OSCE KKCTH 2007

OSCE KKCTH

OSCE – JAN 2007

Question No : 1

1) 4 causes for diastolic dysfunction and 4 causes for systolic

dysfunction.

2) Principles of Management of congestive cardiac failure.

What are the specific drugs used in the

management of congestive cardiac failure?

Answer for Question No : 1

1) a) MS / TS

b) Constrictive Pericarditis

c) Dilated cardio myopathy

d) Myocardial ischemia

e) Acute volume overload (AR & MR)

f) Restrictive cardiomyopathy

Anemia

RHP

SVT

UAO

Cong. HD complicated by anemia, fever endocarditis

2) a) Reducing cardiac work

b) Augmenting myocardial contractility

c) Improving cardiac performance by reducing the heart

size

d) Correcting the underlying cause

Reduce fever, anemia, and infection sedating the Patient

Vasodialators

Captopril after load reducing agents

Enalapril

Digoxin

Question No : 2

.

1) Identify the Organism

2) Which immunodeficiency is associated with chronic

symptomatic infection with this organism?

3) Which 3 malabsorbtion can occur in this infection?

4) What is the appropriate antimicrobial therapy for treating

this infection?


1) Giardia Lamblia -Trophozoite

2) Hypo or agammaglobilinemia

3) a) Carbohydrate b) Fats c) fat soluble vitamins

4) Antiprotozoal agent Pediatric dose

Albendazole (albenza) 400mg once a day for 5 days PO

Furazolidone (Furoxone) 6 mg/kg/24 hr divided qid PO for 10

days

(maximum : 400mg/24 hr)

Metronidazole (Flagyl) 15mg/kg/24hr divided tid PO for 5

days


Paromomycin Not recommended

Quinacrine (Atabrine) 6mg/kg/24 hr divided tid PO for 5

days


Tinidazole 50mg/kg once(maximum :2g) Not

available in the United States

Question No. 3

1. Identify the organ

2. Name 2 GI complications due to this organism

3. Drug of Choice for the GI Complications and dose

4. Name one Pulmonary Complication

5. What is the life span of this organism?


1. Ascaris

Ova

2. a) Intestinal Obstruction

b) Biliary Obstruction

3. a) Piperazine citrate 150 mg / kg stat

Follwed by 6 doses of 65mg / kg Bd

4. Loeffler’s Syndrome

5. 10 to 24 Months

Question No. 4

A child weighing 12Kg is admitted with 25% burns

1. What is the total volume of fluid and what fluid is required

for resuscitation?

2. What is the duration for replacement ?

3. How is it spaced?

4. Is colloid indicated in this child?

5. When is colloid indicated?

Answer for the Question No. 4

1. 1180 ml of Ringer Lactate

2. 24 hrs

3. 50% in the first 8 hrs (590ml)

50% in the next 16 hrs (590ml)

4. No

5. Burns more than 85 %

Question no. 5

Match the following :

1. Phyrostygmine : Mushroom

2. Pyridoxine : Diazepam

3. Diphenhydramine : Clonidine

4. Dimercaptosuccinic acid : Dystonia

5. Flumazenie : Ethylene Glycol

6. Naloxone : Methanol

7. Fomepizole : Betablocker

8. EDTA : Arsenic

9. Ethanol : Anticholinergic Agent

10. Glucogen : Lead

Answer for Question no. 5

1. 9

2. 1

3. 4

4. 8

5. 2

6. 3

7. 5 or 6

8. 10

9. 6 or 5

10. 7

Question No. 6

1. A Mother is being counseled for Prevention of

Allergy. She wants to know which of the following

could be

(A) Food intolerance (B) Food Hypersensitivity

i) Lactose intolerance

ii) Migraine

iii) Urticana

iv) HEINER Syndrome

v) CELIAC disease

vi) Irritable Bowel Syndrome

2. Match the Following :-

a) Cow’s Milk - Paralbumin

b) Egg - Vicilin

c) Peanut - Ovomucoid

d) Fish - Casein

3. What is the ideal age for introducing the following

foods:-

a) Cow’s Milk

b) Egg

c) Peanut & Seafood

Answer for Question No. 6

1. i) A

ii) A

iii) B

iv) B

v) B

vi) A

2. a) 4

b) 3

c) 2

d) 1

3. a) 1 year

b) 1 ½ to 2 years

c) 3 years

Question No. 7

1. A child with Rickets has following Laboratory

findings:-

Sr. Ca - 9 mg/dl

Sr. Phosphare - 1.5 mg/dl

ALP (Alkaline Phosphatase) - 2000 units

a) What is the diagnosis?

b) What is the mode of inheritance?

c) What is the first clinical manifestation?

2. Another child with Rickets has the following findings:-

Sr. Ca - 7 mg/dl

Sr. Phosphare - 1.7 mg/dl

ALP (Alkaline Phosphatase) - 5000 units

This child has got Alopecia

a) What is the diagnosis?

b) What is the type of inheritance?

c) What is the Rx of choice & the dose?


2. a) Familial Hypophosphotemia

or

Vit – D Resistant Rickets

b) x – linked Dominant

c) Bowing of lower extremities

3. a) Vit – D dependent Rickets

or

Hypocalcemic Rickets Type II

b) Autosomal recessive

c) 1,25 Hydroxy Vit D3

15 –30 micro gm / 24 hrs

Question No. 8

1. What is the dose of Methotrexate in JRA?

2. Name two important side effects?

3. Which Micronutrient supplementation is necessary while

giving Methotrexate on a long-term basis?

4. Name one skin condition where Methotrexate is used?

5. What is the mode of Action?


1. 5 to 15 mg / m2 / week

2. a) Hepetotoxicity

b) Megaloblastic anemia

3. Folic Acid

4. Psoriasis

5. Antimetabolite

&

Inhibits DNA & Purine Synthesis

Question No. 9

10 yrs old girl presented with history of recurrent spells of

dizziness, fatigue, syncopal attacks, her HR was 52/min

1) What are the ECG findings?

2) What are the probable causes for this

bradyarrhythmia? (Atleast 3)

3) What is the treatment of choice?


1) Rate - Bradycardia

Rhythm - Idioventricular

Complete Heart Block

2) Autoimmune disorder, complex CHD, Myocarditis, long OT

Syndrome

3) Pacing

Question No. 10

A 1½ yrs old child presents with failure to thrive Muscle

weakness, Constipation, Polyuria.

ABG:

Ph 7.55

Co2 37

Po2 99

Sao298

Hco337

1. What is your interpretation of the ABG

2. List 2 clinical conditions in which this ABG finding can be

seen

3. What electrolyte abnormality is associated

with this condition?


1. Metabolic alkalosis uncompensated

Probable bartter syndrome

2. Laxative or diuretic use, persistent Vomiting, diabetic insipidus.

3. Hypokalemia

Question No : 11

1) Identify the rhythm.

2) What would be the management of a child with this rhythm

and palpable pulses?

3) Name three possible treatable causes for this arrhythmia.

4) Name three drugs used to treat this.


1. Ventricular tachycardia

2. Support ABC / Synchronized cardioversion

3. Hypoxia / Hypovolemia / Hypocalcemia

Hypokalemia / Toxin / Tension pneumothorax Thromboemboli /

Tamponede / Pain

4. Lignocaine

Procainamide

Amiodorone

Question No : 12

1) Identify the abnormality in the ECG.

2) What electrolyte abnormality can cause this?

3) Why is it important to identify this rhythm disturbance?


1. Prolonged QT interval.

2. Hypocalcemia.

3. As it can degenerate into dangerous rhythm – V Tac/VF and cardiac

arrest.

Question No : 13

A one year old child has a

- Weight of 6.4 kg

- Length of 70 cm

- There is no oedema

1) What is the nutritional status of the child as per?

a) IAP Classification

b) WELLCOME Classification

c) GOMEZ Classification

d) WATERLOW Classification

2) Write details of Gomez and Waterlow classification.


1) A) Grade II PEM

B) Under nutrition

C) Grade II malnutrition

D) Normal

2) Gomez Weight for age

Normal >90 %

I degree malnutrition 75 – 90 %

II degree malnutrition 60 – 75 %

III degree malnutrition < 60 %

Waterlow classification

Height for age

Normal > 95 %

I degree stunting 90 – 95 %

II degree stunting 85 – 90 %

III degree stunting < 85 %

Weight for height

Normal > 90 % of expected

I degree wasting 80 – 90 %

II degree wasting 70 – 80 %

III degree wasting < 70 %

Question No : 14

1) What is the radiological finding?

2) Name three common aetiological agents.

3) Name six complications of this condition.


1) Consolidation right upper lobe

2) Pneumococcus

H. Influenza

Staphylococcus aureus

3) Pleural effusion

Empyema

Pericarditis

Meningitis

Septic arthritis

Osteomyelitis

Question No : 15

A 14 yrs old girl is seen at the OPD with short stature, sexual

infantilism, broad chest and cubitus valgue deformity.

1) What would be the clinical diagnosis?

2) What investigations would you ask for to confirm your

diagnosis?

3) What cardiovascular anomaly is most commonly associated

with this condition?

4) Name three skeletal deformities. You would look for in this

child.


1) Turner’s syndrome

2) Chromosomal analysis / Karyotyping

3) Bicuspid aortic valve is the commonest cardiovascular

anomaly seen in 1/3 to ½ of patients with turners.

4)

a) Short 4th metatarsal and metacarpal

b) Epiphyseal dysgenesis of knees and elbows

c) Scoliosis

d) Decreased mineralisation of bones.

Question No : 16

CHICKENPOX VACCINE

1) What is the dose?

2) Above what age are 2 doses recommended and at what

intervals?

3) For postexposure prophylaxis within what period after

exposure, should the vaccine be administered?

4) How long can the vaccine be used after reconstitution?

5) What is the indication for giving Varicella zostel

Immunoglobulin in newborn?

6) What is the route of administration?


1) 0.5 ml

2) 13 yrs

4 – 8 weeks

3) 72 hrs

4) 30 minutes

5) If mother develops Varicella 5 days before to 2 days after

delivery

6) Subcutaneous

Question No : 17

Fill up the contents of the following IV fluids

1) 5 % GDW ----- / caloric / L

2) Dextrose 10 % ----- / caloric / L

3) Blood Na ----- / meq / L

4) Ringer Lactate K ----- / meq / L

Na ----- / meq / L

HCo3 ----- / meq / L

5) 3 % saline Na ----- / meq / L

6) Calcium Gluconate 10 % Ca mg / ml

7) Magnesium Sulphate 50 % Mg meq / ml

8) Resomol solution K meq / L

Glucose gm / L

Na gm / L

Answer for Question No: 17

1) 200 caloric / L

2) 400 caloric / L

3) 135 – 145 meq / L

4) 4 meq / L

130 meq / L

28 meq / L

5) 513 meq / L

6) 9 mg / ml

7) 4 meq / ml

8) 40 mg / L

125 gm / L

45 gm / L

Question No : 18

1) What is the cut off age limit for diagnosis of primary Amenorrhoea?

2) Which is the commonest CNS tumour may be responsible for

primary Amenorrhoea?

3) If FSH and LH levels are elevated, what is the aetiology for

primary Amenorrhoea?

4) At which SMR, majority of girls reach Menarche?

5) A girl with primary Amenorrhoea presents with recurrent

abdominal pain. What is the commonest cause?

6) Name one psychological disorder that can cause primary

Amenorrhoea?

Answer for Question No: 18

1) 16 yrs

2) Craniopharyngioma

3) Primary Gonedal failure

4) SMR 4

5) Imperforete hymen / Hematocolpus

6) Anorexia nervose

Question No : 19

HIV INFECTION IN NEW BORN

1) Mother has HIV infection and if baby is PCR positive within 48

hrs

What does it imply?

PCR negative at 48 hrs but PCR positive within 7 – 90 days

What does it imply?

2) How early can P24 antigen test be done?

3) When do you label a newborn as HIV infected?

4) After what age is HIV ELISA considered the best test for

diagnosis and what is its sensitivity and specificity.


1)

a) It implies inatero infection and rapidly progressive disease

b) It implies postnatal transmission and slowly progressive

disease

2) After 1 month of age (as false possibility rates are higher if

done before)

3) If two positive virologic tests (PCR / culture P24 antegen) are

obtained from different blood samples.

4) > 18 months of age – it is 100 % specificity sensitive.

Question No : 20

A 4 month old baby is brought with respiratory distress. On examination baby is

floppy with absent. DTR has clubfoot and fasiculations in the tongue.

1) What is the most likely diagnosis?

2) Name two definitive diagnostic tests for this condition.

3) What is the mode of inheritance in this condition?

4) How will you counsel the mother?


1) Spinal muscular atrophy type - I

2) a) Genetic analysis for SMN gene (surviour motorneurogene)

b) Muscle biopsy

3) Autosomal recessive

4) Introduce myself to the mother and form a rapport with her

- appraise her regarding the genetic and progressive nature of

the illness her baby had the possibility of recurrences in the

next pregnancy has to be discussed

explain the various prenatal diagnostic options available and if

possible tell her where the tests are available

Discuss the treatment options for her present child has the

disease progresses.

Thanks the mother.

Question No : 21

Answer the questions regarding Turner’s syndrome

1) What is the characteristic neonatal manifestation?

2) Name 3 cardiac anomalies in Turner’s syndrome.

3) Name 2 endocrine problems in turner’s

4) Which GI problems can occur?

5) Name 3 hormones used in Turner’s.

6) What are the most common skeletal abnormalities?


1) Oedema

2) a) Bicuspid aortic valve

b) Coarctation of Aorta

c) Aortic stenosis

d) Mitral valve prolapse

e) Anomalous pulmonary venous drainage

3) a) Autoimmune thyroid disease

b) Type 2 diabetes mellitus

4)

a) IBD

b) GI Bleed

C) Delayed Gastric Empyema

5)

a) GH

b) Estrogen

c) Progesterone

d) Thyroxine

6)

a) Shortening of 4th metatarsal and metacarpal bone

b) Epiphyseal dysgenesis in the joints of knees and elbows

c) Madeling deformity

d) Scoliosis

e) Osseous mineralisation

Question No : 22

Obtain history from a mother who has brought her

6 yrs old child with history of unprovoked seizures.

Checklist:

1) Introduces and establishes rapport.

2) Asks her to act out or re-create a seizure

3) Asks for Aura and automatism

4) Asks about headache and vomiting

5) Elicits h/o failure to thrive

6) Asks for details of medications used that may

precipitate seizure

7) Asks for details of anticonvulsant therapy

7) Asks for compliance

8) Asks for family history

9) Asks for developmental history

10) Asks for birth and neonatal problem

11) Asks for the time of occurrence of seizures

12) Asks for frequency

13) Asks for precipitating factor like from fever.

14) Asks for personality change / school problem / Intellectual

deterioration.

Question No : 23

When the mother is HIV positive

1) What is the percentage of transmission of HIV through breast

milk?

2) What should be mother be appraised of, if she chooses to

breast feed her baby?

3) What are the methods by which breast milk can be

processed to reduce chances of transmission?

4) What criteria should be taken into account if mother wants to

feed the baby with formula milk?


1) a) 14 % if mother acquired infection before pregnancy

b) 29 % increased risk if mother acquired infection during

pregnancy

2) a) Benefits of breast feeding

b) Risk of transmission while breastfeeding (e.g. through

cracked nipple)

c) To avoid mixed feeding and to stop breastfeeds abruptly

after 4th month.

d) Mother should be on ART while feeding

3) a) Pasturised breast milk

b) Boiled human milk

c) Frozen human milk

d) Expressed breast milk allowed to stand and remove the

lipid layer

4) a) Acceptability

b) Affordability

c) Sustainability

d) Safety and feasibility

Question No : 24

1) Define:

a) Drowning

b) Near drowning

2) List 3 predisposing aetiological factor for drowning.

3) List 2 electrolytic disturbances and 1 hematological

complications of near drowning

4) What is the commonest radiological finding?


1. a) Death within 24 hours of an immersion event

b) Any survival from an immersion event

2. a) Seizures

b) Long QT syndrome

c) Poisoning with drugs

3. 1. a) Hypernatremia

b) Hyperkalemia

c) Hypercalcemia

d) Hypermagnesemia

2. Hemolysis

4. Pulmonary edema

Question No : 25

A 13 yr old girl is diagnosed to have graves disease.

1) What are the earliest signs in children with graves disease?

2) What cardiovascular complications would you anticipate in

this child?

3) Name 2 drugs used in the treatment of graves disease and

mention three severe reactions they can cause.


1) Emotional disturbances with motor hyperactivity / irritability / emotional

lability

2) Cardiomegaly and failure atrial fibrillation mitral regurgitation due to

papillary muscle dysfunction.

3) Propylthiocracil

Methimazole

Severe reactions

Agranulocytosis

Hepatic failure

Glomerulonephritis and Vasculitis

Question No : 26

A 6 yr old girl child is brought to ER with wheezing. She was diagnosed

outside as an asthmatic few months earlier. What relevant history would you

like to ask the mother?


Present history

1) When did the present attack start and if the child is getting

better / worse / no improvement?

2) Does the child have rapid breathing / difficulty in talking or

feeding?

3) Any factors that triggered the present attack?

4) What medications has she been administered for the present

attack at what dose and frequency?

5) If associated with fever

Past history

1) How long has she been a wheezer / has frequent and for how

many days the episode last / seasonal / how often symptomatic

at night / how often absent from school?

2) If child is on long term medications – if she has been

complaint and if using MDI, if she follows the right technique?

3) How often she has to use reliever MDI / get nebulised.

4) H/o previous hospitalization and if she needed

Parenteral or oral steroids / IV medications?

5) Frequency of visits to ER

6) Any admission to ICU and if so if mother has been told about

warning signs

7) H/o exposure to passive smoking / pets and other triggers

8) If wheeze is exercise induced?

9) History regarding comorbid conditions like sinusitis / GER /

other allergies

Family History

H/o asthma or atopy in family.

Question No : 27

X - ray

1) Describe 2 essential findings.

2) What is the diagnosis?

3) What is the pathogenesis?

4) What is the treatment?


1) (i) Emphysema of left upper lobe

(ii) Herniation of left upper lobe to the right

(iii) Mediastinal shift to right

2) Congenital Lobar Emphysema

3) (i) Congenital deficiency of bronchial cartilage

(ii) External compression by aberrant vessels

(iii) Bronchial stenosis

(iv) Redundant mucosal flaps

(v) Kinking of bronchus due to herniation into mediastinum

4) Lobectomy

Question No : 28

An infant is being evaluated for IEM.

The infant’s reports are as follows:

Plasma NH3 is 500

ABG – pH 7.38

pCo2 42

1) What is the most likely defect leading to IEM?

2) Give 4 example of disorders in this group.

3) List 5 drugs used in treatment.

4) Which of these disorders affect males more severely?

5) Which is the most common form of these disorders?


1) Urea cycle defect

2) (i) Carbamyl phosphate synthetase (CPS)

(ii) Ornithine Transcarbamylase (OTC)

(iii) Argininosuccinate Synthetase (AS)

(iv) Argininosuccinate Lyase (AL)

(v) Arginase

(vi) N – Acetylglutamate Synthetase

3) (i) Sodium Benzoate

(ii) Phenylacetate

(iii) Arginine

(iv) Lactulose

(v) Neomycin

(vi) Citruline

(vii) Carnitine

4) OTC Deficiency

5) OTC Defects

Question No : 29

4 months old child brought to hospital with generalized

hypotonia / feeding difficulty since birth and h/o poor perception

of fetal movements by mother and polyhydramios antenatally.

1) What would be the probable diagnosis?

2) Name 3 specific types of this disease.

3) What is the basic pathology causing this condition?

4) What would be the line of management for this child?


1) Congenital myopathy

2) Myotubular myopathy

Nemaline rod myopathy

Central core disease

3)

(a) Maturational arrest of fetal muscle during myotubular stage

of development

4)

(a) Confirm the disease

(b) Physiotherapy

(c) NG feeds

(d) Genetic counseling

Question No : 30

1. Picture A

Outline the treatment for this condition.

List 4 complications of this condition.

Any medications you would advise for his 5 yr old elder sister and his mother

who is 2 months pregnant?

2. Picture B

What is the diagnosis?

List 3 clinical features of this condition


I. Varicella

a) Symptomatic treatment with antipyeretics / antihistamines /

hygiene etc is adviced if child is healthy and is uncomplicated

varicella.

A cyclovir is started within 72 hrs if child is

immunosuppressed / on steroids or salicylater. Child has

chronic cardiac / pulmonary disorder or is complicated varicella.

b) Secondary bacterial skin infections

Encephalitis / cerebellar ataxia

Pneumonia

Purpura / HUS

Nephritic syndrome

Arthritis

Myocarditis / pericarditis

Pancreatitis

c) Varicella vaccine can be given for 5 yrs old sister within 3

to 5 days after exposure if she has not been infected or

vaccinated earlier. If mother has not been infected or

vaccinated earlier.

V21G can be given to the mother to prevent her from getting

chicken pox but she has to be told that it may not prevent the

fetus from being infected or prevent development of total

embryopathy.

II. a) congenital varicella syndrome

b) Shortened / malformed extremities

Zigzag scarring of skin – cicatrix

Neurological defects including dysfunction of anal +

urethral sphineters developmental defect of eye including

hormone syndrome and cataracts.

Question No : 31

Regarding Mantoux skin test

1) What is the composition of tuberculin used?

2) After what duration does it become reactive following TB

infection?

3) Mention 4 host related factors, which can depress the skin

test in a child infected with M.T.B.

4) When can a tuberculin reaction of > 5 mm be taken as

positive? (Mention 2 conditions)


1) 0.1 ml contains 1 TU of PPD stabilized with tween 80

2) 3 weeks to 3 months (most often between 4 – 8 weeks)

3)

(i) Malnutrition

(ii) Immune suppression by measles, mumps, varicella, influenza

(iii) Vaccination with live virus vaccine

(iv) Immunosuppression by drugs

(V) Disseminated TB / military TB

4) Children with immunosuppressive conditions – HIV / organ transplantation or on

corticosteriods > 15 mg / 24 hrs for > 1 month.

Question No : 32

A baby born to HBSAG positive mother receives HBIG and HBV soon after

delivery at 1 and 6 months.

1) (i) When would you recommend post vaccination testing for HBSAG and anti

HBS?

(ii) How would you interpret the results?

2) What is the strength of the HBV vaccine used at different ages and for the

immune suppressed?

3) What would be the vaccination schedule for a 2-year-old child who has received

only two doses of HBV vaccine at 1 ½ and 2 ½ months of age?

4) A 15 months old child due for MMR has missed HBV vaccine is infancy what

would be your advice?


1) (i) 9 – 15 months of age

(ii) If positive for anti HBS – immune to HBV

If negative for HBSAG and anti HBS a second complete

HBV series of vaccination followed by retesting.

If positive for HBS the parent should be counselled.

2) 0 – 10 yrs 5 microgram or 10 microgram

>10 yrs 10 microgram or 20 microgram

Immune

suppressed 40 microgram or 40 microgram

3) Give only one dose of HBV to complete the schedule.

4) To start HBV vaccination and administer the I dose simultaneously with MMR

at a different site.

Question No : 33

A 1 ½ years old child is admitted and treated for HAV infection. Child has not

received any immunization so far as he comes from a tribal area. What will be the

immunizations you would advice for this child and at what schedule?


As many vaccines as possible can be administered to this child simultaneously

following the IAP schedule and administering optional vaccines as per the mothers

request. No need for HAV vaccine.

Question No : 34

An 8 months old child is diagnosed to have HIB meningitis

1) What are the factors, which would influence the child’s prognosis? (Mention 3)

2) Mention five major neurological sequelae this child can have.

3) What would be your advice to the child’s parents regarding prevention of spread

of this disease to other members in the household?


1) Prognosis depends on

(a) Age at presentation

(b) duration of illness before appropriate antimicrobial therapy

(c) CSF polysaccharide concentration and the rapidity with which it is cleaned from

blood, CSF and urine

2) Major Neuro Sequelae

Behavioural problems

Language disorder

Impaired vision

Mentalretardation

Motor abnormalities

Ataxia

Seizures

Hydrocephalus

Hearing loss

Question No : 35

1)Comment on this smear

2)Mention atleast 3 DD of this smear

3)How do you confirm the diagnosis?


1) Hypochromic microcytic anemia with few target cells and tear drop cells. WBC

and platelets appear normal.

2)

a) Iron deficiency anemia

b) Thalassemia

c) Sideroblastic anemia

3) Serum Iron / TIBC

Hemoglobin electrophoresis

Bone marrow study.

Question No : 36

Write your dietary advice for a child with CRF.


Diet in CRF

1) Calories – at least the daily requirement of 100 kcal / kg / day

should be given.

For stunted children. RDA for height age is given.

20 % extra calories can be recommended.

2) Protein - Protein (g / kg)

0 – 1 yr 1 – 5 yrs 5 – 10 yrs

mild GFR (20 – 40) 1.8 1.4 1

Mod GFR (5 – 20) 4.1 1 0.8

Severe GFR (< 5) 1 0.8 0.6

3) Salt – no added salt of edema / hypertension is severe (or)

Restrict to 0.5 gm / day in infants and 1 gm / day is older child.

4) water – Insensible water loss and previous days output

5)If Hyperkalemic – avoid K containing food restriction of po4 if severe Po4 is

high.

Vitamins – water soluble – routinely supplemented.

(AEK) Fat soluble vitamins – not needed

W & D supplementation – based on PTH / ca / phosphorous levels

(maintain ca x p level < 55).

Question No : 37

A 3 years old child is seen at OPD with short limbs, long narrow trunk and large

head. The limb shortening is greatest in the proximal segments.

1) What would be your diagnosis?

2) Mention 5 skeletal radiological changes associated with this condition.

3) What two neurological complication would you anticipate in this child?


1) Achondioplasia

2)

(a) Short vertebral pedicles

(b) Progressive decrease in interpedicular distance from L1 to L5 spine

© Short and round iliac bones with flat acetabular roof

(d) Irregular and flared metaphysis and short tubular bones

(e) Disproportionately long fibula compared to tibia

(f) Large calavarial bone with small cranial and skull bones.

3)

(a) Hydrocephalus

(b) Lumbar canal stenosis

Question No : 38

16 months old child with Thalassemia major, had urtricarial rashes following egg

ingestion brought for MMR vaccine.

1) What history would you ask before vaccination & why?

2) What precaution would you take to store, reconstitute and administer MMR

vaccine?

3) If the mother want to administer varicella vaccine also what would be your

advice.


1) When the child last received blood transfusion.

Whether the child had anaphylaxis to egg ingestion – though it is not a

contraindication for MMR the child has to be observed for 90 minutes after

vaccination if there is history of anaphylaxis.

2) MMR has to be stored in the first shelf of the refrigerator and given within 4 hrs

after reconstitution it is given subcutaneously.

3) Both can be given simultaneously at two different sites or at 4 – 8 weeks

interval.

Question No : 39

1) Write your comments on the x - ray

2) Give 3 differential diagnosis which can led to this condition.


1) Normal lungs and heart

Bilateral adrenal calcification

2)a) TB of the adrenals

b) Recovery after waterhouse fridrichsen

c) Woolmans disease

(Calcification is almost always unilateral in adrenal tumour)

Question No : 40

1) What is pulseoximetry?

2) What is the principle behind it?

3) What are its limitations?

4) How does it co-relate with Po2?


1) Pulse oximetry is a non-invasive method of measuring the oxygen saturation of

hemoglobin in arterial blood.

2) Red and infra red light of different wavelengths when transmitted through the

capillary have differential absorption by oxy hemoglobin and reduced hemoglobin.

This ratio is the detected by a transducer and displayed as oxygen saturation.

3) False values occurred in

a) Poor perfusion

b) Ambient light

c) Presence of carboxy hemoglobin / methhemoglobin

4) As per the oxyhemoglobin dissociation curve

Question No : 41

1) What are the 3 classes of histiocytosis syndrome in children?

2) Name 2 of each in class I histiocytosis.

1) Dermal manifestations.

2) Endocrine problems

3) X – ray skeletal findings.

3) What are the serological abnormalities seen in class II histiocytosis?


I

1) Langerhans cell histocytosis

2) a)Familial erythrophagocytic lymphohistiocytosis

b) Infection associated hemo phagocytic syndrome

3) a) malignant histiocytosis

b) Acute monocytic leukemia

2) a) seborrheic dermatitis / petechia

b) Hypothalamic involvement / pituitary dysfunction – diabetis insipidus / primary

hypothyroidism.

c) Osteolytic lesion in born with no evidence of reactive newborn formation /

fractures / vertebral collapse / floating teeth.

3) Hyperlipidemia, hypofibrinogenimia, elevated lever enzymes, extremely

elevated circulating interlukin 2 receptors

Question No. 42

1) What would be the clinical presentation? Describe atleast 5 clinical features.

2) Describe the CT Scan findings.

3) What is the pathologic defects in this condition?


1)

a) Prominent occiput

b) Cerebellar ataxia

c) Macrocephaly

d) Sunset Sign

e) Spasticity of lower limbs

2) Dilated IV ventricle / III & lateral ventricles / Dandy walker malformation.

3) Failure of development of roof of IV ventricles.

Question No. 43

Storage of Vaccines

1. Picture of a Refrigerator

Vaccines are stored in this refrigerator in your clinic. Mention the correct place of

storage of the following.

a) BCG

b) OPV

c) MEASLES

d) DPT / DT / TT

e) Varicella

f) Hepatitis – B

g) Hepatitis – A

h) Typhoid

i) Diluent

j) Ice Cubes

k) Ice Packs

l) Dial Thermometer

m) Water Bottles


1) Top shelf

2) Freezer

3) Top Shelf / freezer

4) Middle Shelf

5) Lower Shelf

6) Middle Shelf

7) Middle Shelf

8) Middle Shelf

9) Crispator

10) Freezer

11) Freezer

12) Top Shelf

13) Side door

Question No. 44

1) If 2 or more soft neurologic signs are persistent it correlates with 4 conditions.

What are they?

2) ELICIT SOFT NEUROLOGICAL SIGNS

(Observer: Dr. Ganesh)

a) TANDEM WALKING

b) DISDIADOKOKINESIS

c) SYNKINESIS (MIRROR IMAGE MOVEMENT)

d) HAND PATS

e) REPETITIVE AND SUCCESSIVE FINGER

MOVEMENT

f) ARM PRONATION – SUPINATION MOVEMENT

g) FOOT TAPS

h) HOPPING

i) ELICITS CHOREOATHETOSIS BY EXTENSION OF

ARMS.


1)

a) Neurologic dysfunction

b) ADHD

c) LD

d) CP

Question No. 45

Match the following

Hb electrophoresis Hemoglobinopathy

1) FA B – Thalassemia

2) FAS Alpha Thalassemia

3) FS Sickle cell trait

4) F Normal

5) FA Bart’s Sickle cell anemia


Hb electrophoresis Hemoglobinopathy

1) FA Normal

2) FAS Sickle Cell Trait

3) FS Sickle cell anemia

4) F B – Thalassemia

5) FA Bart’s alpha thalassemia

Question No. 46

You are investigating some children with reference to

Hepatitis B. Interpret the reports and give your diagnosis.

I. Child A - HbSAg +ve

- Anti HbCAg Igm +ve

- Anti HbSAg –ve

- HbeAg +ve

II. Child B - HbSAg +ve

- Anti HbcAg -ve

III. Child C - HbSAg –ve

- Igm Anti Hbc +ve

IV. Child D - HbSAg +ve

- Hbe +ve

- Anti Hbc IgG +ve

V. Child E - HbSAg –ve

- Anti Hbc IgG –ve

- Anti HbSAg +ve

- Anti Hbe +ve

VI. Child F - HbSAg –ve

- Anti Hbs +ve

- Anti Hbc IgG –ve

- Anti Hbe –ve


I. Acute Hepatitis B highly infective

II. Carrier

III. Acute Hepatitis B

IV. Chronic Hepatitis B high infectivity

V. Recovery from Hepatitis B

VI. Immunised child / Remote hepatitis B infection

Question No. 47

1) Name the factors deficiency of which will be corrected by transfusion of FFP.

(At least 4)

2) What is the dose?

3) List 1 renal condition and 1 thrombolic condition in which FFP may be useful?

4) What are the components of cryoprecipitate?


1)

a) Factor II

b) Factor V

c) Factor X

d) Factor XI

e) Functional deficiency of factors II, VII, IX, X in emergencies (rapid reversal

of warfarin effects)

2) 15 ml / hr

3) - TTP

- Antithrombic C, Pr C, Pr S deficiency

4)

a) Fibrinogen

b) Factor VIII

c) Factor XIII

Question No. 48

Write the correct symbols for the following used in pedigree chart.

1) Sex unspecified

2) Divorced

3) Monozygotic twinn

4) Proband

5) Deceased individual

6) Miscarriage

7) Adopted into family

8) Stillbirth

9) No offspring

10) Affected

Question No. 49

I. Child ‘A’ walks up and down stairs one leg at a time, climbs on

furniture and jumps.

a) What would be your assessment of the age of this child?

b) Name 2 adaptive milestones specific for this age.

II. Child B - copies cross and square

- Imitates construction of “gate” of 5 cubes

a) What would be the child’s probable age?

b) Mention 2 specific motor milestones for this age.

III. Match the following

a) Palmar grasp gone - 8 months

b) Transfers object from hand-to-hand - 4 months

c) Turn pages of book - 5.5 months

d) Thumb finger grasp - 12 months


I.

a) 30 months

b) – Makes tower of 7 cubes

- Circular scribbling

- Imitates vertical stroke

- Dumps pellets from bottle

II.

a) 48 months

b) – Hops on one foot

- Throws ball menhead

- Uses scissors to cut out pictures

- Climbs well

III.

a) 4 months

b) 5.5 months

c) 12 months

d) 8 months

Question No. 50

E.T. Tube

1) Identify the instrument.

2) Name its parts.

3) What size would you use in a 6 yrs old child?

4) Mention 5 physiological changes, which occur when it is used in children.


1) Endotracheal tube uncuffed

2)

a) Adaptor

b) Markings on tube for nasal / oral fixing

c) Vocal cord guide

d) Murphy’s eye

e) Radiological marker

3) 5.5 cm uncuffed (tubes 0.5 cm less and greater in size to be kept ready)

4)

a) ICP

b) Laryngospasm

c) Hypoxia

d) Tachycardia and hypertension in older children

e) Bradycardia and Hypotension in infants

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OSCE KKCTH 2007

Education

Transcript of OSCE KKCTH 2007