severe
immunocompromised state

14. Station - 7
• Comment about this
compound muscle action
potential recorded from
abductor pollicis brevis
following median nerve
stimulation(figure B)
• Diagnosis?
• Mention two other
diagnostic methods
• Mention at least three
treatment methods

15. Station - 7
• Progressive Reduction of action potentials
• Myasthinia Gravis
• Tensilon test, Serology (AchR antibodies)
• Pyridostigmine, Plasmapheresis, IvIg

16. Station - 8
• Jacob is 10 month old male
infant. He was born
weighing 4.2 kg and had an
uneventful perinatal period.
• What is the probable
diagnosis?
• What are the components
of this syndrome?
• Which chromosome carries
the gene responsible for
this disorder?
• What complications do you
expect in such a child?

17. Station – 8
• Beckwith Widemann syndrome
• Omphalocele,macroglossia,microcephaly,visce
romegaly,hemihypertrophy
• 11(11p15.5)
• Tumours –
wilms,hepatoblastoma,gonadoblastoma,adren
al carcinoma,rhabdomyosarcoma

18. Station - 9
• What is the schedule for polio vaccination for an
unimmunized 9 month old child with IPV?
• What is the recommendation for IPV in an
adolescent visiting a country with a polio
outbreak?
• What is your advise regarding typhoid conjugate
vaccine in a child previously taken typhoid
polysaccharide vaccine?
• What is New Rabies post exposure vaccination
schedule WHO-2018?

19. Station - 9
• 2 doses of IPV at 4 weeks interval
• Unimmunised – 0,1 and 6 months IPV
• Previuosly immunised – single booster dose
IPV
• TCV 25 mcg 4 weeks later
• 0,3,7 and 14 – NO 28 Day schedule

20. Station - 10
• Diagnosis?
• Complications?
• Mention the drug of
choice,route,dose and
duration
• One yr old male child
with high fever-15 days
off &on ,occasional loose
stools.
• O/E – Liver-4cm,spleen-
5cm,sick looking, BP
60/40, cervical lymph
nodes 0.5 x 0.5 cm
• Pallor +
• Hb-8,MCV-82,MCH
28,MCHC 29,WBC 2600,
P56 L39 M5,Platelets 1.1L

21. Station -10
• Severe malaria(Complicated Malaria)
• Cerebral oedema,DIC,AKI
• IV Artesunate
• 2.4 mg/kg – 0,12 and 24 hrs then daily till
patient can tolerate oral medications---ACT -
3days

22. Station -11
• CT of a 3 month old
breast fed infant who was
brought to hospital with
history of focal seizure
with no h/o trauma
• Most probable diagnosis
• How would you confirm
etiological diagnosis?
name 3 tests
• Mention any preventive
measure for this
condition

23. Station -11
• ICH with midline shift
• Late onset Vitamin K def
• Abnormal PT and APTT,raised PIVKA
• Vit K prophylaxis at birth

24. Station - 12
• A neonate admitted in NICU with persistent
pulmonary hypertension. He is on ventilator with
FiO2 100%,PIP 35,PEEP 6, MAP 14, and SpO2 85%
and he has following lab values(ABG)
• Ph – 7.22, PCO2 50, PO2 50, HC03 14, Na 136, k
4, Cl 103
• What is interpretation of ABG
• Calculate OI and OSI
• What are the indications of ECMO in terms of
(i)AaDO2 , (ii) OI

25. Station 12
• Mixed acidosis with hypoxemia
• 28 and 14
• (i) oxygen gradient >600 mm hg for 12 hrs
• (ii)OI>40

26. Station - 13
• Total population of children in an area -1300
• Protected against measles by vaccination – 800
• Total cases of measles in one year – 10
• Primary cases – 2
• No of susceptible children coming in contact of primary
cases -15
• Secondary cases that received infection from primary
cases with in the infective period – 8
• Calculate attack rate of measles
• Calculate secondary attack rate of measles

27. Station - 13
• No of cases/spell in a year//no at risk of
measles
• 10/(1300-800)=10/500 = 2%
• Secondary attack rate = secondary cases / no
of susceptible children coming in contact
• 8/15 = 53%

28. Station -14
• 14 yr old boy with giddiness and palpitation
• write characteristic ECG findings
• Diagnosis?
• Treatment

29. Station -14
• Short PR interval
• Slurring of upstroke of QRS complex
• WPW syndrome
• Beta –blockers
• Radiofrequency ablation

30. Station 15
• A 14 yr old boy is brought to Paediatric OPD with
concerns of delayed puberty. On examination he
has preadolescent male genitalia with scanty
axillary hairs, and few fine pubic hairs.
• What is tanner staging of this child?
• What is the first visible sign of puberty in males?
• At what tanner stage does a male child achieve
peak growth velocity?

31. Station - 15
• Stage 1-2
• Testicular enlargement
• Stage 3-4

32. Station - 16
• This 11 month old male child presented with pallor, dark
pigmentation of nail folds, loss of motor mile stones, lethargy and
coarse tremors
• What is your diagnosis?
• How will you manage this child?
• How will you treat tremors?

33. Station-16
• ITS
• VitB12,folic acid, other
multivitamins,iron,calcium
• Propranolol

34. Station - 17
• 4 month old infant
presented with stridor
and recurrent episodes
of wheeze since early
infantile period
• Diagnosis?
• Management?

35. Station -17
• Laryngeal haemangioma
• Steroids,Propranolol

36. Station - 18
42 day old male infant
Fever with seizures
Blindness
Infantile Spasms
Macrocephaly
CSF protein-rasied;20 lymphocytes
CSF ADA – raised
Diagnosis?
Treatment?

37. Station - 18
• Congenital Toxoplasmosis
• Sulfodoxine - Pyrimethamine

38. Station - 19
• A Mother is being counselled for prevention of
allergy. She wants to know which of the following
could be (A) food intolerance (B) food
hypersensitivity.
• i. Lactose intolerance
• Ii.Urticaria
• Iii.Heiner syndrome
• Iv.Celiac disease
• V.Irritable Bowel syndrome

39. Station - 19
• i.A
• Ii.B
• Iii.B
• Iv.B
• V.A

40. Station 20
• 4 yr old female child presented with gradually increasing
difficulty in breathing with cough and fever since past 10
hours. She had one episode of haemoptysis and 1-2
episodes of malena 24 hours back. on examination, she is
pale, HR- 162, RR 50. Examination of respiratory system
reveals bilateral wheezing. Examination of blood shows
microcytic hypochromic anaemia with reticulocytosis.
Serum iron was found to be low.
• What is the diagnosis?
• What is diagnostic investigation findings?
• Which cardiac condition resemble such symptomatology?

41. Station -20
• Pulmonary Haemosiderosis
• Bronchopulmonary lavage showing
haemosiderin laden macrophages
• Mitral stenosis