OSPE Peads Medicine Set 2 SurgicoMed.com
OSPE PEADS MEDICINE SET 2
Case 1
1. Identify 3 physical signs in these photographs? 3
2. What is the diagnosis? 2
Key
1. Physical signs are;
Epicanthic folds
Low set ears
Simian crease
Increased distance b/w 1st and 2nd toe
2. Down Syndrome
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Case 2
1. Give three radiological findings? 3
2. What is the diagnosis? 2
Key 1. Radiological findings are;
Cupping
Widening
Fraying
Flaring
2. Rickets
OSPE Peads Medicine Set 2 SurgicoMed.com
Case 3
1. Identify two radiological abnormalities? 2
2. What is your diagnosis? 1
3. Give two causes? 2
Key 1. Radiological abnormalities are;
Bilateral opacities
Obliteration of costophrenic angles
2. Bilateral pleural effusion
3. Causes:
Nephrotic syndrome
CLD
Connective tissue disorder
CCF
Tuberculosis
OSPE Peads Medicine Set 2 SurgicoMed.com
Case 4 This five years old child presents with easy fatigability for the last 2 years.
1. Identify the physical sign? 3
2. What is the most likely diagnosis? 2
Key
1. Bilateral ptosis
2. Myasthenia gravis
OSPE Peads Medicine Set 2 SurgicoMed.com
Case 5
1. What is your diagnosis? 2
2. Give 3 complications? 3
Key
1. Meningiomyelocele
2. Complication:
Infections / meningitis
Hydrocephalus
Paralysis of the lower limbs (paraplegia)
Bowel and bladder dysfunction
Hip dislocation, foot deformities
OSPE Peads Medicine Set 2 SurgicoMed.com
Case 6
1. Name the physical sign shown in the photograph? 3
2. What is the most likely diagnosis? 2
Key 1. Gower’s sign
2. Duchene Muscular Dystrophy
OSPE Peads Medicine Set 2 SurgicoMed.com
Case 7
A 4 years old girl present with 4 day history of increasing puffiness around the eye. The
investigations are as follow;
Hb 12.6 g/dl
WBC 10,290/mm3
Na 136 mmol/l
K 4.7 mmol/l
Serum albumin 2.6 g %
Urine pH 6.5
1. What is the most likely diagnosis? 2
2. Give 3 further investigations? 3
Key
1. Nephrotic syndrome
2. Investigations:
24 hour urinary protein
Urinary protein creatinine ration
Serum cholesterol
Serum C3 level
Urea and creatinine
OSPE Peads Medicine Set 2 SurgicoMed.com
Case 8
A previously well child with one week history of febrile illness who was treated with injectable
ampicillin presents with mild neck stiffness and hemiplegia. CSF results are as follow;
Protein 80 mg/dl
Sugar 40 mg/dl
WBC 300/mm3
Lymphocytes 68%
Gram staining and culture –ve
1. What is your diagnosis? 2
2. Give 3 other complications? 3
Key
1. Partially treated bacterial meningitis
2. Complications
Subdural effusion
Brain abscess
Cranial nerve palsies
Seizures
SIADH
OSPE Peads Medicine Set 2 SurgicoMed.com
Case 9 An 8 months old boy presented in the emergency room with the complaints of fever and
cough for 3 days, vomiting for 1 day and generalized fits for 1 ½ hour. On examination, he has
fever of 1010F, some dehydration and irritability.
His CSF examination showed TLC 2000/mm3, DLC: poly 75%, lymphocytes 25%, RBCs few,
protein 120 mg/dl and sugar 130 mg/dl.
1. What is your diagnosis?
2. What are the two most probable causative organisms?
3. Enlist steps of management?
Key
1. Acute bacterial meningitis
2. Most causative organisms are:
Haemophilus influenza
Streptococcus pneumoniae
3. Management includes:
ABC (supportive treatment)
Anti-seizures (to control fits)
Anti-biotics (to treat bacterial infection)
OSPE Peads Medicine Set 2 SurgicoMed.com
Case 10
1. Which infectious disease can lead to this deformity? 1
2. Name four diagnostic investigations? 2
3. Name four drugs with dosage and duration? 2
Key 1. Carries spine / Tuberculosis
2. Diagnostic investigations:
Mantoux test (Accelerated BCG test)
X-ray chest
X-ray spine
C.T scan spine
3. Drugs used:
Rifampicin orally 10-20 mg/kg OD before breakfast for 1 year
Isoniazid 10-20 mg/kg/day OD for 1 year
Pyrazinamide orally 15-30 mg/kg/day for initial 2 months
Ethambutol or Inj. Streptomycin 10-15 mg/kg * IM* OD for initial 2 months
OSPE Peads Medicine Set 2 SurgicoMed.com
Case 11
A 7 years old child presents with 2 days history of haematemesis and malena. On examination,
he had massive splenomegaly. His ALT was 65 µ/L, PT and aPTT were within the normal limits
and serum albumin was 4 g/dl.
1. What is the most likely diagnosis?
2. How will you confirm your diagnosis?
3. Enlist three steps of long term management?
Key
1. Pre-hepatic portal hypertension
2. USG of abdomen with Doppler studies
3. Steps of long term management:
B-blockers
Sclerotherapy / Band ligation
Mesocaval shunt
OSPE Peads Medicine Set 2 SurgicoMed.com
Case 12
1. What will you find on abdominal x-ray as shown in this photograph?
2. Name three common diseases responsible for these findings?
3. Describe the laboratory tests required for the diagnosis of above those three diseases?
Key 1. Hepatosplenomegaly
2. Common diseases:
Malaria
Typhoid fever
Tuberculosis
3. Laboratory tests required:
Hb, TLC, DLC, ESR
Malarial parasites, thick and thin film slides
ICT for malarial parasites
Tuberculin test / Accelerated BCG test
X-ray chest (PA view)
Blood test for Salmonella typhi and paratyphi
Widal test / Typhidot test
OSPE Peads Medicine Set 2 SurgicoMed.com
Case 13
A 3 years old child is brought to the OPD with the history of fever and poor weight gain for 3
months. He is unvaccinated. His uncle has history of chronic cough. His investigations reveal:
Hb 9 gm%, TLC 75000/mm3, ESR 100 mm, Mantoux test 12mm.
Chest x-ray showed hilar lymph adenopathy.
1. What is the most probable diagnosis?
2. Write down the steps of management is this case?
Key
1. Pulmonary Tuberculosis (pulmonary T.B)
2. Management steps:
ATT
Nutritional rehabilitation
Family counseling
Family screening for TB and management accordingly
Ensure proper follow up to check response, compliance and look for complications
OSPE Peads Medicine Set 2 SurgicoMed.com
Case 14
1. What is the radiological findings? 1
2. What are three other conditions in Pediatrics leading to such infiltrations x-ray chest? 1.5
3. What are five common findings on clinical examination? 2.5
Key 1. Miliary tuberculosis / Mottling
2. Clinical conditions:
Atypical pneumonia
Fungal pneumonia
Viral pneumonia
3. Findings on clinical examinations:
Emaciation
Hepatosplenomegaly
Choroid tubercles in eyes
Pancreatitis (< 5%)
Multiorgan dysfunction
Adrenal insufficiency
OSPE Peads Medicine Set 2 SurgicoMed.com
Case 15
1. What are 4 positive findings in this photograph? 2
2. What is the diagnosis? 1
3. What are the causes which lead to this condition? 2
Key 1.
Puffy moon shape
Miserable looking and apathetic
Flaky paint dermatitis
Edema foot
2. Kwashiorkor
3.
a) Primary malnutrition
Failure of lactation
Ignorance of weaning
Poverty
Cultural food pattern/food lack
b) Secondary malnutrition
Infections
Congenital disorders
Malabsorption
Metabolic
OSPE Peads Medicine Set 2 SurgicoMed.com
Case 16
1. What is the clinical findings? 1
2. Name the two underlying conditions leading to this finding? 2
3. What is the management? 2
Key 1. Noma / Cancrum oris
2.
Measles
Malnutrition
3. Management:
Nutritious diet
Vitamin A supplement
Vitamin B complex
Vitamin C
Iron
Antibiotics
Ampicillin and metronidazole
OSPE Peads Medicine Set 2 SurgicoMed.com
Case 17
1. What is the diagnosis? 1
2. Describe four causes of this condition? 2
3. Describe four investigations to reach the diagnosis? 2
Key 1. Cervical lymph adenitis
2.
Tuberculous lymph adenitis
Bacterial (suppurative) lymph adenitis
Malignancy
Non-specific / Viral / Atypical micro-bacterial tuberculosis
3.
CBC including peripheral morphology and ESR
X-ray chest
Tuberculin test / BCG accelerated test
FNA / Excisional biopsy / Aspiration
OSPE Peads Medicine Set 2 SurgicoMed.com
Case 18
1. What is the diagnosis? 0.5
2. Describe 12 clinical features of this condition? 3.0
3. Name two diagnostic test and the drug for treatment? 1.5
Key 1. Congenital hypothyroidism (Cretinism)
2.
Coarse facies
Broad nasal bridge
Placid / contended baby
Umbilical hernia
Large tongue
Low hair line
Dry skin
Distended abdomen
Constipation
Short stature
Delayed dentition
Delayed milestones
Anemia
3.
Serum free T4
Serum TSH
OSPE Peads Medicine Set 2 SurgicoMed.com
Case 19
1. Identify 4 positive findings in this picture and present your diagnosis? 2.0
2. How antenatal diagnosis of this condition is made? 1.5
3. What is the risk of recurrence in the next pregnancy? 1.5
Key 1.
Up slanting of eyes
Depressed nasal bridge
Hypotonia
Protruding tongue
Diagnosis is Down’s syndrome
2.
Decreased AFP, decreases Estriol, increased hCG
Chromosomal analysis of fetal cells either by Amniocentesis or by CVS
Ultrasound showing increased nuchal translucency
3.
If non-disjunction is underlying cause recurrence risk 1 %
If translocation: 21/21 100 %
14/21 10-15 % (3-5%)
13/22 10-12 % (5%)
OSPE Peads Medicine Set 2 SurgicoMed.com
Case 20
1. What definition this graph reflects? 1
2. Enumerate 8 common causes of this condition? 2
3. Enumerate 8 steps to prevent malnutrition in children? 2
Key 1. Failure to thrive
2. Causes:
Failure of lactation
Faulty weaning
Poverty / ignorance
Cultural food pattern
Lack of immunization & primary
care
Family planning
Recurrent GIT infections
Recurrent respiratory tract
infections
Measles / Malaria
Tuberculosis
Congenital malformation
3.
Optimum breast feeding
Avoid bottle feeding, pacifiers etc.
Adequate weaning
Immunization
Growth monitoring
Family planning
Health education
OSPE Peads Medicine Set 2 SurgicoMed.com
Case 21
Following is the blood report from a one day old baby presenting with jaundice starting on
day 1 of life:
Hemoglobin (Hb) 10 mg/dl
TLC 15000 / mm3
Poly 40 %
Lymphocytes 58 %
Monocytes 1 %
Eosinophils 1 %
Reticulocytes 15 %
Direct coombs test strongly positive
1. What is most likely diagnosis?
2. What is the best treatment option?
3. Give one complication of this disease?
Key
1. Hemolytic disease of newborn
2. Exchange transfusion
3. Kernicterus
OSPE Peads Medicine Set 2 SurgicoMed.com
Case 22
A 2 years old boy presented with failure to thrive and fits which usually occur in early morning.
His investigations reveal:
Fasting blood sugar 40 mg/dl
ALT 75 IU/L
Uric Acid 8 mg/dl
Serum Triglycerides > 200 mg/dl
1. What is most likely diagnosis?
2. What other clinical sign you will look for?
3. How will you confirm your diagnosis?
Key
1. Glycogen storage disease
2. Hepatomegaly, Doll like facies
3. Liver biopsy, enzyme assay
OSPE Peads Medicine Set 2 SurgicoMed.com
Case 23
How do you interpret APGAR scoring system?
0 1 2
Appearance Pulse
Grimace Activity
Respiration
Key
APGAR 0 1 2
Appearance Central & peripheral cyanosis
Peripheral cyanosis Pink
Pulse < 60 60-100 > 100
Grimace No grimace Some Full cry
Activity Limp Some activity Active
Respiration No respiration Gasping Normal
OSPE Peads Medicine Set 2 SurgicoMed.com
Case 24
A 15 weeks old breast fed infant present with failure to thrive and loose motions. Examination
reveals perianal rashes and eczematous lesions over face and scalp. These lesions did not
respond to antifungal therapy.
1. What is most likely diagnosis?
2. How will you investigate?
3. What therapy would you want to give?
Key
1. Acrodermatitis enterpathica
2. Serum zinc level
3. Zinc sulphate
OSPE Peads Medicine Set 2 SurgicoMed.com
Case 25
A one year old child was brought to OPD with the complications of failure to thrive. The boy
was having weight of 6 kg and length of 60 cm. He is pale and edematous. His serum albumin
is 2 g/dl.
1. What three other clinical signs will you look for?
2. What is the most probable diagnosis?
Key
1. Clinical signs:
Flaky dermatitis
Hypotonia
Hair color and texture
Behavior
2. Kwashiorkor
OSPE Peads Medicine Set 2 SurgicoMed.com
Case 26 A 6 years old boy presented with complaints of progressively increasing weakness of the lower
limbs for the last 3 days. On examination, the boy is conscious and oriented but cannot walk.
His both lower limbs have decreased tone, power of 1/5 and diminished reflexes. His upper
limbs also have decreased power of 3/5. The cranial nerves are intact. The examination of
bladder and spine is unremarkable.
1. What is the most probable diagnosis?
2. What diagnostic test you will perform?
3. How will you manage the patient?
Key
1. Guillain Barre Syndrome
2. Nerve conduction studies
3. Management:
Admission
Monitor for symptoms
IVIG (intravenous immunoglobulin)
Nutritional care
OSPE Peads Medicine Set 2 SurgicoMed.com
Case 27
1. Identify three positive findings in these photographs? 1.5
2. Enumerate 6 causes of above disease? 3.0
3. What is the treatment of choice in above disease? 0.5
Key 1. 3 positive findings:
Large head
Sunset sign
Ventricular dilation (Hydrocephalus)
2. Causes:
Congenital aqueductal stenosis
Dandy walker malformation
Arnold Chiari malformation type II
Congenital TORCH infections
Bacterial meningitis
TBM (Tuberculous Meningitis)
Arachiniditis secondary to bleeding
in arachnoid space
IVH in premature infants
3. Ventriculo-peritoneal shunt (Ventriculo-atrial shunt)
OSPE Peads Medicine Set 2 SurgicoMed.com
Case 28
1. What are the abnormal findings?
2. What is the diagnosis?
3. Write down the management steps?
Key 1.
Emaciated irritable child / wizened face / prominent rib cage
Loss of fat over the buttock and body
2. Marasmus
3.
a) Initial management
Life threatening problems are identified and treated in the hospital
Specific deficiencies are corrected
Metabolic abnormalities are corrected
Feeding is begun
b) Rehabilitation
Intensive feeding is given to recover most of the weight
Emotional and physical stimulation are increased
Training of the mother
Preparation for the discharge