Pediatrics OSCE - Mock exam, Pune, Oct 2012, Dr.Ashwin Borade.

1. Dr. Ashwin Borade
27TH Oct 2013

2. This is a PBS and photograph of a 10 year old boy who has presented with
fatigue, fever, and malaise of > 1week in duration.
On examination, he has generalized lymphadenopathy, splenomegaly and
hepatomegaly. (1X5=5)
1) describe the main features in each picture
2) what is the diagnosis
3) Write 3 complications that may occur
4) What medication is contraindicated
5) what is the treatment

3. • Answer (1X5=5)
• Picture 1 shows tonsillitis with membrane
formation, picture 2 shows atypical mononuclear cells
which are enlarged with irregular nuclei and basophilic
pleomorphic cytoplasm
• Infectious mononucleosis
• Splenic hemorrhage/ splenic rupture/ airway
obstruction causing drooling/ stridor and respiratory
distress/ thrombocytopenia/ Coombs positive
hemolytic anemia/ GBS/ Reyes syndrome
• Ampicillin and amoxycillin
• Rest and symptomatic treatment / avoidance of
contact sports or strenuous athletic activities during
the first 2-3 weeks of illness or while splenomegaly is
present.

4. • A
•
•
•
•
Name the Method used in slide 1/2
Enumerate the steps 1
Name two organisms which can
be stained by this method 1
• B
• Identify the PS 1/2
• Name 4 conditions in which
it can be seen 2

5. • A
• Zheil Neelson technique(1/2)
• Steps: 1
Heat and dry, fix the smear
Add carbol fuschin
Heat for approx 5 minutes, do not boil
Decolorize with 20% sulfuric acid
Decolorize with ethanol
Wash with water
Counter stain with Methylene blue
• Myco tuberculosis , M. Leprae, Nocardia

6. B
• Eosinophilia
• Allergic disorders/ Tissue invasive helminth
infections/ Malignant disorders/
Rheumatological diseases/ Hyper – IgE
syndrome

7. This is a picture of a 5 year old boy with a characteristic rash which was
preceded by a prodromal phase consisting of low grade fever, headache
and mild URTI.
Describe the 2 pictures? 2
What is the diagnosis? 1
And the cause?1
Mention two immune mediated post infectious phenomena of the above organism 2

8. Answer
• Erythema infectiosum/ Parvovirus B19 (1+1)
• Picture-1- slapped cheek appearance (1)
• Picture-2- lacy reticulated rash on the arm(1)
• Rash and arthropathy are immune
mediated, post infectious phenomenon(1+1)

9. VIDEO

10. Station
• Identify the sign 1/2
• What is it used to detect? 1/2
• Name three conditions it can be associated
with 2

11. answer
• Trousseau’s sign 1
• Latent tetany 1
• Hypocalcemia/ hypomagnesemia/ metabolic
alkalosis 3

12. Disorder
DIC
Hemophilia A
Von
Willebrand
ITP
Chronic liver
disease
Platelets
PT
APTT
TT
FDP

13. Disorder
Platelets
PT
TT
FDP
Inc
DIC
APTT
Inc
Inc
Dec
Hemophilia A
Inc
N
N
inc
N
N
N
inc
N
N
Von
Willebrand
N
ITP
Dec
N
N
N
N
Chronic liver
disease
Dec/N
Inc
Inc
N
N

14. Identify inheritance A & B
Give example of each and peculiarity of each
• A
• A

15. A
• DIGENIC INHERITANCE.
• Digenic inheritance explains the occurrence of retinitis
pigmentosa (RP) in children of parents who each carry a
different RP-associated gene. Both parents have normal
vision, as would be expected, but the offspring who were
double heterozygotes developed RP.
• Digenic pedigrees exhibit characteristics of both autosomal
dominant (vertical transmission) and autosomal recessive
inheritance (1 in 4 recurrence risk). A couple in which the
two partners are carriers for two different genes may have
affected children. Any child, however, might transmit both
mutations to an offspring, as in dominant inheritance.

16. B
• Pseudodominant inheritance refers to the
observation of apparent dominant (parent to
child) transmission of a known autosomal
recessive disorder
• This occurs when a homozygous affected
individual has a partner who is a heterozygous
carrier, and it is most likely to occur for relatively
common traits, such as sickle cell anemia or
congenital deafness due to connexin26 gene
mutation.

17. Milestone
Follows moving object 180
Sustain social contact, listen to music
Polysyllable vowel sound
Creep or crawl
Plays simple ball game
Hope of feet
Name 4 colors
Make tower of 4 cubes
Dress and undress
Put 3 words together
Age of attaining ( in months)

18. Milestone
Age of attaining ( in months)
Follows moving object 180
2
Sustain social contact, listen to music
3
Polysyllable vowel sound
7
Creep or crowl
10
Plays simple ball game
12
Hope of feet
48
Name 4 colours
60
Make tower of 4 cubes
18
Dress and undress
60
Put 3 words together
24

19. Write formula for
• PA O 2
• VA
• Ventilation index
• OI
• A-aO2 gradient

20. •
•
•
•
•
PAO2=PI02- (PaCo2 /R)
VA= (VT-VD) X RR
Ventilation index= PIP X VR/1000XPaCO2
OI={(MAP X FIO2)/PaO2 } X100
A-aO2 gradient= PAO2-PaO2

21. • .A 12 yrs old female brought in general OPD
with c/o fever, malaise, weight loss and
recurrent headache since 3 months . On
examination she had asymmetrical blood
pressure and claudication
• What is the diagnosis?
• What are diagnostic criteria?
• What are types of same?
• What is drug of choice for new case, relapse
case and refractory case

22. answer
•
•
•
•
takayasu arteritis
New case- steroid
Relapse- methotrexate
Refractory- cyclophosphamide

24. • What is the clinical condition called?
• Which is the commonest malignancy
associated with this?
• Which chromosome is implicated in malignancy
mentioned in question 2?
• What other malignant disorders are associated
with the malignancy being discussed?

25. answer
• Leucocoria
• Retinoblastoma
• Rb1 gene Ch 13q 14
• Osteosarcoma
Soft tissue sarcomas
Malignant melanoma

26. • . A. What is PICOT study used for?
• What it an acronym for ….
• B Weight of 12 children of 2 yrs is as below
• 10, 8, 9, 10, 12, 15, 10, 6, 9, 7, 11,8
• Calculate mean, mode, median

27. A.
• PICOT is a technique medical researchers use to
develop a clinical research question.
• It may form part of a formal funding or
research proposal, or medical staff may use it to
carry out a small-scale experiment.
• PICOT is an acronym for the five different areas
the technique considers -- patient
population, intervention or issue, comparison
with another intervention or issue, outcome
and time frame.

28. B.
• Mean= 9.5
• Median= 8.5
• Mode= 10

29. • A patient is admitted to the ICU with the following lab values:
• BLOOD GASES under room air
• pH: 7.199
PCO2: 32.2
HCO3: 12
PO2: 86.6
• ELECTROLYTES, BUN & CREATININE
• Na: 136
K: 4
Cl: 103
1 – Describe the metabolic condition (1)
2 – What is the expected compensation? (1)
3 – Calculate anion gap. What is the normal value? (2)
4 – Name two conditions with similar anion gap as above (1)

30. answer
• 1- Metabolic acidosis with partial
compensation
• 2 - 1 bicarb fall decreases Co2 1-1.5
• 3 – Anion gap - [Na] – [Cl] – [HCO3]
= 25
• 4 – Septic shock, Inborn error ( lactic
acidosis), DKA etc

31. • 2yrs old child with seizure, behavioral problems, skin
abnormalities, MRI done
• What is diagnosis?
• What are criteria?
• What is inheritance?
• What are chart eristic CNS presentation
• How u follow up these cases?

32. answer
•
•
•
•
•
•
•
Tuberous sclerosis complex
Major / minor criteria
AD
Epilepsy/ cognitive impairment
F/u examination mRi 1-3 yrs
USG/CT/MRI renal 1-3 yrs
Neurodevelopment assessment

34.  An eight year old child presented with
malaise, anorexia, vomiting, muscle weakness and orthostatic
hypotension. He had H/o a febrile illness with purpuric rash a few
days before.
 What is the significant finding in the picture?
 What is the cause of this finding?
 What is the possible infection preceding it and what is it called
 What are the possible electrolyte
abnormalities ?
 What is the definitive test for
diagnosis of this condition.

35. Answer
• Hyperpigmentation of the gingival and buccal
mucosa.
• Cortisol deficiency leading to increased ACTH
production and Melanocyte stimulating hormone
arising from the ACTH precursor POMC.
• Meningococcemia – Waterhouse-Friderichsen
syndrome
• Hypoglycemia, ketosis, hyponatremia
• ACTH Stimulation test

36. •
•
•
•
•
A. What is diagnosis?1/2
What are predisposing factors
for it? 1
What is t/t? 1/2
What are other manifestations? 1/2
•
•
•
•
B .Clarithromycin
What group it belongs 1/2
What mechanism of action? 1
What organisms it act against 1

37. •
•
•
•
A. Guttate psoriasis
Streptococcal infection, post viral, post steriod
Topical steriod/PT
Arthritis
• B. Macrolide antibotic
• By interfering with their protein synthesis.
• Atypical pneumonias associated with
Chlamydophila pneumoniae, skin and skin
structure infections. In addition, it is sometimes
used to treat legionellosis, Helicobacter pylori, and
lyme disease.

38. • 1) Identify the condition in
the CXR of an ELBW
newborn
• 2) Give the definition of this
condition
• 3) Mention the stages of
this condition in a 34 wk old
• 4) What are the
pharmacological strategies
in the management of this
condition
• 5) Expand INSURE

39. answer
1)Bronchopulmonary dysplasia (BPD)
2) Current definitions include
1. total duration of oxygen supplementation requirement for >28
days,
2. degree of prematurity (<32 weeks gestational age at birth),
AND
3. Oxygen dependency at 36 weeks Postmenstrual Age.

40. answer
3) Stages:
• Mild: Breathing room air at 56 days postnatal age or
discharge*
• Moderate: Need for <30% oxygen at 56 days postnatal age or
discharge*
• Severe: Need for > 30% oxygen and/or positive pressure
(IMV/CPAP) at 56 days postnatal age or discharge*
(* whichever comes first)

41. answer
4) Pharmacological strategies
• -Vitamin A
• -Postnatal steroids
• -Superoxide dismutase
• -Furosemide
5) INtubateSURfactantExtubate

42. 1) What is the radiological investigation
2) What sign is demonstrated?
3) What is the diagnosis?
4) What is the commonest age group in
which the following condition
occurs?
5) What are the other conditions
associated with this abnormality?

43. answer
•
•
•
•
•
Upper GI barium meal study
Corkscrew duodenum
Malrotation with a midgut volvulus
Usually newborns and young infants
Duodenal atresia, duodenal stenosis, annular
pancreas

44. • What are 4 categories of vaccines and
explain them?
• Fill the category below?
VACCINE
BCG
CHICKEN POX
MMR
DTwP
TYPHOID
DTaP
PPV23
RABIES

45. • Categories: Category 1: Vaccine covered under
Expanded Program on Immunization (EPI)
• Category 2: Vaccine recommended by IAP in
addition to EPI
• Category 3: Vaccine which are to be given after
one to one discussion with parents.
• Category 4: Vaccine to be given under special
circumstances.

46. VACCINE
CATEGORY
BCG
Category 1
CHICKEN POX
Category 3
MMR
Category 2
DTwP
Category 1
TYPHOID
Category 2
DTaP
Category 3
PPV23
Category 4
RABIES
Category 4

47. TESTS
HBsAg
anti-HBc
anti-HBs
HBsAg
anti-HBc
anti-HBs
HBsAg
anti-HBc
anti-HBs
HBsAg
anti-HBc
IgM anti- HBc
anti-HBs
HBsAg
anti-HBc
IgM anti- HBc
anti-HBs
RESULTS
Negative
Negative
Negative
Negative
Negative
Positive with >10mIU/mL
Negative
Positive
Positive
Positive
Positive
Positive
Negative
Positive
Positive
Negative
Negative
INTERPRETATION

48. TESTS
HBsAg
anti-HBc
anti-HBs
HBsAg
anti-HBc
anti-HBs
HBsAg
anti-HBc
anti-HBs
HBsAg
anti-HBc
IgM anti- HBc
anti-HBs
HBsAg
anti-HBc
IgM anti- HBc
anti-HBs
RESULTS
Negative
Negative
Negative
Negative
Negative
Positive with >10mIU/mL
Negative
Positive
Positive
Positive
Positive
Positive
Negative
Positive
Positive
Negative
Negative
INTERPRETATION
Susceptible
Immune due to
vaccination
Immune due to natural
infection
Acutely infected
Chronically infected

49. • A .This is lead II ECG of neonate who
presented with excessive crying.
Systolic NIBP is 80 mm HG
• 1) What is the ECG diagnosis?
• 2) DC shock is available. Is DC shock treatment
of choice Y/N?
• 3) If any treatment necessary, if yes mention?

50. • B. Identify the ECG. What is the name of
this condition?
• Mention 4 causes for this.

51. A
• SVT
• No
• Vagal maneuvers , Ice filled packs on face, Carotid
massage
Adenosine with dose and method of administration
Digoxin
Propanolol

52. B
•
•
•
•
•
•
•
2nd degree AV block. Mobitz Type 1
Myocarditis
Cardiomyopathy
Myocardial infarction
Congenital heart disease
Digitalis toxicity
Cardiac surgery

53. Match the following
1. Verapamil
2. Methemoglobinemia
3. TCA
4. Sulfonylureas
5. Propranalol
6. Anticholinergics
7. INH
8. Ethylene glycol
9. Diazepam
10. Morphine
A.
B.
C.
D.
E.
F.
G.
H.
I.
J.
Fomepizole
Octreotide
Pyridoxine
Methylene blue
Insulin
Sodium bicarbonate
Glucagon
Physostigmine
Naloxone
Flumazenil

54. •
•
•
•
•
•
•
•
•
•
1-E
2-D
3-F
4-B
5-G
6-H
7-C
8-A
9-J
10-I

55. • A premature baby was ventilated and on
2nd day had convulsions. His investigation
done which is shown here
11/3/2013
CME,Indore
55

56. •
•
•
•
•
Identify and describe the investigation
Spot the diagnosis with grade
What are preventive measures?
What is the commonest neurological sequel?
What is the commonest Opthalmological
sequel?
11/3/2013
CME,Indore
56

57. Answers
• Cranial USG showing cystic PVL
• Grade 2 PVL
• Early interventions , maintain normal
cerebral perfusion
• Spastic diparesis
• Strabismus, nystagmus, ROP
11/3/2013
CME,Indore
57

58. Write cardiac disorder for
following syndrome (1/4 X 10=2 1/2)
syndrome
Apert
Crouzon
De lange
Noonan
william
Down
Digeorge
Cong.Rubella
Maternal PKA
Carpenter
Cardiac disoder

59. Answer
syndrome
Cardiac disoder
Apert
VSD
Crouzon
PDA/COA
De lange
VSD
Noonan
PS/ASD
william
AS
Down
ECD
Digeorge
Aortic arch anomalies
Cong.Rubella
PDA
Maternal PKA
VSD/ASD
Carpenter
PDA

60. THANK YOU!!!
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