OSPE Peads Medicine Set 2 OSPE · PDF fileOSPE Peads Medicine Set 2 OSPE PEADS ... Identify the physical sign? 3 2. What ... Widal test / Typhidot test

OSPE Peads Medicine Set 2 SurgicoMed.com

OSPE PEADS MEDICINE SET 2

Case 1

1. Identify 3 physical signs in these photographs? 3

2. What is the diagnosis? 2

Key

1. Physical signs are;

Epicanthic folds

Low set ears

Simian crease

Increased distance b/w 1st and 2nd toe

2. Down Syndrome

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Case 2

1. Give three radiological findings? 3


Key 1. Radiological findings are;

Cupping

Widening

Fraying

Flaring

2. Rickets





Case 3

1. Identify two radiological abnormalities? 2

2. What is your diagnosis? 1

3. Give two causes? 2

Key 1. Radiological abnormalities are;

Bilateral opacities

Obliteration of costophrenic angles

2. Bilateral pleural effusion

3. Causes:

Nephrotic syndrome

CLD

Connective tissue disorder

CCF

Tuberculosis





Case 4 This five years old child presents with easy fatigability for the last 2 years.

1. Identify the physical sign? 3

2. What is the most likely diagnosis? 2

Key

1. Bilateral ptosis

2. Myasthenia gravis





Case 5


2. Give 3 complications? 3

Key

1. Meningiomyelocele

2. Complication:

Infections / meningitis

Hydrocephalus

Paralysis of the lower limbs (paraplegia)

Bowel and bladder dysfunction

Hip dislocation, foot deformities





Case 6

1. Name the physical sign shown in the photograph? 3


Key 1. Gower’s sign

2. Duchene Muscular Dystrophy





Case 7

A 4 years old girl present with 4 day history of increasing puffiness around the eye. The

investigations are as follow;

Hb 12.6 g/dl

WBC 10,290/mm3

Na 136 mmol/l

K 4.7 mmol/l

Serum albumin 2.6 g %

Urine pH 6.5


2. Give 3 further investigations? 3

Key

1. Nephrotic syndrome

2. Investigations:

24 hour urinary protein

Urinary protein creatinine ration

Serum cholesterol

Serum C3 level

Urea and creatinine





Case 8

A previously well child with one week history of febrile illness who was treated with injectable

ampicillin presents with mild neck stiffness and hemiplegia. CSF results are as follow;

Protein 80 mg/dl

Sugar 40 mg/dl

WBC 300/mm3

Lymphocytes 68%

Gram staining and culture –ve


2. Give 3 other complications? 3

Key

1. Partially treated bacterial meningitis

2. Complications

Subdural effusion

Brain abscess

Cranial nerve palsies

Seizures

SIADH





Case 9 An 8 months old boy presented in the emergency room with the complaints of fever and

cough for 3 days, vomiting for 1 day and generalized fits for 1 ½ hour. On examination, he has

fever of 1010F, some dehydration and irritability.

His CSF examination showed TLC 2000/mm3, DLC: poly 75%, lymphocytes 25%, RBCs few,

protein 120 mg/dl and sugar 130 mg/dl.

1. What is your diagnosis?

2. What are the two most probable causative organisms?

3. Enlist steps of management?

Key

1. Acute bacterial meningitis

2. Most causative organisms are:

Haemophilus influenza

Streptococcus pneumoniae

3. Management includes:

ABC (supportive treatment)

Anti-seizures (to control fits)

Anti-biotics (to treat bacterial infection)





Case 10

1. Which infectious disease can lead to this deformity? 1

2. Name four diagnostic investigations? 2

3. Name four drugs with dosage and duration? 2

Key 1. Carries spine / Tuberculosis

2. Diagnostic investigations:

Mantoux test (Accelerated BCG test)

X-ray chest

X-ray spine

C.T scan spine

3. Drugs used:

Rifampicin orally 10-20 mg/kg OD before breakfast for 1 year

Isoniazid 10-20 mg/kg/day OD for 1 year

Pyrazinamide orally 15-30 mg/kg/day for initial 2 months

Ethambutol or Inj. Streptomycin 10-15 mg/kg * IM* OD for initial 2 months





Case 11

A 7 years old child presents with 2 days history of haematemesis and malena. On examination,

he had massive splenomegaly. His ALT was 65 µ/L, PT and aPTT were within the normal limits

and serum albumin was 4 g/dl.

1. What is the most likely diagnosis?

2. How will you confirm your diagnosis?

3. Enlist three steps of long term management?

Key

1. Pre-hepatic portal hypertension

2. USG of abdomen with Doppler studies

3. Steps of long term management:

B-blockers

Sclerotherapy / Band ligation

Mesocaval shunt





Case 12

1. What will you find on abdominal x-ray as shown in this photograph?

2. Name three common diseases responsible for these findings?

3. Describe the laboratory tests required for the diagnosis of above those three diseases?

Key 1. Hepatosplenomegaly

2. Common diseases:

Malaria

Typhoid fever

Tuberculosis

3. Laboratory tests required:

Hb, TLC, DLC, ESR

Malarial parasites, thick and thin film slides

ICT for malarial parasites

Tuberculin test / Accelerated BCG test

X-ray chest (PA view)

Blood test for Salmonella typhi and paratyphi

Widal test / Typhidot test





Case 13

A 3 years old child is brought to the OPD with the history of fever and poor weight gain for 3

months. He is unvaccinated. His uncle has history of chronic cough. His investigations reveal:

Hb 9 gm%, TLC 75000/mm3, ESR 100 mm, Mantoux test 12mm.

Chest x-ray showed hilar lymph adenopathy.

1. What is the most probable diagnosis?

2. Write down the steps of management is this case?

Key

1. Pulmonary Tuberculosis (pulmonary T.B)

2. Management steps:

ATT

Nutritional rehabilitation

Family counseling

Family screening for TB and management accordingly

Ensure proper follow up to check response, compliance and look for complications





Case 14

1. What is the radiological findings? 1

2. What are three other conditions in Pediatrics leading to such infiltrations x-ray chest? 1.5

3. What are five common findings on clinical examination? 2.5

Key 1. Miliary tuberculosis / Mottling

2. Clinical conditions:

Atypical pneumonia

Fungal pneumonia

Viral pneumonia

3. Findings on clinical examinations:

Emaciation

Hepatosplenomegaly

Choroid tubercles in eyes

Pancreatitis (< 5%)

Multiorgan dysfunction

Adrenal insufficiency





Case 15

1. What are 4 positive findings in this photograph? 2


3. What are the causes which lead to this condition? 2

Key 1.

Puffy moon shape

Miserable looking and apathetic

Flaky paint dermatitis

Edema foot

2. Kwashiorkor

3.

a) Primary malnutrition

Failure of lactation

Ignorance of weaning

Poverty

Cultural food pattern/food lack

b) Secondary malnutrition

Infections

Congenital disorders

Malabsorption

Metabolic





Case 16

1. What is the clinical findings? 1

2. Name the two underlying conditions leading to this finding? 2

3. What is the management? 2

Key 1. Noma / Cancrum oris

2.

Measles

Malnutrition

3. Management:

Nutritious diet

Vitamin A supplement

Vitamin B complex

Vitamin C

Iron

Antibiotics

Ampicillin and metronidazole





Case 17


2. Describe four causes of this condition? 2

3. Describe four investigations to reach the diagnosis? 2

Key 1. Cervical lymph adenitis

2.

Tuberculous lymph adenitis

Bacterial (suppurative) lymph adenitis

Malignancy

Non-specific / Viral / Atypical micro-bacterial tuberculosis

3.

CBC including peripheral morphology and ESR

X-ray chest

Tuberculin test / BCG accelerated test

FNA / Excisional biopsy / Aspiration





Case 18

1. What is the diagnosis? 0.5

2. Describe 12 clinical features of this condition? 3.0

3. Name two diagnostic test and the drug for treatment? 1.5

Key 1. Congenital hypothyroidism (Cretinism)

2.

Coarse facies

Broad nasal bridge

Placid / contended baby

Umbilical hernia

Large tongue

Low hair line

Dry skin

Distended abdomen

Constipation

Short stature

Delayed dentition

Delayed milestones

Anemia

3.

Serum free T4

Serum TSH





Case 19

1. Identify 4 positive findings in this picture and present your diagnosis? 2.0

2. How antenatal diagnosis of this condition is made? 1.5

3. What is the risk of recurrence in the next pregnancy? 1.5

Key 1.

Up slanting of eyes

Depressed nasal bridge

Hypotonia

Protruding tongue

Diagnosis is Down’s syndrome

2.

Decreased AFP, decreases Estriol, increased hCG

Chromosomal analysis of fetal cells either by Amniocentesis or by CVS

Ultrasound showing increased nuchal translucency

3.

If non-disjunction is underlying cause recurrence risk 1 %

If translocation: 21/21 100 %

14/21 10-15 % (3-5%)

13/22 10-12 % (5%)





Case 20

1. What definition this graph reflects? 1

2. Enumerate 8 common causes of this condition? 2

3. Enumerate 8 steps to prevent malnutrition in children? 2

Key 1. Failure to thrive

2. Causes:

Failure of lactation

Faulty weaning

Poverty / ignorance

Cultural food pattern

Lack of immunization & primary

care

Family planning

Recurrent GIT infections

Recurrent respiratory tract

infections

Measles / Malaria

Tuberculosis

Congenital malformation

3.

Optimum breast feeding

Avoid bottle feeding, pacifiers etc.

Adequate weaning

Immunization

Growth monitoring

Family planning

Health education





Case 21

Following is the blood report from a one day old baby presenting with jaundice starting on

day 1 of life:

Hemoglobin (Hb) 10 mg/dl

TLC 15000 / mm3

Poly 40 %

Lymphocytes 58 %

Monocytes 1 %

Eosinophils 1 %

Reticulocytes 15 %

Direct coombs test strongly positive

1. What is most likely diagnosis?

2. What is the best treatment option?

3. Give one complication of this disease?

Key

1. Hemolytic disease of newborn

2. Exchange transfusion

3. Kernicterus





Case 22

A 2 years old boy presented with failure to thrive and fits which usually occur in early morning.

His investigations reveal:

Fasting blood sugar 40 mg/dl

ALT 75 IU/L

Uric Acid 8 mg/dl

Serum Triglycerides > 200 mg/dl


2. What other clinical sign you will look for?

3. How will you confirm your diagnosis?

Key

1. Glycogen storage disease

2. Hepatomegaly, Doll like facies

3. Liver biopsy, enzyme assay





Case 23

How do you interpret APGAR scoring system?

0 1 2

Appearance Pulse

Grimace Activity

Respiration

Key

APGAR 0 1 2

Appearance Central & peripheral cyanosis

Peripheral cyanosis Pink

Pulse < 60 60-100 > 100

Grimace No grimace Some Full cry

Activity Limp Some activity Active

Respiration No respiration Gasping Normal





Case 24

A 15 weeks old breast fed infant present with failure to thrive and loose motions. Examination

reveals perianal rashes and eczematous lesions over face and scalp. These lesions did not

respond to antifungal therapy.


2. How will you investigate?

3. What therapy would you want to give?

Key

1. Acrodermatitis enterpathica

2. Serum zinc level

3. Zinc sulphate





Case 25

A one year old child was brought to OPD with the complications of failure to thrive. The boy

was having weight of 6 kg and length of 60 cm. He is pale and edematous. His serum albumin

is 2 g/dl.

1. What three other clinical signs will you look for?


Key

1. Clinical signs:

Flaky dermatitis

Hypotonia

Hair color and texture

Behavior

2. Kwashiorkor





Case 26 A 6 years old boy presented with complaints of progressively increasing weakness of the lower

limbs for the last 3 days. On examination, the boy is conscious and oriented but cannot walk.

His both lower limbs have decreased tone, power of 1/5 and diminished reflexes. His upper

limbs also have decreased power of 3/5. The cranial nerves are intact. The examination of

bladder and spine is unremarkable.


2. What diagnostic test you will perform?

3. How will you manage the patient?

Key

1. Guillain Barre Syndrome

2. Nerve conduction studies

3. Management:

Admission

Monitor for symptoms

IVIG (intravenous immunoglobulin)

Nutritional care





Case 27

1. Identify three positive findings in these photographs? 1.5

2. Enumerate 6 causes of above disease? 3.0

3. What is the treatment of choice in above disease? 0.5

Key 1. 3 positive findings:

Large head

Sunset sign

Ventricular dilation (Hydrocephalus)

2. Causes:

Congenital aqueductal stenosis

Dandy walker malformation

Arnold Chiari malformation type II

Congenital TORCH infections

Bacterial meningitis

TBM (Tuberculous Meningitis)

Arachiniditis secondary to bleeding

in arachnoid space

IVH in premature infants

3. Ventriculo-peritoneal shunt (Ventriculo-atrial shunt)





Case 28

1. What are the abnormal findings?

2. What is the diagnosis?

3. Write down the management steps?

Key 1.

Emaciated irritable child / wizened face / prominent rib cage

Loss of fat over the buttock and body

2. Marasmus

3.

a) Initial management

Life threatening problems are identified and treated in the hospital

Specific deficiencies are corrected

Metabolic abnormalities are corrected

Feeding is begun

b) Rehabilitation

Intensive feeding is given to recover most of the weight

Emotional and physical stimulation are increased

Training of the mother

Preparation for the discharge




Documents

OSPE Peads Medicine Set 2 OSPE · PDF fileOSPE Peads Medicine Set 2 OSPE PEADS ... Identify the physical sign? 3 2. What ... Widal test / Typhidot test