Mock OSCE in Pediatrics Apr 2014 Part 1 qn ans

1. Dr.Padmesh

2.  1.Identify
 2.Describe
findings
 3.Associated
syndrome?

3.  1.Lissencephaly
 2.Findings
› Absence of cerebral
convolutions,
› Maldeveloped
sylvian fissures,
› Enlarged ventricles.
 3. Miller-Dieker
syndrome.

4.  1.Identify
 2.Describe
findings
 3.Associated
Kidney
problem?

5.  1.Tuberous sclerosis
 2. Axial CT shows
multiple foci of
periventricular
hyperattenuation
consistent with
subependymal
calcifications
of tuberous sclerosis
 3. Angiomyolipoma

6.  1. Identify
 2. Uses
 3. Mention 4
complicatons

7.  1. PICC (peripherally
inserted central
venous catheter)
 Preserves veins, allows
concentrated
infusates, permits long
term IV alimentation
 Thrombosis, catheter
fracture &
emobolism, infection,
leakage, DVT.

8.  A 14 yr boy treated for attempted suicide , now
getting discharged, you have been asked to
counsel. (Total marks 8)

9.  1.Introduce
 2.Try to get comfortable with some small talk.
 3.Promise Confidentiality
 4.Ask any Future Plans of another attempt
 5.Any Signs of depression (Sleep well ?, Want to listen to music?)
 6.What will you do after going home?
 7.What were the stressors (Girlfriend , Marks)
 8.Ask substance abuse
 9.Where did he get this idea from?

10.  10.Tell Him : make him feel he is not worthless, family and friends still
love you , will welcome you home without change in attitude, try to
have confidence when there are stress events , Other career
options, examples of Sachin Tendulkar, singers,
 11.Take a Promise to not do it again
 12.Any such thoughts , call me up.
 13.We will meet regularly
 14.Continue your medications
 15.If you want , we can speak to your parents or teachers
 16.Never hide anything from parents
 17.Thanks for your time and sharing your intimate/ personal.

11. 4 day old newborn brought to ER with respiratory distress4 day old newborn brought to ER with respiratory distress

12. 1. Diagnosis
2. Differential diagnosis of this Xray:
3. Maternal condition associated
4. Prognostic factors associated with better outcome

13. 1. Diagnosis: Congenital Diaphragmatic Hernia (CDH)
2. Differential diagnosis of this Xray:
-Congenital cystic adenomatoid malformation (CCAM),
-Cystic pulmonary interstitial emphysema
-Staphylococcal pneumonia with pneumatocele formation.
3. Maternal condition associated: Polyhydramnios
4. Prognostic factors associated with better outcome:
-Herniation after 2nd trimester,
-Absence of liver herniation,
-Late onset of postnatal symptoms

14. Three year old toxic boy with fever, drooling, stridor, respiratory
distress.
1. Xray finding
2. Diagnosis
3. Treatment

15. 1. Xray finding: -Increased space between the
pharyngeal air shadow and the
vertebrae.
-Posterior pharyngeal wall is bulging
2. Diagnosis: Retropharyngeal Abscess
3.Treatment: Intravenous antibiotics with or without surgical
drainage.
A third generation cephalosporin with ampicillin-sulbactam
or clindamycin to provide anaerobic coverage.

16. 1. Identify
2. Diagnosis
3. Time needed
between injection &
imaging.
4. Four indications

17. 1. Identify - Technetium99m DMSA (Di mercapto succinic
acid) Scan
2. Diagnosis : Ectopic Rt Kidney
3. Time needed between injection & imaging: 3 hours
4. Four indications:
1. Assessment of Renal Scarring
2. Urinary Tract Infection
3. Pyelonephritis
4. Renal infarct
5. Horseshoe kidney
6. Ectopic kidney

18. 1. Identify
2. What information
do we get?
3. Time needed
between injection &
imaging.
4. Four indications

19. 1. Identify: DTPA (99mTc-diethylene triamine pentaacetic acid) Scan
2. What information do we get?
-Renal blood flow,
-GFR,
-Tubular function
-Urinary excretion.
3. Time needed between injection & imaging.
ImmediateImmediate images of the kidneys are taken as the injection enters the body.
4. Four indications:
-Assessment of GFR, -Differential renal function
-Acute renal failure -Chronic renal failure
-Acute & chronic rejection -Screening of patients with suspected renal HTN
-Obstruction -Hydronephrosis

20.  Test hearing in this 13 year old boy,
describing at each step the procedure.
 (you are provided with tuning fork of
frequencies 128 Hz, 256 Hz, 512 Hz)

21.  1. Wish & introduce yourself.
 2. Get permission of parent & explain what you’re going to do.
 3. Select the appropriate tuning fork. (512 or 256 Hz)
 4. Rinne test: Strike the tuning fork and hold it near the
external ear canal (air conduction) and then against the
mastoid process (bone conduction). Ask the patient which
sound was louder. In subjects with normal hearing and those
with sensorineural loss air conduction is better than bone
conduction (Rinne positive.) In conductive deafness bone
conduction is louder (Rinne negative).

22.  5. Weber test: Base of the vibrating tuning fork is placed on the
vertex or forehead in the midline. Ask the patient whether the
sound is heard in the midline or whether it is lateralized. The
normal response is to hear the sound in the midline; this is also
true if hearing is symmetrically reduced. However, if there is
normal hearing on one side and a pure sensorineural loss on
the other the tuning fork will be louder in the normal ear.
Conversely, if there is a purely conductive hearing loss the
sound will be louder on the side with the conductive deficit.
 6. Thank the child.

23.  Mark the lung volumes & capacities

24.  Mark the lung volumes & capacities

25.  Identify the following in a stool specimen:
 1. 2. 3.

26.  Identify the following in a stool specimen:
2.Ascaris egg
1.Hookworm egg 3.Trichuris
egg

27.  A 2 year old child is brought with
failure to thrive, chronic diarrhea,
ataxia and the peripheral smear is
shown below.
 Identify the peripheral smear ?
 What is the diagnosis ?
 What is the mode of inheritance?
 What is the ocular complication?
 Which vitamin deficiency causes most
of the clinical symptoms?

28.  A 2 year old child is brought with failure to thrive, chronic diarrhea,
ataxia and the peripheral smear is shown below.
 Identify the peripheral smear ? ACANTHOCYTOSIS
 What is the diagnosis ? ABETALIPOPROTEINEMIA
 What is the mode of inheritance? Autosomal recessive
 What is the ocular complication? Retinitis pigmentosa
 Which vitamin deficiency causes most of the clinical symptoms?
Vitamin E

29.  Expand the following in NRHM:
› 1.ASHA-
› 2.CSSM-
› 3.AYUSH-
› 4.PRI-
› 5.IPHS-
› 6.NCMP-
› 7.IDSP-
› 8.F-IMNCI-

30.  Expand the following in NRHM:
› 1.ASHA- Accredited Social Health Activist
› 2.CSSM- Child Survival and Safe Motherhood Programme
› 3.AYUSH- Ayurveda, Yoga and Naturopathy, Unani, Siddha
and Homoeopathy.
› 4.PRI- Panchayati Raj Institutions
› 5.IPHS- Indian Public Health Standards
› 6.NCMP- National Common Minimum Programme
› 7.IDSP- Integrated Disease Surveillance Project
› 8.F-IMNCI- Facility based integrated management of
neonatal and childhood illnesses.

31.  How will you replace ongoing loss in
diarrhea?
 What is the average composition of
diarrhea & gastric fluid with respect to
› Sodium
› Potassium
› Bicarbonate/ Chloride

32.  How will you replace ongoing loss in diarrhea?
› Replace stools ml by ml every 1-6 hours using:
D5 0.2 Normal saline + 20 meq/L Sod bicarb + 20 meq/L KCl
 What is the average composition of diarrhea
with respect to
Diarrhea Gastric fluid
› Sodium- 55 meq/L 60 meq/L
› Potassium - 25 meq/L 10 meq/L
› Bicarbonate - 15 meq/L
› Chloride 90 meq/L