Pediatrics OSCE - Pune mock OSCE 2012

1. MOCK OSCE 2012
PUNE

2. • The OSCE Questions & Answers are prepared by
the faculty for the benefit of Post graduate
students and some are contributed from faulty
• These Questions and answers are made for the
students to understand the pattern of OSCE and
not meant to completely cover the subject of
Pediatrics.
• Answer are checked from standard textbook in
case of doubt plz email
• ashwinborade@yahoo.com
11/7/2012 CME,PUNE 2

3. Station 1
• A 10 year old boy brought to ER having consumed 5
tablets of Tricyclic Antidepressants tablets 2 hrs back.
On examination he is drowsy, but arousable. HR
138/min. temp 100 F. RR 10/ min. BP 80/60 mmHg.
• What are the clinical manifestations of tricyclic
antidepressant poisoning?
• What are the cardinal cardiovascular indicators of
toxicity?
• What is the poor prognostic factor?
• What are the criteria for ECG diagnosis of poisoning ?
• What is specific management and principle behind it?

4. Answer station 1
• Anticholinergic toxidrome-delirium, mydriasis, dry mucus membranes, tachycardia,
hyperthermia, mild hypertension, urinary retention, slow GI motility. CNS toxicity-
lethargy, coma, myoclonic jerks, seizures. Sinus tachycardia-most imp; widening of
QRS complex, PVC, ventricular arrhythmias .Refractory hypotension.
• Sinus tachycardia; refractory hypotension; QRS duration of > 100 ms indicates risk
for seizures & cardiac arrhythmias; R wave in lead aVR of > 3 mm is also an
indicator of toxicity.
• Refractory hypotension
• QRS duration of > 100 ms indicates risk for seizures & cardiac arrhythmias; R wave
in lead aVR of > 3 mm is also an indicator of toxicity
• Alkalinisation with soda bicarb therapy (ANTIDOTE). Goal of bicarb therapy is to
increase sodium concentration and arterial pH. Dose is 1-2 meq/kg until pH> 7.45.
150 meq/L of sodium bicarb diluted with 5% dextrose to maintain pH. Treat
hypotension with normal saline; Vasopressors for hypotension; Airway
management.

5. Station 2
A 9 month old infant who was playing with marbles is
suddenly found to the struggling to breathe. What would
be your steps of intervention.
• 1. Till the baby is conscious.(1)
• 2. If the baby becomes unconscious. (1)

6. Station 2B
• Identify the ECG. [1]
• Write three common causes of this problem.
[1)
• Write treatment of this problem [1 ]

7. Answer Station 2 A
1 (a) 5 back blows between the scapula.
(b) 5 chest thrusts on the lower 3rd of sternum.
2 (a) Give –
1. 2 rescue breaths
2. 5 back blows
3. 5 chest thrusts
4. Look into the mouth
5. If FB seen - remove it.
6. If not - give 2 breaths and continue the sequence.

8. Answ 2 B
• Atrial fibrillation
•
• Rheumatic mitral valve disease ,left AV valve
insufficiency, thyrotoxicosis, pulmonary
emboli, and pericarditis
•
• The best initial treatment is digitalization,
which restores the ventricular rate to normal,
although the atrial fibrillation usually persists.

9. Station 3 :
A 13 year old boy under investigation in OPD
1. What is the abnormality? (1)
2. What is the diagnosis? (1)
3. What clinical features are likely to be present in the child? (1)
4. . Name 2 condition with X linked Recessive inheritance. (1+1)

10. Answer station3
1. Defect in the long arm of X chromosome(Fragile sites)
(Fragile sites are regions of chromosomes that show a tendency for separation,
breakage, or attenuation under particular growth conditions. The abnormality
is caused by FMR1 gene expansion at Xp27.3 which is a fragile site)
2. Fragile X Syndrome
3. Long thin face
Prominent jaw
Macro orchidism
Large ears
Hyperkinetic behavior
Mental retardation
Large head
Normal height
4. X linked Recessive Hemophilia
Duchenne Muscular dystrophy
Becker Muscular dystrophy

11. Station4
A six week old infant is referred for poor weight gain and
seizure. On examination, he looks cachexic and is dysmorphic
with low set ears and a very small lower jaw. He also has severe
thrush affecting the oral cavity and perineum. Cardiac apex is
displaced into the left sixth intercostal space in anterior axillary
line and there is a palpable thrill. A loud pan systolic murmur
and an apical mid diastolic murmur can be heard. He is
tachypneic but the lung fields are clear on auscultation. The
liver is 3 cms below the costal margin in the mid clavicular line.
Investigations: Na 136, K 4.9, Ca 1.7,Albumin 4.2, Urea 7.8, Hb
10.2, WBC 3.8, Platelet 2.45 L, Echo Large VSD
• What is the diagnosis?(1)
• What is commonest presentation during newborn period. (1)
• Most likely explanation for the low plasma calcium ?(1)
• What is the causes of immunodeficiency? (1)
• The etiopathogensis of all these features is ? (1)

12. Answer 4
1. DieGeorge syndrome
2. Hypocalcemic seizures
3. Primary hypoparathyroidism
4. Thymus gland aplasia leading to abnormal cell mediated
immunity
5. An embryological defect of the third and fourth pharyngeal
pouches

13. Station5
15 months old child admitted with anemia with hepatosplenomegaly for
evaluation, PS shows.
1.Identify and describe PBS findings. (1)
2.What is the diagnosis? (1)
3.What is definitive treatment? (1)
4.What are clinical features seen in classical case ? (1)
5.What is the basic etiology for this disorder ? (1)

14. Answer 5
1. PBS showing microcytic, hypochromic anemia with
nucleated RBC, tear drops cells
2. Thalassemia major
3. BMT
4.Thalasemmic facies, Hs megaly, bone fractures
5. Ineffective erythropoisis

15. Station 6A
Identify the slide.(1)
What is treatment?(1)

16. Station 6 B
State True or False-
1. The following are useful in assessing the gestational age of an infant- (0.2 x5)
a) Posture T/F b) Palmar creases T/F
c) Elbow angle T/F d) Square window test T/F
e) Nipple formation T/F
2. Blood flow in the fetus- (0.2 x5)
a) Blood flows from right to left through foramen ovale- T/F
b) Blood in the ascending aorta has higher oxygen content than the blood in
descending aorta- T/F
c) The ductus arteriosus is closed T/F
d) Pulmonary pressure equals systemic pressure T/F
e) Hemoglobin may be 20 g/dl T/F
3. Genetic anticipation occurs in the following conditions- (0.2 x5)
a) Cystic fibrosis T/F
b) Myotonic dystrophy T/F
c) Fragile X Syndrome T/F
d) Huntington’s chorea T/F
e) Marfan’s Syndrome T/F

17. Answer :
6A :
a) Egg of Ascaris Lumbricoides
b) Albendazole 400 mg or Mebendazole 100 mg BD x 3 days
6B:
1. The following are useful in assessing the gestational age of an infant-
a) True b)False c) False d) True e) True
2. Blood flow in the fetus-
a) True b) True c) False d) False e) True
3. Genetic anticipation occurs in the following conditions-
a) False b) True c) True d) True e) False

18. Station 7
A 15 yrs old child with no significant past history comes in OPD with
slow myoclonic seizures since 2 days. Also parents noticed he had
subtle personality changes and poor school performance .His EEG
done
What are the EEG changes? (1)
What is the diagnosis?(1)
What is diagnostic criteria (1)
What is etiology for same ?(1)
What are CNS complications?(1)

19. Answer 7
• High voltage burst slow waves with normal background
• SSPE
• Measles ab in CSF/EEG/histological finding on biopsy
• Persistent measles viral infection in CNS
• Hypertonia, bulbar palsy,choreatheosis,decerebrate
posturing

20. • Station 8 A
A. What test is performed ?(1/2)
B. What are indications? (1/2)
C. What 2 important parameters
it measures? (1/2)
D. Based on these result how
can you differentiate disorders ? (1)
• Station 8 B
A. What is the elemental content of 1 ml ?(2)
B. Which solution is incompatible if mixed with this drug?(1)
C. Give 2 indications for its use (2)

21. Answer 8
A
A Spirometry
B To differentiate obstructive n restrictive respiratory diseases.
C FVC and FeV1
D FVC,FEV1 both low- restrictive
FVC-N FEV1 Low - obstructive
FVC low FEV1 very low- mixed diseases .
B
A. Ca Gluconate 10% (1 ml = 9 mg elemental Ca)
B. Do not mix with HCO3
C. Bradycardia, Asystole and Sclerosis

22. Station 9
Write the specific odour of urine in following condition (10x0.5=5 )
1.Glutaric acedemia mousy
2. Hawkinswria tomcat urine
3. 3-hydroxy 3 methyglutaric acidemia maple syrup
4. Isovaluric acedemia cat urine
5. Maple syrup urine diseses sweaty feet
6. Hypermethioninemia rancid butter /boiled cabbage
7. Multiple carboxylase defiency , boiled cabbage
8. Phenyketnuria swimming pool
9. Trimethylamuria rotting fish
10. Tyrosiemia sweaty feet

23. Answer Station 9
The specific odour of urine in following condition
• Glutaric acedemia –sweaty feet
• Hawkinswria,-swimming pool
• 3-hydroxy 3 methyglutaric acidemia,-cat urine
• isovaluric acedemia,-sweaty feet
• maple syrup urine diseases –maple syrup
• hypermethioninemia,-boiled cabbage
• multiple carboxylase defiency ,-tomcat urine
• Phenyketnuria-mousy
• Trimethylamuria,-rotting fish
• Tyrosiemia-rancid butter /boiled cabbage

24. Station 10 A
2 yrs old child admitted
with anemia , hepatosplenomegaly
and fever. PBS shows :
• What is the diagnosis?(1)
• What are complications?(1)
• What is late treatment failure in this case.(1)

25. Station 10 B
1. What is the radiological diagnosis? ( 1)
2. Name 2 risk factors for the development of this condition (1/2 +1/2)

26. Answer 10 A
• Falciparum malaria
• Severe anemia, cerebral malaria, respiratory distress,
hypoglycemia
• Late treatment failure: Patient will exhibit late treatment
failure (LTF) under following situations:
• (i) Development of danger sign or severe malaria on any
day between day 4 and day 14 in presence of parasitemia.
• (ii) Axillary temperature >37.5ºC in presence of parasitemia
on any day from day 4 to day 14.

27. Answer 10 B
1. Right & Left pneumothorax with left upper zone haziness
2.Risk Factors-
• Assisted ventilation (including CPAP)
• MAS,RDS
• Other Air Leak Syndromes (e.g. PIE)
• Pulmonary hypoplasia
• Idiopathic or spontaneous

28. Station 11
• A:Write content of the following in Human milk fortifier
(1/4X 8=2)
1. Protein
2. Fat
3. Sodium
4. Calcium
5. Vit D
6. Thiamine
7. Vit B12
8. Zinc
• B:Write biological value, net protein utilization and protein
efficacy ratio of –
1.Meat
2. Egg
3. Bengal gram
4. Wheat (12 X 0.25=3 )

29. Answer 11A
PROTEIN 0.2g
Fat 0.1g
NA 1.5
calcium 50
Vit D 250
Thiamine 12
B12 0.05
Zinc 0.18

30. Answer11B
BIOLOGICAL NPU PER
VALUE
Meat 74 76 3.2
EGG 96 96 3.8
Bengal gram 74 61 1.3
WHEAT 66 61 1.3

31. Station 12
• Identify diagram .(1)
• What are the uses? (1)
• Name each components A-F along with interpretation of
each (1/4 x 6=3)

32. Answer 12
• Scatter diagram and correlations.
• A scatter diagram is a tool for analyzing relationships between two
variables. One variable is plotted on the horizontal axis and the other is
plotted on the vertical axis. The pattern of their intersecting points can
graphically show relationship patterns.
• A;No Correlation There is no demonstrated connection between the two
variables
• B;Weak Positive Correlation The value of Y increases slightly as the value of
X increases
• C;Strong Positive Correlation The value of Y clearly increases as the value of
X increases.
• D;Weak Negative Correlation The value of Y decreases slightly as the value
of X increases
• E;Strong Negative Correlation The value of Y clearly decreases as the value
of X increases.
• .F; Perfect Correlation The value of Y seems to be related to the value of X.

33. Station 13
• 2 yrs old girl brought with pubic hair and clitoromegaly, increased
irritability gradually increasing since the past 3 months. No history
of drug ingestion or hyperpigmentation.
• On examination she has BMI above the 95 th centile. BP:112/80
mm of Hg. HR:92/min & RR:24/min. She has hirsutism and few
acneform eruptions on the face. Her cheeks are chubby & few pink
striae present over the face and abdomen. Genital examination
shows pubic hair stage 2 & clitorus measuring 1.8 cms. She is
extremely irritable. Systemic examination is normal.
• What is the diagnosis? (1)
• What is most likely etiology at this age? (1)
• Enlist 2 important screening tests used for the above condition?
(1+1)
• Name 2 drugs used for the medical management of this condition?
(1/2+ 1/2)

34. Answer 13
• Cushings syndrome
• Etiology:
Below age of 7 yrs: ACTH independent autonomous adrenal lesion like Adrenal
adenoma or carcinoma
• Screening tests:
Assessment of diurnal cortisol rhythm
Overnight dexamethasone supression test
24 hour urinary free cortisol
Salivary cortisol
• Drugs that can be used:
Ketoconazole
Aminoglutethimide
Cyproheptidine
Metyrapone
Mitotane

35. Station 14
6 yr old boy brought with the deformity shown in the figure. His sister, 8 yrs also has a
similar deformity gradually increasing since 3 yrs of age. On examination his height
is below the third percentile & US/LS ratio is 1.6:1. There are multiple dental
abscesses. Mother also has a similar deformity but very mild in nature. S. calcium :
8.8 mg/dl, Phosphorus : 1.8 mg/dl Alk phosphatase: 380 IU PTH levels: 18 pg/ml
(9-55 pg/ml) 25-OH Cholecalciferol: 26 ng/ml(10-50 ng/ml)
1,25(OH)2Cholecalciferol: 18 pg/ml (20-60 pg/ml)
TMPO4/GFR: reduced. X-ray of both
lower limb shows florid richetic changes
• What is the Diagnosis? (1)
• What is the inheritance ?(1)
• It is due to mutation of which gene?( 1)
• What is the Treatment?(1)
• Write 4 endocrinal causes of short stature. (1)

36. Ans 14
• Hypophosphatemic Rickets
• X-linked dominant
• Mutation in PHEX gene
• Treatment: Phosphorus supplement orally- 1-4 g/day QDS Alfacalcidol- 25-50
ng/kg/day or calcitriol 0.25-2 mcg/day.
• 4 causes-
1.Pan hypopitutarisum
2.Isolated GHD
3.Hypothyrodisum
4.Cushing syndrome
5.DM

37. Station 15
Our patient is a 17 yr old female with history of recurrent seizures. Admitted in PICU
with stroke. She was evaluated for same.
• Identify and describe the investigation? (1/2+1/2)
• What is the diagnosis? (1)
• What other disorder are associated with this disease? (1)
• What is the treatment of choice? (1)
• What are syndromes associated with contralateral hemiplgia in children? (1)

38. Answer 15
1. a)MRI T1 weighted images show extensive collateralization
of vessels in region of circle of willis.
b) MRA reveals reduced luminal calibre of left internal
carotid artery in petrous, cavernous and supraclinoid
segments.
2. Moya moya disease.
3. Down syndrome, neurofibromatosis, or sickle cell disease
4. Direct superficial temporal artery (STA) to middle cerebral
artery (MCA) bypass is considered the treatment of choice.
5. Weber syndrome, Benedict syndrome ,millard gublar
syndrome.

39. Station 16 A
• Write RNTCP cat IV regimen (1)

40. Station 16 B :
What is the graph? (1)
What are its uses? (1)
How do you use it? (1)
What are the other charts used for this purpose? (1)

41. Answer 16 A
6(9) Kmofx(Lvx) Eto Cs Z E/ 18 ofx (Lvx) Eto Cs E
Answer 16 B
• Trivandrum development screening chart
• Development assessment upto 24 months
• SAT hospital, TVM
• A vertical line is drawn or pencil is kept vertically at level
age at child being tested ,if child fails to achieve any item
that falls short on left side of vertical line child had
developmental delay
• DDST,DST,BSID

42. Station 17 ( 5 marks)
Write the laboratory values for following disorders
( either N,
calcium phosphorus PTH 25(OH)2D3 1,25(OH)2
D3
Vit D def.
VDDR type 2
CRF
ADHR
Fanconi
syndrome

43. Answer 17
calcium phosphorus PTH 25(OH)2D3 1,25(OH)2
D3
Vit D def. N / dec dec incre dec Dec/N/Inc
VDDR type 2 N/dec dec incres N incre
CRF N/dec incre incre N dec
ADHR N dec N N Rd
Fanconi N dec N N Rd or incre
syndrome

44. Station 18
2 yrs old child with MR admitted for evaluation , On examination he had anemia
with organomegaly. Lab evaluation showed anemia with thrombocytopenia .BM
done .
1.What is the diagnosis?
2.What are the marrow findings?
3.What is the etiology for such findings?
4.What are the typical radiological findings?
5.What is the definitive treatment?
(1x5=5)

45. Answer 18
• Gaucher disease .
• Wrinkled paper cells in BM
• Intracytoplsmic substrate inclusion
• Erlenmeyer flask deformity in distal femur
• Enzyme replacement with b glucosidase

46. Station 19 (1X5=5)
1.How will you immunize a child with bleeding disorder? (1)
2.Name the vaccines which can be placed in the freezer
compartment of the refrigerator (1)
3.Write down the time limits for using the following vaccines after
reconstitution-
• Varicella (1)
• Measles/MMR (1)
4. Write the schedule of rabies vaccine for a person, who has been
bitten by a dog but has received 5 doses of rabies vaccine
earlier. (1)

47. Answer 19
1.Subcutaneous route should be used (Unless contraindicated)
For aluminium adjuvanted vaccines that can only be given intramuscularly,
vaccination should be scheduled after factor replacement therapy
Needles <23G should be used for injection and the parents should be asked to apply
firm and sustained pressure, without rubbing, for at least 5 minutes.
2.Freezer compartment: BCG, OPV, Measles, and MMR.
3. Varicella = 30 min (and protect from light)
Measles/MMR = 4 to 6 hours
4. Two doses are given on days 0 and 3.
(For re exposure at any point of time after completed (and documented) pre or post
exposure prophylaxis)

48. Station 20
Interpret the following ABG reports:
1. pH-7.6/ PaCo2-25/ Pao2-160/ HCo3-24 (Fio2-50%)
Calculate AaDO2 and write the formula (1+ 1/2)
2. pH-7.38/ PaCo2-65/ Pao2-48/ HCo3-34 (Fio2-60%)
(a) what is the ABG diagnosis (1)
(b) What is normal PaO2 level expected if a child is breathing at room air
with normal lungs? (1)
3. pH-7.45/ PaCo2-40/ Pao2-120/ HCo3-28.5/ Spo2 99%/ Hg 8 gm%
Calculate Oxygen content in given blood gas (1+1/2)

49. Answer 20
1. 165.25
(Formula)
AaDO2 = (713 x FiO2) – (pCO2 / 0.8) – (paO2)
2. a)Respiratory acidosis with metabolic compensation
b) 80-100 mmHg
3. 11 ml O2 /dl
Arterial Oxygen content = (Hb x 1.36 x SpO2 ) + ( 0.0031
x PaO2)

50. Station 21 :
Which materials are used to sterilize the given items- (1X5=5)
• Floor
• Ambu bag
• Chittle forceps
• Probe of pulse oximeter and Weighing scale
• Laryngoscope

51. Answer 21
• FLOOR : By Phenol
• Ambu bag : after dismantling clean with soapimmearse
in Cidex for 4-6 hrs rinse with water dry,wrap and put
a date
• Cheattle forceps : autoclave
• Probe of Pulse oxymeter : by spirit
• Weighing machine : 2% Bacillocid
• Laryngoscope : by spirit. If used for infected patient than
wash with soap & water -- after removing bulb,put blade
in 2% cidex  wash, dry and wrap.

52. Station 22
Match the following (5)
Characterstics
Level of evidence
I Case series
II Lesser quality RCT ( eg less than 30% follow up; no blinding;
improper randomization) /systematic review of level II RCT
III Expert opinion
IV High quality RCT with statistically significant difference or no
statistically significant difference but narrow confidence
interval/systematic review of level I RCT
V Case control study, observational, retrospective comparative study/
systematic review of level III RCT

53. Station 22 answer (5)
Characterstics
Level of evidence
I High quality RCT with statistically significant difference or no
statistically significant difference but narrow confidence
interval/systematic review of level I RCT
II Lesser quality RCT ( eg less than 30% follow up; no blinding;
improper randomization) /systematic review of level II RCT
III Case control study, observational, retrospective comparative study/
systematic review of level III RCT
IV Case series
V Expert opinion