OSPE Peads Medicine Set 3 OSPE · PDF fileOSPE Peads Medicine Set 3 OSPE PEADS ... Name the diagnosis and its complications in this case? 1 ... Tuberculous meningitis

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 spots

2. 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.

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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






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 dehydration

2. 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/kg Infants (< 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






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






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 )






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






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






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







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






Case 10

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 up

3. Elimination of disease:

5 dose schedule of TT (tetanus toxoid) to mother

5 Cs (clean delivery, clean cutting, clean umbilicus, clean tying, clean …..)







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)






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






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







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






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 HiB vaccination






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






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 palsy

2. 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






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






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)






Case 20 (CVS)

1. What are the abnormal findings? 2


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






Case 21 (CVS)

1. Write two abnormal findings in this x-ray of cyanotic infant? 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






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






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






Case 24 (Musculo-skeletal)

1. Identify the procedure which is being performed in the photograph? 1

2. What are the indications of this procedure? 2

3. 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







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





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OSPE Peads Medicine Set 3 OSPE · PDF fileOSPE Peads Medicine Set 3 OSPE PEADS ... Name the diagnosis and its complications in this case? 1 ... Tuberculous meningitis