Year 5 Paeds End-Of-Posting SAMPLE OSCE

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Class of 2001, National University of Singapore
Toggling of answers available for IE4 and above, Inspired by the Grace of God.

Paediatrics OSCE (30 June 2000)

15 stations, 5 minutes each.
15 pictures.

1)ECG of 6-month old girl with cyanotic heart disease
a)What are the EGG abnormalities?[Can't answer]
b)What is the possible diagnosis?[Can't answer]
b)Pulmonary Atresia, Tricuspid Atresia

2)History of fever 2 weeks ago.
Picture of hand: swollen and with peeling skin

a)What investigations would you do?
b)Is this likely to recur?
[Kawasaki disease]
b)May recur but not likely

3)4 year old child.
Picture of foot: thin reddish wheal-like line extending horizontally across sole

a)Cutaneous larva migrans

4)Fundoscopy: Normal vessels, some white patches
a)What are the abnormalities?
b)What is the likely cause?
a)Cotton wools spots/exudates
b)Miliary tuberculosis. (Not Diabetes, not CMV)

5)Boy's face with bilateral partially red conjunctiva.
a)Describe the abnormality.
b)What is a likely cause?
a)Subconjunctival haemorrhage
b)Whooping cough

6)Chest X Ray: Right middle/lower zone well demarcated consolidation.
a)What is the first line treatment of choice?
a)Amoxycillin/Erythromycin. (Not Cephalosporins)

7)Growth chart: 3, 6 and 9 month. Weight & Height: follow 50th percentile.
OFC: 50th percentile at 3 and 6, then 70% at 9 months

a)Describe the growth chart
b)What might you be worried about?
a)As above. say it "Crosses percentiles"
b)Hydrocephalus, tumor, etc.

8)Hand with mildly-swollen PIP joints
a)Name 3 investigations you would do.
[?TB of joint] a)Mantoux test,Xray hand,CXR

9)15 year old patient with Chromosomal karotype: 45XO
a)Give 2 possible reasons the karotype was done.
a)Delayed puberty, Short stature

10)Lower limb erythematous rash with islets of sparing
a)What is the diagnosis?
b)What are indicators of deterioration?
a)Dengue Fever
b)(Signs of pre-shock)Decreasing platelets, abdominal pain, haemoconcentration

11)Face with adenoma sebaceum and plaque over left forehead
a)Describe the abnormalities in this picture
b)Name 2 complications
a)(As above). [Tuberous sclerosis]
b)Mental retardation, Seizures, Angiolipoma

12)This is a 10kg, 10month old child with 10% dehydration.
a)Write the fluid orders
a)2.5L (1L DSR, 1.5L DSM) - half in the 1st 8 hours, the rest in the next 16 hours.
[Maintenance=10kg x 150ml/kg, Replacement=10% x 10kg]

13)Osmotic fragility test: Resistant. Hb electrophoresis:A + A2(5%) + F.
a)What is the diagnosis?
b)What would the peripheral blood film look like?
a)beta-Thalassemia minor
b)Hypochromic, microcytic anaemia with target cells, anisocytosis, poikilocytosis.

14)Temperature chart given with 3 days of values.
a)What information can be obtained from the temperature chart?
a)Biodata, date of admission, duration of stay, HR, RR, BP, Ht/Wt
Bowel output, Temperature, Tmax, Temperature pattern.

15)Standing child with huge uniformly distended abdomen.
Mild periorbital oedema, slight ankle swelling.
a)What is the diagnosis?
b)Urea 8.2, Creatinine 40, Calcium 1.2. What are the abnormalities and explain why.
a)Nephrotic syndrome.
b)Urea & Cr up because haemoconcentration.
Calcium down because low albumin. (Spurious hypocalcaemia)

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