ospe paeds medicine set 3
TRANSCRIPT
8/18/2019 OSPE Paeds Medicine Set 3
http://slidepdf.com/reader/full/ospe-paeds-medicine-set-3 1/25
OSPE Peads Medicine Set 3 SurgicoMed.com
OSPE PEADS MEDICINE SET 3
Case 1
1. What is the abnormal findings in this eye? 1
2.
Which vitamin deficiency cause this condition? 2
3. What is the WHO classification and recommendation to treat this condition? 3
Key
1.
Bitot spots2. Vitamin A deficiency
3.
Classification Primary Signs
X1A Conjunctival xerosis
X1B Bitot spots with conjunctival xerosis
X2 Corneal xerosis
X3A Corneal ulceration with xerosis
X3B Keratomalacia
XN Night blindness
XF Xerophthalmic fundus
XS Corneal scars
XB Bitot spots
Vitamin A: 200,000 IU (100,000 in < 1 year of age) on day 1, 3 and 14.
8/18/2019 OSPE Paeds Medicine Set 3
http://slidepdf.com/reader/full/ospe-paeds-medicine-set-3 2/25
OSPE Peads Medicine Set 3 SurgicoMed.com
Case 2
(Nutrition)
1.
What are the complications of bottle feeding? 3
2.
Enumerate benefits of breast feeding? 2
3.
Write two absolute contra-indications of breast feeding?
Key
1. Complication:
Repeated GIT infections
Repeated respiratory infections
Expensive
Difficult to maintain hygiene
2. Benefits:
Inexpensive
Available all the time
Composition is ideal for the infant growth
Emotionally satisfactory
Bifidus factor which promote the growth of lactobacillus
Promote involution of the uterus
Natural contraception
Decreased incidence of breast cancer
Lactofarin
Species specific, no allergy
Decreased incidence of infection
3.
Absolute contraindications:
Galactosemia
Phenylketonuria
8/18/2019 OSPE Paeds Medicine Set 3
http://slidepdf.com/reader/full/ospe-paeds-medicine-set-3 3/25
OSPE Peads Medicine Set 3 SurgicoMed.com
Case 3
1.
What is the sign shown in the photograph? 1
2.
Write down 4 other signs of this condition? 2
3.
Write down the management steps of this condition according to WHO protocol? 2
Key
1.
To check skin turgor in dehydration2.
Other signs:
Lethargic or unconscious
Sunken eyes
Not able to drink or drinking properly
Pulse weak or absent
3.
ORS / Homemade remedies
Age First give 30 ml/kg in Then give 70 ml/kgInfants (< 12 months) 1 hour 5 hours
Children (12 M up to 5 Years) 30 min 1 ½ hours
Type of fluid is Linger lactate or normal saline
8/18/2019 OSPE Paeds Medicine Set 3
http://slidepdf.com/reader/full/ospe-paeds-medicine-set-3 4/25
OSPE Peads Medicine Set 3 SurgicoMed.com
Case 4
A 12 hours old full term baby having 1.5 kg weight presented with focal fits. His investigations
are: Blood sugar 28 mg/dl, S/Ca2+ 8.5 mg/dl and Na+ 128 mg/dl.
1.
Name the diagnosis and its complications in this case? 1
2.
Enumerate four common causes of SGA? 2
3.
Enumerate eight common complication of SGA? 2
Key
1.
SGA (small for gestational age) with hypoglycemic fits
2.
a.
Maternal Causes:
Chronic illness like essential HTN, PIH, CRF, Diabetes
Young maternal age < 18 years
Poor maternal weight gain
Short stature (maternal malnutrition)
Anemia
Smoking in mother
b.
Fetal Causes:
Chromosomal disorders
Congenital infections
c.
Placental Causes:
Decreases placental weight
Placental separation
Twin twin transfer syndrome
3.
Complications:
Hypoglycemia
Hypothermia
Hypocalcaemia
Polycythemia
Infections
Perinatal asphyxia
Meconium aspiration
Congenital malformation
Pulmonary haemorrhage
8/18/2019 OSPE Paeds Medicine Set 3
http://slidepdf.com/reader/full/ospe-paeds-medicine-set-3 5/25
OSPE Peads Medicine Set 3 SurgicoMed.com
Case 5
(Nutrition)
1.
Name the final step in the formation of vitamin D? 2
2. Name 6 common causes of rickets? 1.5
3.
Name 6 common clinical features of rickets? 1.5
Key
1.
Renal activation of 25-hydroxycholecalciferol
With the help of 1 α-hydroxylase to form 1, 25-hydroxycholecalfiferol
2.
Causes:
Nutritional rickets
Vitamin D dependent rickets
Vitamin D resistant rickets
Rickets due to malabsorption
Rickets due to chronic anti-convulsant therapy
Hepatic
Renal
Hypophosphatemia rickets
3.
Clinical features:
Head large with frontal bossing
Delayed eruption of teeth with defective enamel
Thorax (Rachitic rosary, Harrison’s sulcus, Pigeon chest deformity)
Spine (Kyphosis, scoliosis, lordosis)
Pelvis (contracted pelvis)
Extremities (Widening of head of long bones, genu valgum or genu varus
deformity )
8/18/2019 OSPE Paeds Medicine Set 3
http://slidepdf.com/reader/full/ospe-paeds-medicine-set-3 6/25
OSPE Peads Medicine Set 3 SurgicoMed.com
Case 6
(Nutrition)
1.
What is the findings in this photograph? 1.5
2.
What is the most likely diagnosis? 1.0
3.
What is the treatment? 1.5
Key
1. Widening, cupping and fraying of ends
2.
Rickets
3. Treatment:
Vitamin D3 (either oral or IM injection)
Calcium supplements
Vitamin D dependent rickets 1, 25 (OH)2-D3
Diet high in calcium and vitamin D
Exposure to sunlight
8/18/2019 OSPE Paeds Medicine Set 3
http://slidepdf.com/reader/full/ospe-paeds-medicine-set-3 7/25
OSPE Peads Medicine Set 3 SurgicoMed.com
Case 7
(Infectious Diseases)
1.
What is the abnormal finding? 1
2.
What is the diagnosis and complications? 2
3.
What is the treatment? 2
Key
1.
Bilateral greyish membrane on tonsils with surrounding hyperemia
2.
Pharyngeal diphtheria
Complications:
Myocarditis
Polyneuritis
Bronchopneumonia
Miscellaneous (Hepatitis, nephritis, adrenal hemorrhage, gastritis)
3.
Treatment:
Diphtheria antitoxin
Antibiotics (Penicillin, Erythromycin)
Suppurative intervention directed at complications
Strict isolation
8/18/2019 OSPE Paeds Medicine Set 3
http://slidepdf.com/reader/full/ospe-paeds-medicine-set-3 8/25
OSPE Peads Medicine Set 3 SurgicoMed.com
Case 8
(Infectious Diseases)
1.
What are the different methods to prevent neonatal tetanus? 2
2.
Write down the management steps of neonatal tetanus? 3
Key
1.
Prevention:
Conduct the delivery in the hospital
Strict aseptic techniques as washing of hands, sterilized instruments and Lenin
First dose immunization schedule
2.
Management:
Sedation
Feeding
Nursing care
Antitoxin
Antibiotics (Benzyl penicillin to kill vegetative Clostridium tetani)
Counselling
Follow up
8/18/2019 OSPE Paeds Medicine Set 3
http://slidepdf.com/reader/full/ospe-paeds-medicine-set-3 9/25
OSPE Peads Medicine Set 3 SurgicoMed.com
Case 9
(Infectious Diseases)
1. What is the abnormal findings in this baby? 2
2.
What is the diagnosis? 1
3.
What are the management steps of this condition? 2
Key
1.
Findings:
Risus sardonicus / Lockjaw
Generalized spasm
2.
Tetanus neonatorum
3.
Management:
Sedation
Feeding
Nursing care
Antitoxin (ATS, TIG)
Antibiotics (Benzyl penicillin to kill vegetative C. tetani)
Counselling
Follow up
8/18/2019 OSPE Paeds Medicine Set 3
http://slidepdf.com/reader/full/ospe-paeds-medicine-set-3 10/25
OSPE Peads Medicine Set 3 SurgicoMed.com
Case 1
1. Which is the abnormal findings and diagnosis? 1
2.
What are the steps of management? 2
3. How can you eliminate this disease in the neonate? 2
Key
1.
Risus sardonicus / Lockjaw & tetanus neonatorum
2.
Management:
Sedation
Feeding
Nursing care
Antitoxin (ATS, TIG)
Antibiotics (Benzyl penicillin to kill vegetative C. tetani)
Counselling
Follow up3.
Elimination of disease:
5 dose schedule of TT (tetanus toxoid) to mother
5 Cs (clean delivery, clean cutting, clean umbilicus, clean tying, clean…..)
8/18/2019 OSPE Paeds Medicine Set 3
http://slidepdf.com/reader/full/ospe-paeds-medicine-set-3 11/25
OSPE Peads Medicine Set 3 SurgicoMed.com
Case 11
(Infectious Diseases)
1.
What is the type of rash and what is the diagnosis?
2. Write 6 conditions which produce such type of skin irruption?
3.
What are 8 complications of most likely diagnosis?
Key
1.
Maculopapular rash in Measles
2.
Conditions
Measles
Rubella
Scarlet fever
Typhoid fever
Roseola infectiosum
3.
Complications:
Otitis media
Pneumonia
Encephalitis
Hemorrhage measles
Gastroenteritis
Myocarditis
Immune suppression
SSPE (subacute sclerosing pain encephalitis)
8/18/2019 OSPE Paeds Medicine Set 3
http://slidepdf.com/reader/full/ospe-paeds-medicine-set-3 12/25
OSPE Peads Medicine Set 3 SurgicoMed.com
Case 12
(Infectious Disease)
1.
What is the diagnosis of this vaccine preventable infectious disease? 1
2.
How can you prevent this condition by immunization? 2
3.
Write 8 complications of this disease? 2
Key
1.
Mumps
2.
By MMR vaccine at 15 months and before school entry
3. Complications:
Meningoencephalomyelitis
Epididymo-orchitis
Pancreatitis
Deafness
Oophoritis
Thyroiditis
Myocarditis
Arthritis
Thrombocytopenia
8/18/2019 OSPE Paeds Medicine Set 3
http://slidepdf.com/reader/full/ospe-paeds-medicine-set-3 13/25
OSPE Peads Medicine Set 3 SurgicoMed.com
Case 13
1.
What is the abnormal finding? 1.0
2.
What are three differential diagnosis? 1.5
3. What are the complications of the most probable diagnosis? 2.5
Key
1.
Bilateral greyish membrane on tonsils with surrounding hyperemia
2.
Differential:
Diphtheria
Acute tonsillitis
Infectious mononucleosis
3.
Complications:
Myocarditis
Toxic polyneuritis
Broncho pneumonia
Hepatitis, Gastritis
Nephritis, Adrenal hemorrhage
8/18/2019 OSPE Paeds Medicine Set 3
http://slidepdf.com/reader/full/ospe-paeds-medicine-set-3 14/25
OSPE Peads Medicine Set 3 SurgicoMed.com
Case 14
(Infectious Diseases)
1.
What do the figures show? 1
2. What are the different modes of transmission of infectious diseases? 2
3. Write down the treatment of pulmonary tuberculosis? 2
Key
1.
Droplet infection
Right lung involvement in pulmonary tuberculosis
2.
Modes of Transmission: Droplet infection
Sexual route
Needle pricks
Fecal-oral route
3. Treatment:
a. General Supportive
Hygienic and nutritional care
Screening of family
b. Specific Treatment
Isoniazid
Rifampicin
Pyrazinamide
Ethambutol / Streptomycin (depending upon the severity of the infection such as Miliary and
disseminated tuberculosis)
c. Counselling
d. Follow Up
8/18/2019 OSPE Paeds Medicine Set 3
http://slidepdf.com/reader/full/ospe-paeds-medicine-set-3 15/25
OSPE Peads Medicine Set 3 SurgicoMed.com
Case 15
(Hematology)
1.
Write two positive findings in the photographs? 1.0
2.
Write three common differential diagnosis? 1.5
3. Write the management steps of the most common acquired disorder of the childhood? 2.5
Key
1.
Purpuric rash on the feet
Subconjunctival hemorrhage
2. Differentials:
ITP
Leukemia
Aplastic anemia
3.
a) Supportive measures
Prevention of trauma Restrict physical activity
Avoid anti-platelet medication
Platelet transfusion
b) Pharmacological Treatment
IVIG Anti Rh-D
Steroid
c) Management of chronic ITP
As above + splenectomy with pneumococcal, meningococcal and H iB vaccination
8/18/2019 OSPE Paeds Medicine Set 3
http://slidepdf.com/reader/full/ospe-paeds-medicine-set-3 16/25
OSPE Peads Medicine Set 3 SurgicoMed.com
Case 16
(Hematology)
1. Write down the positive findings in the photograph? 0.5
2. Which inherited bleeding disorder causes such swelling and what is the heritance? 1.0
3. Write down the management steps of this condition? 3.5
Key
1. Swollen knee joints / Hemarthrosis
2.
Hemophilia X-linked recessive
3. Management:
a. General Supportive Management
Prevention of trauma
Avoid aspirin
Immunization against Hepatitis B
b. Pharmacological Treatment
Desmopressin
Aminocaproic acid
Tranexamic acid
FFP, cryoprecipitate
Administration of factor VIII concentrate
c. Counselling
General counselling to the parents
Genetic counselling
8/18/2019 OSPE Paeds Medicine Set 3
http://slidepdf.com/reader/full/ospe-paeds-medicine-set-3 17/25
OSPE Peads Medicine Set 3 SurgicoMed.com
Case 17
(CNS)
1. Which cranial nerve is paralyzed in this photograph? 1
2.
Enumerate 8 other clinical findings in such a patient? 2
3.
Name 8 causes of this condition in children? 2
Key
1.
Facial nerve palsy2. Clinical findings:
Loss of frowning of forehead
Loss of closure of eye
Loss of nasolabial fold
Collection of food particles on the
effected side
Deviation of angle of mouth to
the opposite side
Whistling is inappropriate
Loss of taste of anterior 2/3 of tongue
Hyperacusis
3.
Causes:
Idiopathic (Bell’s palsy)
Acute or chronic otitis media
Temporal bone fracture
Herpes zoster oticus
Pyo-meningitis
Encephalitis
Tuberculous meningitis
Brain tumor
8/18/2019 OSPE Paeds Medicine Set 3
http://slidepdf.com/reader/full/ospe-paeds-medicine-set-3 18/25
OSPE Peads Medicine Set 3 SurgicoMed.com
Case 18
(CNS)
1. What is the abnormality visible in the photograph? 0.5
2. What is the definition of cerebral palsy? 1.0
3. What is management steps of cerebral palsy? 3.5
Key
1.
Left lower limb is flexed
Toe walking
These conditions are present in upper motor neuron type of hemiplegia.
2. It is static encephalopathy in which there is non-progressive, permanent disorder of posture and
movement due to insult of immature brain.
3.
a. Multidisciplinary approach
Pediatrician (major role)
Psychotherapist
Occupation therapist
Psychiatrist
Orthopedic surgeon
Nutritionists
b. To reduce spasticity
Diazepam, Baclofen, Dantrolene
Hearing, vision, learning and mental disorders are managed accordingly
c. Counselling
8/18/2019 OSPE Paeds Medicine Set 3
http://slidepdf.com/reader/full/ospe-paeds-medicine-set-3 19/25
OSPE Peads Medicine Set 3 SurgicoMed.com
Case 19
(CNS)
1.
What is developmental age of this child?
2.
What are the different field development?
3.
Write down the one developmental milestone in each field in a 9 month old infant?
Key
1.
4 to 8 weeks
2.
Gross motor
Fine motor and visions
Hearing and speech
Social behavior
3.
Gross motor (site without support, reach for the toy in front, pull to stand, crawl)
Fine motor and visions (watches rolling ball at 10 feet, drops an object and look at fallen
object, uncover the toy)
Hearing and speech (localized sound above and below ear level at 3-6 feet, imitates
adult playful sound)
Social behavior (holds, bites and chews a biscuit, stranger anxiety, grasps bell by handle
and ring in imitation, follow one step verbal command)
8/18/2019 OSPE Paeds Medicine Set 3
http://slidepdf.com/reader/full/ospe-paeds-medicine-set-3 20/25
OSPE Peads Medicine Set 3 SurgicoMed.com
Case 2
(CVS)
1.
What are the abnormal findings? 22. What is the diagnosis? 1
3. What are the management steps? 2
Key
1.
Cyanosis / cyanotic spells
Clubbing of the fingers
2.
Cyanotic congenital heart disease (TOF)
3.
a.
Medical Management
Nutritional and hygienic care
Maintain adequate hydration
Maintain body temperature
Maintain hematocrit in adequate range
Iron supplements
Prophylaxis of bacterial endocarditis
Treat polycythemia
Management of cyanotic spells
b.
Surgical Management
Palliative surgery
BT shunt, Waterston shunt, Pots shunt
Corrective surgery
8/18/2019 OSPE Paeds Medicine Set 3
http://slidepdf.com/reader/full/ospe-paeds-medicine-set-3 21/25
OSPE Peads Medicine Set 3 SurgicoMed.com
Case 21
(CVS)
1. Write two abnormal findings in this x-ray of cyanotic infant? 1
2. What is the diagnosis? 1
3. What are the steps of management? 3
Key
1.
Boot shaped heart (with up tilted apex due to RVH)
Oligemic lung fields (diminished pulmonary vascular markings)
Narrow pedicle / base
Pulmonary artery bay
2.
Tetralogy of Fallot (TOF)
3.
a. Medical Management
Nutritional and hygienic care
Maintain adequate hydration
Maintain body temperature
Maintain hematocrit in adequate range
Iron supplements
Prophylaxis of bacterial endocarditis
Treat polycythemia
Management of cyanotic spells
b.
Surgical Management
Palliative surgery
BT shunt, Waterston shunt, Pots shunt
Corrective surgery
Closing of VSD and resecting the right ventricular outflow obstruction
c. Counselling
8/18/2019 OSPE Paeds Medicine Set 3
http://slidepdf.com/reader/full/ospe-paeds-medicine-set-3 22/25
OSPE Peads Medicine Set 3 SurgicoMed.com
Case 22
(CVS)
1. What is the diagnosis of this condition?
2.
Name the commonest acquired cause of this condition in Pediatrics?
3. What clinical findings will be present in this case?
Key
1. Aortic regurgitation disease
2. Rheumatic fever / rheumatic valvular heart disease
3. Clinical findings:
High volume bounding pulses
Collapsing / Water hammer pulse
Bulging of precordium
Lateral and downward shifting of apex beat
Muffled second heart sound
Early diagnostic murmur at aortic area
8/18/2019 OSPE Paeds Medicine Set 3
http://slidepdf.com/reader/full/ospe-paeds-medicine-set-3 23/25
OSPE Peads Medicine Set 3 SurgicoMed.com
Case 23
(Musculo-skeletal)
1.
Identify the sign which is being demonstrated? 1
2.
What is the diagnosis and its inheritance? 2
3.
Enumerate 4 investigations with their yield? 2
Key
1.
Gower’s sign
2. Duchene’s muscular dystrophy and it is x-linked recessive disorder
3. Investigations:
CPK
EMG
Muscle biopsy
Gene analysis (DNA) from peripheral blood
8/18/2019 OSPE Paeds Medicine Set 3
http://slidepdf.com/reader/full/ospe-paeds-medicine-set-3 24/25
OSPE Peads Medicine Set 3 SurgicoMed.com
Case 24
(Musculo-skeletal)
1. Identify the procedure which is being performed in the photograph? 1
2.
What are the indications of this procedure? 23. What are the contra-indications of this procedure? 2
Key
1. Thoracentesis / Pleural tap
2. Indication:
Diagnostic evaluation of pleural effusion
Therapeutic drainage of pleural effusion in patients with respiratory compromise
3. Contra-indications:
Local skin infections (e.g. Herpes zoster)
Bleeding diathesis, anticoagulant therapy
Mechanical ventilation
8/18/2019 OSPE Paeds Medicine Set 3
http://slidepdf.com/reader/full/ospe-paeds-medicine-set-3 25/25
OSPE Peads Medicine Set 3 SurgicoMed.com
Case 25(Infectious Diseases)
1. Identify the pathological pulmonary lesions shown in the photograph? 1.5
2. What is the clinical diagnosis? 1.0
3. Enumerate the 10 complications / sites of extra pulmonary involvement
of this infectious disease? 2.5
Key
1. Primary complex comprised by lymph nodes, lymphatics and ghon focus
2. Primary tuberculosis
3. Complications:
Miliary tuberculosis
TBM
Pneumonia
Pleural effusion
Atelectasis
Pneumothorax
Abdominal tuberculosis
Carries spine
Bronchiectasis