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
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