DNB

OSCE Pediatrics

1Q

1. 2. 3. 4.

Describe the findings in this photograph What is the nutritional status of this child What are the causes of abdominal distention in this child What are the life threatening emergencies associated with this condition

1A 1. Generalized wasting no edema alert 2. !arasmus 3. Worm infestation h"po#alemia $.%. peritonitis &or' disseminated tuberculosis 4. ("pogl"cemia ("po#alemia ("pothermia )ulminant sepsis

2Q 1. 2. 3. 4. W hat is the diagnosis $wo other congenital defects associated with this condition *ame four teratogenic drugs producing this defect +deal age for correcting this malformation

2A 1. ,left lip and palate 2. ,ongenital heart diseases h"poplasia or agenesis of th"mus and parath"roid h"poplasia of auricle. 3. -hen"toin carbamazepine prednisolone and alcohol. 4. .ip / 3 months -alate / 12 months

3Q An 0 "ear old bo" was brought to the hospital with shallow respiration and altered sensorium with a G,1 of 2312. $he pupils were 3 mm in size and sluggishl" reacting to light. (e had a histor" of accidental ingestion of pesticides 4 da"s ago and was treated at a pri5ate nursing home and sent home on da" 3. (e was as"mptomatic at home for the past 3 da"s. *ow he is brought with the abo5e s"mptoms. 1. 2. 3. 4. 3A 1. +ntermediate s"ndrome of 7-, poisoning &*euro to8ic' 2. Airwa" and breathing maintained b" 5entilator" support 9 ,irculation b" cr"stalloids colloids : +onotropes 9 -ralido8ime continuous infusion 1;;mg /2;;mg3(r 9 Antibiiotics to pre5ent sepsis. 3. ,holinestrase le5el < 1;= 5er" se5ere 1;= / 2;= 9 moderate 2;= / 3;= / !ild 4. Wrist drop foot drop : !uscle paral"sis What is the problem in this child %riefl" narrate the management *ame the blood in5estigation to confirm and prognosticate. *ame chronic se6uelae associated with this poisoning

4Q $he following food substances which contain >it.A need to be arrange d based on >itamin A content from high to low. -apa"a Gua5a Amaranth Drumstic# lea5es ?gg (uman mil# ,arrot 4A ,arrot Amaranth Drumstic# lea5es ?gg -apa"a (uman !il# Gua5a 114@ 212 3;; 14; 110 30 ;

2. Q 4 month old male infant brought to the emergenc" room for recurrent seizure since birth. %ab" was macrosomic and had macroglossia at birth and there is no maternal histor" of diabetes. During each episode of fits h"pogl"cemia was documented. 7ther base line in5estigations were found to be normal. 1. What is the diagnosis. *ame one s"ndrome associated with this. 2. What is the dose of glucose name the ne8t drug that "ou will use to treat h"pogl"cemia. 3. (ow will "ou confirm the diagnosis 4. *ame the Drugs used to treat this condition 2. A 1 1. ("pogl"cemia bec#with wiedman s"ndrome 2ml 3 #g 1;= de8trose intra5enous push followed b" 4 to 0 mg3#g3min maintenance of glucose. +f re6uirement of the glucose e8ceeds 12mg3#g3min thin# of h"perinsulinimic states. -robable diagnosis is recurrent 2. 3. ("pogl"cemia due to h"perinsulinism. ("drocortisone 1;mg3#g3da" -lasma insulin le5el. Diazo8ide stomatostatin and octreotide

4Q A )i5e9"ear9old female child was brought to the emergenc" department with a histor" of altered sensorium for 2 da"s and 5omiting since afternoon. $here was a histor" of fall 2 da"s bac#. )ather had prolonged bleeding following appendicectom". +n5estigation re5ealed A normal -rothrombin time. normal A-$$ normal $hrombin time and normal platelet count. 1. 2. 3. 4. 4. A 1. 2. 3. %leeding disorder probabl" factor 13 deficienc" now presenting with intracranial bleed )actor 13 assa" &urea clot l"sis' a. ,.$. 1can brain to rule out intracranial hemorrhage ))- transfusion 9 ,r"oprecipitate 9 )actor 13 concentrate b. *eurosurgical consultation to e5acuate intracranial haematoma 4. $rane8mic acid What is the probable diagnosis and what is the complicationA (ow will "ou confirm "our diagnosisA What is "our immediate managementA *ame the drug used to treat the minor complication

@Q A 40 hrs old term bab" was gi5en respirator" support following neonatal con5ulsions. (is A%G -( / @.4 -,o2 / 10 -72 / 214 %?991 (co3 / 1@.1

1. 2. 3.

What is "our diagnosisA What is the causeA (ow will "ou manageA

@.A 1. 2. 3. Bespirator" al#alosis ("per5entilation Beduce the 5entilator" settings -rimaril" 5entilator" rate

0Q A 3 "ear old bo" is brought to the emergenc" room with histor" of fe5er for one da" sudden onset of stridor and d"spnoea. 7n e8amination the bo" is to8ic an8ious febrile and has drooling of sali5a pulse rate 12;3minuteBespirator" rate 4;3minute

1' What is the diagnosisA 2' What is the causati5e organismA 3' What radiological sign in the D ra" nec# is obser5edA

0A 1. Acute epiglotitis 2. ( influenza 3. $humb sign

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CQ +n a -(, area of population of 3; ;;; the total births in the "ear 2;;2 was 212 of which 12 were stillbirths. 2; infants died in the same "ear of which 12 died in the first wee#s of life. 1' ,alculate infant mortalit" rate 2' *ame the state with lowest and highest infant mortalit" rate. 3' Write 3 cost effecti5e mechanism to bring down the infant mortalit" rate C. A 1. +nfant death E 2; *eonatal death E 12 $otal li5e birthE total birth9still birthE2;; +nfant mortalit" rate E *o. of infants who died in the "ear 8 1;;; $otal li5e births in the same "ear E 1;;31;;; li5e births 2. .owest mortalit" rate / Ferala (ighest mortalit" rate 9 %ihar 3. ?8clusi5e breast feeding F!, and immunization

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1;.Q *ational rural health mission &*B(!' 1. 2. 3. 4. 1;.A 1. $he goal of the mission is to impro5e the a5ailabilit" of and access to 6ualit" health care b" people especiall" for those residing in rural areas the poor women and children 2. $rain and enhance capacit" of -ancha"ati BaG +nstitutiosn to own control and manage public health ser5ices promote access to impro5ed health care at household le5el through a female health acti5ist &A1(A' (ealth plan for each 5illage through 5illage health committee of the pancha"at 3. A1(A is Accredited 1ocial (ealth Acti5ist / chosen to be accountable to pancha"at to act as the interface between the communit" and the public health s"stem 4. 1he will be honorar" 5olunteer recei5ing performance based compensation for promoting uni5ersal immunization referral and escort ser5ices for B,( construction of household toilets facilitate 5illage health plan and co / ordinate with the A*!Hs and Anganwadi wor#ers in all health acti5ities. What is the ultimate goal of *B(! What are its core strategies at the 5illage le5el Who is A1(A What is the role of A1(A at the ground le5el

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11Q 12 "rs old male child is brought with histor" of poor growth 1' Write two ob5ious abnormal ph"sical findings 2' What is the probable diagnosisA 3' Gi5e one differential diagnosis 4' What is the inheritance pattern of this condition and write 4 diseases with similar inheritanceA 2' !ention 4 abnormal radiological findings in these children 4' Write 2 neurological complications seen in these children

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11A 1' !acrocephal" Disproportionate short stature -ro8imal shortening %owing of legs 2' Achondroplasia 3' ("pochondroplasia 4' Autosomal dominant Apert s"ndrome ,rouzon s"ndrome !arfans s"ndrome *eurofibromatosis 7steogenesis imperfecta 2' 1hort tubular bones 1hort 5ertebral pedicles through out the spine interpedicular distance decreases +liac bones short and round with flat acetabular roof ,al5arial bones are large 4' ("drocephalus 1pinal cord compression at foramen magnum and lumbarspine
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12.Q 4 "ears old bo" admitted with 1; to 12 large 6uantit" of water" stools in a da" and decreased urine output. (ad an episode of con5ulsion Gust before coming to the hospital $he weight was 1;#gs pre5iousl" now is 0.0#gs.73? altered sensorium and no focal neurological deficit +n5estigation re5ealed *a9123 me63litre F93.0 me63litre (co3910me63litre 1' 2' 3' 12.A 1.Acute water" diarrhoea with se5ere deh"dration with h"ponatremia 2.h"ponatremia 3.*a deficitE &1329123' 81;8.4 E@2 me63litre 1ml of 3= nacl E ;.2 me63litre 144 ml of 3=*acl to be infused to correct the ("ponatremia What is the diagnosis What is the probable cause for seizure and altered sensorium (ow will "ou manage the abo5e problemA

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13.Q

1' What is the abnormalit" 2' .ist three biochemical abberations which will cause this abnormalit" 3' What are the common clinical presentation associated with this ?,G abnormalit" 4' What is the drug which could cause this abnormalit" in earl" infanc"

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13.A 1' -rolonged Q$ inter5al 9+t starts with the onset of Q or B to the end of $ in seconds 2' ("po#alemia ("pocalcemia ("pomagnesemia 3' 1"ncope seizures 4' ,izapride

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14.Q 1. What is the ideal schedule for this 5accinationA 2. What are the ad5antages o5er 7-> 3. What is the ad5erse effectA 4. Where was the last outbrea# in +ndiaA

14.A 1' 1st dose at 0 wee#s of age 2 doses with 0 wee#s inter5al I 1 booster optional 3additi5e &AA- 1chedule' 2 a' ,an be gi5en to immunocomprimised indi5iduals b' >accine induced paral"tic polio is absent 3. *o ad5erse effect %ut if patient is allergic to neom"cin streptom"cin and pol"mi8in it can produce allergic manifestation 4. Western J.-

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FUNDUS PICTURE

12.Q 1' What is the diagnosis 2' !ention 3 diseases with similar findings 3' ?arliest clinical presentation of this condition 4' *ame two treatable conditions with the same findings

1C

12.A 1' Betinitis pigmentosa 2' A. !.-.1. %. .ate onset gangliosidosis ,. .awrence moon biedl s"ndrome D. Befsums disease ?. Abetalipoprotenimia ). Jshers s"ndrome 3' *ight blindness 4' Befsums disease and abetalipoprotenemia

2;

14Q.

1' What is "our diagnosis 2' *ame three ris# factor for this diagnosis 3' What is the drug used to pre5ent this disease 4' What is the dose

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14A 1. Bespirator" distress s"ndrome 2. -reterm male electi5e .1,1 gestational diabetes multiple gestation asph"8ia 3. Antenatal corticosteriods9%etametasone 4. %etametasone 12 mg 12hour inter5al +.!. 24 hours prior to deli5er"

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1@.Q 2 "ear old female child brought to the hospital for progressi5e difficult" in climbing stairs and a positi5e gowers sign. ,hild also has wasting of the thenar h"pothenar and distal muscle. $ongue is thin and atrophic.

1. 2. 3. 4.

What is the clinical diagnosis *ame one clinical sign which will support "our diagnosis ,ardiac manifestation of this disease *ame two drugs that will diminish the s"mptom of this disease

1@.A 1' !"tonic muscular d"stroph" 2' !"otonic refle8 3' (eart bloc# and ar"thmias &other d"stroph" will cause cardiom"opath"' 4' !e8ilitiene phen"toin carbamazepine procainamide and 6uinidine sulphate

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10.Q

1. What is the clinical diagnosisA 2. !ention two points seen in this ,$ to Gustif" "our Diagnosis 3. What is the immediate managementA 4. *ame the complication seen in the ,$.

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10.A 1. ,erebral abscess / Bight fronto parietal region 2. ("podense lesion measuring about 3cm 8 2cm Bing enhancement / larger area differentiates this from granuloma and irregularit" 3. 1urgical drain 4. >entriculitis right lateral 5entricle

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1C.Q +n "our hospital the following biomedical waste was generated from a patient with t"phoid. +ndicate what colour code "ou will assign to dispose the waste. 1. $orn under garment 2. -lastic food bo8 3. ,otton used to wipe blood from the site of 5enepuncture 1lide containing smear 4. *eedle used to gi5e +! inGection.

1C.A 1' Bed 2' Green 3' Bed 4' %lue

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2;.Q

1. Beport the smear 2. !ention two features seen which gi5e the diagnosis 3. !ention an" two preparations used to treat the condition 4. $wo important complications

2;.A

1. 1mear shows B%,s with trophozoites gametoc"tes of -. falciparum. 2. %anana shaped B%, with intracellular inclusion 3. ,hloro6uine 6uinine artisunates. 4. ,erebral malaria bac#water fe5er algid malaria

2@

21Q 1' 2' 3' 4' What is this de5iceA !ention 2 ad5antages and 2 disad5antages of this de5iceA What is the flow rate of o8"gen to be used in this de5iceA What is the ma8imum fio2 this de5ice can deli5erA

21A 1' 2' 78"gen (ood $wo ad5antages / allows eas" access to chest trun# and e8tremities. 9 -ermits control of impro5ed o8"gen ,oncentration and nebulization 3' 4' flow rate 9 K 1; to 12 . 3 min )io2 / 0; / C; =

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22Q

1. )indings in this 8 ra" 2. What are the two important conditions which produce similar findings. 3. (ow do "ou differentiate radiologicall" these two conditions. 4. What hematological problems can occur in a child with such 89ra" findings.

2C

22A 1. 9 +ncreased densit" of bone 9 ,hanges suggesti5e of of ric#ets 2. 9 7steopetrosis 9 -"#nod"sostosis 3. &a' Angle of mandible normal in osteopetrosis +ncreased angle of mandible in p"#nod"sostosis &b' Distal phalanges normal in osteopetrosis *arrow distal phalanges in p"#nod"sostosis. 4. Anemia

3;

23Q

1' What is abnormal in thisA 2' What is the probable diagnosisA 3' Write 4 conditions predisposing to this. 4' $reatment of choice for this condition.

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23A 1' ,olon cut off sign is seen -aucit" of distal bowel gas shadow 2' +ntussusception 3' Gastroenteritis Jpper respirator" tract infection -ol"p (1(emangioma Bota5irus 5accine !ec#els di5erticulum ."mphoma 4' -neumatic reduction

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24.

-alpation of -recordium 1. a' Wish and introduce "ourself and establish a rapport and get permission to remo5e the shirt to e8amine the precordium b' Warm up "our hands 2. -alpation for ape8 beat 9 Good light 9 1upine3sitting position 9 -almar palpation and digital localization 3. -arasternal hea5e 9 1upine position 9 $o #eep the ulnar aspect of hand o5er the right parasternal area 4. -alpation of heart sounds b" digit 9 7pening snap Gust inside the ape8 9 -2 / pulmonar" area 2. $hrill o5er precordium 9 1upine position 9 $o #eep the palmar aspect of the hand o5er the precordium to locate the thrill &s"stolic thrill o5er parasternal area and diastolic thrill o5er the ape8'

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22

,ounseling

39month9old infant brought b" the mother for *7$ ?*7JG( !+.F ,ounsel the mother 1. +ntroduce and establish rapport 2. Questions to be as#ed regarding 9 >olume and fre6uenc" of urine output 9 )re6uenc" of feeding 9 Artificial feeding3bottle feeding 9 An" chronic illness or acute illness in the mother 3. 1ee for the position and attachment 9Weight gain 3; grams 3da" 4.$ell about importance of gi5ing feed continuousl" b" demand 9Weight gain and urine output are the good indicator of ade6uate feeding 9?ncourage to ta#e ade6uate food and rest 2.%uildup confidence in the mother ?ncourage night feeds )re6uent and complete empt"ing the breast will help in lactation $ell about the dangers of artificial food li#e allerg"3 diarrhea 3 recurrent respirator" infection

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