RIPE 2012

PEDIATRICS
OSCE
OSCE 1
MATCH THE FOLLOWING
DRUGS USED EXPECTED ADVERSE
IN PREGNANCY OUTCOME ON THE
FOETUS

1. Chloroquine A. Macrosomia
2. Penicillamine B. VACTERAL Association
3. Statins C. Cutis laxa syndrome
4. Lithium D. Arthrogryposis
5. Misoprostol E. Deafness
6.Prednisolone F. Neuroblastoma
7.Tetracycline G. Minamata disease
8.Busulfan H. Cataract
9. Phenytoin I. Oral clefts
10.Methyl Mercury J. Corneal opacities
OSCE 1
ANSWERS
DRUGS USED EXPECTED ADVERSE
IN PREGNANCY OUTCOME ON THE
FOETUS

1. Chloroquine E. Deafness
2. Penicillamine C. Cutis laxa syndrome
3. Statins B. VACTERAL Association
4. Lithium A. Macrosomia
5. Misoprostol D. Arthrogryposis
6.Prednisolone I. Oral clefts
7.Tetracycline H. Cataract
8.Busulfan J. Corneal opacities
9. Phenytoin F. Neuro blastoma
10.Methyl Mercury G. Minamata disease
 OSCE -2
A 12 year old adolescent boy, known
Nephrotic syndrome presented in
Emergency Room with the history of
acute onset of breathlessness. In the
ER, his vitals: HR-100/mt, BP- 120/80 mm
Hg, RR- 40/mt,Spo2 98% in Room air. His
ABG , PH- 7.55,Pco2-20 mm/Hg, Pao2-
110 mm/Hg, Hco3-26meq/L.

1. What is the interpretation of ABG?

2. What is the formula for compensation?
3. Name two electrolyte disturbances
associated with this ABG finding?
4. Name two drug overdose causing
OSCE 2
ANSWERS
1. Acute uncompensated Respiratory
Alkalosis

2. Acute compensation-Plasma Hco3 falls

by 2 for each 10mm/Hg decrease in
Pco2. .
Chronic compensation-Plasma Hco3
falls by 4 for each 10mm/Hg decrease
in Pco2

3. Hypocalcemia, Hypokalemia

4. Salicylates,caffeine,Theophylline.
OSCE-3
10 day old neonate with macular rash over face.

ECG
 OSCE - 3
A 10 day old neonate with macular rash over the
face.

1. Interpretation of ECG and probable diagnosis?

2. How will you confirm the diagnosis?

3. How will you prevent this condition?

4. What is the treatment?

5. What is the risk of recurrence in future

pregnancies?
OSCE 3
ANSWERS
1. Complete Heart Block, Neonatal
Lupus.

2. Presence of Maternal Anti-Ro (SSA),

Anti-La(SSB) antibodies.

3. Treatment with IVIG in pregnant

women with anti-Ro,anti-La antibodies.

4. Cardiac pacing.

5. 15%
 OSCE-4
PERIPHERAL
SMEAR
 OSCE - 4
1. What is the diagnosis?

2. What is the drug of choice for the

prevention of painful episodes?

3. What are measures for the primary

prevention of stroke in these children?

4. What are the antibiotics of choice in

acute chest syndrome?

5. What type of renal malignancy is

common in this condition?
OSCE 4
ANSWERS

1. Sickle cell anemia.

2. Hydroxy urea.

3. Transcranial Doppler assessment of

blood velocity in the terminal portion
of the ICA and proximal portion of the
MCA.Periodic blood transfusion if Time
Averaged Mean Maximum blood
flow(TAMM) is more than 200cm/sec to
maintain Hb S levels less than 30%

4. Macrolide and third generation

cephalosporin.
 OSCE-5

A)

1.What is the mode

of inheritance?
2.What is the
characteristic
feature of this
inheritance?
3.Give one
example?
 OSCE-5

B)
1. What is the mode
of
inheritance?

2. What is the
characteristic
feature of this
inheritance?

3. Give one
example?
 OSCE 5
ANSWERS

A)
1. Mitochondrial Inheritance.

2. Since Mitochondrial genome is entirely

derived from the mother awomen with
this disorder can have affected offspring of
either sex but an affected father cannot
pass on the disease to his offspring.

3. 3. Leber hereditary optic neuropathy,Leigh

disease,MELAS, MERRF.
B)
4. Y-Linked inheritance.

5. Only male to male transmission,only males

are affected.
 OSCE - 6

Three year old child with fever,

irritability, poor feeding
and drooling of saliva.
 OSCE - 6

1. What is the diagnosis?

2. Name two most common micro-

organisms associated?

3. What is the drug of choice?

4. Name two complications?

5. What is Lemierre disease?

 OSCE 6
ANSWERS
1. Retropharyngeal Abscess.
2. Group A Streptococcus,Anerobic
bacteria,Staphlyococcus Aureus,
H.Influenza.
3. 3rd generation Cephalosporin+Ampicilin-
Sulbactum/Clindamycin.
4. Upper airway obstruction,Aspiration
pneumonia,Mediastinitis.
5. Parapharyngeal abscess extending to
cause septic thrombophlebitis of the
Internal Jugular vein and embolic
abscess in the lungs.
OSCE 7

Out of 6000 children in a village,50

cases of tuberculosis already exist.There
are 10 newly diagnosed cases in a
year.Two children died of
tuberculosis.Calculate the Prevalence
rate, Incidence rate, Case fatality rate of
tuberculosis in that village.
 OSCE 7
ANSWER
No.of existing (50)+New
cases(10)
Prevalence rate =
----------------------------------------------- * 100
Population at
risk(6000)
= 1%.

New cases(10)
Incidence rate = --------------------------------
* 1000
Population at
risk(6000)

= 1.6
OSCE 8
HISTORY TAKING

A 3 year old male child has bruising over

his shins and knees. Elicit a Targeted
History (10 Points) :-
OSCE 8
ANSWERS
1. Greetings, Introduction & Establishing
Rapport
2. History regarding walking activity and
frequency of falls (Normal toddler
bruising)
3. History of preceding fever (ITP)
4. History of bleeding elsewhere including
hematuria (ITP,HSP)
5. History of Abdominal and joint pain
(HSP)
6. History of painful swollen joints with
OSCE 8
ANSWERS

7. History of intake of NSAIDS like aspirin

(Drug induced)
8. Social history and enquiry about care
takers and family dynamics (Non
Accidental Injury)
9. History of prolonged fever
(leukemia,aplastic anemia)
10. History of progressive pallor requiring
transfusions (leukemia,aplastic anemia)
 OSCE - 9
You have performed Incision &drainage
of Gluteal abscess in a child.How will u
dispose the used items given below?

1) Cotton and gauze contaminated with

pus.
2) Scalpels and needles.
3) Intravenous set and tubings.
4) Remaining contaminated Lignocaine
used for Local
anasthesia.
 OSCE - 9
ANSWERS

1) Yellow plastic bag

2) Blue/white puncture proof container.

3) Red- plastic bag/disinfected container

4) Black plastic bag

 OSCE - 10
As per IMNCI clinical guidelines

1) How will you categorize children

based on age group?
2) What are the following colour codings
stand for?
a) Pink b) Yellow c) Green
3) What are the six steps of case
management process
in INMCI?
4) What will you advise for a child
presenting with
 OSCE - 10
ANSWERS
1) < 2 months, 2 months to 5 yrs
2) Pink- referral, Yellow initial treatment
in health center, Green management
at home.
3) Step 1- Assess the young infant /child.
Step 2- Classify the illness
Step 3- Identify treatment
Step 4- Treat the young infant/child.
Step 5- Counsel the mother
Step 6- Follow up care.
4) Give iron and folic acid for 14 days,
 OSCE -11
A 10 year old girl is brought with
deteriorating academics, psychological
withdrawal and episodes of abnormal
behaviour for past 8 months. She also has
frequent falls, involuntary jerky
movements involving the limbs & trunk.
Clinical Examination reveals Hypertonia
with sluggish reflexes & episodes of
myoclonic jerks.

1) What is the likely diagnosis?

2) What are the diagnostic findings?

 OSCE - 11
ANSWERS
1) Subacute Sclerosing Panencephalitis.

2) The diagnostic Findings are:

) CSF Measles Antibody titer > 1:8
) EEG: Burst Suppression pattern.
) Isolation of virus or viral Antigen on
Brain Biopsy.

3) Isoprinosine, Interferon 2
 OSCE - 12
A 14 year old boy has sustained injury to
the neck due
to a Road Traffic Accident. He is breathing
but cannot
move or feel his arms or legs.

1. What is the recommended maneuver for

opening the airway in neck injuries?
2. X ray of the Cervical spine shows no
bony injury. Is it still possible for the
boy to have a spinal cord injury? Name
the condition, its incidence and mode of
diagnosis?
 OSCE - 12
ANSWERS
1. Jaw Thrust without Head tilt.

2. YES. SCIWORA (Spinal Cord Injury

Without Radiographic bone
Abnormalities)Incidence 20%. MRI
Spine.

3. High dose Methyl Prednisolone (30

mg/kg) within 8 hrs of injury.
 OSCE - 13
Picture of a three year old child
 OSCE - 13

1. What is the diagnosis?

2. Name 4 associated abnormalities:

3. What are the differential diagnoses?

4. When does the skin lesion disappear?

5. What will be the finding in CT brain?

 OSCE - 13
ANSWERS
1. Hypomelanosis of Ito
2. Mental retardation, Seizures,
microcephaly and Muscular Hypotonia
3. Differential Diagnoses:
. Systematized Nevus Depigmentosus
. Incontinentia pigmenti
4. Fades during Adulthood
5. Cerebral Atrophy
OSCE - 14

A 4 year old child

admitted with high
fever had a gradual
resolution of fever
on day 3 of
admission. But he
developed faint
pink non pruritic
rash on the trunk,
spreading to face &
extremities.
 OSCE - 14
1. What is the condition?

2. What is the causative organism?

3. What is the typical finding seen in oral

cavity?

4. Name 3 complications?

5. Can Breast milk transmit the disease to

the baby?
 OSCE - 14
ANSWERS
1. Roseola Infantum or Exanthem Subitum or
Sixth Disease.

2. HHV Type 6, belonging to Roseola Virus

Genus.

3. Nagayama Spots, Ulcers at the Uvulo-

palato-glossal junction.

4. Seizures, Encephalitis, Cerebellitis,

Hepatitis and Myocarditis.
 OSCE - 15
OSELTAMIVIR
1. Indications for this drug?

2. Mechanism of Action?

3. Dose & Duration of therapy in pediatric

H1N1 A Infection?

4. Which drug when co-administered

improves the half life of
Oseltamivir?

5. Which Vaccine is contra indicated within

 OSCE - 15
ANSWERS
1. Treatment of Influenza A & B in patients >
1 year of age,
who have been symptomatic for no more
than 2 days. Also
used for prophylaxis.

2. Neuraminidase inhibitor, prevents new viral

particles from being released by infected
cells.

3. By Weight:
< 15 kg: 30 mg BD for 5 days
15-23 Kg: 45 mg BD for 5 days
 OSCE - 15
ANSWERS
For Infants:
< 3 mon: 12 mg BD for 5 days
3-5 mon: 20 mg BD for 5 days
6-11 mon: 25 mg BD for 5 days

4. Probenazid.

5. Live attenuated Influenza Vaccine,

Intranasal.
 OSCE - 16
JAPANESE ENCEPHALITIS
VACCINE
1. What is the type of vaccine used in
india?

2. What are the IAPCOI recommendations

for use?

3. No of doses, Route & Site of

administration?

4. Age Group for Vaccination?

 OSCE - 16
ANSWERS
1. Live attenuated, cell culture derived SA 14-14-2
JE vaccine.

2. Only in Endemic areas as Catch up Vaccine.

3. 0.5 ml Subcutaneous Single dose in Left Upper

Arm (Below the usual site of BCG Scar).

4. 8 mon 15 Years, Catch up vaccination: All

susceptible children upto 15 years should be
administered during disease outbreak / ahead of
anticipated outbreak in campaigns.

5. Measles.
 OSCE - 17
A 15 month old boy is brought with loss of language
skills,
abnormal eye contact, failure to respond to name &
lack of
interactive play.

1. Name 2 Chromosomes implicated in this disorder?

Mode
of Inheritance suggested?
2. Name 3 pathological conditions linked to this
disorder?
3. What are the typical Neuro-anatomical findings
that are reported in this condition?
4. Name 2 Screening tools, used for early detection?
5. Name 3 drugs useful in this condition?
 OSCE - 17
ANSWERS
1. Chromosome 2q,7q,15q11-13; X-linked
Inheritance.
2. Tuberous Sclerosis, Fragile X Syndrome,
Angelman Syndrome.
3. Macrocephaly, with abnormal growth in
frontal, temporal, cerebellar and limbic
regions of brain.
4. M-CHAT: Modified Checklist for Autism in
Toddlers
PDDST: Pervasive Developmental
Disorders Screening test.
5. Clomipramine, Fluoxetine, Clonidene,
 OSCE - 18
TRUE OR FALSE
Regarding Tricyclic Anti depressant Poisoning:

1. Emesis is contra indicated because of the

danger of aspiration from vomiting.
2. Hypertension is a poor prognostic sign.
3. Lidocaine is used to treat dysrrhythmias
unresponsive to serum alkalinization.
4. Physostigmine, if given within 6 hours after
exposure prevents dysrhythmias.
5. Multiple doses of activated charcoal are
recommended to prevent intestinal
absorption.
 OSCE - 18
ANSWERS
1. True

2. False

3. True

4. False

5. True
 OSCE 19
A 6 year old boy is evaluated for recurrent pneumonia
&
Osteomyelitis of multiple sites. On examination, He
had
Anemia, malnutrition & Cervical Lymphadenitis. He
also
had Folliculitis & multiple cutaneous granulomas.

1. What is the possible Diagnosis?

2. What is the closest differential diagnosis?
3. What are the Gastro-Intestinal complications of this
condition?
4. What is the recent diagnostic test for this condition?
5. Name 3 drugs used in the management?
 OSCE - 19
ANSWERS
1. Chronic Granulomatous Disease.
2. G6PD deficiency.
3. Pyloric Outlet Obstruction, Rectal Fistulae
and Granulomatous colitis simulating
Crohns disease.
4. Flow Cytometry using Dihydro Rhodamine
123 (DHR) to measure oxidant
production.
5. Drugs used in management:
. Daily Trimethoprim-Sulfamethoxazole &
Itraconazole for prophylaxis of Bacterial &
Fungal Infections
. Corticosteroids For treatment of Antral
OSCE - 20
MATCH THE FOLLOWING
LYSOSOMAL STORAGE DISORDERS

1. Metachromatic A.
Leukodystrophy. Galactocerebrosidase.

2. Krabbes disease.
B. Galactosidase
3. Fabry disease.
C. Ceramidase
4. Farber disease.

5. Wolman D. Acid Lipase

disease
E. Aryl Sulfatase A
 OSCE - 20
MATCH THE FOLLOWING
1. IEM with PECULIAR ODOUR
Multiple
Carboxylase
deficiency. A. Sweaty Feet.

2. Hypermethionine
mia. B. Rotting Fish.

3. Isovaleric C. Boiled Cabbage.

acidemia.
D. Swimming pool.
4. Trimethyl
Aminuria. E. Tomcat urine.

5. Hawkinsinuria
 OSCE - 20
ANSWERS
MATCH THE FOLLOWING

LYSOSOMAL STORAGE DISORDERS:

1-e ;2-a; 3-b; 4-c; 5-d

IEM with PECULIAR ODOUR:

1-e; 2-c; 3-a; 4-b; 5-d

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