Mock OSCE in Pediatrics Apr 2014 Part 1 qn ans

Dr.Padmesh

1.Identify 2.Describe

findings 3.Associated

syndrome?

1.Lissencephaly

2.Findings› Absence of cerebral

convolutions, › Maldeveloped

sylvian fissures,› Enlarged ventricles.

3. Miller-Dieker syndrome.

1.Identify 2.Describe

findings 3.Associated

Kidney problem?

1.Tuberous sclerosis

2. Axial CT shows multiple foci of periventricular hyperattenuation consistent with subependymal calcifications of tuberous sclerosis

3. Angiomyolipoma

1. Identify

2. Uses

3. Mention 4 complicatons

1. PICC (peripherally inserted central venous catheter)

Preserves veins, allows concentrated infusates, permits long term IV alimentation

Thrombosis, catheter fracture & emobolism, infection, leakage, DVT.

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

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.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.

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

1. Diagnosis

2. Differential diagnosis of this Xray:

3. Maternal condition associated

4. Prognostic factors associated with better outcome

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

Three year old toxic boy with fever, drooling, stridor, respiratory distress.

1. Xray finding2. Diagnosis3. Treatment

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.

1. Identify

2. Diagnosis

3. Time needed between injection & imaging.

4. Four indications

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 Scarring2. Urinary Tract Infection3. Pyelonephritis4. Renal infarct5. Horseshoe kidney6. Ectopic kidney

1. Identify

2. What information do we get?

3. Time needed between injection & imaging.

4. Four indications

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

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)

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).

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.

Mark the lung volumes & capacities

Mark the lung volumes & capacities

Identify the following in a stool specimen:

1. 2. 3.

Identify the following in a stool specimen:

2.Ascaris egg1.Hookworm egg 3.Trichuris

egg

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?

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

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

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.

How will you replace ongoing loss in diarrhea?

What is the average composition of diarrhea & gastric fluid with respect to › Sodium› Potassium› Bicarbonate/ Chloride

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