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DNB OSCE SGRH - 2
This document contains a series of stations from an OSCE (Objective Structured Clinical Examination) in pediatrics. It includes 23 stations testing knowledge of various pediatric conditions through patient scenarios, investigations, images, and smears. For each station, the examinee is asked to identify findings, diagnoses, appropriate tests or management. The stations cover topics like congenital heart disease, meningitis, nephrotic syndrome, diabetes insipidus, Stevens-Johnson syndrome, and various hematologic conditions discernible from blood smears.
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DNB OSCE SGRH - 2
- 1. OSCE Centre for ChildHealth Sir Ganga Ram Hospital
- 2. STATION 1 This 9-month-old infant was cyanosed at birth and had a cardiac operation at 3 months of age. What condition is shown here? Name all features of this condition?
- 3. Answer 1 • leftsided Horner’s syndrome • It results in ptosis (drooping upper eyelid), miosis (constricted pupil), and occasionally apparent enophthalmos (the impression that the eye is sunk in) and anhidrosis (decreased sweating ) on one side of the face
- 4. STATION 2 A 14-year-oldboy from Uttarakhand was seen in the Accident & Emergency Department of Sir Ganga Ram Hospital with a generalised convulsion. His parents said that he had complained for two weeks previously of mild headaches, which had occurred at different times of the day. At the age of 12 he was found to be sniffing glue but subsequently told his parents he had discontinued the practice. His progress at school was good and his behaviour had been normal. On the afternoon of admission he had complained of a sudden generalised headache; despite this he had gone to see some friends but returned home with the headache. His mother had given him paracetamol. As he was sitting down to watch television, he became stiff and had a generalised convulsion.The family called an ambulance and rectal diazepam was administered. He continued to fit and on arrival at the hospital, intravenous lorazepam was required to terminate the convulsion. He remained very drowsy and non-responsive.
- 5. STATION 2 On examination,there was some resistance to flexion of his neck but he was afebrile. His respirations were laboured, he was not cyanosed and was well perfused peripherally. His blood pressure was 160/90 mmHg. Examination of his heart, respiratory system and abdomen were normal. His pupils were of equal size and both reacted sluggishly to light. Examination of the fundi showed no abnormalities; there was a generalised increase in tone in his limbs but no focal abnormal neurological signs.
- 6. STATION 2 • Whatis the most appropriate investigation to establish the diagnosis? • What are the two most appropriate forms of immediate management? • What is the most likely diagnosis?
- 7. ANSWER 2 • CTscan • administer intravenous mannitol and arrange for intubation and ventilation • subarachnoid haemorrhage
- 8. STATION 3 A 14-year-oldboy presented with an 8 weeks history of occasional vomiting, weight loss, listlessness and increasing pallor. During this period he complained intermittently of headache, pain in the lower chest anteriorly, and episodes of feeling hot and breathless. He had been short of breath on exertion. He had been drinking more water and passing more urine than previously. He complained of pains in his hands and feet and his family doctor arranged for an x-ray (Q9). His parents reported that since the onset of the illness his heart rate had become rapid and his heart beat unduly forceful. He had a long history of episodes of fever, abdominal pain and vomiting which had been diagnosed as “abdominal migraine”. Both parents and his 4-year-old brother were healthy. His father was a factory worker and the family lived in a modern two-bedroomed flat.
- 9. STATION 3 On examinationhis weight was 30kg and his height was 138cm (growth charts Q11). He was alert and afebrile. His respiratory rate was 40/minute and his pulse rate was 130/minute. There was some pitting oedema over the dorsum of each foot. Jugular venous pressure was 5cm above the sternal angle. The apex beat was in the fifth interspace in the anterior axillary line and was thrusting in character. The first and second heart sounds were normal; the third heart sound was heard in the apical and left parasternal regions. The femoral pulses were readily palpable. The blood pressure was 160/110 mmHg. Fine crepitations were heard at both lung bases. The appearance of the fundus is shown (Q10). The liver edge was palpable 3cm below the costal margin. Neither bladder nor kidneys could be palpated and there was no abdominal tenderness. Urinalysis was positive for protein (+) and negative for both glucose and blood.
- 10. • Hb 9.2 g/dl •urea 78 mg/dl • MCV 73 fl • creatinine 3.4mg/dl • MCH 23 pg • total protein 70 g/l • MCHC 31 g/l • albumin 38 g/l • WBC 8.0 x 109/l •S.calcium 2.1 mmol/l • •S. phosphate 2.7 mmol/l neutrophils 5.20 x 109/l (normal range 0.99-1.57) • lymphocytes 2.64 x 109/l •alkaline phosphate 496 IU/l • monocytes 0.08 x 109/l (normal range for age 71-234) • eosinophils 0.08 x 109/l •Chest x-ray normal • Na-133 /K-4 •Abdominal ultrasound: Kidneys • S. chloride 97 mmol/l small with increased echogenicity • S. bicarbonate 20 mmol/l •No bladder abnormality
- 11. STATION 4 What is the most important abnormality on the radiograph of the hand shown of the boy in St 3? A delayed bone age B osteomalacia C osteoporosis D splayed epiphyses E subperiosteal erosions
- 12. ANSWER 4 E subperiostialerosions
- 13. STATION 5 Whatis the most likely pathogenesis of the abnormality shown in X-ray shown in STATION 4? A chronic ill health B hypophosphataemia C poor dietary calcium intake D primary hyperparathyroidism E secondary hyperparathyroidism F vitamin D deficiency
- 14. ANSWER 5 E secondaryhyperparathyroidism
- 15.
- 16. STATION 6 What arethe two most important features demonstrated on the growth chart? A bone age: advanced B bone age: delayed C bone age: normal D height: high E height: low F height: normal G pubertal staging: advanced H pubertal staging: delayed I pubertal staging: normal J weight for height: high K weight for height: low L weight for height: normal
- 17. Answers 6 E Height:low H pubertal staging: delayed
- 18. STATION 7 What isthe best interpretation of the appearance of the optic fundus ?
- 19. ANSWER 7 Hypertensive retinopathy Group I: minimal narrowing of the retinal arteries Group II: narrowing of the retinal arteries in conjunction with regions of focal narrowing and arteriovenous nicking Group III: abnormalities seen in groups I and II, as well as retinal hemorrhages, hard exudation, and cotton-wool spots Group IV (i.e., malignant hypertension): abnormalities encountered in groups I through III, as well as swelling of the optic nerve head.
- 20. STATION 8 What isthe most likely cause of his breathlessness? A anaemia B left ventricular failure C metabolic acidosis D myocardial ischaemia E raised intracranial pressure F right ventricular failure
- 21. Answer 8 B -Left ventricular failure
- 22. STATION 9 What isthe most likely cause of his renal impairment? A acute tubular necrosis B chronic glomerulonephritis C hypertensive nephropathy D hypovolaemia E reflux nephropathy
- 23. ANSWER 9 E - reflux nephropathy
- 24. STATION 10 Which ofthe following renal investigations should now be performed? A abdominal CT B DMSA isotope scan C MAG 3 isotope scan D micturating cysto-urethrogram (MCUG) E renal arteriogram F renal biopsy
- 25. ANSWER 10 DMSA istopescan micturating cysto-urethrogram (MCUG)
- 26. STATION 11 What isthe best description of this lesion?
- 27.
- 28. STATION 12 What arethe two most important abnormalities present?
- 29. Answer 12 left pleuraleffusion mediastinal shift
- 30. STATION 13 This is the face of a boy aged five years. What is the most likely diagnosis?
- 31. Answer 13 • Stevens-Johnsonsyndrome • Both Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis can start with non-specific symptoms such as cough, aching, headaches, and feverishness. This may be followed by a red rash across the face and the trunk of the body, which can continue to spread to other parts of the body. The rash can form into blisters, and these blisters can form in areas such as the eyes, mouth and vaginal area. The mucous membranes can become inflamed, and with Toxic Epidermal Necrolysis layers of the skin can also come away with ease and often the skin peels away in sheets. The hair and nails can also come away in some cases, and sufferers can become cold and feverish.
- 32. STATION 14 An 8-month-oldmale infant is referred because of non-bilious vomiting. His general practitioner (GP) had seen him frequently for constipation over the last few months. Examination reveals a thin, non-dysmorphic infant weighing 6.8kg (1st centile). He has a scaphoid abdomen and his capillary refill time is three seconds. General examination was otherwise unremarkable.
- 33. STATION 14 Hb 12.2g/dl Urine microscopy WBC 13 x 109/l - no red cells neutrophils 9.4 x 109/l - no white cells lymphocytes 3.6 x 109/l Platelets 373 x 109/l - no casts plasma sodium 154 mmol/l Urine osmolality plasma potassium 3.8 mmol/l -180 mOsm/kg plasma urea 6.0 mmol/l
- 34. STATION 14 1.What isthe most likely diagnosis? 2 .What would be the most appropriate test to confirm the diagnosis?
- 35. Answer 14 1. diabetesinsipidus 2. response to DDAVP
- 36. STATION 15 This is an x-ray of the abdomen in a 12-year- old girl who attended a school for children with learning difficulties and complained of recurrent abdominal pain. What abnormality can be seen on the plain abdominal film?
- 37.
- 38. STATION 16 A 2-week-oldmale infant, Blood gases: previously well, pH 7.33 (plasma hydrogen presented with vomiting. ion concentration 47 Hb 12.9 g/dl nmol/l) WBC 18.5 x 109/l PaO2 6.7 kPa (50 mmHg) neutrophils 10.0 x 109/l PaCO2 4.5 kPa (34 mmHg) lymphocytes 7.8 x 109/l monocytes 0.7 x 109/l plasma bicarbonate 17.3 mmol/l platelets 604 x 109/l blood glucose 4.2 mmol/l Base deficit -7.8 mmol/l Na- 123/K-6.2 BUN-12 mg/dl
- 39. STATION 16 What isthe most likely diagnosis?
- 40. ANSWER 16 Congenital adrenalhyperplasia (21-hydroxylase deficiency)
- 41. STATION 17 • The dentist reported this incidental finding in a 16- year-old female. • What is the diagnosis? A aberrant parathyroid B cavernous haemangioma C cystic hygroma D lingual thyroid E lymphoma F mucus retention cyst G peri-tonsillar abscess H rhabdomyosarcoma
- 42. Answer 17 D –Lingual Thyroid
- 43. STATION 18 • What two abnormalities are seen on the CT scan with IV contrast of a 4 yr old boy? • What is the likely diagnosis?
- 44. Answer 18 1. -displacedright kidney - solid tumour of the right kidney 2. Wilms' tumour
- 45. STATION 19 • What are your findings on this smear?
- 46. Answer 19 • Malarialparasite
- 47. STATION 20 • What are your findings on this smear?
- 48. Answer 20 • Sicklecell anemia
- 49. STATION 21 • What are your findings on this smear?
- 50. Answer 21 • Blastsseen- most likely lymphoblasts
- 51. STATION 22 • What are your findings on this smear?
- 52. Answer 22 • Bandcell –Immature neutrophil
- 53. STATION 23 • What are your findings on this smear?
- 54. Answer 23 • MicroHypo Anemia
- 55.