OSCE in Pediatrics - Rainbow H

1. RAINBOW HOSPITAL OSCE

2. QUESTION 1

3. QUESTION 1
• What is your diagnosis?
• Name 4 conditions in which it is seen.
• What is the underlying mechanism?

4. ANSWER 1
• Cherry Red spot
• Tay sachs disease, Sandhoff disease, Niemann pick
disease, central retinal artery occlusion.
• Due to loss of transparency of the retinal ganglion
cell layer secondary to lipid accumulation/edema.
Because ganglion cells are not present in the fovea,
the fovea transmits the underlying choroidal colour.

5. QUESTION 2
• Surface marking of right lung.

6. ANSWER
• 2.5cm above the medial end of clavicle.
• Sternoclavicular joint.
• 4th costal cartilage.
• Midclavicular line at 6th rib.
• Midaxillary line at 8th rib.
• Lateral border of erector spinae at 10th rib.
• Oblique fissure – line joining spine of T3 vertebra to 6 th
rib in midclavicular line.
• Horizontal fissure – horizontal line extending from 4th
costal cartilage continued to meet oblique fissure in
midaxillary line.

7. QUESTION 3

8. QUESTION 3
• What is your diagnosis.
• Mention a few potential reversible causes of
this condition.
• Name 2 drugs used in treatment.

9. ANSWER 3
• Wide complex tachycardia – ventricular
tachycardia.
• Hypoxia, hypothermia, hypo/hyperkalemia,
hypoglycemia, Toxins, tamponade, tension
pneumothorax, trauma.
• Amiodarone, procainamide.

10. QUESTION 4
• You have done therapeutic aspiration of
pleural fluid from a child with empyema.
Mention how will you dispose the following
after the procedure.
• Gloves.
• 18 gauge needle.
• Disposable syringe.
• Cotton and gauze.

11. ANSWER 4
• Gloves – yellow bin.
• needle – puncture proof container.
• Disposable syringe – red bin.
• Cotton and gauze - yellow bin.

12. QUESTION 5
This is the MRI of an infant evaluated for
recurrent seizures with developmental delay

13. QUESTION 5
• What is your diagnosis?
• Mention 2 ocular abnormalities associated
with this condition.
• Name the syndrome associated with this
condition.

14. ANSWER 5
• Lissencephaly (absence of cerebral
convolution and poorly formed sylvian fissure)
• Hypoplasia of the optic nerve and
microphthalmia.
• Miller-Dieker syndrome.

15. QUESTION 6

16. QUESTION 6
• Identify the organism.
• Mention 4 commonly used stains for
identification of the organism.
• Mention 2 drugs used in treatment.

17. ANSWER 6
• Pneumocystis jirovecii
• Grocott/gomori silver, toluidine blue, giemsa,
fluorescein-labeled monoclonal antibody
stains.
• Trimethoprim-sulfamethoxazole, pentamidine
isethionate, atovaquone, trimethoprim plus
dapsone, clindamycin plus primaquine.

18. QUESTION 7
• Demonstration of cerebellar signs.

19. ANSWER 7
• Nystagmus – gaze evoked nystagmus.
• Gait – unsteady and irregular with a wide base.
• Intention tremor.
• Dysdiadokokinesia.
• Past pointing.
• Coordination – finger nose and heel shin test.
• Reflexes – pendular knee jerk.
• Dysarthria – scanning and robotic with syllable
pronounced individually and slowly.

20. QUESTION 8
• Counsel a mother whose child has been
diagnosed to have Acute lymphoblastic
leukemia.

21. ANSWER 8
• Introduces self.
• Says that child has been diagnosed to have
leukemia which is a blood cancer of WBC’s.
• Shows sympathy and reassures that the
overall prognosis is excellent.
• Says that the etiology is not known.
• Says that treatment involves drugs (chemo)
and occasionally radiotherapy.

22. • Says that the duration of treatment will be 2 ½ to 3yrs.
• Says regarding side effects of chemo like hairfall,
infections, bleeding tendencies etc.
• Also mentions about long term complications like
decreased growth, repeat cancer.
• Stresses the need for neutropenic care – avoid giving
outside food, avoid overcrowded places, avoid
frequent visitors.
• Mention the risk of relapse – CNS, testicular, blood and
hence the need for regular followup after completion
of treatment.
• Mention about vaccination – to consult doctor before
giving regular vaccines.

23. QUESTION 9
• A 3 yr old child is brought with history of
sudden onset of difficulty in breathing. The
child was playing with toys and was found
drowsy by the mother.
• On arrival in the ER, the child is unresponsive,
tachypneic, cyanosed with good peripheral
pulses.
• Mention the steps in management of this
child.

24. ANSWER 9
• Open the victim’s airway using a tongue-jaw
lift and look for an object in the mouth and
pharynx. If an object is visible, remove it. Do
not perform blind finger sweeps.
• Open the airway with a head tilt-chin lift and
attempt to provide rescue breaths. If breaths
are not effective, reposition the head and
reattempt ventilation.

25. • If the breaths are still not effective, prepare
to perform abdominal thrusts (Heimlich’s
maneuver).
• Repeat the steps until the object is dislodged
and the airway is patent or until attempts
have lasted approximately 1 minute. If the
infant remains unresponsive after 1minute,
activate the EMS system.

26. QUESTION 10
• Elicit Moro’s reflex, rooting and sucking reflex,
palmar and plantar grasp in this neonate.

27. QUESTION 11
• This is the electrolyte report of a 1yr old infant
who was evaluated for failure to thrive,
recurrent vomiting and polyuria.
• Na – 134mEq/dl, K – 2.6mEq/dl, Cl 100mEq/dl,
HCO3 – 28mEq/dl.

28. QUESTION 11
• What is your diagnosis.
• Mode of inheritance?.
• What is the underlying defect.
• Treatment.

29. ANSWER 11
• Barrter syndrome.
• Autosomal recessive inheritance.
• Defect in sodium and chloride resorption in
the loop of henle.
• Oral potassium supplement, potassium
sparing diuretic, Indomethacin.

30. QUESTION 12
• While drawing blood sample from a patient,
whose HIV status is unknown, your hospital
nurse has an accidental needle stick injury
(non intact skin, small volume exposure).
• Mention the setps which should be taken in
such a situation with regards to the following.

31. QUESTION 12
• Care of the exposed site.
• Counselling of the health care personnel.
• Counselling of the source.
• Tests to be done and timing of the test.
• Drug therapy – duration and dose.
• Administrative action.

32. ANSWER 12
• Wash the exposed site thoroughly with running water.
Wash skin with soap.
• Reassure and inform about PEP.
• Counsel the source and obtain consent for testing –
determination of HIV,HBV,HCV status of the source.
• HIV,HBV,HCV testing of the health care personnel. HIV
testing at zero hour, 6wks, 12wks, 6months.
• Zidovudine 300mg BD & Lamivudine 150mg BD for 4
weeks.
• Recording and reporting of the even.t

33. QUESTION 13
• A 1-1/2 year old with VSD on antifailure drugs
develops illness suggestive of influenza.
• What Category does this child belong to as
per govt of India guidelines.
• Mention 2 appropriate steps recommended
for this category
• What is the correct dosage and duration of
oseltamivir in children?

34. ANSWER 13
• Category B
• Home isolation and oseltamivir therapy
• For weight 15kg 30mg BD for 5 days

35. QUESTION 14
• 16 year old girl presents with h/o passing red
coloured urine for the last few hours. There
was no h/o fever. There was h/o drug intake
for diarrheal illness 3 days ago.
O/E she had gross pallor and a tinge of scleral
icterus
• What is the provisional diagnosis?
• Describe the peripheral smear picture in this
girl.
• Immediate steps in management.

36. ANSWER 14
• Acute intravascular hemolysis
• Fragmented RBC,Bite cells,nucleated
RBCs,severe thrombocytopenia
• Packed cell transfusion

37. QUESTION 15
• Mention the duration and temperature at
which the following blood products can be
stored?
• 1.Red Blood Cells
• 2.Fresh Frozen Plasma
• 3.Platelet Concentrate
• 4.Cryoprecipitate

38. ANSWER 15
• Packed RBC – 42 days in the refrigerator or 10
years in the freezer.
• FFP - 1 year in the freezer
• Platelet Concentrate – 5 days at room
temperature
• Cryoprecipitate – 1 year in the freezer

39. QUESTION 16

40. QUESTION 16
• This is the karyotype obtained from the
bonemarrow of a 6 year old girl with a
hematological malignancy.
• Comment on the abnormality
• Mention 1 favourable and 1 unfavourable
translocation in ALL

41. ANSWER 16
• Hyperdiploidy
• BCR ABL – Unfavourable
• TELL AML - Favourable

42. QUESTION 17

43. QUESTION 17
• Mention the abnormality in this CXR.
• Mention 3 causes of this appearance.
• What further investigations would you order?

44. ANSWER 17
• Mediastinal enlargement
• Lymphoma
• Thymoma
• Teratoma
• CT chest,CT guided biopsy and HPE

45. QUESTION 18

46. QUESTION 18
• What is the abnormality seen on this
radiograph?
• Name 2 disorders which may give rise to this
abnormality

47. ANSWER 18
• Xray skull lateral view showing multiple lytic
lesions
• Histiocytosis
• Secondaries
• Multiple myeloma

48. QUESTION 19
• Define Polio eradication and elimination
• Mention core strategies for eradication of
polio.

49. • Eradication – No cases of paralytic polio by
wild polio virus in the last 3 calender years
• Elimination – No cases of paralytic
poliomyelitis by wild polio virus in 1 calender
year.
• CORE STRATEGIES:
• Maintaining high routine immunisation
coverage with 4 doses of OPV
• Mass campaign
• Sensitive Surveillence
• Mop up campaign

50. QUESTION 20
• HPV VACCINE
• What are the types of vaccine available?
Mention the serotypes covered by them.
• What is the recommended dose?
• What is the recommended age for
vaccination?

51. ANSWER 20
• Quadrivalent vaccine (gardasil) – serotypes 16,
18, 6, 11.
• Bivalent vaccine (cervarix) – serotypes 16, 18.
• 0.5ml intramuscular at deltoid.
3 doses - 0, 2, 6months – gardasil.
3 doses - 0, 1, 6months – cervarix.
• Initiation of vaccine 10-12years of age. Catch
up vaccination up to 26yrs of age.

52. QUESTION 21

53. QUESTION 21
• Identify this graph.
• What do the square and area of each square
represent?
• What do the horizontal and vertical line
represent?
• What does the diamond represent?
• What does the centre of diamond represent?

54. ANSWER 21
• Forest plot (forest plot shows information
from individual studies that went into meta-
analysis at a glance. They show the amount of
variation between the studies and an estimate
of the overall result.
• Each square symbol represents a study
contributing to metanalysis and the area of
square corresponds to the weight of the
corresponding study to the metaanalysis.

55. ANSWER 21
• The horizontal line through the square shows
the confidence interval. The solid vertical line
represents no effect.
• The diamond represents the overall estimate
from the meta-analysis.
• The centre of diamond represents the pooled
point estimate and the horizontal tips
represent the confidence interval.

56. QUESTION 22

57. QUESTION 22
• Identify this peripheral smear.
• What is the underlying defect?
• Confirmatory test for diagnosis?
• Treatment options?

58. ANSWER 22
• Hereditary spherocytosis.
• Defect in spectrin or ankyrin - results in
uncoupling in the vertical interactions of the
lipid bilayer skeleton and loss of membrane
microvesicles.
• Osmotic fragility test.
• Folic acid 1mg/day, splenectomy.

59. QUESTION 23

60. QUESTION 23
• Identify this peripheral smear.
• Mention a few complications associated with
this condition.

61. ANSWER 23
• Plasmodium falciparum malaria.
• Cerebral malaria, blackwater fever, pulmonary
edema, algid malaria.

62. QUESTION 24
1 ½ yr old child with history of chronic diarrhea was
brought with complaints of perioral and perineal rash.

63. QUESTION 24
• What is your diagnosis?
• Mode of inheritance?
• Investigation used for diagnosis?
• Treatment of choice?
• Mention a few differential diagnosis.

64. ANSWER 24
• Acrodermatitis enteropathica.
• Autosomal recessive – defect in intestinal zinc
specific transporter gene.
• Low plasma zinc concentration.
• Zinc – 50mg/day for infants, upto 150mg/day
for children.
• MSUD, organic acidemia, methylmalonic
acidemia, biotidinase def, severe PEM.

65. QUESTION 25

66. QUESTION 25
• What is your diagnosis?
• What is the causative organism?
• Mention a few other manifestations.
• Mention a few complications.

67. ANSWER 25
• Erythema infectiosum.
• Parvovirus B19
• Arthropathy, transient aplastic crisis,
myocarditis.
• Thrombocytopenic purpura, aseptic
meningitis, infection associated
hemophagocytic syndrome, persistent
arthritis.

68. QUESTION 26

69. QUESTION 26
• Identify this pedigree chart. What is the mode
of inheritance.
• Mention a few disorders with this mode of
inheritance.

70. ANSWER 26
• X-linked dominant inheritance.
• Hypophosphatemic rickets, incontinentia
pigmenti.

71. QUESTION 27
Stool microscopy of a child showed the
following

72. QUESTION 27
• What is your diagnosis?
• Mention a few clinical manifestations.
• Drugs used in treatment.

73. ANSWER 27
• Hookworm egg.
• Iron deficiency anemia, dermatitis, cutaneous
larva migrans, cough due to
laryngotracheobronchitis.
• Albendazole 400mg stat, Mebendazole 100mg
BD for 3 days, pyrantel palmoate 11mg/kg OD
for 3 days.

74. QUESTION 28
1.Mark the parts of the ETCO2 graph and explain each part.
2.Mention 2 conditions which cause this type of ETCO2
recording

75. ANSWER 28
2.Intravenous bicarbonate injection
Release of a tourniquet from a surgical
limb

76. QUESTION 29

77. QUESTION 29
• Identify this condition.
• Mention 3 treatment options
• Mention 2 complications

78. ANSWER 29
• Dense bones suggestive of osteopetrosis
• Steroids,Interferon,Bone marrow
Transplantation
• Infections,Bleeds,Loss of vision

79. Question 30
A 1 month old child
was brought with pink
staining of the diapers
since birth. He also had
history of blisters on
sun exposed areas.
On examination the
color of the urine is as
shown.

80. 1. What is your diagnosis?
2. Name the deficient enzyme.
3. What are the other clinical manifestations?
4. Mention the diagnostic lab finding.

81. Answer:
1. Congenital Erythropoietic Porphyria (Gunther disease)
2. Uroporphyrinogen III synthase (UROS)
3. Bullous cutaneous photosensitivity– hydroa aestivale,
hypertrichosis,
erythrodontia,
hemolytic anemia,
bone abnormalities
4. Markedly elevated levels of uroporphyrin I and
coproporphyrin I in urine,stool and RBC’s.

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