1. Findings in this x-ray: Bilateral coalesced opacities in upper and mid zones. 2. Two important conditions which produce similar findings: Pulmonary tuberculosis, pneumonia. 3. To differentiate radiologically: In tuberculosis, opacities are more dense and cavitation is seen. In pneumonia, opacities are less dense and consolidation is seen. 4. Hematological problems that can occur: Anemia due to chronic disease, thrombocytopenia.

1. DNB
OSCE Pediatrics

2. 1Q
1. Describe the findings in this photograph
2. What is the nutritional status of this child
3. What are the causes of abdominal distention in this child
4. What are the life threatening emergencies associated with this condition
1

3. 1A
1. Generalized wasting, no edema, alert
2. Marasmus
3. Worm infestation, hypokalemia
T.B. peritonitis (or) disseminated tuberculosis
4. Hypoglycemia
Hypokalemia
Hypothermia
Fulminant sepsis
2

4. 2Q
1. W hat is the diagnosis
2. Two other congenital defects associated with this condition
3. Name four teratogenic drugs producing this defect
4. Ideal age for correcting this malformation
3

5. 2A
1. Cleft lip and palate
2. Congenital heart diseases, hypoplasia or agenesis of thymus and parathyroid,
hypoplasia of auricle.
3. Phenytoin, carbamazepine, prednisolone and alcohol.
4. Lip – 3 months
Palate – 12 months
4

6. 3Q
An 8 year old boy was brought to the hospital with shallow respiration and
altered sensorium with a GCS of 5/15. The pupils were 3 mm in size and sluggishly
reacting to light. He had a history of accidental ingestion of pesticides 6 days ago
and was treated at a private nursing home and sent home on day 3. He was
asymptomatic at home for the past 3 days. Now he is brought with the above
symptoms.
1. What is the problem in this child
2. Briefly narrate the management
3. Name the blood investigation to confirm and prognosticate.
4. Name chronic sequelae associated with this poisoning
3A
1. Intermediate syndrome of OPC poisoning (Neuro toxic)
2. Airway and breathing maintained by ventilatory support
- Circulation by crystalloids, colloids, & Ionotropes
- Pralidoxime continuous infusion 100mg –500mg/Hr
- Antibiiotics to prevent sepsis.
3. Cholinestrase level
< 10% very severe
10% – 20% - moderate
20% – 30% – Mild
4. Wrist drop, foot drop & Muscle paralysis
5

7. 4Q
The following food substances, which contain Vit.A, need to be arrange d based on
Vitamin A content from high to low.
 Papaya,
 Guava
 Amaranth
 Drumstick leaves
 Egg
 Human milk
 Carrot
4A
 Carrot 1167
 Amaranth 515
 Drumstick leaves 300
 Egg 140
 Papaya 118
 Human Milk 38
 Guava 0
6

8. 5. Q
6 month old male infant brought to the emergency room for recurrent seizure since
birth. Baby was macrosomic and had macroglossia at birth and there is no maternal
history of diabetes. During each episode of fits, hypoglycemia was documented.
Other base line investigations were found to be normal.
1. What is the diagnosis. Name one syndrome associated with this.
2. What is the dose of glucose, name the next drug that you will use to treat
hypoglycemia.
3. How will you confirm the diagnosis
4. Name the Drugs used to treat this condition
5. A
1 Hypoglycemia,beckwith wiedman syndrome
1. 2ml / kg 10% dextrose intravenous push followed by 6 to 8 mg/kg/min
maintenance of glucose. If requirement of the glucose exceeds
12mg/kg/min think of hyperinsulinimic states. Probable diagnosis is
recurrent Hypoglycemia due to hyperinsulinism. Hydrocortisone
10mg/kg/day
2. Plasma insulin level.
3. Diazoxide , stomatostatin and octreotide
7

9. 6Q
A Five-year-old female child was brought to the emergency department with a
history of altered sensorium for 2 days and vomiting since afternoon. There was a
history of fall 2 days back. Father had prolonged bleeding following
appendicectomy. Investigation revealed A normal Prothrombin time., normal APTT,
normal Thrombin time and normal platelet count.
1. What is the probable diagnosis and what is the complication?
2. How will you confirm your diagnosis?
3. What is your immediate management?
4. Name the drug used to treat the minor complication
6. A
1. Bleeding disorder probably factor 13 deficiency now presenting with
intracranial bleed
2. Factor 13 assay (urea clot lysis)
a. C.T. Scan brain to rule out intracranial hemorrhage
3. FFP transfusion
- Cryoprecipitate
- Factor 13 concentrate
b. Neurosurgical consultation to evacuate
intracranial haematoma
4. Tranexmic acid
8

10. 7Q
A 48 hrs old term baby was given respiratory support following neonatal
convulsions.
His ABG
PH – 7.6
PCo2 – 18
PO2 – 214
BE--1
Hco3 – 17.1
1. What is your diagnosis?
2. What is the cause?
3. How will you manage?
7.A
1. Respiratory alkalosis
2. Hyperventilation
3. Reduce the ventilatory settings
Primarily ventilatory rate
9

11. 8Q
A 3 year old boy is brought to the emergency room with history of fever for one day,
sudden onset of stridor and dyspnoea. On examination the boy is toxic , anxious,
febrile and has drooling of saliva pulse rate 150/minuteRespiratory rate 60/minute
1) What is the diagnosis?
2) What is the causative organism?
3) What radiological sign in the X ray neck is observed?
8A
1. Acute epiglotitis
2. H influenza
3. Thumb sign
10

12. 9Q
In a PHC area of population of 30,000 the total births in the year 2005 was 215 of
which 15 were stillbirths. 20 infants died in the same year of which 15 died in the
first weeks of life.
1) Calculate infant mortality rate
2) Name the state with lowest and highest infant mortality rate.
3) Write 3 cost effective mechanism to bring down the infant mortality rate
9. A
1. Infant death = 20
Neonatal death = 15
Total live birth= total birth-still birth=200
Infant mortality rate
= No. of infants who died in the year x 1000
Total live births in the same year
= 100/1000 live births
2. Lowest mortality rate – Kerala
Highest mortality rate - Bihar
3. Exclusive breast feeding, KMC, and immunization
11

13. 10.Q
National rural health mission (NRHM)
1. What is the ultimate goal of NRHM
2. What are its core strategies at the village level
3. Who is ASHA
4. What is the role of ASHA at the ground level
10.A
1. The goal of the mission is to improve the availability of and access to quality
health care by people, especially for those residing in rural areas, the poor,
women and children
2. Train and enhance capacity of Panchayati Raj Institutiosn to own, control and
manage public health services, promote access to improved health care at
household level through a female health activist (ASHA), Health plan for
each village through village health committee of the panchayat
3. ASHA is Accredited Social Health Activist – chosen to be accountable to
panchayat to act as the interface between the community and the public
health system
4. She will be honorary volunteer, receiving performance based compensation
for promoting universal immunization, referral and escort services for RCH,
construction of household toilets, facilitate village health plan and co –
ordinate with the ANM’s and Anganwadi workers in all health activities.
12

14. 11Q
12 yrs old male child is brought with history of poor growth
1) Write two obvious abnormal physical findings
2) What is the probable diagnosis?
3) Give one differential diagnosis
4) What is the inheritance pattern of this condition and write 4 diseases with similar
inheritance?
5) Mention 4 abnormal radiological findings in these children
6) Write 2 neurological complications seen in these children
13

15. 11A
1) Macrocephaly
Disproportionate short stature
Proximal shortening
Bowing of legs
2) Achondroplasia
3) Hypochondroplasia
4) Autosomal dominant
Apert syndrome
Crouzon syndrome
Marfans syndrome
Neurofibromatosis
Osteogenesis imperfecta
5) Short tubular bones
Short vertebral pedicles through out the spine
interpedicular distance decreases
Iliac bones short and round with flat acetabular roof
Calvarial bones are large
6) Hydrocephalus
Spinal cord compression at foramen magnum and
lumbarspine
14

16. 12.Q
6 years old boy admitted with 10 to 15 large quantity of watery stools in a day and
decreased urine output. Had an episode of convulsion just before coming to the
hospital The weight was 10kgs previously now is 8.8kgs.O/E altered sensorium and
no focal neurological deficit Investigation revealed
Na-123 meq/litre
K-3.8 meq/litre
Hco3-18meq/litre
1) What is the diagnosis
2) What is the probable cause for seizure and altered sensorium
3) How will you manage the above problem?
12.A
1.Acute watery diarrhoea with severe dehydration with hyponatremia
2.hyponatremia
3.Na deficit= (135-123) x10x.6 =72 meq/litre
1ml of 3% nacl = 0.5 meq/litre
144 ml of 3%Nacl to be infused to correct the
Hyponatremia
15

17. 13.Q
1) What is the abnormality
2) List three biochemical abberations which will cause this abnormality
3) What are the common clinical presentation associated with this ECG
abnormality
4) What is the drug which could cause this abnormality in early infancy
16

18. 13.A
1) Prolonged QT interval
-It starts with the onset of Q or R to the end of T, in seconds
2) Hypokalemia
Hypocalcemia
Hypomagnesemia
3) Syncope, seizures
4) Cizapride
17

19. 14.Q
1. What is the ideal schedule for this vaccination?
2. What are the advantages over OPV
3. What is the adverse effect?
4. Where was the last outbreak in India?
14.A
1) 1st dose at 8 weeks of age
2 doses with 8 weeks interval + 1 booster optional /additive (AAP Schedule)
2 a) Can be given to immunocomprimised individuals
b) Vaccine induced paralytic polio is absent
3. No adverse effect
But if patient is allergic to neomycin, streptomycin and polymixin it can
produce allergic manifestation
4. Western U.P
18

20. FUNDUS PICTURE
15.Q
1) What is the diagnosis
2) Mention 3 diseases with similar findings
3) Earliest clinical presentation of this condition
4) Name two treatable conditions with the same findings
19

21. 15.A
1) Retinitis pigmentosa
2) A. M.P.S.
B. Late onset gangliosidosis
C. Lawrence moon biedl syndrome
D. Refsums disease
E. Abetalipoprotenimia
F. Ushers syndrome
3) Night blindness
4) Refsums disease and abetalipoprotenemia
20

22. 16Q.
1) What is your diagnosis
2) Name three risk factor for this diagnosis
3) What is the drug used to prevent this disease
4) What is the dose
21

23. 16A
1. Respiratory distress syndrome
2. Preterm, male, elective LSCS, gestational diabetes multiple gestation, asphyxia
3. Antenatal corticosteriods-Betametasone
4. Betametasone 12 mg 12hour interval I.M. 24 hours prior to delivery
22

24. 17.Q
5 year old female child brought to the hospital for progressive difficulty in
climbing stairs and a positive gowers sign. Child also has wasting of the thenar,
hypothenar and distal muscle. Tongue is thin and atrophic.
1. What is the clinical diagnosis
2. Name one clinical sign which will support your diagnosis
3. Cardiac manifestation of this disease
4. Name two drugs that will diminish the symptom of this disease
17.A
1) Mytonic muscular dystrophy
2) Myotonic reflex
3) Heart block and arythmias (other dystrophy will cause cardiomyopathy)
4) Mexilitiene, phenytoin, carbamazepine,procainamide and quinidine sulphate
23

25. 18.Q
1. What is the clinical diagnosis?
2. Mention two points seen in this CT to justify your Diagnosis
3. What is the immediate management?
4. Name the complication seen in the CT.
24

26. 18.A
1. Cerebral abscess – Right fronto parietal region
2. Hypodense lesion measuring about 3cm x 2cm
Ring enhancement – larger area differentiates this from granuloma and irregularity
3. Surgical drain
4. Ventriculitis right lateral ventricle
25

27. 19.Q
In your hospital the following biomedical waste was generated from a patient with
typhoid. Indicate what colour code you will assign to dispose the waste.
1. Torn under garment
2. Plastic food box
3. Cotton used to wipe blood from the site of venepuncture
Slide containing smear
4. Needle used to give IM injection.
19.A
1) Red
2) Green
3) Red
4) Blue
26

28. 20.Q
1. Report the smear
2. Mention two features seen which give the diagnosis
3. Mention any two preparations used to treat the condition
4. Two important complications
20.A
1. Smear shows RBCs with trophozoites, gametocytes of P. falciparum.
2. Banana shaped RBC with intracellular inclusion
3. Chloroquine, quinine, artisunates.
4. Cerebral malaria, backwater fever, algid malaria
27

29. 21Q
1) What is this device?
2) Mention 2 advantages and 2 disadvantages of this device?
3) What is the flow rate of oxygen to be used in this device?
4) What is the maximum fio2 this device can deliver?
21A
1) Oxygen Hood
2) Two advantages – allows easy access to chest, trunk
and extremities.
- Permits control of improved oxygen
Concentration and nebulization
3) flow rate - > 10 to 15 L / min
4) Fio2 – 80 – 90 %
28

30. 22Q
1. Findings in this x ray
2. What are the two important conditions which produce similar findings.
3. How do you differentiate radiologically these two conditions.
4. What hematological problems can occur in a child with such x-ray findings.
29

31. 22A
1. - Increased density of bone
- Changes suggestive of of rickets
2. - Osteopetrosis
- Pyknodysostosis
3. (a) Angle of mandible normal in osteopetrosis
Increased angle of mandible in pyknodysostosis
(b) Distal phalanges normal in osteopetrosis
Narrow distal phalanges in pyknodysostosis.
4. Anemia
30

32. 23Q
1) What is abnormal in this?
2) What is the probable diagnosis?
3) Write 4 conditions predisposing to this.
4) Treatment of choice for this condition.
31

33. 23A
1) Colon cut off sign is seen
Paucity of distal bowel gas shadow
2) Intussusception
3) Gastroenteritis
Upper respiratory tract infection
Polyp
HSP
Hemangioma
Rotavirus vaccine
Meckels diverticulum
Lymphoma
4) Pneumatic reduction
32

34. 24.
Palpation of Precordium
1. a) Wish and introduce yourself and establish a rapport and get permission to
remove the shirt to examine the precordium
b) Warm up your hands
2. Palpation for apex beat
- Good light
- Supine/sitting position
- Palmar palpation and digital localization
3. Parasternal heave
- Supine position
- To keep the ulnar aspect of hand over the right parasternal area
4. Palpation of heart sounds by digit
- Opening snap just inside the apex
- P2 – pulmonary area
5. Thrill over precordium
- Supine position
- To keep the palmar aspect of the hand over the precordium to locate the
thrill (systolic thrill over parasternal area and diastolic thrill over the
apex)
33

35. 25 Counseling
3-month-old infant brought by the mother for NOT ENOUGH MILK
Counsel the mother
1. Introduce and establish rapport
2. Questions to be asked regarding
- Volume and frequency of urine output
- Frequency of feeding
- Artificial feeding/bottle feeding
- Any chronic illness or acute illness in the mother
3. See for the position and attachment
-Weight gain 30 grams /day
4.Tell about importance of giving feed continuously by demand
-Weight gain and urine output are the good indicator of adequate feeding
-Encourage to take adequate food and rest
5.Buildup confidence in the mother
Encourage night feeds
Frequent and complete emptying the breast will help in lactation
Tell about the dangers of artificial food like allergy/ diarrhea / recurrent respiratory
infection
34

36. http://groups.yahoo.com/group/PediatricsDNB/
Theory: http://dnbpediatricstheory.blogspot.in/
OSCE: http://oscepediatrics.blogspot.in/
Clinical: http://clinicalpediatrics.blogspot.in/
Practicals: http://practicalpediatrics.blogspot.in/
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