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OSCE PUNE
Station 1

            This female
            neonate
            was born
            with a large mass
            in relation to the
            umbilical cord
•   Identify the condition
•   Give three important aspects that you
    will take care of in the transport of
    such a neonate.
Answers
•   Exomphalos major/ omphalocele
•   Transport supine with the hernia
    suspended by a string
•   Cover the omphalocele with a
    waterproof covering
•   Provide additional fluids
Station 2



            This male
            neonate was
            born with
            multiple fractures
            and deformities
            of the limbs
•   Identify the condition
•   How is the condition inherited?
•   What is the biochemical defect?
•   What are the medical treatment
    options of this condition?
Answers
•   Osteogenesis Imperfecta
•   Autosomal dominant
•   Reduction in collagen formation
•   a. Growth hormone
•   b. Bisphosphonates/ allendronate/
    pamidronate
STATION 3

            Study this
            picture of an
            8 month
            infant who
            developed a
            rash during
            the declining
            phase of fever
            starting with
            the cheeks
STATION 3
•   What is the most probable diagnosis?
•   What is the causative organism?
•   Name two situations where infection
    with this organism may be life
    threatening
Answers Station 3
•  Erythema infectiosum/ fifth disease/
•  Parvovirus B 19
a. Aplastic crisis in hemolytic anemia
b. Non-immune hydrops fetalis in fetal
   infection
Station 4 (Observed Station)

  An 8 yr old child is known case
  of IDDM for last 1 yr.
  He requires 6 units of long acting
  insulin and 4 units of short acting
  insulin for his day.
  Kindly load the syringe
  with both types of insulin
Material Required
• Two vials of Insulin Marked Long acting
  and short acting
• Insulin Syringes
• Spirit swabs
• Two chairs one for the examiner and one
  for the candidate
Methodology for the Examiner
•    Draw an amount of air equal to the dose of insulin
     required (Long acting + Short acting) and inject into the
     vial to avoid creating a vacuum. (2)
•    Swab the top of the vial with spirit swab provided (1)
•    Inject air into the long acting first keeping the vial
     upright. (2)
•    Then inject air into the short acting insulin. (2)
•    Turn the vial upside down and withdraw the short
     acting insulin first (2)
•    Then the long-acting insulin.(1)
Station 5
• Give intradermal BCG vaccine
Material Required Station 5
•   Insulin Syringes
•   Dummy
•   BCG Vial
•   Cutter
•   Saline ampoules
Methodology For the Examiner
• (Each step carries 2 points)
• Amount of vaccine (0.1 ml = 0.1 mg of
  reconstituted vaccine) and Load in to syringe
  (Breakage of vial)
• Selection of area (Left deltoid just above its
  insertion)
• Don’t clean the area with spirit
• Keep the beveled end of needle up and
  technique of insertion
• Don’t rub the area
STATION 6
• 3 yr male child presented 3 days duration of loose stools
  5 days back.
• On 2nd day onwards patient passed blood along with
  stool.
• On 4th day of illness loose motions stopped but pateient
  developed oliguria.
• Patient became irritable.
• Patient also had one episode of abnormal movement 1
  hour back which subsided within 1 hour.
• Parents were giving ORS for past 3 days.
• Weaning was started 3 months back
• On examination – Pallor ++, petechiae, hepatomegaly,
  tachypnoea, oedematous, BP – 100/60
• Mild acidosis on ABG.
Questions Station 6
1. Name two differential diagnosis.
2. Name surgical condition which can be
   associated with above clinical picture.
3. Name three electrolyte disturbances
   which can be associated with it.
4. Management plan.
5. Name common agent causing it.
Answers Station 6
1 a) HUS b) AGN c) Dys-electrolytemia d)
  Intussuception
2 Intussuception
3 Hyponatremia / Hypenatremia /
  Hyperkalemia
4 IVF (ARF regime), PD
5 E Coli – 0157: H7
Station 7
• 14 Year old female child c/o pain in abdomen for
  past 10 days. She also developed vomiting /
  loose motions for past 4 days.
• Patient also c/o weakness of both lower limbs
• Unable to walk past 24 hours
• On examination - Patient was hypertensive,
  tachycardia +++, poor tone in both lower limbs,
  power grade 2 in both LL, DTR not elicitable.
Questions Station 7
1. Write 2 differential diagnoses (2 marks)
2. Investigations revealed Na – 110 / K 4,
   SGPT 37, patient passed high colored
   urine - What is the probable diagnosis (1
   mark)
3. Suggest one investigation for diagnosis
   (1 mark)
4. Treatment (1 mark)
Answers Station 7
1 GBS / Ac intermittent Porphyria /
  Hypokalemia
2 Ac Intr PORPHYRIA
3 Urine for Porphyria
4 Glucose / Hematin
Station 8
    15 year old male presented
    with pain in abdomen for
    past 25 days (acute intermittent,
    periumblical),also developed
    swelling over scrotum 6 days
    back which subsided within
    24 hours. Past 2 days patient is
    having pain over Rt wrist with
    swelling of Rt knee. Patient
    also developed rash over
    gluteal region. Patient was
    passing red stool. Per abd
    examination showed empty
    Rt lower quadrant.
Questions Station 8

1 Name probable diagnoses (mark 2)

2 X-ray abdomen as shown – What complication

  patient has developed (mark 2)

3 Medical treatment (specific for disease – other

  than blood / resuscitative fluid) (mark 1)
Answers Station 8
1. HS Purpura
2. Intussusception
3. Steroids
Station 9
•   ABG report
•   Ph           7.343
•   PaCO2        60
•   PaO2         47.6 mmHg
•   Bicarb       32
Questions Station 9
1. Interpret this blood gas (1 mark)
2. What is normal PaO2 level expected if a child is
   breathing at room air with normal lungs ? (1 mark)
3. Above mentioned ABG was taken when patient was
   inspiring 60% Fio2. Choose the correct option to
   describe oxygen status of the patient (1 mark)
   •   Corrected hypoxemia
   •   Under corrected Hypoxemia
   •   Normoxemia
   •   Over corrected hypoxemia
4. What is normal bicarbonate level in a normal blood gas
   write unit also. (1 mark)
5. What is normal PaCo2 in normal blood gas – write unit
   also. (1 mark)
Answers Station 9

2. Respiratory acidosis with metabolic
   compensation
3. 80-100 mmHg
4. b
5. 24mmol/L
6. 40mmHg
Station 10
• 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
Questions Station 10
1. Describe metabolic condition (1)
2. Describe compensation (calculate
   exact compensation) (1)
3. Calculate anion gap (1)
4. Name two conditions with similar
   anion gap as above (2)
Answers Station 10
•   Metabolic acidosis with partial
    compensation
•   1 bicarb fall decreases CO2 1-1.5
•   Anion gap 25
•   Septic shock, Inborn error (lactic
    acidosis), DKA etc
Station 11
5 year male child recently diagnosed as a case of AML.
TLC 57000.
Chest X Ray normal.
Hemodynamically stable with RR of 23/min.
Normotensive Pulse oximetry showed SpO2 of 98%.
ABG report
pH           7.43
PaCO2        34
PaO2         47.6 mmHg
Bicarb       24
Questions Station 11
1. Above mentioned ABG was taken when
   patient was inspiring at room air. Kindly
   explain blood gas (1 mark).
2. Suggest measure to improve PaO2 in
   above patient? (mark 1)
Answers Station 11
1. Pseudo Hypoxemia due to oxygen
   consumption by high TLC
2. Send sample in ICE
Station 12
2. National Malaria Control Program ( NMCP) was launched
   in India in_______ year
3. National Malaria Eradication Program ( NMEP) was
   launched in________ year.
4. In NMEP the program was divided into 4 phases ( name
   them)
5. Modified plan of operation under NMEP came into force
   from______ year.
6. Endemic areas under modified plan of operation under
   NMEP is defined as annual parasite index ( API) >
   ________.
7. Within the modified plan of operation an additional
   component known as "P. falciparum containment
   program" has been introduced from October 1977,
   through the assistance of_________________________
   agency.
Answers Station 12
1. 1953
2. 1958
3. a) Preparatory
   b) Attack
   c) Consolidation
   d) Maintenance
4. 1977
5. 2
6. Swedish International Development Agency
Station 13
• You are resuscitating a newborn at birth.
  The baby has gasping respiration at 30
  seconds after birth. Demonstrate what
  steps you would take for the next 30
  seconds.
Checklist for examiner
          (2 marks each)
1. Check Ambu Bag, mask, reservoir and
   oxygen source
2. Attatch reservoir, and oxygen source
3. Correct technique of ambu bagging
4. Correct frequency of ambu bagging
5. Counting heart rate at end of 30 seconds
Answer Following questions
based on X Ray seen on
STATION 14
1. What is abnormal in this X
ray?
2. What is the ideal position of
placement of umbilical arterial
and umbilical venous line?
3. After putting in a UA line, the
right lower limb appears pale.
What would you do?
4. What is the level of the renal
artery?
5. How do you maintain a UA
line?
Answers Station 14
1. Abnormally placed umbilical arterial line in the
   subclavian artery
2. For umbilical arterial line - High: Between T7-
   T10; Low: Between L2-L3
• For umbilical vein - Just above the diaphragm
3. Warm the other limb; If still pale >1/2 hour,
   remove the UA line
5. L-1
6. Use heparin infusion at rate of 0.5-1.0 Unit per
   hour
Station 15
• A newborn presents on day 2 of life with
  seizures. Write first 5 steps of
  management in sequential order.
Answers Station 15
1. Management of the airway, breathing and circulation
2. Do the blood sugar; If < 40mg%, give a bolus of 2ml/kg
   of D10%; If >40 proceed to next step
3. Take sample for S. calcium; Give Inj. Calcium gluconate
   2ml/kg 1:1 diluted. If seizures do not subside, proceed
   to next step
4. Give Inj. Phenobarbitone in a dose of 20mg/kg as a
   slow iv injection. If seizures do not subside proceed to
   next step.
5. Repeat Inj. Phenobarbitone in a dose of 10mg/kg after
   half hour of the first injection.
Station 16

       Question for CT scan head
       What is your Diagnosis?
Answer Station 16
• Right parietal lobe edema with midline
  shift.
Station 17
•  2 year old female presents with seizures
•  GCS 6
•  HR 60/MIN
•  Irregular respiration
•  Normotensive with CT scan already shown –
6. What is the Immediate management.
7. Drug which can help the patient (assuming he is
   normotensive )
8. What is the most common electrolyte disturbance
   associated with above patient?
9. Which parasitic infection can mimic this condition?
Answers Station 17
1.   Hyperventilation
2.   Mannitol
3.   Hyponatremia ( Sodium )
4.   Neurocysticercosis
Station 18
1. When was National tuberculosis control program
   started?
2. When was Revised National tuberculosis control
   program was started?
   Fill in the blanks
• Under RNTCP treatment services will be made most
   assessable to the patients with a view to achieve a
   cure rate of at least ______________% amongst all
   newly detected sputum positive cases .
• In tuberculosis control program DTC stands for
   _____________________________________________
   _______
• One tuberculosis unit will function as managerial
   unit for __________________ million population
Answers Station 18
1.   1962
2.   District tuberculosis center
3.   1992
4.   85%
5.   0.3 – 0.5 million
Station 19
Questions Station 19
•   Define this problem (ECG diagnosis)
    and immediate management after ABC
    (Initial resuscitation), patient without
    pulses (2 mark)
•   Name common metabolic problems
    related with above diagnosis and drug of
    choice for antagonizing the described
    metabolic effect. (1 mark)
Answers Station 19
1. Ventricular tachycardia, immediate
   treatment. Defibrillation
2. Hyperkalemia, Injectable calcium
Station 20
• Name anti arrhythmic agent which is best
  used in management of Torsade de
  pointes in acute settings? (2 mark)
Answers Station 20
1. Injectable Magnesium Sulphate
Station 21
1. Mention one indication other than antifungal agent
2. Maximum intravenous dose (mg / kg / day) – Do not
   mention total cumulative dose
3. Amphotericin B can be give through oral route
   True / false
• Most common side effect of Amphotericin B therapy
   (Name the system effected)
• Which of the following is not the side effect of
   Amphotericin B
a. Hypokalemia
b. Hyperkalemia
c. Hypomagnesemia
d. Hypermagnesemia
Answers Station 21
1. LEISHMANIASIS / Echinococcus
   multilocularis
2. 1.5 mg / kg day
3. True
4. Renal
5. d
DTPA scan




            Station 22
Station 22
1. What is the diagnosis in this DTPA scan?
2. What is the full form of DTPA?
ANSWERS STATION 22




1. Absent excretory function in left kidney



2. DTPA- Diethylene triamine penta acetic acid
STATION 23
Questions Station 23
1. Identify the abnormality in this
   Karyotype
2. Give the description of karyotype
   47,XY,+21? What does it mean?
ANSWERS STATION 23
1. It’s a karyotype of Down syndrome


3. The key to the karyotype description is as follows:
  47:  the total number of chromosomes
  XY:  Is the sex chromosomes (Male)
  +21:  Designates the extra chromosome as a 21
Station 24
Questions Station 24
1. Identify the spot with its grade
2. Give the grades of clubbing
ANSWERS STATION 24

1. Grade 4 or 5 clubbing
2. Grade 1- Fluctuation and softening of the nail bed
  Grade 2- Loss of normal angle
  Grade 3- Accentuated convexity of the nail
  Grade 4- Broadened terminal pulp of the digit
  Grade 5- Shiny and glossy changes in the nail and
                adjacent skin
Station 25
• 7 year old male child presents with cough
  10 days, fever 5 days, fast breathing one
  day. Examine respiratory system of this
  child?
Answers Station 25
• Points to be noted
• Took permission from mother & child (1
  mark)
• Undressed the patient? (1 mark)
• Examined the patient from head end or
  foot end for respiration? (1 mark)
• Palpated for tracheal deviation (1 mark)
• Percussed gently and followed rules of
  percussion (1 mark)
Station 26
• HISTORY TAKING
• A 2 yr old child presents to emergency
  department with severe pallor. Take the
  history of the child from mother.
Answers Station 26
• Introduces himself and tries to make the mother comfortable 0.5
  marks
• Asks onset sudden or gradual       1 mark
• History of bleeding or bluish spots 1 mark
• History of associated symptoms: fever, failure to thrive 1 mark
• Recurrent blood transfusions 1 mark
• History of associated jaundice 1 mark
• History of worm infestation 0.5 mark
• Birth history 0.5 mark
• Community and religion and history of consanguinity 1 mark
• Dietary history 1 mark
• Family history 0.5 mark
• Drug history 1 mark
Station 27
Question Station 27
• What is your diagnosis?
• What is the drug used to treat this
  condition?
Station 28
1. Define Median, 1st Quartile and 3rd
   Quartile.
2. What is the difference between Rate and
   Ratio
3. What is the basic difference between a
   ‘Case control’ and ‘Cohort’ Study design
4. What is the difference between Incidence
   and Prevalence
Answers Station 28
2. If the observations are arranged in ascending or descending order:
    Median: 50% observations are below and 50% above this value
    1st Quartile: 25% observations are below and 75% above this
        value
    3rd Quartile: 75% observations are below and 25% above this
        value
3. Rate: Numerator is part of denominator
    Ratio: Numerator is NOT part of denominator
4. Case Control study is Retrospective and Cohort Study is
   Prospective
5. Incidence: The number of NEW cases occurring in defined
   population during a specified period of time.
    Prevalence: Number of all cases old or new at a given point of time
        or over a period of time in a given population
Station 29
Interpret the following statement:
• In a RCT the ‘odds’ of developing HMD
  were 0.55 (95% CI 0.3 – 2.1) in infants
  whose mothers were given ‘Antenatal
  Steroids’.
Answers Station 29
• In infants of mothers who had received
  antenatal steroids the chances of
  developing HMD are 45% less as
  compared to those whose mother had not
  received antenatal steroids. However, the
  95% Confidence intervals are not
  significant
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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OSCE Pediatrics (Pune)

  • 2. Station 1 This female neonate was born with a large mass in relation to the umbilical cord
  • 3. Identify the condition • Give three important aspects that you will take care of in the transport of such a neonate.
  • 4. Answers • Exomphalos major/ omphalocele • Transport supine with the hernia suspended by a string • Cover the omphalocele with a waterproof covering • Provide additional fluids
  • 5. Station 2 This male neonate was born with multiple fractures and deformities of the limbs
  • 6. Identify the condition • How is the condition inherited? • What is the biochemical defect? • What are the medical treatment options of this condition?
  • 7. Answers • Osteogenesis Imperfecta • Autosomal dominant • Reduction in collagen formation • a. Growth hormone • b. Bisphosphonates/ allendronate/ pamidronate
  • 8. STATION 3 Study this picture of an 8 month infant who developed a rash during the declining phase of fever starting with the cheeks
  • 9. STATION 3 • What is the most probable diagnosis? • What is the causative organism? • Name two situations where infection with this organism may be life threatening
  • 10. Answers Station 3 • Erythema infectiosum/ fifth disease/ • Parvovirus B 19 a. Aplastic crisis in hemolytic anemia b. Non-immune hydrops fetalis in fetal infection
  • 11. Station 4 (Observed Station) An 8 yr old child is known case of IDDM for last 1 yr. He requires 6 units of long acting insulin and 4 units of short acting insulin for his day. Kindly load the syringe with both types of insulin
  • 12. Material Required • Two vials of Insulin Marked Long acting and short acting • Insulin Syringes • Spirit swabs • Two chairs one for the examiner and one for the candidate
  • 13. Methodology for the Examiner • Draw an amount of air equal to the dose of insulin required (Long acting + Short acting) and inject into the vial to avoid creating a vacuum. (2) • Swab the top of the vial with spirit swab provided (1) • Inject air into the long acting first keeping the vial upright. (2) • Then inject air into the short acting insulin. (2) • Turn the vial upside down and withdraw the short acting insulin first (2) • Then the long-acting insulin.(1)
  • 14. Station 5 • Give intradermal BCG vaccine
  • 15. Material Required Station 5 • Insulin Syringes • Dummy • BCG Vial • Cutter • Saline ampoules
  • 16. Methodology For the Examiner • (Each step carries 2 points) • Amount of vaccine (0.1 ml = 0.1 mg of reconstituted vaccine) and Load in to syringe (Breakage of vial) • Selection of area (Left deltoid just above its insertion) • Don’t clean the area with spirit • Keep the beveled end of needle up and technique of insertion • Don’t rub the area
  • 17. STATION 6 • 3 yr male child presented 3 days duration of loose stools 5 days back. • On 2nd day onwards patient passed blood along with stool. • On 4th day of illness loose motions stopped but pateient developed oliguria. • Patient became irritable. • Patient also had one episode of abnormal movement 1 hour back which subsided within 1 hour. • Parents were giving ORS for past 3 days. • Weaning was started 3 months back • On examination – Pallor ++, petechiae, hepatomegaly, tachypnoea, oedematous, BP – 100/60 • Mild acidosis on ABG.
  • 18. Questions Station 6 1. Name two differential diagnosis. 2. Name surgical condition which can be associated with above clinical picture. 3. Name three electrolyte disturbances which can be associated with it. 4. Management plan. 5. Name common agent causing it.
  • 19. Answers Station 6 1 a) HUS b) AGN c) Dys-electrolytemia d) Intussuception 2 Intussuception 3 Hyponatremia / Hypenatremia / Hyperkalemia 4 IVF (ARF regime), PD 5 E Coli – 0157: H7
  • 20. Station 7 • 14 Year old female child c/o pain in abdomen for past 10 days. She also developed vomiting / loose motions for past 4 days. • Patient also c/o weakness of both lower limbs • Unable to walk past 24 hours • On examination - Patient was hypertensive, tachycardia +++, poor tone in both lower limbs, power grade 2 in both LL, DTR not elicitable.
  • 21. Questions Station 7 1. Write 2 differential diagnoses (2 marks) 2. Investigations revealed Na – 110 / K 4, SGPT 37, patient passed high colored urine - What is the probable diagnosis (1 mark) 3. Suggest one investigation for diagnosis (1 mark) 4. Treatment (1 mark)
  • 22. Answers Station 7 1 GBS / Ac intermittent Porphyria / Hypokalemia 2 Ac Intr PORPHYRIA 3 Urine for Porphyria 4 Glucose / Hematin
  • 23. Station 8 15 year old male presented with pain in abdomen for past 25 days (acute intermittent, periumblical),also developed swelling over scrotum 6 days back which subsided within 24 hours. Past 2 days patient is having pain over Rt wrist with swelling of Rt knee. Patient also developed rash over gluteal region. Patient was passing red stool. Per abd examination showed empty Rt lower quadrant.
  • 24. Questions Station 8 1 Name probable diagnoses (mark 2) 2 X-ray abdomen as shown – What complication patient has developed (mark 2) 3 Medical treatment (specific for disease – other than blood / resuscitative fluid) (mark 1)
  • 25. Answers Station 8 1. HS Purpura 2. Intussusception 3. Steroids
  • 26. Station 9 • ABG report • Ph 7.343 • PaCO2 60 • PaO2 47.6 mmHg • Bicarb 32
  • 27. Questions Station 9 1. Interpret this blood gas (1 mark) 2. What is normal PaO2 level expected if a child is breathing at room air with normal lungs ? (1 mark) 3. Above mentioned ABG was taken when patient was inspiring 60% Fio2. Choose the correct option to describe oxygen status of the patient (1 mark) • Corrected hypoxemia • Under corrected Hypoxemia • Normoxemia • Over corrected hypoxemia 4. What is normal bicarbonate level in a normal blood gas write unit also. (1 mark) 5. What is normal PaCo2 in normal blood gas – write unit also. (1 mark)
  • 28. Answers Station 9 2. Respiratory acidosis with metabolic compensation 3. 80-100 mmHg 4. b 5. 24mmol/L 6. 40mmHg
  • 29. Station 10 • 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
  • 30. Questions Station 10 1. Describe metabolic condition (1) 2. Describe compensation (calculate exact compensation) (1) 3. Calculate anion gap (1) 4. Name two conditions with similar anion gap as above (2)
  • 31. Answers Station 10 • Metabolic acidosis with partial compensation • 1 bicarb fall decreases CO2 1-1.5 • Anion gap 25 • Septic shock, Inborn error (lactic acidosis), DKA etc
  • 32. Station 11 5 year male child recently diagnosed as a case of AML. TLC 57000. Chest X Ray normal. Hemodynamically stable with RR of 23/min. Normotensive Pulse oximetry showed SpO2 of 98%. ABG report pH 7.43 PaCO2 34 PaO2 47.6 mmHg Bicarb 24
  • 33. Questions Station 11 1. Above mentioned ABG was taken when patient was inspiring at room air. Kindly explain blood gas (1 mark). 2. Suggest measure to improve PaO2 in above patient? (mark 1)
  • 34. Answers Station 11 1. Pseudo Hypoxemia due to oxygen consumption by high TLC 2. Send sample in ICE
  • 35. Station 12 2. National Malaria Control Program ( NMCP) was launched in India in_______ year 3. National Malaria Eradication Program ( NMEP) was launched in________ year. 4. In NMEP the program was divided into 4 phases ( name them) 5. Modified plan of operation under NMEP came into force from______ year. 6. Endemic areas under modified plan of operation under NMEP is defined as annual parasite index ( API) > ________. 7. Within the modified plan of operation an additional component known as "P. falciparum containment program" has been introduced from October 1977, through the assistance of_________________________ agency.
  • 36. Answers Station 12 1. 1953 2. 1958 3. a) Preparatory b) Attack c) Consolidation d) Maintenance 4. 1977 5. 2 6. Swedish International Development Agency
  • 37. Station 13 • You are resuscitating a newborn at birth. The baby has gasping respiration at 30 seconds after birth. Demonstrate what steps you would take for the next 30 seconds.
  • 38. Checklist for examiner (2 marks each) 1. Check Ambu Bag, mask, reservoir and oxygen source 2. Attatch reservoir, and oxygen source 3. Correct technique of ambu bagging 4. Correct frequency of ambu bagging 5. Counting heart rate at end of 30 seconds
  • 39. Answer Following questions based on X Ray seen on STATION 14 1. What is abnormal in this X ray? 2. What is the ideal position of placement of umbilical arterial and umbilical venous line? 3. After putting in a UA line, the right lower limb appears pale. What would you do? 4. What is the level of the renal artery? 5. How do you maintain a UA line?
  • 40. Answers Station 14 1. Abnormally placed umbilical arterial line in the subclavian artery 2. For umbilical arterial line - High: Between T7- T10; Low: Between L2-L3 • For umbilical vein - Just above the diaphragm 3. Warm the other limb; If still pale >1/2 hour, remove the UA line 5. L-1 6. Use heparin infusion at rate of 0.5-1.0 Unit per hour
  • 41. Station 15 • A newborn presents on day 2 of life with seizures. Write first 5 steps of management in sequential order.
  • 42. Answers Station 15 1. Management of the airway, breathing and circulation 2. Do the blood sugar; If < 40mg%, give a bolus of 2ml/kg of D10%; If >40 proceed to next step 3. Take sample for S. calcium; Give Inj. Calcium gluconate 2ml/kg 1:1 diluted. If seizures do not subside, proceed to next step 4. Give Inj. Phenobarbitone in a dose of 20mg/kg as a slow iv injection. If seizures do not subside proceed to next step. 5. Repeat Inj. Phenobarbitone in a dose of 10mg/kg after half hour of the first injection.
  • 43. Station 16 Question for CT scan head What is your Diagnosis?
  • 44. Answer Station 16 • Right parietal lobe edema with midline shift.
  • 45. Station 17 • 2 year old female presents with seizures • GCS 6 • HR 60/MIN • Irregular respiration • Normotensive with CT scan already shown – 6. What is the Immediate management. 7. Drug which can help the patient (assuming he is normotensive ) 8. What is the most common electrolyte disturbance associated with above patient? 9. Which parasitic infection can mimic this condition?
  • 46. Answers Station 17 1. Hyperventilation 2. Mannitol 3. Hyponatremia ( Sodium ) 4. Neurocysticercosis
  • 47. Station 18 1. When was National tuberculosis control program started? 2. When was Revised National tuberculosis control program was started? Fill in the blanks • Under RNTCP treatment services will be made most assessable to the patients with a view to achieve a cure rate of at least ______________% amongst all newly detected sputum positive cases . • In tuberculosis control program DTC stands for _____________________________________________ _______ • One tuberculosis unit will function as managerial unit for __________________ million population
  • 48. Answers Station 18 1. 1962 2. District tuberculosis center 3. 1992 4. 85% 5. 0.3 – 0.5 million
  • 50. Questions Station 19 • Define this problem (ECG diagnosis) and immediate management after ABC (Initial resuscitation), patient without pulses (2 mark) • Name common metabolic problems related with above diagnosis and drug of choice for antagonizing the described metabolic effect. (1 mark)
  • 51. Answers Station 19 1. Ventricular tachycardia, immediate treatment. Defibrillation 2. Hyperkalemia, Injectable calcium
  • 52. Station 20 • Name anti arrhythmic agent which is best used in management of Torsade de pointes in acute settings? (2 mark)
  • 53. Answers Station 20 1. Injectable Magnesium Sulphate
  • 54. Station 21 1. Mention one indication other than antifungal agent 2. Maximum intravenous dose (mg / kg / day) – Do not mention total cumulative dose 3. Amphotericin B can be give through oral route True / false • Most common side effect of Amphotericin B therapy (Name the system effected) • Which of the following is not the side effect of Amphotericin B a. Hypokalemia b. Hyperkalemia c. Hypomagnesemia d. Hypermagnesemia
  • 55. Answers Station 21 1. LEISHMANIASIS / Echinococcus multilocularis 2. 1.5 mg / kg day 3. True 4. Renal 5. d
  • 56. DTPA scan Station 22
  • 57. Station 22 1. What is the diagnosis in this DTPA scan? 2. What is the full form of DTPA?
  • 58. ANSWERS STATION 22 1. Absent excretory function in left kidney 2. DTPA- Diethylene triamine penta acetic acid
  • 60. Questions Station 23 1. Identify the abnormality in this Karyotype 2. Give the description of karyotype 47,XY,+21? What does it mean?
  • 61. ANSWERS STATION 23 1. It’s a karyotype of Down syndrome 3. The key to the karyotype description is as follows: 47:  the total number of chromosomes XY:  Is the sex chromosomes (Male) +21:  Designates the extra chromosome as a 21
  • 63. Questions Station 24 1. Identify the spot with its grade 2. Give the grades of clubbing
  • 64. ANSWERS STATION 24 1. Grade 4 or 5 clubbing 2. Grade 1- Fluctuation and softening of the nail bed Grade 2- Loss of normal angle Grade 3- Accentuated convexity of the nail Grade 4- Broadened terminal pulp of the digit Grade 5- Shiny and glossy changes in the nail and adjacent skin
  • 65. Station 25 • 7 year old male child presents with cough 10 days, fever 5 days, fast breathing one day. Examine respiratory system of this child?
  • 66. Answers Station 25 • Points to be noted • Took permission from mother & child (1 mark) • Undressed the patient? (1 mark) • Examined the patient from head end or foot end for respiration? (1 mark) • Palpated for tracheal deviation (1 mark) • Percussed gently and followed rules of percussion (1 mark)
  • 67. Station 26 • HISTORY TAKING • A 2 yr old child presents to emergency department with severe pallor. Take the history of the child from mother.
  • 68. Answers Station 26 • Introduces himself and tries to make the mother comfortable 0.5 marks • Asks onset sudden or gradual 1 mark • History of bleeding or bluish spots 1 mark • History of associated symptoms: fever, failure to thrive 1 mark • Recurrent blood transfusions 1 mark • History of associated jaundice 1 mark • History of worm infestation 0.5 mark • Birth history 0.5 mark • Community and religion and history of consanguinity 1 mark • Dietary history 1 mark • Family history 0.5 mark • Drug history 1 mark
  • 70. Question Station 27 • What is your diagnosis? • What is the drug used to treat this condition?
  • 71. Station 28 1. Define Median, 1st Quartile and 3rd Quartile. 2. What is the difference between Rate and Ratio 3. What is the basic difference between a ‘Case control’ and ‘Cohort’ Study design 4. What is the difference between Incidence and Prevalence
  • 72. Answers Station 28 2. If the observations are arranged in ascending or descending order: Median: 50% observations are below and 50% above this value 1st Quartile: 25% observations are below and 75% above this value 3rd Quartile: 75% observations are below and 25% above this value 3. Rate: Numerator is part of denominator Ratio: Numerator is NOT part of denominator 4. Case Control study is Retrospective and Cohort Study is Prospective 5. Incidence: The number of NEW cases occurring in defined population during a specified period of time. Prevalence: Number of all cases old or new at a given point of time or over a period of time in a given population
  • 73. Station 29 Interpret the following statement: • In a RCT the ‘odds’ of developing HMD were 0.55 (95% CI 0.3 – 2.1) in infants whose mothers were given ‘Antenatal Steroids’.
  • 74. Answers Station 29 • In infants of mothers who had received antenatal steroids the chances of developing HMD are 45% less as compared to those whose mother had not received antenatal steroids. However, the 95% Confidence intervals are not significant
  • 75. 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/ Download at: http://www.4shared.com/folder/t8E_yjDv/_online.html