DNB osce

OSCE: 

OSCE D.N.B Workshop

Question 1: 

Question 1 Describe this CT Scan.

Answer 1: 

Answer 1 The CT scan above demonstrates the mass effect of the extra dural haematoma on the main structures of the brain. Midline shift. The ventricles show signs of being compressed.

Question 2: 

Question 2 A. Describe the CT findings. B. Give DD

Answer 2: 

Answer 2 A large, inhomogenous mass is seen on the right side of the abdomen, compressing the right kidney posteriorly . The mass did not appear to arise from the right adrenal gland or right kidney DD Neuroblastoma Wilms tumor Lymphoma Soft tissue sarcoma Pheochromocytoma

Question 3: 

Question 3 A. Describe this X-ray B. Diagnosis C. Management steps

Answer 3: 

Answer 3 Bowel loops in the chest cavity Rt Sided Diaphragmatic Hernia Management NG on drainage No bag and mask ventilation Intubation and ventilation till pt stabilizes and the corrective surgery

Question 4: 

Question 4 Picture: 1 Identify the following Chicken Pox

Question 4: 

Question 4 Picture: 2 Identify the following Alopecia areata

Question 4: 

Question 4 Picture: 3 Identify the following Mongolian Spots

Question 4: 

Question 4 Picture: 4 Identify the following Milia

Question 4: 

Question 4 A 7 year old child post head injury :- Opens eyes in response to voice Utters inappropriate words Localizes painful stimuli Calculate the GCS ? Part II

Answer 4: 

Answer 4 Eye Opening 3 + Verbal Response 3 + Motor Response 5 ========= Answer 11

Question 5: 

Question 5 Describe the ECG Identitify the condition Treatment

Slide 15: 

Narrow complex tachycardia SVT IV Adenosine / Cardioversion

Question 6: 

Question 6 A. According to RNTCP write the treatment protocol for a case of treatment failure. B. According to IAP write the treatment protocol for miliary TB Answer: 2HRZE + 1HRZE + 5HRE Answer: 2HRZE + 7HR

Question 7: 

Question 7 Write down four differences between Supraglottic and tracheal obstruction

Answer 7: 

Answer 7 Supraglottic Tracheal Stridor inspiratory Expiratory Cry is muffled Voice normal Dyspnea is less severe Marked Cough is less marked Barking cough

Question 8: 

Question 8 A Neonate 2 hrs of age has a Respiratory rate of 75/min, Requires more than 40% oxygen, Has moderate to severe retractions, Grunting audible with stethetoscope And decreased air entry. Calculate the Downe’s score for this baby ?

Answer 8: 

Answer 8 1 + 2 + 2 + 1 + 1 = 7

Question 9: 

Question 9 A 4 hrs old neonate has arterial pO2 of 100, pCO2=30. He is on FiO2 of 0.4. Calculate the a/ApO2 ratio? RQ=1

Answer 9: 

Answer 9 ApO 2 = FiO 2 (760-47) - PCO 2 /RQ ApO2= 0.4(760-47)-30/1 =255 apO 2 /ApO 2 = 100/ 255 = 0.39

Question 10: 

Question 10 Write down the details of Manning score (Fetal biophysical profile score)

Answer 10: 

Answer 10 Components of the 30 minute Biophysical Profile Score Component Definition Fetal movements > 3 body or limb movements Fetal tone One episode of active extension and flexion of the limbs; opening and closing of hand Fetal breathing movements > 1 episode of > 30 seconds in 30 minutes - Hiccups are considered breathing activity. Amniotic fluid volume A single 2 cm x 2 cm pocket is considered adequate. Non-stress test 2 accelerations > 15 beats per minute of at least 15 seconds duration

Question 11: 

Question 11 Counsel the mother who has brought her 2 year old male child with the first episode of simple febrile convulsion. -10 marks Observer station

Answer 11: 

Answer 11 Wish the the mother and introduce yourself Explain what a simple febrile and a complex febrile seizure is. Ask for family history febrile convulsions Ask for history of seizures Ask for history of neurodevelopment Use of antipyretics Use of hydrotherapy Prophylaxis intermittent..antipyretics, diazepam, clobazam Management of a seizure at home 1% risk of future epilepsy

Question 12: 

Question 12 Newborn, Term , with MSAF, Weight 3.5 kg. This neonate is delivered limp. Manage. -10 marks Observer station

Answer 12: 

Answer 12 Wash hands, Ask for help of another staff Intubate and suck out the meconium … can be done twice Provide warmth Dry, stimulate , reposition Evaluate resp , HR, COLOR. Provide Positive pressure ventilation HR<60 Chest compressions Administer epinephrine Administer volume Post resuscitation care

Question 13: 

Question 13 Organophosphate Iron Benzodiazepines Cyanides Copper Write down antidotes for the following ?

Answer 13: 

Answer 1 3 Organophosphate------------Atropine, Pralidoxime Iron-------------------------------- Desferrioxamine Benzodiazepines--------------- Flumazenil Cyanides--------------------------Amyl nitrite Copper----------------------------- Penicillamine

Question 14: 

Question 14 Demonstrate the examination of the 5 th nerve ?

Answer 14: 

Answer 14 Corneal Reflex Conjunctival Reflex Sensory examination over scalp, cheek and mandible Loss of pain over the ant 2/3 rd of the tongue Masseter and temporalis examination Pterygoid muscle

Question 15: 

Question 15 Write common causes of leukocorea . - 5 Marks

Answer 15: 

Answer 15 cataract retinoblastoma Pupillary membrane Vitreous opacity Retrolental fibroplasias Retinal detachment

Queston 16: 

Queston 16 Interpret this ABG ? Ph 7.14 Pco2 54 PO2 55 HCO3 13 BE –7

Answer 16: 

Answer 16 Uncompensated respiratory and metabolic acidosis with hypoxemia Ph 7.14 Pco2 54 PO2 55 HCO3 13 BE –7

Question 17: 

Question 17 Steps for Gram staining ? - 5 marks

Answer 17: 

Answer 17 Make a slide of tissue or body fluid that is to be stained. Heat the slide for few seconds until it becomes hot to the touch so that bacteria are firmly mounted to the slide. Add the primary stain crystal violet and incubate 1 minute. Add Gram's iodine for 1 min. It is not a stain; it is a mordant . It doesn't give color directly to the bacteria but it fixes the crystal violet to the bacterial cell wall. Wash with Decolorizer . If the bacteria is Gram-positive it will retain the primary stain. If it is Gram-negative it will lose the primary stain. Add the secondary stain, safranin , and incubate 1 min, then wash with water for a maximum of 5 seconds. If the bacteria is Gram-positive then it will retain the primary stain and will not take the secondary stain. It will look black-violet in a pink background. If it is Gram-negative then it will lose the primary stain and take secondary stain making it pink-red.

Question 18: 

Question 18 Live bacteria, attenuated Live virus attenuated Viral subunit Capsular polysaccharide Toxoid Write 1 example of each of the following ?

Answer 18: 

Answer 18 Live bacteria, attenuated… BCG, Ty21a Live virus attenuated………OPV,MMR Viral subunit………………… Hep B Capsular polysaccharide… Hib , Meningo , Pnemococal Toxoid ………………………… DT,TT

Question 19: 

Question 19 The following is a table which shows cigarette smoking and lung cancer ? Calculate the relative risk ? Cigarette smoking Developed cancer Did not devlop cancer Yes 70 6930 no 3 2997

Answer 19: 

Answer 19 RR= Incidence of disease in exposed/Incidence of disease in non exposed Incidence of disease in exposed = 70/7000=10 per 1000 Incidence of disease in non exposed=3/3000= 1 per 1000 So RR=10/1= 10

Question 20: 

Question 20 A: Describe the PS B: Management

Answer 20: 

Answer 20 Sickling is demonstrated on the PS Treatment Maintain adequate hydration Avoid hypoxia Folic acid supplements Blood transfusions BMT Hydroxy Urea

Question 21: 

Question 21 Describe the PS Diagnosis Inheritance Treatment

Answer 21: 

Answer 21 Spheroidal cells seen… Hereditary Spherocytosis AD Folic acid, Spleenectomy

Question 22: 

Question 22 Child admitted with sudden breathing problems . There was history of playing with marbles at the time of development of marbles. X-RAY done shows ? Describe XRAY ( 2 marks ) Diagnosis ( 2 marks ) Treatment ( 1 mark )

Answer 22: 

Answer 22 X-Ray findings:- The right lung volume is increased and has herniated across the mid-line. The left lung is compressed by the displaced heart and mediastinum . The left lung remains airated and normal bronchi are seen on that side. The right main bronchus cannot be traced from its origin. Rt main bronchus partially obstructed by non opaque foreign body Bronchoscopy and removal

Question 23: 

Question 23 4 year old boy with the following photo and CT. Identify syndrome 2 marks Describe the CT 2 marks Mode of inheritance 1 mark

Answer 23: 

Answer 23 Sturge -Weber Syndrome Axial nonenhanced CT scan shows left hemiatrophy of the cerebral cortex and typical gyral calcification AD

Slide 51: 

Thanks……