Rainbow Hospital OSCE

RAINBOW HOSPITAL OSCE

QUESTION 1

QUESTION 1

• What is your diagnosis?• Name 4 conditions in which it is seen.• What is the underlying mechanism?

ANSWER 1

• Cherry Red spot

• Tay sachs disease, Sandhoff disease, Niemann pick disease, central retinal artery occlusion.

• Due to loss of transparency of the retinal ganglion cell layer secondary to lipid accumulation/edema. Because ganglion cells are not present in the fovea, the fovea transmits the underlying choroidal colour.

QUESTION 2

• Surface marking of right lung.

ANSWER• 2.5cm above the medial end of clavicle.• Sternoclavicular joint.• 4th costal cartilage.• Midclavicular line at 6th rib.• Midaxillary line at 8th rib.• Lateral border of erector spinae at 10th rib.• Oblique fissure – line joining spine of T3 vertebra to 6th

rib in midclavicular line.• Horizontal fissure – horizontal line extending from 4th

costal cartilage continued to meet oblique fissure in midaxillary line.

QUESTION 3

QUESTION 3

• What is your diagnosis.• Mention a few potential reversible causes of

this condition.• Name 2 drugs used in treatment.

ANSWER 3

• Wide complex tachycardia – ventricular tachycardia.

• Hypoxia, hypothermia, hypo/hyperkalemia, hypoglycemia, Toxins, tamponade, tension pneumothorax, trauma.

• Amiodarone, procainamide.

QUESTION 4

• You have done therapeutic aspiration of pleural fluid from a child with empyema. Mention how will you dispose the following after the procedure.

• Gloves.• 18 gauge needle.• Disposable syringe.• Cotton and gauze.

ANSWER 4

• Gloves – yellow bin.• needle – puncture proof container.• Disposable syringe – red bin.• Cotton and gauze - yellow bin.

QUESTION 5This is the MRI of an infant evaluated for

recurrent seizures with developmental delay

QUESTION 5

• What is your diagnosis?• Mention 2 ocular abnormalities associated

with this condition.• Name the syndrome associated with this

condition.

ANSWER 5

• Lissencephaly (absence of cerebral convolution and poorly formed sylvian fissure)

• Hypoplasia of the optic nerve and microphthalmia.

• Miller-Dieker syndrome.

QUESTION 6

QUESTION 6

• Identify the organism.• Mention 4 commonly used stains for

identification of the organism.• Mention 2 drugs used in treatment.

ANSWER 6

• Pneumocystis jirovecii• Grocott/gomori silver, toluidine blue, giemsa,

fluorescein-labeled monoclonal antibody stains.

• Trimethoprim-sulfamethoxazole, pentamidine isethionate, atovaquone, trimethoprim plus dapsone, clindamycin plus primaquine.

QUESTION 7

• Demonstration of cerebellar signs.

ANSWER 7

• Nystagmus – gaze evoked nystagmus.• Gait – unsteady and irregular with a wide base.• Intention tremor.• Dysdiadokokinesia.• Past pointing.• Coordination – finger nose and heel shin test.• Reflexes – pendular knee jerk.• Dysarthria – scanning and robotic with syllable

pronounced individually and slowly.

QUESTION 8

• Counsel a mother whose child has been diagnosed to have Acute lymphoblastic leukemia.

ANSWER 8

• Introduces self.• Says that child has been diagnosed to have

leukemia which is a blood cancer of WBC’s.• Shows sympathy and reassures that the

overall prognosis is excellent.• Says that the etiology is not known.• Says that treatment involves drugs (chemo)

and occasionally radiotherapy.

• Says that the duration of treatment will be 2 ½ to 3yrs.• Says regarding side effects of chemo like hairfall,

infections, bleeding tendencies etc.• Also mentions about long term complications like

decreased growth, repeat cancer. • Stresses the need for neutropenic care – avoid giving

outside food, avoid overcrowded places, avoid frequent visitors.

• Mention the risk of relapse – CNS, testicular, blood and hence the need for regular followup after completion of treatment.

• Mention about vaccination – to consult doctor before giving regular vaccines.

QUESTION 9

• A 3 yr old child is brought with history of sudden onset of difficulty in breathing. The child was playing with toys and was found drowsy by the mother.

• On arrival in the ER, the child is unresponsive, tachypneic, cyanosed with good peripheral pulses.

• Mention the steps in management of this child.

ANSWER 9

• Open the victim’s airway using a tongue-jaw lift and look for an object in the mouth and pharynx. If an object is visible, remove it. Do not perform blind finger sweeps.

• Open the airway with a head tilt-chin lift and attempt to provide rescue breaths. If breaths are not effective, reposition the head and reattempt ventilation.

• If the breaths are still not effective, prepare to perform abdominal thrusts (Heimlich’s maneuver).

• Repeat the steps until the object is dislodged and the airway is patent or until attempts have lasted approximately 1 minute. If the infant remains unresponsive after 1minute, activate the EMS system.

QUESTION 10

• Elicit Moro’s reflex, rooting and sucking reflex, palmar and plantar grasp in this neonate.

QUESTION 11

• This is the electrolyte report of a 1yr old infant who was evaluated for failure to thrive, recurrent vomiting and polyuria.

• Na – 134mEq/dl, K – 2.6mEq/dl, Cl 100mEq/dl, HCO3 – 28mEq/dl.

QUESTION 11

• What is your diagnosis.• Mode of inheritance?.• What is the underlying defect.• Treatment.

ANSWER 11

• Barrter syndrome.• Autosomal recessive inheritance.• Defect in sodium and chloride resorption in

the loop of henle.• Oral potassium supplement, potassium

sparing diuretic, Indomethacin.

QUESTION 12

• While drawing blood sample from a patient, whose HIV status is unknown, your hospital nurse has an accidental needle stick injury (non intact skin, small volume exposure).

• Mention the setps which should be taken in such a situation with regards to the following.

QUESTION 12

• Care of the exposed site.• Counselling of the health care personnel.• Counselling of the source.• Tests to be done and timing of the test.• Drug therapy – duration and dose.• Administrative action.

ANSWER 12

• Wash the exposed site thoroughly with running water. Wash skin with soap.

• Reassure and inform about PEP.• Counsel the source and obtain consent for testing –

determination of HIV,HBV,HCV status of the source.• HIV,HBV,HCV testing of the health care personnel. HIV

testing at zero hour, 6wks, 12wks, 6months.• Zidovudine 300mg BD & Lamivudine 150mg BD for 4

weeks.• Recording and reporting of the even.t

QUESTION 13

• A 1-1/2 year old with VSD on antifailure drugs develops illness suggestive of influenza.

• What Category does this child belong to as per govt of India guidelines.

• Mention 2 appropriate steps recommended for this category

• What is the correct dosage and duration of oseltamivir in children?

ANSWER 13

• Category B

• Home isolation and oseltamivir therapy

• For weight 15kg 30mg BD for 5 days

QUESTION 14• 16 year old girl presents with h/o passing red

coloured urine for the last few hours. There was no h/o fever. There was h/o drug intake for diarrheal illness 3 days ago.

O/E she had gross pallor and a tinge of scleral icterus

• What is the provisional diagnosis?• Describe the peripheral smear picture in this

girl.• Immediate steps in management.

ANSWER 14

• Acute intravascular hemolysis

• Fragmented RBC,Bite cells,nucleated RBCs,severe thrombocytopenia

• Packed cell transfusion

QUESTION 15

• Mention the duration and temperature at which the following blood products can be stored?

• 1.Red Blood Cells• 2.Fresh Frozen Plasma• 3.Platelet Concentrate• 4.Cryoprecipitate

ANSWER 15

• Packed RBC – 42 days in the refrigerator or 10 years in the freezer.

• FFP - 1 year in the freezer• Platelet Concentrate – 5 days at room

temperature• Cryoprecipitate – 1 year in the freezer

QUESTION 16

QUESTION 16

• This is the karyotype obtained from the bonemarrow of a 6 year old girl with a hematological malignancy.

• Comment on the abnormality• Mention 1 favourable and 1 unfavourable

translocation in ALL

ANSWER 16

• Hyperdiploidy• BCR ABL – Unfavourable• TELL AML - Favourable

QUESTION 17

QUESTION 17

• Mention the abnormality in this CXR.• Mention 3 causes of this appearance.• What further investigations would you order?

ANSWER 17

• Mediastinal enlargement• Lymphoma• Thymoma• Teratoma• CT chest,CT guided biopsy and HPE

QUESTION 18

QUESTION 18

• What is the abnormality seen on this radiograph?

• Name 2 disorders which may give rise to this abnormality

ANSWER 18

• Xray skull lateral view showing multiple lytic lesions

• Histiocytosis• Secondaries• Multiple myeloma

QUESTION 19

• Define Polio eradication and elimination

• Mention core strategies for eradication of polio.

• Eradication – No cases of paralytic polio by wild polio virus in the last 3 calender years

• Elimination – No cases of paralytic poliomyelitis by wild polio virus in 1 calender year.

• CORE STRATEGIES: • Maintaining high routine immunisation

coverage with 4 doses of OPV• Mass campaign• Sensitive Surveillence• Mop up campaign

QUESTION 20

• HPV VACCINE• What are the types of vaccine available?

Mention the serotypes covered by them.• What is the recommended dose?• What is the recommended age for

vaccination?

ANSWER 20

• Quadrivalent vaccine (gardasil) – serotypes 16, 18, 6, 11.

• Bivalent vaccine (cervarix) – serotypes 16, 18.• 0.5ml intramuscular at deltoid. 3 doses - 0, 2, 6months – gardasil. 3 doses - 0, 1, 6months – cervarix. • Initiation of vaccine 10-12years of age. Catch

up vaccination up to 26yrs of age.

QUESTION 21

QUESTION 21

• Identify this graph.• What do the square and area of each square

represent?• What do the horizontal and vertical line

represent?• What does the diamond represent?• What does the centre of diamond represent?

ANSWER 21

• Forest plot (forest plot shows information from individual studies that went into meta-analysis at a glance. They show the amount of variation between the studies and an estimate of the overall result.

• Each square symbol represents a study contributing to metanalysis and the area of square corresponds to the weight of the corresponding study to the metaanalysis.

ANSWER 21

• The horizontal line through the square shows the confidence interval. The solid vertical line represents no effect.

• The diamond represents the overall estimate from the meta-analysis.

• The centre of diamond represents the pooled point estimate and the horizontal tips represent the confidence interval.

QUESTION 22

QUESTION 22

• Identify this peripheral smear.• What is the underlying defect?• Confirmatory test for diagnosis?• Treatment options?

ANSWER 22

• Hereditary spherocytosis.• Defect in spectrin or ankyrin - results in

uncoupling in the vertical interactions of the lipid bilayer skeleton and loss of membrane microvesicles.

• Osmotic fragility test.• Folic acid 1mg/day, splenectomy.

QUESTION 23

QUESTION 23

• Identify this peripheral smear. • Mention a few complications associated with

this condition.

ANSWER 23

• Plasmodium falciparum malaria.• Cerebral malaria, blackwater fever, pulmonary

edema, algid malaria.

QUESTION 241 ½ yr old child with history of chronic diarrhea was

brought with complaints of perioral and perineal rash.

QUESTION 24

• What is your diagnosis?• Mode of inheritance?• Investigation used for diagnosis?• Treatment of choice?• Mention a few differential diagnosis.

ANSWER 24

• Acrodermatitis enteropathica.• Autosomal recessive – defect in intestinal zinc

specific transporter gene.• Low plasma zinc concentration.• Zinc – 50mg/day for infants, upto 150mg/day

for children.• MSUD, organic acidemia, methylmalonic

acidemia, biotidinase def, severe PEM.

QUESTION 25

QUESTION 25

• What is your diagnosis?• What is the causative organism?• Mention a few other manifestations.• Mention a few complications.

ANSWER 25

• Erythema infectiosum.• Parvovirus B19• Arthropathy, transient aplastic crisis,

myocarditis. • Thrombocytopenic purpura, aseptic

meningitis, infection associated hemophagocytic syndrome, persistent arthritis.

QUESTION 26

QUESTION 26

• Identify this pedigree chart. What is the mode of inheritance.

• Mention a few disorders with this mode of inheritance.

ANSWER 26

• X-linked dominant inheritance.• Hypophosphatemic rickets, incontinentia

pigmenti.

QUESTION 27Stool microscopy of a child showed the

following

QUESTION 27

• What is your diagnosis?• Mention a few clinical manifestations.• Drugs used in treatment.

ANSWER 27

• Hookworm egg.• Iron deficiency anemia, dermatitis, cutaneous

larva migrans, cough due to laryngotracheobronchitis.

• Albendazole 400mg stat, Mebendazole 100mg BD for 3 days, pyrantel palmoate 11mg/kg OD for 3 days.

1.Mark the parts of the ETCO2 graph and explain each part.2.Mention 2 conditions which cause this type of ETCO2 recording

QUESTION 28

2.Intravenous bicarbonate injection Release of a tourniquet from a surgical limb

ANSWER 28

QUESTION 29

QUESTION 29

• Identify this condition.• Mention 3 treatment options• Mention 2 complications

ANSWER 29

• Dense bones suggestive of osteopetrosis• Steroids,Interferon,Bone marrow

Transplantation• Infections,Bleeds,Loss of vision

Question 30 A 1 month old child

was brought with pink staining of the diapers since birth. He also had history of blisters on sun exposed areas.

On examination the color of the urine is as shown.

1. What is your diagnosis?2. Name the deficient enzyme.3. What are the other clinical manifestations?4. Mention the diagnostic lab finding.

Answer:1. Congenital Erythropoietic Porphyria (Gunther disease)2. Uroporphyrinogen III synthase (UROS)3. Bullous cutaneous photosensitivity– hydroa aestivale,

hypertrichosis, erythrodontia, hemolytic anemia, bone abnormalities

4. Markedly elevated levels of uroporphyrin I and coproporphyrin I in urine,stool and RBC’s.

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