osce pediatrics dr.mehta hospital 2012

OSCE (PEDIATRICS)DR.MEHTA HOSPITAL, 2012.

OSCE 1

The goals to be achieved by the NRHM at national level include1.Infant mortality rate reduced to −−−− per 1000 live births2. Maternal mortality rate reduced to −−−per 1 lac live births3. Malaria mortality rate reduction to −−− by 20124. Dengue mortality rate reduction to −−− by 20125. Tuberculosis DOTS services maintain −− cure rate through

entire mission period6. Increasing utilisation of FRUs from <20% to −−7. Engaging −−− female ASHA in 10 states8. NRHM was launched in the year −− for a period of −− years9. NRHM is operational in the country with special focus on −−

states

OSCE 1The goals to be achieved by the NRHM at the National level include:a) Infant Mortality rate reduced to: 30 per 1000 live births (1)b) Maternal Mortality ratio reduced to: 100 per 1 lac live births (1)c) Malaria Mortality Rate reduction to: 10% by 2012 (HALF MARK EACH)d) Dengue Mortality Rate reduction to: 50% by 2012e) Tuberculosis DOTS services maintain 85% cure rate through entire mission

periodf) Increasing utilization of FRUs from <20 % to 75%g) Engaging 2,50,000 female ASHA in 10 statesh) NRHM was launched in the year 5th April 2005 for a period of seven (2005-

2012) yearsi) NRHM is operational in the whole country with special focus on eighteen

states.

OSCE 2

4 year old boy came with fever 10 days, cough and this clinical finding

OSCE 21. Describe the lesion2. What is the diagnosis?3. Causative organism ?4. Transmitted by5. Any 3 complications6. Two treatment forms

• Diagnosis: Eschar in scrub typhus• Lesion: Necrotic area, like the skin burn of cigarette butt,

but painless Erythematous rim, lymphadenopathy.• Orientia tsutsugamushi• Trombiculid mite• Complications: Meningoencephalitic, ARF, myocarditis, • Treatment: IV Azithromycin, Oral Doxycycline

• OSCE 2 ANS: ( 1 MARK EACH)

OSCE 3

Calorie and protein content of the following food items per 100 gram1. Rice2. Bengal gram3. Groundnut4. Fish5. Egg6. Dates7. Apple8.Almond

OSCE 3

Calorie and protein content of the following food items Rice 350 kcal 7g Bengal gram 360 kcal 17g Groundnut 560 kcal 25g Fish 80 kcal 6g Egg 80 kcal 6g Dates 317 kcal 2.5g Apple 59 kcal 0.2g Almond 655 kcal 20g (8 MARKS)

1.Diagnosis?2.Describe the lesion?3.Causes?- Two infections/ two drugs4. Management5. Name two complications

OSCE 4

OSCE 4

1. STEVEN JOHNSON SYNDROME2. Severe bullous lesions, target lesions, mucosal

involvement(eye,oral, genital)3. Mycoplasma & Herpes simplex Sulphonamides, Carbamazepine4. Antibiotics for secondary infection, topical steroids for eyes,saline

compresses for denuded skin,mouth washes IvIg and steroids in some cases5. Corneal ulcer, anterior uveitis, myocarditis, hepatitis, acute tubular necrosis, osteomyelitis

(1+1+2+1+1)

OSCE 5

3 yr old male child comes to PHC situated in an area with lowmalaria risk with fever1. What 3 questions you will ask as per IMNCI?2. Mention the 3 categories into which the child can be classified

into3. List the steps in the management if the child has meningeal

signs

OSCE 51. Duration of fever/ how long the fever? If more than 7 days, is it every day? History of measles in the last 3 months

2. Very severe febrile disease Malaria Fever- Malaria unlikely

3. Make blood smear and give first dose of im quinine First dose of iv or im chloramphenicol/amoxicillin Treatment to prevent low blood sugar First dose of paracetamol Refer urgently (2+2+2 MARK)

OSCE 6A 5 day old newborn male with history of oligo-hydramnios inthe antenatal period in the mother underwent MCU

1. Describe the MCU2.What is the absolute indication for MCU in newborn?3.What antenatal intervention would have helped this child?4. What are the chances of CKD in adolescence in this child?5. What are the surgical procedures possible ?

OSCE 6

1. MCU showing narrow anterior urethral stream, dilated posterior urethra, dilated and trabeculated bladder with diverticulae and secondary VUR

2. Suspected PUV3. Vesico amniotic shunting4. 20%-30% 5. Primary fulguration, vesicostomy and high

ureterostomy/ureterostomies(2+1+1+1+1)

OSCE 7

A 3 yr old child had ARF following bloody diarrhea and peripheral smear is done1.Read the smear2. Two Common conditions associated with this sort of smear?3.Diagnosis in this child? What are the types?4. What is the prognosis in this condition?5. What is the singular description of kidney biopsy?

OSCE 7

1. Peripheral blood smear showing many schistocytes and RBC fragments due to hemolysis, and relatively few platelets reflective of thrombocytopenia.

2. RBC fragmentation (Schistocytes) can be seen in HUS, TTP, DAVC, SLE, artificial cardiac valves, intracardiac patches and in hemolytic transfusion reaction

3. HUS – Typical (D+) and atypical (D-)4. Relatively good in typical with small percentage settling with

residual renal failure whereas in atypical most of them have recurrences with chances of progressing to ESRD

5. Thrombotic microangiopathy

(1+1+2+1+1)

OSCE 8

1. What is the effect of this drug on pulmonary blood flow?2. What will happen if it is used in a hypovolemic child?3. Predominant mechanism of action?4. Arrange alpha, beta1 & beta2 in order of reducing affinity.5. Advantage of this drug ?6. Dose range?

OSCE 8

1. Pulmonary vasodilatation and attenuates hypoxic vasoconstriction of pulmonary blood vessel2. Decrease in the cardiac output3. Beta 1 agonist4. Beta1> beta2>alpha5. No effect on HR, PVR & BP6. 1-20mcg/kg/min

1 mark each

OSCE 9

1. What is the abnormality?2. Ideal Lead for identifying abnormality3. What is Bazett formula? 4. Two drugs should be avoided?5. Two Associated syndromes?

OSCE 9

OSCE 9

1) Prolonged QT interval: Beginning of the QRS complex to the end of the T wave, of activation and recovery of the ventricular myocardium.

2) Ideal lead: LII, V1, V23) The Bazett formula is used to calculate the

QTc, as follows: QTc = QT/square root of the R-R interval

OSCE 9 CONTD.

4) Drugs (Direct) Terfenadine, Astemizole, Ketoconazole, EM(Indirect) by prolonging their metabolism

5) Syndromes associated: Romano Ward (AD), Jervell Lange Nielsen (AR, uncommon)

1 mark each answer,2 mark for last answer

OSCE 10

5 yr old brought with fall from a height Develops vomiting and GCS drops from 14/15 to 9/15

1.Describe the abnormality2. What is the diagnosis?3. Which is the commonest site and

vessel involved?4. What is the differential diagnosis

and how will you differentiate the two?

5. What is the management?

OSCE 10

1.High density biconvex shadow 2.Extradural hematoma3.Temporoparietal region,middle meningeal artery.MMA4. Subdural Haematoma. Subdural Haematoma is

crescent shaped5.Intubation due to sudden fall in GCS Urgent neurosurgical referral for craniotomy(1+1+2+1+1)

OSCE 11

IPV1. Dose and storage2. What is the seroconversion rate after 2 doses?3. Three antibiotics present in trace amounts in IPV which

contributes to allergic reactions?4. IAPCOI recommendation on IPV and schedule5. Absolute indication for IPV and what is the exception in the

schedule for that condition?6. IPV Vaccine recommendation for the child who completed

primary series of OPV?

OSCE 11

1. 0.5 ml 2-8 degree celsius2. 90 to 100 percent3. Streptomycin, Neomycin & Polymyxin (PNS)4. IAPCOI recommends IPV. 6,10,14 weeks and booster at one

and half years5. B cell immunodeficiency. Second booster dose at 5 years is

recommended.6. Two doses of IPV at 2 months interval.(1 mark for each)

OSCE 12

• 5yr female child brought with bleeding PV past 2 yrs, • hyperpigmented patch over neck, thelarche+,• X-ray bone age advanced, X-ray femur- ?#

1. What is your diagnosis ?

2. What are the components of this syndrome ?

3. Name two endocrine associations.

4. How will you treat

OSCE 12

OSCE 12

1. Mccune Albright syndrome2. Precocious puberty, polyostotic fibrous dysplasia and café au

lait spots.3. Hyperthyroidism, Cushings syndrome, Gigantism/

acromegaly ( GH producing adenomas & Thyroid follicular adenoma)

4. Aromatase inhibitors (Anastrazole, letrazole) and Antioestrogen(Tamoxifen)

(1 + 2 + 2 + 1)

OSCE 135months girl with developmental delay with breathlessnessNa 140 K 4.3 Cl 95 HCO3 5

OSCE 13

1. List the abnormalities in ABG2. Calculate the anion gap3. Two conditions with increased anion gap4. Two conditions with decreased anion gap

30

OSCE 13

1. Mixed Metabolic acidosis and hyperoxia2. 403. Diabetic ketoacidosis, Uraemia, Methanol,Propylene glycol,

IEM, lactic acidosis, ethylene glycol,salicylates4. Hypoalbuminemia, lithium toxicity

(1+ 1 + 2 + 2)

OSCE 14

OSCE 14

1.What is the diagnosis?2.Incidence ?3.If Antenatally detected what is the advise for the

mode of delivery? why?4.How will u manage after birth?5.What % is associated anomalies?6.Which condition closely resembles & how will u

differentiate ?

OSCE 141.omphalocele2.1 in 5,000 livebirths3.LSCS–when defect large>5cm,bcoz it prevent rupture of sac4.latex free products Continuous NG sump suctioning Warm saline soaked gauge Monitor temp&pH Antibiotics5.80% associated anomalies6.gastrochisis- no sac,immediate surgical evaluation,1 in 10,000

births,<5% associated anomalies

(1 mark for each point)

OSCE 157 Yr old child presented with bilateral sudden loss of vision, motor weakness and seizures following upper respiratory Infection. There is no significant family history. MRI finding of thechild is shown here

1.Describe the abnormality and diagnosis?2.Give a differential diagnosis3.How will you differentiate between the two?4.What is the CSF finding?5.What is the line of treatment?6.What is the prognosis?

OSCE 151. Large, patchy areas of subcortical and deep white matter hyperintensity in the

bilateral corona radiata s/o ADEM2. Multiple sclerosis3.ADEM MS B/L optic neuritis Unilateral < 10 yrs >10 yrs Prone for recurrences

4. Lymphocytic pleocytosis5.Intravenous methylprednisolone 30mg/kg/day for 3-5 days followed By oral prednisolone 1mg/kg/day for 10 days.6. 70 percent will recover without any residual disability in 6 months(1 mark for each point)

OSCE 16

10 month old child Santosh comes to emergency department withcomplaints of fever for 1 day followed by one episode of generalised tonic clonic seizures lasting for less than 2 min.Child is Developmentally appropriate for age with no neonatal issues or significant past history. How will you counsel the parents for this Condition?

OSCE 16

1. Introduces (1/2)2. Risk of recurrence and good long term prognosis3. Details first aid for seizures4. Discuss option for intermittent anticonvulsant prophylaxis or

advises the same5. There is no need for EEG6. Explain it is not due to intracranial infection7. It is different from epilepsy8. Do u have any doubts9. Thank you (1/2)1 mark for the other points

OSCE 17

WRITE APPROPRIATE TERMINOLOGIES IN SCREENING TEST1.Indicator measures actually what is supposed to measure?2.Measured indicator has same value if measured by different

people in similar circumstances?3.Indicator is sensitive to changes in situation concerned?4.Indicator reflects changes only in situation concerned?5.Indicator has ability to obtain data needed?

OSCE 17

1. Validity

2. Reliability/ Repeatability

3. Sensitivity

4. Specificity

5. Feasible

OSCE 18

1. What is this device?2. Indication?3. Contraindication?4. Limitation?5. Complication?

OSCE 18

1. What is this device? Laryngeal Mask Airway (1)2. Two Indications?

1. Routine airway in operating room, 2. In cases with difficult bag mask ventilation (0.5x2=1)

3. Contraindication? Severe airway obstruction (1)4. Two Limitations?

1. Dislodgement during transport, 2. minimizes but cannot prevent aspiration

5. Complication? Regurgitation and aspiration (2)

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