PG CME at Dr.D.Y.Patil Medical College. 19.08.2012. Prepared by Dr.Ashwin Borade

1. OSCE MADE EASY
CME, 19/8/2012
Dr. Ashwin Borade
Consultant, Sant Dnyaneshwar Medical Education & Research
Centre,Pune
Consultant, Inamdar Multispecialty Hospital ,Pune
8/19/2012 CME,Pune 1

2. Objective structured clinical examination (OSCE)
30 stations (4-5 rest stations) = 150 marks
Five observed stations (50 marks = 1/3rd of OSCE)
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3. OSCE is an skill assessment of your entire post
graduation.
It attempts to assess candidates in all aspects.
It’s an opportunity for student to make up marks.
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4. • FOLLOWING ARE TYPES OF STATIONS
(Based on memory of candidates)
• 1.COUNSELLING 13.CLINICAL METHOD
• 2.NATIONAL PROGRAMME 14.PSM
15.INSTRUMENT
• 3.CLINICAL QUESTION
16.ECG
• 4.PERIPHERAL SMEAR 17.X-RAY
• 5.WASTE MANAGEMENT 18.HISTORY TAKING
• 6.IMMUNIZATION PROGRAMME 19. GENETIC
• 7.NUTRITION 20.CT/USG
21.PEDIGREE CHART
• 8.PICTURE
INTERPRETATION
• 9.ABG 22.NEONATAL
• 10.DRUG RESUCITATION/PALS
• 11.STATISTICS 23.POISONING
• 12.BIBILOGRAPHY 24.PROCEDURE
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5. Format of questions
• Q/A
• Clinical scenarios
• Match the following
• Fill in the blanks
• Photographs, charts, slides
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6. OBSERVED
STATION
OBSERVED
STATION
OBSERVED
STATION
OBSERVED REST
STATION STATION
REST STATION
STATION 1 OBSERVED CME,Pune REST STATION 6
STATION

7. Question Blank OSCE Sheets
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13. • The OSCE Questions & Answers are
prepared by the faculty for the benefit of Post
graduate students.
• These Questions and answers are made for the
students to understand the pattern of OSCE and
not meant to completely cover the subject of
Pediatrics.
• Answer are checked from standard textbook in
case of doubt plz email
• ashwinborade@yahoo.com
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14. Imaging
• X ray (CVS, RS,GIT, CNS, NUT)
• CT scan
• MRI scan
• USG ( neonatal)
• Nuclear scan
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15. What you should Know
• View , preparation, dye used
• Normal structure seen in image
• Abnormality/ problem
• About disease and Treatment of disease
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16. • Describe the X ray findings .
• What is the diagnosis?
• What is the treatment of choice ?
• Write 4 life threatening complications of Kawasaki
disease.
• 8/19/2012 4 side effects pertaining to CVS of Digitalis .
Write CME,Pune 16

17. • X ray chest PA view with air trapped s/o
Pneumopericrdium
• Pneumopericrdium
• O2 and monitoring if severe distress prompt
evacuation.
• MI, Coranry aneurusm, Thrombosis, DIC
• Atrial, ventricular extrasystole, heart
block,AV block, VT,VF
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19. •1. Identify and describe the findings.
•2.What is probable diagnosis ?
•3. What is the treatment?
•4. What is Indian contribution in treatment of
this condition
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20. Answers
• CT scan showing Ventricular dilation
• Hydrocephalus
• Medical Acteazolamide, furosemide and
surgical VP shunt
• Chhabra Shunt /Upadhyaya VP shunt
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22. • Interpret the MRI (1)
• Interpret the EEG (1)
• What is the most probable diagnosis (1)
• Name the drug of choice (1)
• What is the definition of Eosinophilic Meningitis
(1)
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23. Answer
• Cortical damage seen in Bilateral temporal
lobes
• PLEDS Periodic lateralizing Epileptiform
Discharges
• HSV Encephalitis
• Acyclovir
• 10 or more eosinophils/mm3of CSF
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24. • A premature baby was ventilated and on 2 ed
day had convulsions. His investigation done
which is shown here
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25. • Identify and describe investigation
• Spot the diagnosis with grade
• What are preventive measures?
• What is the commonest neurological sequel?
• What is the commonest Opthlmoligical
sequel?
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26. Answers
• Cranial USG showing cystic PVL
• Grade 2 PVL
• Early interventions , maintain normal
cerebral perfusion
• Spastic diparesis
• Strabismus, nystagmus, ROP
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27. • Peripheral Smears and slides
and clinical photographs
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28. • What you should Know
• Peripheral smear and B.M Picture,
• Stain, method , Normal cells, abnormal cells,
Parasite
• Hematology and Oncology
• Inheritance, clinical feature, Prognostic factor
• Treatment, recent advance
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29. Clinical Photo :-
• Syndrome, disorder
• Instrument, PFT,
• Dermatology, Neurocutenous mark, Rash,
• Clinical sign
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30. 8/19/2012 CME,Pune 30

31. • Identify this slide (1)
• Name 2 drugs which can cause this state (2)
• Name 2 non nutritional causes of this state (2)
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32. Answers
• Macrocytic anemia
• Phenytoin / Sulfa group / Zidovudine /
Phenobarbital
• Hypohyroidism / orotic acid uria / Lesch
Nyhan syndrome / Down syndrome /
Marrow failure
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33. What is the organism ?
What is the commonest
presentation ?
What is the drug of choice by
FDA ?
What is incubation period?
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34. • Giardia Lamblia
• Mostly asymptomatic (but rarely Sudden
onset explosive watery diarrhea with
distension of abdomen)
• Tinidazole ,Nizonide
• 1-2 weeks
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35. An anxious mother of a day 5 neonate has brought her baby with
history of following rash since birth.
What is this condition 1
What is the etiology 1
How complications you can encounter1
What is the management 1
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36. • Klippel Trenaunay weber syndrome
• cute nous cavernous vascular malformation
• Cellulites, Thrombophelitits, Heart failure,
Gangrne
• corrective surgery and supportive care
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37. • ECGS
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38. What you should Know
• Normal ECG / Various waves and duration
calculation
• ECG in CHD/ RHD/ electrolyte disorder
• Atrial Flutter ,Wide Complex Tachycardia
• Atrial Fibrillation ,Pericariditis- ,Sinus Tachycardia
• Wolff Parkinson White ,Heart Block ,Electrolyte
abnormalities
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39. 8/19/2012 CME,Pune 39

40. • What does this EKG strip show (1)
• Name 3 EKG findings that helped you in
diagnosis (1)
• Name 2 emergency pharmacological treatment
options of a SVT. (1)
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41. Answer
• Wolff-Parkinson-White [WPW] syndrome)
• short P-R interval, delta wave, and wide
QRS
• adenosine / phenylephrine / edrophonium /
Verapamil
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42. • STATION 1:
•1. Identify the ECG :
•2. Name drugs causing this
•3. Name Inherited conditions a/w this
•4.What is the treatment?
•5.what is common clinical presentation?
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43. • Long Qt
• Amidarone, cispride, Haloperidol
• Jervell and Lange-Nielsen syndrome
Romano-Ward syndrome
• B blokers
• Syncopal episodes by exercise , fright
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44. EEG
Normal waves , pattern
Typical EEG pattern in some disorders
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45. • 8 mts old female child with delayed development milestones
flexor spasm EEG done.
• Describe characteristic EEG findings
• What is diagnosis?
• What is T/t?
• Which type having the good prognosis?
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46. • Hppsarrythmia
• Infartile spasms
• ACTH and glucocorticoids
• Cryptogenic infantile spasms
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47. • Clinical case scenarios
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48. • What you should Know
• Case
• Infection , CVS,RS, CNS,Endo.
• HBsAg +ve, Chicken Pox,HIV, TB
• Unimmunized child, Rabies
• Infection :- Rash, clinical feature, incubation,
Period drug of choice, isolation complications
• Endocrinology
• BMI, Target height, short stature, DKA,
insulin dosage, Tanner staging
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49. • A 10 day old infant male suddenly developed
vomiting, lethargy, not feeding well on evaluation
his CBC and sepsis work up was negative. His
ABG showed PH 7.38 PCO2 -40
• Plasma NH3 525 umol/L
• What is Probable diagnosis?
• Enlist drugs used to treat it?
• What is commonest form of this disorder?
• In this patient what form will be more severe?
• What lab parameters are decreased in neonatal
sepsis?
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50. • Urea cycle defect
• Sodium benzoate, Argenine, cetrulline
• Carniline, Lactulose
• Carbomoyl Phosphatan synthase deficiency
• OTC deficiency
• Platelet, WBC count
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51. Drugs and Vaccine
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52. • What you should Know
• Drugs
• Classification, dosage, route, uses, side effect,
precaution. Eg.Adrenaline, sodabicarb, Ampo
B, IVIG, Surfactant
• Drug of choice,IV fluid constituents, ORS
• Vaccine
• UIP, IAP schedule, Newer vaccine
• Vaccine dose, schedule side effects
indications and contraindications, storage
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53. Caffeine Citrate
• Which group this drug belong ? (1)
• What is mech of action (1)
• What are indications? (1)
• What is dosages ? (1)
•8/19/2012 are side effects? (1)
What CME,Pune 53

54. Answers
• Methylxantine
• Resp. centre stimulation, Antagonism of
adenosine, Incr. Diaphragm contractility
• Apnea of prematurity
• Lading dose 20 mg/Kg IV followed by 5-12
mg/kg
• Cardiac arrthymia, tachycardia, Irritability
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55. • What is dose of Leviractam and
Lamotrigine?
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56. • Leviractam 20 mg/kg/day
• Lamotrigine 2 MG/kg/24hrs → 5-10
mg/kg/day
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57. Chicken pox vaccine
• What is the dose ?
• What strain is used ?
• Post exposure prophylaxis how vaccine can
be given?
• What are indications for varicella
immunoglobin in neonate
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58. Answers
• 0.5 ml S. C
• Oka strain
• Within 72 hrs ( 3-5 days)
• If mother develops varicella 5 days before
to 2 daysafter delivery
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59. • Electrolyte/ ABG’s / Ventilators
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60. • What you should Know
• Case study
• Interpretation of ABG, calculation of PaO2,
CaCo2
• Formula for AaDo2, OI
• Ventilator setting/modes/change as per ABG
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61. A 4 yrs old male child with fever and AGE admitted in PICU
with cold extremities and respiratory distress . His ABG done
showing
pH -7.27 , PaCo2- 33 mmHg, PaO2- 84 mmHg, HCO3-
17mMol/L
and base excess- 7 mMol/L
• What is ABG diagnosis
• What is line of treatment?
• What is formula to calculate AaDO2
• What is formula to calculate OI
• How u calculate anion gap
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62. Answer
• Metabolic acidosis
• IV fluid resuscitation
• AaDO2 = PA02-PaO2
• OI= MAPX FiO2/ Postductal PO2 X 100
• Na- Cl – Hco3
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63. • PSM / Statistics / Biomedical / Biblography
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64. • What you should Know
• Health Programme – ICDS, CSSM, Mid Day Meal,RNTCP
• Biomedical Waste – Infectious waste,Non infectious waste
• Medical Stastics
• Def. Mean, mode, meclian, 1st Quartile, 3rd Quartile incidence
Prevalance, Specifically
• Case Control, cohort study
• TP, TN, RR, odd ratio
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65. • What is RNTCP?
• When was RNTCP was started ?
• As per RNTCP aim is to achieve cure rate
of
• What is defaulter ?
• What is treatment failure?
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66. Answer
• Revised Natioanl Tuberculosis control program
• 1992
• 85%
• Patient who return sputum smear + ve after having left t/t
for 2 months
• Patient who was smaer +ve and on t/t remain sputum smear
+ ve again at 5 months or later during t/t.
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67. Dispose the following waste
• Wound dressing material
• Needles
• Plastic wraper
• Indwelling Umbilical catheters
• Discarded food
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68. • Wound dressing material – Yellow bag
• Needles –Blue puncture proof container
• Plastic wraper- Black Bags
• Indwelling Umbilical catheters– Red bags
• Discarded food- Black Bags
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69. Write following journal article in
Vancouver style
Article :Cardiogenic Shock With
Hypereosinophilic Syndrome
Authors :Vinitha Prasad, L Rajam and Ashwin
Borade
Journal : Indian Pediatrics
Year :2009
Volume 46
Page 801-803
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70. Author's surname Initials, Author's surname Initials. Title of
article. Title of Journal. [abbreviated]
Year of publication Month date;Volume Number(Issue
number):page numbers.
• Prasad V, Rajam L , Borade A.Cardiogenic
Shock With Hypereosinophilic Syndrome.
Indian Pediatr. 2009;46: 801-3.
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71. • During a study at hospital the PEFR of 100
adolescences boys follow a normal distribution
with a mean of 280 lit/min, standard deviation 30
lit/min and standard error of 2 lit/min
• What will be the range in which 95% of the boys
PEFR will lie in the sample?
• What will be the range in which mean PEFR of the
population will lie from which the sample was
taken?
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72. Range in which 95% of girls PEFR in the
sample will lie:
mean +/- 2SD = 280 +/-2(30)=220-340
Range in which mean PEFR Value will lie:
mean +/- 2SE( Standard error)-
95% Confidence interval = 280+/- 2(2)= 276-
284
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73. • Determine the sample size to find out the Vitamin A
requirement in the under five children of Pune district . From
the existing literature the mean daily requirement of the same
was documented as 930 I.U with a SD of 90 I.U. Consider the
precision as 9.
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74. Quantitative data
N = 4SD2/L2
4 x 90 x 90 /9 x9 = 400
• Qualitative data N = 4pq/L2
• P = positive factor /prevalence/proportion
• Q = 100 – p
• L = allowable error or precision or variability
• 4 = 1.962(Alpha error) 2
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75. Station
• What is name of curve ? (1/2)
• What are uses ? (1)
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76. Answer
• A scatter plot chart
• It displays series as a set of points specified
by x and y coordinates. A scatter plot is
useful for showing nonlinear relationships
between variables. It requires at least one
category and two series (representing the x
and y coordinates).
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77. Instruments
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78. Station
Identify the instrument. (1/2)
What are indications? (1/2)
What are contraindications ?(1/2)
What is size equipment to be used for child of 7 Kg?
(1/2)
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79. Answer
• Larygneal mask airway
• Elective surgical procedure where face
mask are used or endotracheal intubation is
not necessary.
• Known or unexplained difficult airways,
Profound unconscious patient, patient who
resist LMA
• 1 1/2
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80. Identify instrument?
What it measure ?
What are uses?
How u calculate PEFR using hight in OPD ?
At which variability of PEF we garde as mild intermittent asthma?
8/19/2012 CME,Pune 80

81. Answers
• Peak flow meter
• It measure Peak expiratory flow rate
• Used to assess severity of asthma and
response
• Diagnosis of asthma and monitoring
• PEFR= ( Ht – 100 ) X 5 + 100
• < 20 %
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82. • Emergencies and Poisoning
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83. •
•1. Identify the ECG
•2.What is the treatment if hemodynamic compromise?
•Which cardiac condition it is assosiated ?
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84. • VT
• Defibrillation
• Cardiomyopathy, ALCAPA,
Intramyocardial tumors, Following
corrective surgery for TGA, VSD
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85. A 4 yrs old child brought in ER at 10 AM
with 12 kg and 45 % burn while playing at 8
AM , as a attending Pediatrician
• Calculate his fluid requirement in 48 hr ( As
Per Parkland Formula)
• His 24 hr correction will be complete by
which time?
• What is the desired S. albumin level
• In this patient how much 0.5 % albumin u
will infuse
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86. Answers
• 1st 24 hrs RL 4 ml X 12 ( wt) X 45 ( % of burn )
• ½ in first 8 hrs and ½ in over 16 hrs (2160 ml)
• 2 ed 24 hrs RL with 5 % D ( ½ of 1 st day fluid)
• Next day 8 AM
• 2 gm/dL
• 30-50% burn 0.3 ml of 0.5 % alb/ Kg/ % of burn over 24 hr
(0.3 X12X 45 = 162 ml)
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87. Match the following antidotes
• Paracetamol Atropine/PAM
• Dhatura BAL
• Cyanide myl Nitrite
• Mercury Physostigmine
• OP N- Acetylcysteine
• INH Naloxone hydrochloride
• Opiods Pyridoxine
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88. Answers
• Paracetamol N- Acetylcysteine
• Dhatura Physostigmine
• Cyanide Amyl Nitrite
• Mercury BAL
• OP Atropine/PAM
• INH Pyridoxine
• Opiods Naloxone hydrochloride
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89. Nutrition / Growth / Development
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90. Arrange following food items in descending order of
calories content
• 1 cup Tea
• 1 TSF Sugar
• 1 glass milk ( 200 ml)
• 1 cup Cooked Rice
• 1 egg
• 1 TSF Ghee/ Butter
• 1 TSF cooked dal
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91. • 1 cup Cooked Rice 175
• 1 glass milk ( 200 ml) 120
• 1 egg 80
• 1 cup Tea 60
• 1 TSF Ghee/ Butter 36
• 1 TSF Sugar 20
• 1 TSF cooked dal 10
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92. Station
Write average age of attainment in months
for following milestone
• Brings hands together in midline (1/2)
• Builds tower of 6 cubes (1/2)
• Follows one step command without gesture
(1/2)
• Speaks 10-15 words (1/2)
• Stares at own hand (1/2)
• Pretend play with doll (1/2)
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93. • Answer
• Brings hands together in midline -3
• Builds tower of 6 cubes-22
• Follows one step command without gesture-10
• Speaks 10-15 words-18
• Stares at own hand-4
• Pretend play with doll-17
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94. Write down the age at which following
reflex appears
• Palmer grasp
• Rooting reflex
• Moro reflex
• Tonic neck reflex
• Parachute reflex
8/19/2012 CME,Pune 94

95. Answers
• Palmer grasp 28 Wks
• Rooting reflex 32 Wks
• Moro reflex 28-32 Wks
• Tonic neck reflex 35 Wks
• Parachute reflex 7-8 months
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96. Genetics
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97. • What you should Know
• Pedigree, Mechanism of inheritance
• Example, Symbols, clinical photo
• Associated anomalies
• Karyotype, features, T/t
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98. 1.Identify patter of inheritance
2.What is the characteristic feature of this inheritance
3.Give 2 examples
4.In this disorder which organs are most affected
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99. 1. A mitochondrial inheritance pedigree
2 All the children of an affected female but
none of the children of an affected male will
inherit the disease.
3.MERRFand MELAS
4. Organ with greater energy requirement like
brain, muscle and heart, liver
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100. A neonate in LR with characteristic crying
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101. • What is the diagnosis
• What is the defect
• What is commonest presentation ?
• What cardiac lesion can be seen with this?
• What facial feature can be seen with this?
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102. Answers
• Cri Du Chat syndrome
• Micro deletion of short arm of chr, 5
• Cat like cry ( hypotonic, SS, microcephaly)
• VSD, ASD,PDA
• Microcephaly, moon like face,
hypertelorisum, epicantal fold, wide flat
nasal bridge
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103. • Video / audio / Figures
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104. • Video of procedure , NRP
• Audio heart sound
• Figures- diagrammatic presentation of
murmur, type of respiration, ophthalmic
findings
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105. During intubation which is the
correct position
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106. 8/19/2012 CME,Pune 106

107. What is the score is called ?
What are uses ?
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108. • Silverman anderson score
• Asses respiratory distress in newborn
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109. A 4 day old newborn delivered by LSCS with resiratory distress admitted
in nicu brought with icterus, on evaluation s. bilirubin was 16.5. what ur
plan of tretment
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110. Start PT
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111. Plot hight weight of the child and interpret
age 4 yrs , Ht-100 cm, Wt-15
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112. 8/19/2012 CME,Pune 112

113. Best of Luck
Thank You
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