dnb pediatrics osce set 2

D.N.B Workshop

Describe this CT Scan.

A. The CT scan above demonstrates the mass effect of the extra dural haematoma on the main structures of the brain.

B. Midline shift.

C. The ventricles show signs of being compressed.

A. Describe the CT findings.

B. Give DD

A. A large, inhomogenous mass is seen on the right side of the abdomen, compressing the right kidney posteriorly.

The mass did not appear to arise from the right adrenal gland or right kidney

B.B. DDDD1.Neuroblastoma2.Wilms tumor3.Lymphoma4.Soft tissue sarcoma5.Pheochromocytoma

A.Describe this X-ray B.Diagnosis

C. Management steps

A. Bowel loops in the chest cavity

B. Rt Sided Diaphragmatic Hernia

C. Management1. NG on drainage2. No bag and mask ventilation3. Intubation and ventilation till pt

stabilizes and the corrective surgery

Picture:

1

Identify the following

Chicken Pox

Picture:

2

Identify the following

Alopecia areata

Picture:

3

Identify the following

Mongolian SpotsMongolian Spots

Picture:

4

Identify the following

MiliaMilia

A 7 year old child post head injury :-

1. Opens eyes in response to voice

2. Utters inappropriate words

3. Localizes painful stimuli

Calculate the GCS ?

Part II

Eye Opening 3

+Verbal Response

3+

Motor Response 5

=========Answer 11

A. Describe the ECG

B. Identitify the condition

C. Treatment

A. Narrow complex tachycardia

B. SVTC. IV Adenosine /

Cardioversion

A. According to RNTCP write the treatment protocol for a case of treatment failure.

B. According to IAP write the treatment protocol for miliary TB

Answer:

2HRZE +1HRZE +5HRE

Answer:

2HRZE +7HR

Write down four differences between Supraglottic and tracheal obstruction

A Neonate 2 hrs of age has a

1.Respiratory rate of 75/min, 2.Requires more than 40%

oxygen, 3.Has moderate to severe

retractions, 4.Grunting audible with

stethetoscope 5.And decreased air entry.

Calculate the Downe’s score for this baby ?

1 + 2 + 2 + 1 + 1 = 7

A 4 hrs old neonate has arterial pO2 of 100, pCO2=30. He is on FiO2 of 0.4.

Calculate the a/ApO2 ratio?

RQ=1

A. ApO2= FiO2 (760-47) - PCO2/RQ

ApO2= 0.4(760-47)-30/1 =255

B. apO2/ApO2 = 100/ 255

= 0.39

Write down the details of Manning score

(Fetal biophysical profile score)

Components of the 30 minute Biophysical Profile ScoreComponents of the 30 minute Biophysical Profile Score

Component DefinitionFetal movements > 3 body or limb movements

Fetal tone One episode of active extension and flexion of the limbs; opening and closing of hand

Fetal breathing movements

>1 episode of >30 seconds in 30 minutes - Hiccups are considered breathing activity.

Amniotic fluid volume A single 2 cm x 2 cm pocket is considered adequate.

Non-stress test2 accelerations > 15 beats per minute of at least 15 seconds duration

Counsel the mother who has brought her 2 year old male child with the first episode of simple febrile convulsion.

-10 marks

Observer station

1) Wish the the mother and introduce yourself

2) Explain what a simple febrile and a complex febrile seizure is.

3) Ask for family history febrile convulsions

4) Ask for history of seizures5) Ask for history of neurodevelopment 6) Use of antipyretics7) Use of hydrotherapy8) Prophylaxis intermittent..antipyretics,

diazepam, clobazam9) Management of a seizure at home10)1% risk of future epilepsy

Newborn, Term , with MSAF, Weight 3.5 kg. This neonate is delivered limp. Manage.

-10 marks

Observer station

1. Wash hands, Ask for help of another staff

2. Intubate and suck out the meconium… can be done twice

3. Provide warmth

4. Dry, stimulate , reposition

5. Evaluate resp, HR, COLOR.

6. Provide Positive pressure ventilation

7. HR<60 Chest compressions

8. Administer epinephrine

9. Administer volume

10. Post resuscitation care

A.Organophosphate

B.Iron

C.Benzodiazepines

D.Cyanides

E.Copper

Write down antidotes for the following ?

A. Organophosphate------------Atropine,

Pralidoxime

B. Iron--------------------------------Desferrioxamine

C. Benzodiazepines---------------Flumazenil

D. Cyanides--------------------------Amyl nitrite

E. Copper-----------------------------Penicillamine

Demonstrate the examination of the 5th nerve ?

1.Corneal Reflex

2.Conjunctival Reflex

3.Sensory examination over scalp, cheek and mandible

4.Loss of pain over the ant 2/3rd of the tongue

5.Masseter and temporalis examination

6.Pterygoid muscle

A.Write common causes of leukocorea.

- 5 Marks

1. cataract

2. retinoblastoma

3. Pupillary membrane

4. Vitreous opacity

5. Retrolental fibroplasias

6. Retinal detachment

Interpret this ABG ?

Ph 7.14Pco2 54PO2 55HCO3 13BE –7

Uncompensated respiratory and metabolic acidosis with hypoxemia

Ph 7.14Pco2 54

PO2 55

HCO3 13

BE –7

Steps for Gram staining ?

- 5 marks

1. Make a slide of tissue or body fluid that is to be stained. Heat the slide for few seconds until it becomes hot to the touch so that bacteria are firmly mounted to the slide.

2. Add the primary stain crystal violet and incubate 1 minute.

3. Add Gram's iodine for 1 min. It is not a stain; it is a mordant. It doesn't give color directly to the bacteria but it fixes the crystal violet to the bacterial cell wall.

4. Wash with Decolorizer. If the bacteria is Gram-positive it will retain the primary stain. If it is Gram-negative it will lose the primary stain.

5. Add the secondary stain, safranin, and incubate 1 min, then wash with water for a maximum of 5 seconds. If the bacteria is Gram-positive then it will retain the primary stain and will not take the secondary stain. It will look black-violet in a pink background. If it is Gram-negative then it will lose the primary stain and take secondary stain making it pink-red.

A.Live bacteria, attenuated

B.Live virus attenuated

C.Viral subunit

D.Capsular polysaccharide

E.Toxoid

Write 1 example of each of the following ?

A. Live bacteria, attenuated… BCG, Ty21a

B. Live virus attenuated………OPV,MMR

C. Viral subunit…………………Hep B

D. Capsular polysaccharide… Hib, Meningo,

Pnemococal

E. Toxoid………………………… DT,TT

The following is a table which shows cigarette smoking and lung cancer ?

Calculate the relative risk ?

Cigarette smoking

Developed cancer Did not devlop cancer

Yes 70 6930

no 3 2997

1. RR= Incidence of disease in exposed/Incidence of disease in non exposed

2. Incidence of disease in exposed = 70/7000=10 per 1000

3. Incidence of disease in non exposed=3/3000= 1 per 1000

4. So RR=10/1= 10

A: Describe the PS

B:Management

A. Sickling is demonstrated on the PS

B. Treatmenta) Maintain adequate hydrationb) Avoid hypoxiac) Folic acid supplementsd) Blood transfusionse) BMTf) Hydroxy Urea

A. Describe the PS

B. Diagnosis

C. Inheritance

D. Treatment

A. Spheroidal cells seen…

B. Hereditary Spherocytosis

C. AD

D. Folic acid, Spleenectomy

Child admitted with sudden breathing problems . There was history of playing with marbles at the time of development of marbles. X-RAY done shows ?

A.Describe XRAY ( 2 marks )

B.Diagnosis ( 2 marks )

C.Treatment ( 1 mark )

A. X-Ray findings:- The right lung volume is increased and has

herniated across the mid-line. The left lung is compressed by the displaced

heart and mediastinum. The left lung remains airated and normal

bronchi are seen on that side. The right main bronchus cannot be traced from its origin.

B. Rt main bronchus partially obstructed by non opaque foreign body

C. Bronchoscopy and removal

4 year old boy with the following photo and CT.

A.Identify syndrome 2 marks

B.Describe the CT

2 marks

C.Mode of inheritance

1 mark

A.Sturge-Weber Syndrome

B.Axial nonenhanced CT scan shows left hemiatrophy of the cerebral cortex and typical gyral calcification

C.AD

http://groups.yahoo.com/group/PediatricsDNB/

oscepediatrics.blogspot.in/

Thanks……