PEDIATRICS OSCE

STATION 1
STUDY THE PICTURE BELOW AND ANSWER THE FOLLOWING QUESTIONS

1. This is an MRI of the skull

2. There is evidence of midline shift
3. There is dilatation of the third ventricle
4. There is evidence of periventricular edema
5. There is marked compression of the cerebral white matter
6. This picture demonstrates cracked pot sign
7. This child may present with seizures
8. There could be a positive history of fever in the mother while pregnant

Possible causes of this condition include

9. Bickers – Adam’s syndrome
10. Intraventricular hemorrhage
11. Neonatal meningitis
12. Dandy-walker syndrome
13. May be associated with meningocele
14. Acetazolamide is useful in treating this condition
15. Shunts are inserted only after the age of 1 year
 STATION 2

16. This condition presents between the ages of 6 – 14yrs of age

17.This condition is more likely to be of the epidemic variety
18.Probably caused by postnatal infection with EBV
19.Histology may show starry sky appearance
20.This condition commonly involves the lymph nodes
21.Other clinical features in this child may be anorexia and weight loss
22.X-ray of the jaw may show loss of dental lamina dura and osteosclerotic bone
lesions
23.Other investigation sin this child may include ascitic fluid cytology
24. Radiotherapy is useful in this client
25. Chemotherapy includes Cyclizine, Vincristine, Methotrexate and Prednisone
26. Cytosine arabinoside may be useful in CNS prophylaxis
27. Staging for this condition is called the Sarnat staging
28. The site shown above is the commonest site in this region
29. There is evidence of orbito-ocular involvement in this child
30. T- cells are mainly affected in this lesion
 STATION 3
STUDY THE PICTURE BELOW AND ANSWER THE FOLLOWING
QUESTIONS

31.This condition is inherited in origin

32.It is commoner in males
33.There is atony of the anterior abdominal wall
34.It may be associated with undescended testes
35.The pregnancy may have been smaller than normal for gestational age
36.There may be dilated pelvi-calyceal system on abdominal x-ray
37.It is called Eagle-Barrett syndrome
38.It may be associated with increased risk of UTI’s
39.It may be associated with pulmonary hypoplasia
40.Other anomalies of the heart and bowel may occur in association
 STATION 4
STUDY THE PICTURE BELOW OF A NEONATE AND ANSWER THE
FOLLOWING QUESTIONS

-p0

41.There is evidence of floppiness

42.It may be associated with hypotonia
43.This child may likely have normal developmental milestones

This posture/phenomenon may be associated with the following

44.Down’s syndrome
45.Werdnig-Hoffman disease
46.Myasthenia gravis
47.Guillain-Barre syndrome
48.Poliomyelitis
49.Congenital Hyperthyroidism
50.Kernicterus
51.Perinatal asphyxia
52.Perinatal exposure to Benzodiazepines
53.Cerebral palsy
54.It may lead to respiratory failure if severe
55.Difficulty in swallowing may be present
 STATION 5
THIS IS A PICTURE OF A CLIENT WHO FELL OFF HIS CHAIR WHILE
PLAYING

56.This picture shows an ecchymosis

57.This condition may be inherited
58.The pattern of bleeding suggests platelet dysfunction
59.This client may have a positive family history on his father’s side
60.May have presented with epistaxis and bleeding
61.It may be inherited as an autosomal recessive condition
62.The etiology may lead to reccurent hemarthroses in the small joints
63.It may lead to osteoporosis and ankylosis if severe and untreated
64.There may be prolonged PTT and PT times
65.Protamine test may be positive
66.PCT is markedly deranged such that serum and plasma PTT may be similar
67.Mild cases have 6 – 30% of clotting activity
68.DDAVP is a treatment option
69.The history suggests hemophilia
70. Aspirin is useful in the treatment of this client
 STATION 6

THIS IS THE LEG X-RAY OF A BOY WHO CAME TO THE A&E WITH
FEVER OF 2 WEEKS DURATION
71.There is evidence of soft tissue swelling
72.There is osteolysis of the tibia
73.There is a “bone in bone appearance”
74.There is evidence of periosteal reaction
75.The radiograph suggests acute pyomyositis
76.This radiograph confirms an infection of the soft tissue
77.There will be a positive history of abnormal gait
78.On examination there may be tenderness and limitation of movement in the affected
limb
79.Pencil rolling test is most likely going to be negative
80.Antibiotic treatment will include Cloxacillin and metronidazole
81.Treatment is usually started orally

Predisposing factors include

82.Trauma
83.Sickle cell trait
84.Sepsis
85.Commonest orgainism isolated is Streptococcus pyogenes
 STATION 7
STUDY THE PICTURE BELOW AND ANSWER THE FOLLOWING
QUESTIONS

Concerning this picture

86.There is gross pedal edema
87.There is evidence of ascites
88.This child may have weight of 60 -80% of expected
89.This child most likely has had recurrent infections
90.This is the commonest variety of childhood undernutrition

The following are complications of this condition

91.Hypothermia
92.Hypoglycemia
93.Anemia
94.Seizures
95.Hypokalemia
 STATION 8
STUDY THE PICTURE BELOW AND ANSWER THE FOLLOWING
QUESTIONS

Concerning this lesion

96.It is commoner in females
97.It is a tumor of vascular origin
98.May be associated with Kasabach-merrit syndrome
99.It may be of the cavernous variety
100. It may be emptied on manual pressure
101. May be associated with respiratory obstruction
102. Occurs most commonly in the head and neck
103. May be associated with Sturge weber syndrome
104. It may be treated with steroids
105. It is pre-malignant
 STATION 9
STUDY THIS PICTURE AND ANSWER THE FOLLOWING QUESTIONS

Features obvious in this picture include

106. Prominent epicanthal folds
107. Hypertelorism
108. Flattened nose bridge
109. Macroglossia
110. Low set ears
111. This child has features of Down’s syndrome

Other features that may be present include

112. Brachycephaly
113. Joint hyper-extensibility
114. Brachydactyly

The following may be true

115. It is associated with a history of polyhydramnios in the mother
116. Majority are born to mothers greater than 35yrs of age
117. This child may present with neonatal intestinal obstruction
118. May be associated at birth with drooling of saliva at birth
119. Brushfield spots may be present on the retina
120. The child may present in heart failure
 STATION 10
STUDY THE PICTURE BELOW AND ANSWER THE FOLLOWING
QUESTIONS

121. This condition is transmitted from mother to child

122. The condition if not fatal, conferrs life long immunity
123. It may be prevented by administration of 2 doses of ATS to the mother during
pregnancy
124. It may manifest with poor sucking during the early neonatal period
125. Innoculation and culture on appopriate media in low O 2 tension is useful in
supporting the diagnosis
126. This condition may be controlled by IV Diazepam 3 – 5ml/kg/day
127. IV fluids 5% dextrose in saline is the fluid used for maintenance

Principles of management includes

128. IV penicillin 100,000 IU/kg per dose 6hrly for 10 days
129. Neutralise toxin with 100,000 IU stat.
130. Immunization with aluminium adsorbed toxoid 0.5ml
 STATION 11
Babatunde a known atopic 8 yr old primary four pupil was refered to LUTH from a
private hospital where he presented with cough and difficulty in breathing which
started while at play this morning and was not responsive to his ventolin inhaler.
Physical examination showed profuse perspiration, rapid breathing with prolonged
expiration, wheezing, cyanosis, and crepitations. An aminophylline was given at the
private hospital.

OTHER POSSIBLE FINDING IN THIS CHILD INCLUDE

131. Inability to complete a sentence in one breath
132. Intercostal recession
133. Dermatitis on extensor surfaces
134. Basophilia in the blood
135. Pigeon chest

MANAGEMENT OF THIS CHILD WOULD INVOLVE

136. Oxygen therapy via tracheostomy
137. Salbutamol via a nebulizer
138. Intravenous theophylline bolus over 15 minutes (loading dose)
139. Pulse oximetry
140. Steroids are contraindicated
141. Chest x-ray for cancer

COMPLICATIONS OF THIS CONDITION INCLUDE THE FOLLOWING EXCEPT

142. Atelectesis
143. Pneumothorax
144. Emphysema
145. Cor pulmonale
 STATION 12

10 year old Tosin was rushed to the ORKCHER after she had an episode of
convulsion. Two days earlier she complained of headache and body pains and her
nanny said she had a fever and was very drowsy. She had also been passing dark
coloured urine since this morning. According to her nanny this had never
happened before. Tosin just returned a week ago from Germany where her
parents work as diplomats. Her parents both carry the sickle cell trait.

MANAGEMENT OF TOSIN WOULD INCLUDE

146. Oxygen therapy
147. Carbamazepine to control seizure
148. Renal biopsy
149. Sponging with cold water
150. Intravenous paraldehyde to control convulsion
151. Electroencephalogram to determine seizure type
152. IV quinine in 5% dextrose
153. Intravenous urography
154. Thin and thick blood film for Neisseria meningitidis
155. Correction of anaemia

LIKELY CAUSE OF TOSIN’S CONDITION INCLUDE

156. Presence of Sickle shaped rbc’s in the blood (sickle cell anaemia)
157. Rubeola
158. Sequestration of parasitized rbc’s in the microcirculation
159. Intracranial neoplasm
160. Nephroblastoma
 STATION 13
Kingston is a 3 year-old kindergarten pupil who presented at the emergency room
with progressive restlessness together with a barking cough, hoarseness of the
voice and an inspiratory stridor which was worse at night. All these according to his
mother, was preceded by fever and “runny” nose. Physical examination showed
tachypnoea, suprasternal, intercostals and subcostal recession. Breath sounds
were reduced and rhonchi as well as crepitations were heard.

CONCERNING THIS CHILD’S CONDITION

161. It is caused mostly by parainfluenza type II
162. It is known as croup
163. It is also referred to as acute epiglottitis
164. Another common cause is Haemophilus influenza type B
165. Laryngoscopy would reveal a cherry-red epiglottis
166. It is less common acute laryngotracheobronchitis
167. The fever is typically high grade
168. It may occur following measles
169. It is most common among 4 year olds

MANAGEMENT OF THIS CONDITION WOULD ENTAIL

170. Warm and dehumidified oxygen via face mask
171. Antibiotics
172. Acyclovir orally for 2 weeks
173. Tracheal intubation may be needed
174. Management is mainly supportive
175. Steroids may be beneficial
 STATION 14
Baby Mustapha was born at home 3 days ago after 39 weeks of intrauterine life. He
presented at the ORKCHER today with 2 day history bleeding from the umbilical cord,
nose as well as passage of blood in urine. He was rushed to the ORKCHER when he
vomited blood and lost consciousness. There was no history of trauma and no family
history of bleeding tendencies.

THE LIKELY CAUSE(S) OF HIS CONDITION INCLUDE

176. Haemolytic disease of the newborn

177. Swallowed blood syndrome
178. Haemophilia A
179. Haemorrhagic disease of the newborn
180. Deficiency of α tocopherol (vitamin K)
181. Prematurity

INVESTIGATIONS WOULD REVEAL

182. Prolonged coagulation time

183. Normal prothrombin time
184. Decreased PTTK
185. Normal platelet count
186. Increased capillary fragility

TREATMENT OF THIS CHILD WOULD INCLUDE

187. Intravenous tocopherol (vit K) 1mg stat

188. Blood transfusion with packed rbc’s
189. Oxygen therapy via face mask
190. Fresh frozen plasma may be useful
 STATION 15
Four- year old Uchechukwu was brought to the clinic today by his mother with a
complaint 3-day history of rash all over his body. According to his mother, this was
preceded 9 days ago by a low-grade fever, dry cough, redness of the eye and nasal
discharge. The fever subsided as the rash appeared which began from the face.
Examination revealed maculopapular lesions most prominent in the trunk and
limbs with areas of desquamation on the face. In-between his coughs Uchechukwu
declared he wanted to be a doctor.

MANAGEMENT AND PREVENTION OF HIS CONDITION WOULD INCLUDE

191. Admission to D-Block and isolation
192. Administration of vitamin A
193. Use of antibiotics is contraindicated
194. Correction of fluid and electrolyte imbalance
195. Ensure adequate nutrition
196. Prophylaxis by administering a killed vaccine at 9 months of age

COMPLICATIONS OF UCHECHUKWU’S CONDITION DOES NOT INCLUDE

197. Otitis media
198. Cancrum oris
199. Kwashiorkor
200. Subacute non-sclerosing panencephalitis
201. Rubeola
202. Flaring up of tuberculosis
203. Keratitis
204. Koplik spots
205. Guillain-Barre syndrome
 STATION 16

Two-year old Mudiaga drew the attention of his 9-year old elder brother when he
vomited a characteristic smelling fluid. It was later found that he had ingested
about half the kerosene his mother stored in a Coca-cola bottle. Immediately he
was brought to the ORKCHER. At presentation he was coughing, dyspnoeic and
wheezing. Auscultation revealed chest rhonchi.

IN THE MANAGEMENT OF THIS CHILD

206. Induction of emesis is required
207. Gastric lavage is mandatory
208. Chest x-ray is not relevant
209. Oxygen therapy is indicated
210. Antibiotics therapy is needed
211. Steroids may be useful

COMPLICATIONS THAT MAY ARISE INCLUDE

212. Emphysema
213. Retrobulbar neuritis
214. Atelectasis
215. Bronchospasm
216. Acute glomerulonephritis
217. Bacterial pneumonia
218. Pancreatitis
219. Convulsion
220. Reye’s syndrome
 STATION 17

EXAMINE THIS LIMPING CHILD

STATION 18

CONCERNING THE CHILD YOU JUST EXAMINED

221. There is differential warmth in both limbs

222. The left ankle is swollen
223. Movement in right hip is limited
224. Pencil rolling sign was positive
225. The left leg is tender
226. The right leg is longer than the left.

THIS CHILD LIKELY HAS

227. Acute osteomyelitis
228. Limb fracture
229. Duchenne muscular dystrophy
230. Dislocation of the right hip joint
 STATION 20

231. This child is 7 days old

232. The child is male
233. The informant is the aunty of the child
234. She is unemployed
235. The mother had Gestational diabetes
236. This child is premature
237. There is evidence of bilirubin encephalopathy in this child
238. The scenario as per blood group is supportive of a diagnosis of rhesus
isoimmunization
239. Neonatal sepsis is a strong differential possibility
240. The child is at risk for sepsis

Possible complications include

241. Cerebral palsy
242. Enamel hyperplasia
243. Sensorineural deafness
244. Mental retardation
245. Anemia
246. Hypertrophic cardiomyopathy
247. Polycthemia
248. Neonatal seizures
249. Hyaline membrane disease

STATION 19

TAKE A HISTORY FROM THIS

WOMAN