BANGALORE BAPTIST HOSPITAL

DEPARTMENT OF PEDIATRICS

PEDIATRICS OSCE WORKSHOP 3/9/11

ANSWERS TO OSCEs

OSCE STATION - VACCINE

In a primary health centre monthly requirement of DPT is 280 doses. Lead time (time between ordering of new stock and its receipt) is 1 week.

a. Calculate what should be the buffer stock 1b. What should be the minimum stock level (reorder level)? 2c. What is the maximum stock level? 2

Buffer stock serves as cushion or buffer against emergencies, major fluctuations in vaccine demands or unexpected transport delays. (25% of monthly requirment for vaccines and 10% of monthly requirement for syringes). DPT buffer stock should be 25% of 280 = 70

Minimum stock level (reorder level) is the the least amount you should have in stock, usually expressed as weeks/ months of supply. It is the amount of stock you will have between placing and receiving an order plus the buffer stock. Since lead time is 1 week, the minimum stock should be 1 week requirement i,e 280 devided by 4 = 70. Buffer stock is 70. So, minimum stock level is 70+ 70 = 140.

Maximum stock level is largest amount of stock you should have, usually expressed as weeks/ months supply. It is minimum stock plus amount of stock used between orders. 140 + 3 weeks stock of 210 doses. (1 week stock is 280 divided by 4 = 70. So 3 weeks stock is 70 multiplied by 3 = 210.).Maximum stock = 210 + 140 = 350 doses.

OSCE STATION – X RAYS

1.

a. What is the diagnosis? 1b. What is this sign called? 1c. What are the structures that cause this appearance in this condition? 0.5

a. Total anomalous pulmonary venous drainage- supracardiac type

b. Snow man appearance, figure of 8 appearance

c. Cardiomegaly with increased vascular markings Dilatation of both the left and right innominate veins and right SVC producing the classical snow man or figure of 8 appearance Superior mediastinum is enlarged secondary to right venacava, innominate artery and ascending vertical vein.

2.

a. Describe the findings on the spine 1 b. Name the disease where this is seen 1 c Name 2 other skeletal complications of this condition. 0.5

a. Infarction affecting the central part of the vertebrae (fed by a spinal artery branch) results in the characteristic h vertebrae of sickle cell disease. The outer portions of the plates are spared because of the numerous apophyseal arteries. The lateral cxr shows multiple vertebral end-plate irregularities and depressions. The peripheral portions of the end-plates are spared. The appearance is due to bone infarction and subsequent collapse. This is an early example of the classical h-shaped vertebrae seen in sickle-cell anaemia.b. Sickle cell anemia (also seen in Gauchers disease)c. Dactylitis, avascular necrosis of femoral head and humerus, osteomyelitis

OSCE STATION - KARYOTYPE1.

a. Identify the karyotype. 1 b. What is the basic genetic defect? 0.5

c. List four clinical features of the same. 1

a. Fragile X syndrome

b. 200-2000 repeats of CGG/CCG on fragile site of distal long arm of chromosome X

c. Mental retardation, macro-orchidism, long face, prominent jaw, stereotyped speech and behaviour.

2.

a. Identify the karyotype 1 b. What is the basic genetic defect? 0.5 c. List four clinical features. 1

a. Cri-du-chat syndrome

b. 5p deletion

c. Characteristic cry, hypotonia, microcephaly with prominent metopic suture, hypertelorism, bilateral epicanthic folds, high arched palate, flat nasal bridge, short stature and mental retardation.

OSCE STATION- AUDIOGRAM

1.

a What is the study?b. Interpret the same.c. Give two conditions for the same.

a. Audiogram 1b. Bilateral conductive deafness 1c. Ear wax, otitis media 0.5

2.

a. Interpret the study.b. Give two conditions for the same

a. Bilateral sensorineural deafness 1.5b. CMV, congenital rubella syndrome, ototoxic drugs 1

OSCE STATION- INTRAOSSEOUS NEEDLE INSERTION

Demonstrate the procedure and verbalize the same

Pretends to wash hands and follows universal precautions- 0.5

Paints and drapes the leg and places it in slight external rotation 0.5

Identifies the tibial tuberosity and locates the site one finger breadth below and medial to it 0.5

Stabilizes the leg at the knee joint and does not place the hand below the leg 0.5

Holds the needle like a knife and inserts the needle perpendicular to the tibia in a twisting manner 0.5

Continues to insert the needle till there is a give way feeling once in the marrow space 0.5

Needle is steady once in the marrow space 0.5

Aspirates the marrow and flushes with a small volume of saline and makes sure there is no swelling of soft tissues 0.5

Fixes the needle and connects IV fluid 0.5

Verbalizes the whole procedure 0.5

OSCE STATION- CLINICAL EXAMINATION

Examine the motor system of the child excluding reflexes

Findings will be documented in the next station

Measures bulk in all the areas 1

Examines tone 2

Examines power in all four limbs 2

Examines gait 1

OSCE STATION- DOCUMENTATION OF CLINICAL FINDINGS

Document the findings of motor system excluding reflexes

Posture 1

Bulk 1

Tone 1

Power 2

Gait 1

OSCE STATION- SLIDES

a. Identify the slide 1.5

b. Mention the clinical condition concerned with the same 0.5

c. Mention the drugs used to treat the same. 0.5

a. Bone marrow smear showing Leishmania donovani

b. Kala Azar/ Leishmaniasis

c. Sodium stilbogluconate, pentamidine

2.

a. Identify the slide 1.5 b. Mention the clinical condition concerned 0.5

c. Mention two complications of the same 0.5

a. Corynebacterium diphtheriae

b. Diphtheria

c. Toxic myocarditis, toxic neuritis, air way obstruction

OSCE STATION- CASE SCENARIO

A father brings his 5 year old son Raju to OPD concerned that he is hyperactive. Past history

shows that he was treated for iron deficiency anaemia with 5mg/kg/day elemental iron for 3

months an year back. He has also been treated at home for stomach pains and constipation

with a laxative. His sister has been diagnosed with ADHD and is repeating Std 1. Father has

an automobile repair shop and mother is a housewife and is 3 months pregnant. On

examination, Raju is in the 10th percentile for height and weight. His attention span is very

short and he has difficulty following simple instructions. Except for the slightly delayed

language and social skills, Raju has reached most important developmental milestones.

a) What is the diagnosis? 1 Lead poisoning

b) What test would you order to confirm or rule out your diagnosis? 0.5 Venous blood lead levels

c) Which family member is at greatest risk? 0.5 The unborn baby

d) Name two drugs used for treatment 0.5 Calcium disodium EDTA BAL(dimercaprol) D-penicillamine Succimer(DMSA)

OSCE STATION- CASE SCENARIO

Soumya is 4 months pregnant with her first child. Her 15 year old brother Jai began to have

difficulty in climbing stairs at 4 years of age. He is now confined to a wheelchair. All other

family members including Sowmya are normal. She is worried that her child may be affected. a. What is the most likely clinical diagnosis?

Duchennes muscular dystrophy 1

b. What is the inheritance pattern? 0.5

X linked recessive

c. What are the chances that Sowmya could be affected with the same diasease?

0 %. She will be a carrier. 0.5

d. What would you recommend for antenatal diagnosis? 0.5

Chorionic villi sampling by 12 weeks of gestation for DNA analysis

OSCE STATION- CLINICAL PHOTOGRAPH

1.

1.

a. Identify the rash 1

b. Name the clinical condition in which it is seen. 1

a. Erythema marginatum

b. Rheumatic fever

OSCE STATION- CLINICAL PHOTOGRAPH

2.

a. Identify the clinical condition. 1.5 Beckwith Wiedemann syndrome.

b. What are the physical findings? 1 Hemihypertrophy, macroglossia, omphalocoele, macrosomia, visceromegaly

c. What is the metabolic abnormality? 0.5 Hyperinsulinemic hypoglycemia.

OSCE STATION- PEDIGREE

1.

a. Identify the inheritance pattern 1.5Autosomal dominant inheritance

b. Mention four clinical conditions with the same inheritance 1 Neurofibromatosis type-1,

Von Willebrands disease, Autosomal dominant polycystic kidney,

Hereditay spherocytosis

2. a. Identify the inheritance 1.5 Mitochondrial inheritance

b. Mention two clinical conditions with the same inheritance 1Lebers hereditary optic atrophy

Kerans Sayers disease

OSCE STATION - ECG1.

a. Identify the ECG rhythm 1Sinus tachycardia

b. Write the points in favour of your diagnosis. 0.5 HR 170 beats/min

Presence of P waves preceding ORS

narrow QRS<0.8 sec

OSCE STATION2.

a. Identify the ECG rhythm

1

b. Write the points in favour of your diagnosis.

0.5

a. Supra ventricular tachycardia

b. HR 300 beats/min

Absence of P waves

Narrow QRS<0.8

3.

a. What is the diagnosis? 1 Hyperkalemia

b. Mention the drugs used to treat this condition. 1 Inj.Calcium glucaonate 10/%

Inj Sodium bicarbonate Salbutamol nebulization

Glucose insulin drip

OSCE STATION-ULTRASOUND

1.

a. What is the clinical diagnosis? 1.5

Intaventricular hemorrhage

b. Mention four causes for the same

Prematurity- germinal matrix bleed

Haemorrhagiic disease of the newborn

Neonatal ITP

Trauma/ Child abuse 1

2.

a. What is the diagnosis? 1.5

Congenital hypertrophic pyloric stenosis

b. What is the electrolyte imbalance seen? 1

Hypochloremic metabolic alkalosis

OSCE STATION- ASTHMA COUNSELING

9 year old Arun has been diagnosed with bronchial asthma. His mother has been explained about the chronic nature of the illness and treatment options. She is anxious about the measures she can take at home to prevent recurrent attacks. In the next 5 minutes talk to Arun’s mother about “PREVENTION and ELIMINATION OF TRIGGERS AT HOME” You are being observed by the examiner for health education and communication skills.

MotherWhat precautions should I take at home to prevent my child from getting recurrent attacks?EXAMINER CHECKLIST (maximum 3 marks for 6 and above)SKILL1. Bed room to be kept clean and dust free2. Wet mopping preferable to dry mopping3. Light plain curtains, bed sheets easily washable ones in child’s bedroom (to be washed in hot water)4. Regular dusting of calendars and paintings and books when child not at home5. Keeping animal pets like dogs and cats away from the child’s bed room6. Smoking to be avoided at home7. Strong and pungent odours like wet paint, disinfectants minimized8. Windows to be kept open when strong smells of cooking or smoke at home9. Windows to be closed when outside air is very much polluted or full of pollen from flowers and trees10. Avoid very cold foods

ATTITUDE (0.5 mark each)1. INTRODUCTION TO THE MOTHER

2. MANNER OF THE STUDENT IS GENTLE WITH THE MOTHER

3. EXPLANATION TO THE M0THER IS CLEAR AND ORGANISED

4. TAKES FEEDBACK FROM THE MOTEHR TO BE SURE IF SHE HAS UNDERSTOOD

OSCE STATION- ORDER SHEET

Mehul, one year old child weighing 10 kg is admitted with loose stools and vomiting with no

obvious signs of dehydration. His serum sodium is 160 meq/l and serum potassium is

3.5 meq/l.Urine output is adequate.

a. Calculate the free water deficit 2

FWD = 0.6 x wt x (1 - 145/current sodium) = 560 ml

b. Write the fluid orders for this child. 3

Hypernatremia should be corrected over 48 hours

Serum sodium should be monitored serially

Fluid order for each day= maintenance fluid +half of FWD + ongoing losses

Adequate urine out implies 2ml/kg/hr= 480ml/day

Maintenance fluid= 1000ml + Half of FWD = 280 ml + Ongoing losses = 480ml

Total fluid requirement per day = 1760 ml

D50.45NS 440 ml IV Q 6 hourly with 5meq Inj KCl in each 500 ml of IV fluid to be given

each day for two days

OSCE STATION

1.

a. Identify the clinical condition 2Pyothorax

b. What is the sign seen in the imaging study? 1Split pleura sign

c. How will you treat the condition?

IV antibioticsIntercostal drainage VATS

OSCE STATION

2.

What is the diagnosis? 1

Extradural hematoma

3.

What is the diagnosis? 1

Subdural hematoma

OSCE STATION

1

a. Identify the slide 1.5Macrocytic anemia

b. Mention two causes for the same 1 B12 deficiencyFolate deficiency

2.

a. Identify the slide 1.5AML

b. Mention two points of identification 1

Large immature cells

Two or more nucleoli

Auer rods- distinctive rod like red staining structures

OSCE STATION: BLS

c. 14 year old male child has collapsed suddenly.

Provide one rescuer CPR for the child

Please clean the mouth of the mannequin with spirit cotton before stating CPR

Checks for response- 0.5

Activates emergency response 0.5

Opens airway using head tilt and chin lift 0.5

Checks for breathing 0.5

Gives two rescue breaths 0.5

Checks for carotid pulse 0.5

Locate CPR hand position 0.5

Delivers first 30 cycles of chest compressions at the correct rate 1

Gives two rescue breaths 0.5

OSCE STATION- PFT

1. Identify the study

2. Identify the clinical patterns in a, b and c

a.

b.

c.

1. Spirometry- flow volume curves

2.

a. normal curve

b. restrictive lung diseasse

c. obstructive lung disease

OSCE STATION – NALS

Resuscitate a newborn with the provided equipments.

Please ask questions regarding status of infant –wherever necessary.

1) Check the following equipments before proceeding further

Ø Bag mask valve

Ø Laryngoscope

2) Get information about the infant from the observer before proceeding to resuscitate and at each step whenever necessary

Answer Key

Check list for observer.

Bag mask valve…does the candidate 1- attach reservoir?- check pop off valve?Laryngoscope – Checks bulb & handle

Does candidate ask the following 3 questions? 1

Ø Crying well – breathing well or not?Ø Pink or blue colour?Ø Good muscle tone?

The Observer Should Say Baby Is Not BreathingDoes he clear airway/provide warmth/ position dry infant/stimulate? 1

and then ask status of baby

Observer Says: Baby Still Not Breathing well

Does he give PPV for 30 seconds? 1Correct positionEC clamp technique

Chest expansionand then ask status of baby

Observer Says Hr- 50/Min, Blue

Does he start chest compressions? 1Correct technique?

Recent changes in Neonatal resusciatation (2010 guidelines)

OSCE STATION- ANTHROPOMETRY

PHYSICAL EXAMINATION STATION (TIME 5 MINUTES)

Measure the following in this child and document.

1. Standing height

2. Head circumference

3. Chest circumference

4. Upper segment to lower segment ratio

You are being observed for skills in anthropometry.

EXAMINER CHECK LIST

HEAD CIRCUMFERENCE 1

1. Occipital protruberance to supraorbital ridges2. Crossed tape method (firm pressure on hair to compress)

STANDING HEIGHT 1

1. Heels buttocks and back brought in contact with vertical surface- wall2. Frankfurt plane—horizontal3. Head piece firmly over vertex to compress hair

CHEST CIRCUMFERENCE 1

Measures the chest circumference at the level of nipples

LOWER SEGMENT

Measures from pubic symphysis to sole

UPPER SEGMENT

Standing height – lower segment

UPPER SEGMENT TO LOWER SEGMENT RATIO 1

ATTITUDE 1

1. EXPLAINED TO THE CHILD WHAT HE IS GOING TO DO

2. WAS GENTLE WITH THE CHILD

3. WAS COURTEOUS

OSCE STATION- DRUG

PROSTAGLANDIN E1

1. What are the indications for administration? 2

2. Mention four adverse effects of this drug? 2

3. How do you monitor the newborn when the drug is given? 1

1. INDICATIONS

1. Transposition of the great vessels.2. Lesions with ductal dependent pulmonary blood flow- TOF, PS, pulmonary atresia,

tricuspid atresia, Ebsteins anomaly3. Lesions with ductal dependent systemic blood flow- AS, COA, hypoplastic left heart

syndrome, interrupted aortic arch

2. ADVERSE EFFECTS

1. Apnoea.2. Hypotension.3. Hyperthermia (transient).4. Hypoglycaemia5. Tachycardia.6. Bradycardia.7. Seizures.8. Diarrhoea.9. Skin flush secondary to vasodilation- occurs more frequently with intraarterial

administration.10. Sepsis, cardiac arrest, disseminated intravascular coagulation, hypokalaemia, oedema,

cortical proliferation of the long bones.

3. MONITORING

o Observe respiratory effort closelyo Monitor arterial pressure closely. o Watch for apneao Watch for bleeding diathesis-

OSCE STATION- SENSITIVITY/ SPECIFICITY

1000 babies were born in a maternity home in 2010. 185 babies had cord TSH more than 25µIU/ml. 95 of these turned out to be congenital hypothyroidism. 5 babies had cord TSH less than 25 µIU/ml who later on had proven congenital hypothyroidism.

Calculate the following for newborn thyroid screening test-

a. True positive and true negative 1b. Sensitivity 1c. Specificity 1d. Positive predictive value 1e. Negative predictive value 1

Total population = 1000

Positive test = 185 Negative test = 815

True positive = 95 False positive = 90

Flase negative = 5 True negative = 810

Sensitivity = TP/ TP + FN x 100 = 95%

Specificity = TN/ TN + FP x 100 = 90%

Positive predictive value= TP/ TP + FP x 100 = 51.4%

Negative predictive value= TN/ TN + FN x100= 99.4%

OSCE STATION – NATIONAL HEALTH PROGRAMME

1. 28 year old Meera who has delivered 1 hour ago in your hospital. Baby weighs 2.8 kg and has no apparent problem. She was tested HIV positive during early preganency. Her CD4 count was 500. She has been on Anti retroviral drugs (tripple drug regimen) since 14 weeks of gestation.

a. What is advice regarding breast feeding and weaning? 1.5Exclusive breast feeding upto six months Start complementary feeds at six monthsContinue breast feeds with complementary feeds upto one year of age

b. What is the advice regarding ART for the baby? 1

Syrup nevirapine 15 mg OD for 6 weeks only

2. 25 years old, Mrs Nazeema has delivered a female baby weighing 3 kgs one hour back. She was unbooked and was detected to be HIV positive during delivery. She was given nevirapine during delivery.

a. What is the advice regarding breast feeding? 1.5 Exclusive breast feeding upto six months Start complementary feeds at six monthsContinue breast feeds with complementary feeds upto one year of age

b. What is the advice regarding ART for the baby? 1 Syrup nevirapine 15 mg OD for 6 weeks Syrup nevirapine 20 mg OD for 6 weeks -6 months Syrup nevirapine 15 mg OD for 6 -9 months Syrup nevirapine 15 mg OD for 9 months to 1 year

Syrup nevirapine to be continued for one week after all the breast feeding is stopped.

OSCE STATION

1. 3 year old child with loose stools-Na- 134 meq/l, K – 2.9 meq/l, Cl – 113 meq/l, HCO3- 16 2ABG- ph- 7.31, PCO2- 34, HCO3- 16

a. Calculate anion gap( Na +K) – (Cl+HCO3)= 7.9

b. What is the acid base imbalance?

Compensated Metabolic acidosisExpected PCO2 = (1.5x HCO3) + 8 +/- 2 = 32+/- 2

2. 10 year old child with salycilate poisoning. 1.5Anion gap= 30ABG- ph- 7.3, pCO2 = 32, HCO3= 10

What is the acid base imbalance?

Expected PCO2= 23 +/-2Actual PCO2= 32, so there is respiratory acidosis also

In all cases of high anion gap metabolic acidosis, corrected HCO3 = Actual HCO3 + [anion gap-12] , should be calculated. Corrected HCO3 = 28Corrected HCO3 > 24 is associated with coexisting metabolic alkalosis

This child has -metabolic acidosis with respiratory acidosis with co-existing metabolic alkalosis

3. 5 year old child with severe respiratory distress 1.5PaO2=56, PaCO2= 50

Calculate d(A-a)

PAO2= 150-1.25(PaCO2)=87.5d(A-a)= PAO2-PaO2 = 31.5

OSCE STATION- DEVELOPMENTAL ASSESSMENT

I. Child ‘A’ walks up and down stairs with alternating legs.

a) What would be your assessment of the age of this child?

b) Name 2 adaptive milestones specific for this age.

II. Child B - copies cross and square

- Imitates construction of “gate” of 5 cubes

a) What would be the child’s probable age?

b) Mention 2 specific motor milestones for this age.

III. Match the following

a) Palmar grasp gone - 8 months

b) Transfers object from hand-to-hand - 4 months

c) Turn pages of book - 5.5 months

d) Thumb finger grasp - 12 months

I. a) 30 monthsb)

• Makes tower of 9 cubes• makes vertical and horizontal strokes, but generally will not join them to make

cross; • imitates circular stroke, forming closed figure

II.a) 48 monthsb) – Hops on one foot

- throws ball overhand- Uses scissors to cut out pictures- Climbs well

III.a) 4 monthsb) 5.5 monthsc) 12 monthsd) 8 months

OSCE STATION- MORTALITY RATES

Total births in 2006 – 1,00000Died between 28 weeks to term - 500Died during first week – 300Died after one week but before one month – 100Total deaths under 1 year – 100

Calculatea. Perinatal mortality rateb. Neonatal mortality ratec. Infant mortality rate

PMR = Total perinatal deaths/Total no. of live births X 1000

800/1.00000 X 1000 = 8 per 1000 births

NMR = Total neonatal deaths/Total live births X 1000

400/1.00000 X 1000 = 4.0/ 1000 live births

IMR = No. of deaths < one year/Total live births X 10001000/100000 X 1000 = 10/ 1000 live births

OSCE STATION- HISTORY TAKING

Two year old female child is brought with global developmental delay

Elicit – Birth history from the mother.

EXAMINER CHECK LIST

Introduces to the mother 0.5Attitude- polite, courteous, good posture, maintains eye to eye contact Asks leading questions

ANTENATAL (at least six points)1. What was the age at conception? 1.52. What was the pre-pregnancy weight?3. Any pre-existing illness?4. Was it a spontaneous/assissted conception?5. Was the pregnancy booked, supervised with regular follow ups?6. What was the weight gain during pregnancy?7. Did you take iron and calcium tablets from third month to end of pregnancy?8. Did you have any fever with rash and lymphadenopathy during first three months?u 9. Did you have any exposure to drugs/radiation?10.Any H/O PIH,GDM,UTI, bleeding PV?

NATAL (at least six points) 1.5 1. Was it a hospital/home delivery?2. Who conducted the delivery?3. Were sterile precautions taken if it was a home delivery?4. What was the duration of labour?5. What was the duration of leaking PV?6. Did y fevou have any fever before or during delivery?7. Did you have any foul discharge PV?8. Was the delivery- NVD/ Cs/instrumental?9. Was it a twin delivery?

POST NATAL (at least six points) 1.51. Did baby cry at birth?2. If not any treatment done?3. What was the birth weight?4. Did baby suck well on the breast?5. Did baby have any fast breathing?6. Any abnormal movements was noticed in the baby?7. Any yellowish discolouration of skin?8. Any fever, rash or poor feeding was noticed in the baby?9. Any floppiness, paucity of movements, abnormal fisting, prolonged sleeping was noticed in the baby?

OSCE STATION – HISTORY TAKING

One year old child Raghav is brought to your OPD with concerns of shortness of hearing.

Elicit relevant history.

EXAMINER CHECK LIST

Introduces to mother, polite, courteous, and asks leading questions. 0.5

Response to noises of varied loudness and progression of the disease 1.5

H/O trauma to the ear, ear infection, ear discharge

H/O fever with seizures and prolonged illness

Did baby receive any ototoxic drugs?

ANTENATAL- H/O fever with rash and lymphadenopathy 0.5 NATAL Was the baby term or preterm? 0.5

POST NATAL- Did baby cry at birth? 1 What was the birth weight?

Did the baby have jaundice? Do you know how high the bilirubin value was? Was the baby ventilated for any reason?

Did the baby have any fever, rash and convulsions?

DEVELOPMENT- When did baby start recognising your voice, 0.5 turning towards loud noises?

FAMILY HISTORY OF DEAFNESS 0.5

OSCE STATION – INSTRUMENTS

1.

a. Identify the device 1

Peripherally inserted central catheter /epicath

b. What is it used for? 0.5

To provide medium and long term IV access/ TPN in neonates

2.

a. Identify the device

1

Amplatzer septal occluder

b. What is it used for?

1

For device closure of ASD

3.

a. Identify the device 1.5 PDA coil

OSCE STATION : IMMUNIZATION

Aryan is a 1 year old healthy child. He has been fully immunized.

His mother is concerned that he does not have a BCG scar. She is worried that he

may catch TB. She is also concerned about the BCG vaccine which she feels may

need to be repeated.

How do you address these two concerns?

You are being observed by the examiner for health education and communication

skills.

Marking:

Health Education• 1 ½ marks each for :

1. Repeat BCG vaccination is required.

2. Mentioning the natural history after a BCG vaccine such as development of a nodule after 4-6 weeks with possibility of formation of abscess and ulcer.

• -1 mark for mentioning a Mantoux test.

Communication skills:

½ mark each for the following:• Introduction to the mother

• Non-verbal communication skills such as eye contact/hand gestures/body lan-guage

• Verbal communication skills such as ability to explain in clear English with non-medical terminology in a clear and organized manner

• Concluding with a brief summary + asking the mother if she has any questions.

http://groups.yahoo.com/group/PediatricsDNB/

Theory: http://dnbpediatricstheory.blogspot.in/

OSCE: http://oscepediatrics.blogspot.in/

Clinical: http://clinicalpediatrics.blogspot.in/

Practicals: http://practicalpediatrics.blogspot.in/

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