MBBS Essential Project : OSCE Division

PAEDIATRIC
By: ISZAID BIN IDRIS

Group B2,
Batch 22,
071303618
Content
Basically it contain passive (you sit down and write)
and active station (you perform with running
documentary)
The slide had been separated, question can
combine any of these.
No guarantee 100% will come out from slide but at
least something to practice .
My answer might be wrong, so try by your self ok..
=P
Reminder
Be aware that this is NOT Empire Maharaja copyright protected
but compilation from Others so, you can download, print or sent it
to oversea….. But
DO NOT SHOW THIS TO YOUR LECTURER!!

Coz I don’t want to get into trouble… who cares?

Good Luck Exam bro!!!

Thank You,
Ministry of Paediatric Maharaja Iszaid
Passive
Station
Question 1
This 7 month old baby
has anaemia and a
tinge of jaundice. He
has a mild
splenomegaly

1.1 Describe the Blood Film abnormalities

1.2 What is the diagnosis?

1.3 What additional test will confirm the
diagnosis?
OSCE Paediatric
• Target Cell, Microcytic Hypochromic Anemia
• Thalasemia
• Electrophoresis

Reference:
 Ghai Essential pediatric, 7th edition, OP Ghai, 2010
Current diagnosis & Treatment Pediatric, 9th Edition, William Way, 2009
Manual of Neonatal Care, 6th edition, John Pauty, 2008
The Short Text Book of Pediatric, 11th edition, Surg Gupta, 2009
Question 2
This rash appeared in a well
child two weeks following a
minor viral infection. No
lymphoblasts were seen in the
peripheral blood film.

2.1 Identify the rash.

2.2 What is the likely Diagnosis?
2.3 What is the likely abnormality in the full
blood count?
OSCE Paediatric
2.1 Identify the rash.
Purpura

2.2 What is the likely Diagnosis?

ITP/ Henoch-schonlein Purpura

2.3 What is the likely abnormality in the full

blood count?
Decrease Platelet

Reference:
 Ghai Essential pediatric, 7th edition, OP Ghai, 2010
Current diagnosis & Treatment Pediatric, 9th Edition, William Way, 2009
Manual of Neonatal Care, 6th edition, John Pauty, 2008
The Short Text Book of Pediatric, 11th edition, Surg Gupta, 2009
This investigation was done on a boy with dysmorphic features
3.1 What is this investigation?
3.2 What is the abnormality seen?
3.3 What is your diagnosis?

Question 3
OSCE Paediatric
3.1 What is this investigation?
Karyotyping
3.2 What is the abnormality seen?
47,XY+21
3.3 What is your diagnosis?
Down Syndrome

Reference:
 Ghai Essential pediatric, 7th edition, OP Ghai, 2010
Current diagnosis & Treatment Pediatric, 9th Edition, William Way, 2009
Manual of Neonatal Care, 6th edition, John Pauty, 2008
The Short Text Book of Pediatric, 11th edition, Surg Gupta, 2009
Question 4 This two month old
baby was born by
breech delivery
4.1 Describe the
abnormal posture
shown
4.2 What is the
diagnosis?
4.3 What is the
underlying
aetiology of this
condition?
OSCE Paediatric
This two month old baby was born by breech delivery
4.1 Describe tht abnormal posture shown
Int rotation of shoulder jt,pronation of forearm,flexion of wrist
4.2 What is the diagnosis?
Erb’s palsy
4.3 What is the underlying aetiology of this condition?
Brachial plexus injury

Reference:
 Ghai Essential pediatric, 7th edition, OP Ghai, 2010
Current diagnosis & Treatment Pediatric, 9th Edition, William Way, 2009
Manual of Neonatal Care, 6th edition, John Pauty, 2008
The Short Text Book of Pediatric, 11th edition, Surg Gupta, 2009
Question 5
This 11 year old boy has
fever for 3 weeks
5.1 Describe the rash

5.2 What is the

diagnosis?

5.3 What is the

underlying aetiology of
this condition?
OSCE Paediatric
5.1 Describe the rash—
erythema marginatum
it is serpengeneous snake like rash , pale centred, red
margin, coalesce into ring shaped patches in trunk ( back)

5.2 What is the diagnosis?

acute rheumatic fever

5.3 What is the underlying aetiology of this condition

Preceding streptococcus infection

Reference:
 Ghai Essential pediatric, 7th edition, OP Ghai, 2010
Current diagnosis & Treatment Pediatric, 9th Edition, William Way, 2009
Manual of Neonatal Care, 6th edition, John Pauty, 2008
The Short Text Book of Pediatric, 11th edition, Surg Gupta, 2009
Question 6
This is the chest X-ray of
an infant who is on
antibiotics for fever, cough
and breathing difficulties

6.1 What is the

diagnosis based
on this chest
X-ray?
6.2 What is the likely pathogenic organism?
6.3 Which antibiotic will you use to treat this
infant?
OSCE Paediatric
6.1 What is the diagnosis based on this chest
X-ray?
Lobar pneumonia
6.2 What is the likely pathogenic organism?
Pneumococus, RSV
6.3 Which antibiotic will you use to treat this
infant?
Ceftrizine

Reference:
 Ghai Essential pediatric, 7th edition, OP Ghai, 2010
Current diagnosis & Treatment Pediatric, 9th Edition, William Way, 2009
Manual of Neonatal Care, 6th edition, John Pauty, 2008
The Short Text Book of Pediatric, 11th edition, Surg Gupta, 2009
Question 7

This 5 year old boy

developed swelling
over the angles of
his jaw over the last
two days

7.1 What is the diagnosis?

7.2 List THREE possible complications
7.3 How will you prevent this disease?
OSCE Paediatric
7.1 What is the diagnosis?
7.2 List THREE possible complications
7.3 How will you prevent this disease?

Reference:
 Ghai Essential pediatric, 7th edition, OP Ghai, 2010
Current diagnosis & Treatment Pediatric, 9th Edition, William Way, 2009
Manual of Neonatal Care, 6th edition, John Pauty, 2008
The Short Text Book of Pediatric, 11th edition, Surg Gupta, 2009
Question 8

8.1 Name the

instruments

8.2 In which condition is it used?

8.3 Describe how you will instruct your
patient to use it
OSCE Paediatric
8.2 In which condition is it used?
Asthma
8.3 Describe how you will instruct your
patient to use it
Maximally inhale, pinch nose, blow forcefully.

Reference:
 Ghai Essential pediatric, 7th edition, OP Ghai, 2010
Current diagnosis & Treatment Pediatric, 9th Edition, William Way, 2009
Manual of Neonatal Care, 6th edition, John Pauty, 2008
The Short Text Book of Pediatric, 11th edition, Surg Gupta, 2009
Question 9

9.1 Give the

name of the
chart

9.2 What is the inheritance pattern shown

here?
9.3 List TWO disorders with this mode of
inheritance
OSCE Paediatric
5.1 Name the inheritance pattern shown in the pedigree
chart.
X-Link Recesive inheritance

5.2 Describe THREE fundamental principles of this

mode of inheritance
-Only Women carrier, No male carrier, 100% male to female
-Involve each generation,
-no male to male trasmission.

5.3 Name TWO diseases with this mode of inheritance

Hemophilia A, duchene muscular dystrophy, G6PD
Reference:
 Ghai Essential pediatric, 7th edition, OP Ghai, 2010
Current diagnosis & Treatment Pediatric, 9th Edition, William Way, 2009
Manual of Neonatal Care, 6th edition, John Pauty, 2008
The Short Text Book of Pediatric, 11th edition, Surg Gupta, 2009
Question 10
This is the growth
chart of a five month
old baby girl from
birth to five months

10.1 Interpret the

growth chart

10.2 What is the likely

diagnosis?

10.3 List TWO

possible causes for this
problem
Question 11
This 4 year old boy has a
two day history of
jaundice and anaemia.
He has a mild
splenomegaly
1.1 Describe the Blood
Film abnormalities

1.2 What additional test will confirm the

diagnosis?
1.3 What is the inheritance pattern of this
condition?
OSCE Paediatric
1.1 Describe the Blood Film abnormalities
small red blood cells lacking the central pallor,abnormal
shape of RBC

1.2 What additional test will confirm the

diagnosis?
osmotic fragility test

1.3 What is the inheritance pattern of this

condition?
Autosomal dominant

Reference:
 Ghai Essential pediatric, 7th edition, OP Ghai, 2010
Current diagnosis & Treatment Pediatric, 9th Edition, William Way, 2009
Manual of Neonatal Care, 6th edition, John Pauty, 2008
The Short Text Book of Pediatric, 11th edition, Surg Gupta, 2009
Question 2

This investigation was done on a 9 year old girl

with short stature
OSCE Paediatric
2.1 What is the abnormality?
45, XO
2.2 What is the Diagnosis?
Tuner Syndrome
2.3 Name TWO abnormalities you may find on clinical
examination.
Web Neck
Short statue
Increase carrying angle
Reference:
 Ghai Essential pediatric, 7th edition, OP Ghai, 2010
Current diagnosis & Treatment Pediatric, 9th Edition, William Way, 2009
Manual of Neonatal Care, 6th edition, John Pauty, 2008
The Short Text Book of Pediatric, 11th edition, Surg Gupta, 2009
Question 3
This picture
shows the
buccal mucosa
of the cheeks of
a febrile child.

3.1 Describe the lesion.

3.2 What is the lesion called?
3.3 What is the diagnosis?
OSCE Paediatric
3.1 Describe the lesion.
multiple small white/blue spots with reddish rim in buccal
mucosa of mouth
3.2 What is the lesion called?
Koplik spots
3.3 What is the diagnosis?
Measles

Reference:
 Ghai Essential pediatric, 7th edition, OP Ghai, 2010
Current diagnosis & Treatment Pediatric, 9th Edition, William Way, 2009
Manual of Neonatal Care, 6th edition, John Pauty, 2008
The Short Text Book of Pediatric, 11th edition, Surg Gupta, 2009
Question 4 This is a 9 year old
boy who has a
chronic bleeding
tendency
4.1 Describe the
abnormalities.
4.2 What is the
likely diagnosis?
4.3 What is the
treatment?
OSCE Paediatric
4.1 Describe the abnormalities-
Heamarthrosis
4.2 What is the likely diagnosis?
Hemophilia
4.3 What is the treatment?
replacing the missing clotting factor(VIII for A, IX for B) and if
necessary blood transfusion.

Reference:
 Ghai Essential pediatric, 7th edition, OP Ghai, 2010
Current diagnosis & Treatment Pediatric, 9th Edition, William Way, 2009
Manual of Neonatal Care, 6th edition, John Pauty, 2008
The Short Text Book of Pediatric, 11th edition, Surg Gupta, 2009
Question 5

5.1 Name the

inheritance pattern
shown in the
pedigree chart.

5.2 Describe THREE

fundamental
principles of this mode of inheritance
5.3 Name TWO diseases with this mode of
inheritance
OSCE Paediatric
5.1 Name the inheritance pattern shown in the pedigree chart.
autosomal dominance inheritance

5.2 Describe THREE fundamental principles of this mode of

inheritance
- single allele manifest disease
-transmission pattern : successive generation ( vertical transmission )
- off spring 50% chance of inheriting the disease

5.3 Name TWO diseases with this mode of inheritance

Marfan syndrome, AD polycystic kidney disease

Reference:
 Ghai Essential pediatric, 7th edition, OP Ghai, 2010
Current diagnosis & Treatment Pediatric, 9th Edition, William Way, 2009
Manual of Neonatal Care, 6th edition, John Pauty, 2008
The Short Text Book of Pediatric, 11th edition, Surg Gupta, 2009
Question 6

6.1 Describe the abnormality shown in

these sequential pictures
OSCE Paediatric
6.1 Describe the abnormality shown in these sequential
pictures..
child need to turn prone to rise ,then has to use his hands to
climb up on his knees before standing.

6.2 What is the name given to this manoeuvre?

Gower’s sign

6.3 Name TWO disorders in which it may be seen

duchenne’s muscular dystrophy,
becker’s muscular dystrophy

Reference:
 Ghai Essential pediatric, 7th edition, OP Ghai, 2010
Current diagnosis & Treatment Pediatric, 9th Edition, William Way, 2009
Manual of Neonatal Care, 6th edition, John Pauty, 2008
The Short Text Book of Pediatric, 11th edition, Surg Gupta, 2009
Question 7 This 10 year old boy is on
regular blood transfusions
for anaemia and has an
enlarged liver and spleen

7.1 Describe and

identify the facies.
7.2 What is the
diagnosis?
7.3 Name THREE
transfusion related
blood- borne infections
Question 8
A 4 year old male
child has a two
week history of
bone pains,
lymphadenopathy
and rash
8.1 Describe and
identify the rash.
8.2 What is your diagnosis? Name another
condition with similar picture.
8.3 Name ONE investigation to confirm the
diagnosis
Question 9

This newborn baby has a birth weight of

2kg
9.1 List the abnormal features in
this picture.

9.2 What is the likely diagnosis?

9.3 Mention TWO other problems

they are more prone for
Question 10 This is the Chest X-Ray of a
premature baby ventilated for
respiratory distress
syndrome(hyaline membrane
disease).

10.1 List abnormal

features on the
Chest X-Ray.
10.2 What is the
diagnosis?
10.3 Identify the interventive procedure to be
undertaken on the baby based on this X-Ray.
Question 1
This is a Chest X-Ray
of a newborn who
presented with
Respiratory Distress
soon after birth

1.1 Describe the Radiological abnormalities

1.2 What is your diagnosis?
1.3 What resuscitative method
would you employ in the above condition?
OSCE Paediatric
1.1 Describe the Radiological abnormalities
Loop of bowel in the left chest
displacement of mediastinum
1.2 What is your diagnosis?
diaphragmatic hernia
1.3 What resuscitative method would you employ in the
above condition?
large NG tube for suction,
repaired hernia surgically

Reference:
 Ghai Essential pediatric, 7th edition, OP Ghai, 2010
Current diagnosis & Treatment Pediatric, 9th Edition, William Way, 2009
Manual of Neonatal Care, 6th edition, John Pauty, 2008
The Short Text Book of Pediatric, 11th edition, Surg Gupta, 2009
 Question 2
This is 6 month old male
baby with intermittent
crying & drawing up of
legs for the last 12 hours

2.1 What does the picture show?

2.2 What is the Diagnosis?
2.3 What would you find on clinical examination of
the baby’s abdomen?
OSCE Paediatric
2.1 What does the picture show?
red current jelly stool
2.2 What is the Diagnosis?
iliocolic intussuseption
2.3 What would you find on clinical examination of
the baby’s abdomen?
absent feeling of right iliac region

Reference:
 Ghai Essential pediatric, 7th edition, OP Ghai, 2010
Current diagnosis & Treatment Pediatric, 9th Edition, William Way, 2009
Manual of Neonatal Care, 6th edition, John Pauty, 2008
The Short Text Book of Pediatric, 11th edition, Surg Gupta, 2009
OSCE Paediatric
1) comment the above xray
Contrast Xray of abdomen showing a claw sign
2) what is your diagnosis?
intussusception
3) what other Ix can be done to confirm diagnosis and what is the finding?
Abd USG; doughnut appearance of concentric rings in transverse section
4) In which age group it is common?
5-10 months
5) What are the classical triad of features?
Vomiting. Abd pain, passing of blood per rectum
6) How manage the case
Supportive…
Non surgical reduction – hydrostatic/pneumatic reduction
Surgical – milking out intussusceptum out of intussuscipiens OR surgical
resection with end to end anastomoses

Reference:
 Ghai Essential pediatric, 7th edition, OP Ghai, 2010
Current diagnosis & Treatment Pediatric, 9th Edition, William Way, 2009
Manual of Neonatal Care, 6th edition, John Pauty, 2008
The Short Text Book of Pediatric, 11th edition, Surg Gupta, 2009
 Question 3
A 2 year old male
child from low
socio-economic
group is brought
with complaints
of pica &
irritability

3.1 What is this investigation?

3.2 Describe the abnormalities.
3.3 What is your diagnosis? Name another
condition with similar picture.
OSCE Paediatric
3.1 What is this investigation?
Peripheral blood smear

3.2 Describe the abnormalities.

Anisopoikilocytosis,tear drop,

3.3 What is your diagnosis? Name another

condition with similar picture.?
Iron defeciency Anemia
Thalasemia
Myelofibrosis

Reference:
 Ghai Essential pediatric, 7th edition, OP Ghai, 2010
Current diagnosis & Treatment Pediatric, 9th Edition, William Way, 2009
Manual of Neonatal Care, 6th edition, John Pauty, 2008
The Short Text Book of Pediatric, 11th edition, Surg Gupta, 2009
Question 4 This is a Growth Chart of
Height of a 9 year old girl,
whose teacher observed
Height that she is lethargic of late.
The weight of the same girl
was between the 25th & 10th
centile.

4.1 Interpret the growth

chart.
4.2 What is the likely
diagnosis?
4.3 Name TWO causes
for it
Question 5

5.1 What
investigation
is this?

5.2 What is the

abnormality?

5.3 Name TWO causes for it

 Question 6

6.1 List the abnormal features in this

picture.
OSCE Paediatric
6.1 list the abnormal features in this picture.
-hypertelorism, depresses nasal bridge, bilateral medial
epicanthal fold of the eye, brushfield spot, simian(single
palmar) crease,
6.2 what Ix you would do to confirm?
-karyotyping. 47(XY), 21+X
6.3 mention one haematological problem they are more
prone for?
- Acute Lymphoid Leukemia

Reference:
 Ghai Essential pediatric, 7th edition, OP Ghai, 2010
Current diagnosis & Treatment Pediatric, 9th Edition, William Way, 2009
Manual of Neonatal Care, 6th edition, John Pauty, 2008
The Short Text Book of Pediatric, 11th edition, Surg Gupta, 2009
6.2 What investigation you
would do to confirm?

6.3 Mention ONE

Haematological problem
they are more prone for
Question 7
This rash appeared in a well
child with the following;
Hb:11g/dl,
WBC:7000/cumm
Platelet:22,000/cumm.No
abnormal cells were seen in
blood film
7.1 Identify the rash Purpura
7.2 What is the diagnosis? ITP
7.3 List 2 differential
diagnosis• Wiskott-Aldrich
•vWD type 2B, Viral fever
Question 8
This is the
umbilicus of
a 6 month old
baby.

8.1 What is
your
diagnosis?

8.2 Which babies are at higher risk of this

complication?
8.3 What is the treatment?
OSCE Paediatric
8.1 What is your diagnosis?
umbilical hernia
8.2 Which babies are at higher risk of this complication?
afro-carribean infant
8.3 What is the treatment?
conservative treatment (wait n see)since baby under 2years
old(95% resolve spontaneously)

Reference:
 Ghai Essential pediatric, 7th edition, OP Ghai, 2010
Current diagnosis & Treatment Pediatric, 9th Edition, William Way, 2009
Manual of Neonatal Care, 6th edition, John Pauty, 2008
The Short Text Book of Pediatric, 11th edition, Surg Gupta, 2009
 Question 9

This adolescent male presented with

complaints of mild fever 2-4 hours prior to
the appearance of the rash.
9.1 Describe the lesions.
9.2 What is the diagnosis?
9.3 List TWO complications
Question 10
This is the Chest
X-Ray of a
premature baby
with respiratory
difficulty.

10.1 List abnormal feature on the Chest X-Ray.

10.2 Identify TWO interventive procedures
undertaken on the baby based on this X-Ray
10.3 What is the diagnosis?
OSCE Paediatric
10.1 List abnormal feature on the Chest X-Ray.
• oligemic lung field,
• small boot shape heart (coeur en sabot)
10.2 Identify TWO interventive procedures
undertaken on the baby based on this X-Ray

10.3 What is the diagnosis?

Tetralogy of Fallot

Reference:
 Ghai Essential pediatric, 7th edition, OP Ghai, 2010
Current diagnosis & Treatment Pediatric, 9th Edition, William Way, 2009
Manual of Neonatal Care, 6th edition, John Pauty, 2008
The Short Text Book of Pediatric, 11th edition, Surg Gupta, 2009
Active
Station
Abdominal
ON INSPECTION
-Abdoment is distended, Flanks are
full
-All Quadrant of Abdoment move
symentrically during respiration
-Umbilicus is centrally place, no
discharge
-No Scar no dilatated vein
-Inguinal orifice no cought impulse
-Renal angle not swelling
ON PALPATION
-No rise of Tempreture
-No superficial tenderness
-No Deep tenderness
-No Enlargement of Liver, Liver
spand of 8cm
-No Enlargement of Spleen
-No palpable kidney, Not ballotable
-No succution Splash
ON PERCUSSION
-All area are Resonace
-Dull on flank
-Shifting dullness positive
-Fluit Trills Positive
-Ausculto-palpation positive
-Knee albow percussion positive
ON AUSCULTATION
-Peristalsis sound heart: 2 sound
per Min
-No Bruit on Renal artery
OTHERS:
Per Rectal: Not done
Virchow Node: Not palpable
Chest
ON INSPECTION -Chest Expansion: 5cm
-Nasal Septal deviation/ polyps -Chest AnteroLateral ratio:
-pharyn no enlargement tonsil (5:7)Elepsoid
-Tracheal deviation -Apex beat felt
-Shoulder drooping -Vocal fremiter Sign +
-Suprasternal norch
-No pectus carinum/ pectus excavacum ON PERCUSSION
SKIN: No Scar, no dilatated vein -Resonance node
-Chest move during breathing = 23 bpm -Liver spand : 8cm
-Hypertrophy of intercostal muscle and -cardiac dullness on 4th Intercostal left
indrawing
-Spine in midline ON AUSCULTATION
-Vesicular breath sound, normal
ON PAPATION intensity, duration
-No tenderness of sinus -No crepitation
-Tracheal not deviated -No added sound
-Suprasternal norch -Vocal resonace sign +
-No Tenderness on chess
-Chest Movement: Symetrical both side
-Chest Circumference : 80 cm
Precardium
INPECTION AUSCULTATION
-No bulging -S1s2 heart
-SKIN: no scar, no dilatated vein -Normal intensity
-No apex beat -normal duration, regular interval
Focal: Jugulovenous pulse -No murmur
-no Added sound
PALPATION No splitting of s1s2.. s3s4 not
-Apex beat felt heart Node: Not palpable
-parasternal beat

PERCUSSION
-Not done
CNS
HIGHER MENTAL FUNCTION -Contracture not seen
Patient is fully concious. Orientated to time, place, -Deformity absent
person. -no skin changes: Scar, dilatated vein
Memory of Immediate, recent and remote are ON PALPATION
intact. -No rise tempreture or tenderness,
Emotion is stable with appripriate affect. -No abnormal Bony prominace
No dellusion nor Hallusination. -Tone present
Right Handedness, Intelligent appropritate to age. -Active Movemen & Passive movement
Speech are Fluent and comprehensive. -Reflex
-Clonus
CRANIAL NERVE EXAMINATION
CN 1: (Skip last) SENSORY EXAMINATION
CN 2,3,4,6: Lid, Axis, Movement, Pupil (LAMP) Pain (compare)
(Evidance Occulomotor Palsy) Vibration (compare)
CN 5: Sensory-Motor of Jaw Propioception
CN 7: Close-eye, Open-try, Wrinkle, Clench-teeth,
Smile (COWS) AUTONOMIC EXAMINATION
(Evidance of Facial Palsy) -Pen Test:Normal resistance
CN 8: Hearing/ Ballance -No hair loss or brittle nail
CN 9,10: (Skip last)
CN 11: Shouder power FOCAL EXAMINATION
CN 12: Toungue power -Vessel: Pulse and Capilary filling
-Nerve: Motor and Sensory
MOTOR EXAMINATION -Lymph node
ON INSPECTION
-Attitute of natural position,
Thank You!
From : ISZAID BIN
IDRIS