Pediatrics OSCE

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STATION 1 STATION 1: CHECKLIST

Mentioned Not mentioned


(0)
Instruction to Students: (1)

Initial approach to
the patient
Please take a focused history from a 10- (Introduces him-
year-old patient presented with abdominal herself, explains
pain. (Simulated Patient) what he/she will be
doing) Inquire about

– Location

– Onset
– Quality
– Severity
– Exacerbating/relieving
factors
– Associated symptoms
– Setting in which it
occurs
– Drug history
Overall rating

Communication Skills 5 4 3 2 1

____________________
Evaluator

STATION 2 STATION 3
Instruction to students: Read the short case history then answer
the following questions.
Instruction to students.
Read the short statement carefully then answer the A 3200 grams baby boy was born via normal
following questions. (Fill in the blanks) spontaneous delivery to a 28-year-old G1P0
mother with the following physical findings at
In the PE of the abdomen, inspection is the birth.
1 min 5 min
most important step. Please complete the
following statement. HR
160
140 beats/min 2
beats/min 2
Respirations
Crying 2 Crying 2
1. A scaphoid abdomen can be sign of
• diaphragmatic hernia – bowel herniation into Blue Body pink
Color
the chest all over 0 Blue extremities 1
• pyloric stenosis – narrowing of antrum Flexed arms
Tone Active 2
and legs 1
Reflex irritability Sneezes with catheter
Grimaces 1
2. A distended abdomen may signify inserted in the nose 2
• Obesity, celiac disease (intolerance to
wheat/gluten – irreg.BM), intussusception(SI
invaginates intestinal lumen - obstruction),
megacolon (dilatation d/t mechanical
obstruction)

3. On newborn examination, the


number of umbilical vessels should be
noted: 2 Arteries 1 Veins Question 1: Apgar score at 1 min 6

Question 2 : Apgar score at 5 min 9


STATION 4
STATION 5
REST STATION Instruction to Student. Plot the weight of newborn
infant born by C/S at 35 weeks age of gestation
weighing 4000 grams.
Question 1: After plotting in the growth
chart, what is the classification of this
newborn based on maturity and intrauterine
growth?
A. Term, AGA
B. Term, SGA
C. Term, LGA
D. Preterm, AGA
E. Preterm, SGA
F. Preterm, LGA
Question 2: What is the most important and
common maternal risk factor in this case?
1. Maternal smoking
2. Maternal undernutrition
3. Maternal diabetes
4. Maternal infection

STATION 6 STATION 7
Instruction to student:
Locate the auscultatory areas on the Instruction to students: Read the short statement
carefully and then answer the following questions.
anterior chest wall of the following heart
valves (Indicate your answer in capital
Auscultation tells us most about the
letters).
functioning of the valves which we hear
opening and closing. (Choose the correct
answer)

C D Question 1: What denotes closing of the AV


A
valves?
B
A. First heart sound (S1)
A
B. Second heart sound (S2)
C. Third heart sound (S3)

Question 2: What is responsible for closing of


1. Mitral valve TH
A 5 ICS L MCL the semilunar valves?
2. Aortic valve C 2ND ICS R PSB 1. First heart sound (S1)

3. Tricuspid valve B 4TH ICS L PSB 2. Second heart sound (S2)


4. Pulmonic valve D 2ND ICS L PSB 3. Third heart sound (S3)
STATION 9
STATION 8
Instruction to students: Study the photo carefully
then answer the following questions

REST
STATION
Question: What birth injury sustained by
this newborn infant during labor and
delivery? CAPUT SUCCEDANEUM (a
diffuse edematous swelling of soft
tissues of the scalp that may EXTEND
across the suture line)

STATION 10
STATION 10: CHECKLIST
Instruction to students. Mentioned (1) Not Mentioned
(1)
Formulate the Maternal and Birth Initial approach to the patient
history from a mother who just (Introduces him-herself,
explains what he/she will be
delivered. (Simulated patient) doing)
Inquire about:

– Age , gravidity and parity


of mother at delivery

– Prenatal Check-ups
– Alcohol/smoking/ drugs/
irradiation
– Maternal infections/ illness

– Genetics/ hereditary
disease
– Manner of delivery
– Maternal complications
– APGAR score
– Birth weight
– Postnatal complications

Overall rating

Communication Skills 5 4 3 2 1

____________________
Evaluator
STATION 11
STATION 12
Instruction to students:
Take and record the
anthropometric measurements of
this patient. (Doll /simulated
REST patient)

STATION

STATION 12: CHECKLIST STATION 13


Performed Performed but Not performed Instruction to student:
competently not fully or incompetent
(2) competent (0)
(1)
Initial approach to the Fill in the blanks provided for on the
patient following routine immunizations in infants
(Introduces him-
herself, explains what and children:
he/she will be doing)
Anthropometrics Age of Route of
1. Head Immunization
circumference Administration Administration
2. Weight – BCG
3. Height
At birth ID
4. Chest
– Hepatitis B
circumference At birth IM
5. Abdominal
circumference – DTaP + OPV
36 MOS IM + PO
Overall rating
– Measles
6-9 MOS SC
– MMR
15 MOS SC
____________________
Evaluator
STATION 15:
STATION 14 Instruction to student:

In the Pediatric physical


examination, what information
should you include in the
GENERAL SURVEY?
REST
STATION

STATION 15: CHECKLIST


Mentioned
(1)
Not Mentioned
(0)
STATION 16

Initial approach to the


Instruction to students.
patient
(Introduces him-
herself, explains what
Test the integrity of CN II, CN III,
he/she will be doing)
Did the student ask
IV and VI. (Simulated patient)
about
1. Patient’s general
appearance
Mental state
Nutritional state
Sate of hydration
State of development
2. Patient’s activity level
Ambulatory or
bedridden
3. Whether the patient
appears to be ill
4. Whether the patient is
interacting with
surroundings
5. Level of distress
Cardiopulmonary
Overall rating

Communication Skills 5 4 3 2 1

____________________
Evaluator
STATION 17
STATION 16: CHECKLIST
Performed Performed but not Not performed
competently fully competent or incompetent
(2) (1) (0)
Initial approach
to the patient

REST
(Introduces
him-herself,
explains what
he/she will be

STATION
doing)
Cranial Nerves
Examination
- CN 2 (visual
acuity)
- CN 3, CN 4,
CN 6 (EOM
movements,
pupillary size
and reaction
to light
Overall rating

____________________
Evaluator

STATION 18: CHECKLIST


STATION 18
Performed Performed but not Not performed
Instruction to students. competently
(2)
fully competent
(1)
or incompetent
(0)
Initial approach
Test the integrity of CN IX, CN X, to the patient
(Introduces
CN XI and CN XII. (Simulated him-herself,
patient) explains what
he/she will be
doing)
- CN 9, CN 10
(gag reflex)
- CN 11
(turning head
against
resistance)
- CN 12
(tongue
deviation)
Overall rating

____________________
Evaluator
STATION 19

Instruction to students:

Read the given data below then answer the


following questions.

A 2 year old boy with actual weight of 10


kg.

Question 1: Plot the actual weight of this


boy in the growth chart and
note down the percentile by
weight.

Question 2: Compute the ideal body


weight in kg?
(Show your calculation)

Age in years x 2 + 8 for IB W


2x2+8 =12kg

STATION 20

Instruction to students:

Read the given data below then answer the


following questions.

A 2 year old girl with actual height or length


of 85 cm.

Question1. Plot the actual height of this girl


in the growth chart and note down the
percentile by height.

Question 2: Compute the ideal body height


or length in cm of this girl?
(Show your calculation)

cm agex6+77
2 years x6+77 = 89cm
STATION 21 STATION 22:

Instruction to student: Perform the


following primitive reflexes of the newborn
(simulated patient/doll)

A. Moro’s Reflex

REST
STATION
B. Palmar and Plantar Grasp Reflex STATION 22: CHECKLIST
Performed Performed but not Not performed
competently fully competent or incompetent
(2) (1) (0)
Initial
approach to
the patient
(Introduces
him-herself,
explains what
he/she will be
doing)
Did the student
perform the
following
Ref: http://www.hindawi.com/journals/ijpedi/2012/191562/ A. Moro
reflex
B.Palmar and
Plantar
Grasp
Reflex
Overall rating

____________________
Evaluator

STATION 24
STATION 23
Instruction to student:

Perform the Babinski reflex on this

REST patient (Simulated patient-Doll).

STATION
STATION 24: CHECKLIST STATION 25
Instruction to student: Study the photo carefully
Performed Performed but not Not performed
competently fully competent or incompetent In the examination of the head of this neonate
(2) (1) (0) born after a difficult delivery. identify the
Initial approach to the
patient abnormality noted.
(Introduces him-
herself, explains what
he/she will be doing)
C. Did the student
position the
patient with
the foot
perpendicular
to the ground
and the outer
side of the sole
of the foot is
stimulated?
D. Did the student
elicit by firm
steady slow
stroking of the
external
portion of the
sole of the foot
with an object
such as key
beginning at
the heel
extending to
the base of the
toes? CEPHALHEMATOMA (a
Overall rating subperiosteal hemorrhage that NEVER
EXTENDS across the suture line)

STATION 27
Instruction to student: Please answer the
following questions: (Fill in the blanks)
STATION 26
1) A child’s length lying flat or supine on a
table is measured until 2 years old.

REST
Head circumference is a measurement taken around the
largest part of a child’s head. This measurement is
typically taken with children ages 0-3 years old.

2) Head circumference is measured until 3

STATION years old in all pediatric cases regardless


whether there is neurologic problem.
Length is the linear measurement for infants up to 24
months. Length measurements (instead of height) are
also taken for children 24 to 36 months who cannot
stand without assistance.

3) Anterior fontanel should be closed at


approximately 9-12 months of age.

4.) Posterior fontanel should be closed at


approximately 2-4 mos weeks/months of
age

http://www.orphannutrition.org/nutrition-best-
practices/growth-charts/using-the-who-growth-charts/
STATION 28 STATION 29
Instruction to student. Study carefully the photo of
Instruction to Student: Read the short case history this newborn infant then answer the following
of a patient shown in the photo and then answer the questions:
following questions. You have elicited the Moro’s reflex in this
newborn infant.

This 3 day old newborn full term infant delivered


via NSD and has this physical finding on the
back. Question 1: Moro’s reflex disappear in most normal babies
at what age? A. 10-12 months
Question 1: Identify the abnormal finding B. 8-10 months

present in this newborn C. 4- 6 months


Question 2: Asymmetric Moro’s response may signify sign
of local injury – damage to peripheral
MONGOLIAN SPOT (dark blue or
nerves, cervical cord or fracture of the
purple bruise like macular spots clavicle
usually over the sacrum)

STATION 30
STATION 31
Examine the
Instruction to student.

REST tympanic membrane of this patient.

STATION
STATION 31:
STATION 32
(Checklist)
Instruction to student: Read the short statement
Performed Performed but not Not performed carefully then answer the following questions.
competently fully competent or incompetent
(2) (1) (0)
Initial approach
Abdominal palpation can be enhanced by
to the patient having the child hold the examiner’s hand
(Introduces him- (i.e the hand being used to examine the
herself, explains
what he/she will abdomen) and the child may have to bend
be doing) his / her knees to allow a thorough
1. Did the student examination.
restrain the patient?
2. Did the student
hold the patient’s Question 1: Identify the 4 quadrants on
head to one side? abdomen and organs that can be palpated
3. Did the student in each quadrant.
insert gently the
otoscope speculum
in the external
auditory canal?

STATION 33

REST
STATION
STATION 34
Instruction to student: Interpret the chest STATION 35
radiography done on a 3 year old boy admitted to the
hospital for fever cough and increasing respiratory
difficulty of 2 days duration. Instruction to student. Test the integrity of CN
V, VII and VIII.

ATELECTASIS (A pneumothorax, as well as


atelectasis, is a collapsed lung - with one primary
difference. A pneumothorax involves puncture of
the pleural lining of the lung, releasing air into the
chest cavity. Atelectasis is simply a collapsed
lung which is unable to expand.)
http://icekin10.hubpages.com/hub/Atelectasis-and-Pneumothorax

STATION 35 Checklists
Performed
competently
Performed but not
fully competent
Not performed
or incompetent STATION 37
(2) (1) (0)
Initial approach
to the patient

REST
(Introduces
him-herself,
explains what
he/she will be

STATION
doing)
1. CN V (Corneal
reflex, movement
of temporalis,
masseter and
jaw muscles
2. CN VII
(strength and
symmetry of
facial muscles)
3. CN VIII
(hearing test, use
of noise clacker,
tuning fork,
Musical toy)

Evaluator_________________
STATION 39
Instruction to Student:
STATION 38 Study the photo carefully and read the short case history. Then answer
the following question.
Instruction to student. Read the short statement
carefully then answer the following questions.

Newborns are frequently examined for physical and


neuromuscular maturity using various scales such as
the Ballards. Enumerate the physical characteristics
included in the assessment of physical maturity.
1. ___________ Baby was born full term to a G1P0 mother via NSD.
2. ___________
3. ___________
4. ___________ Question1. What aspects of history do you need to get
5. ___________
from the mother?

Question2: What neurologic finding that is present in this


baby? Asymmetric crying facies (ACF) When the baby
cries, the mouth is pulled downward on one side while not moving on
the other side. This facial weakness only affects the lower lip.

http://www.perinatology.com/calculators/Ballard.htm

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