Ward OSCE of Peadriatics Material1. pptx

Peadriatics

1. Ward osce of Peads 2 Group E BATCH 48 ( deewans group)

2. NOTE : THIS PDF’S QUESTION HAS MANY ANSWERS BUT HERE THE ACCURATE ONE IS RELTED TO THE TOPICS SUGGESTED BEFORE THE WARD TEST.

3. STATION:1 1.CONDITION? The combination of cyanosis and an ejection systolic murmur on the left upper sternal border in a baby raises concern for congenital heart defects, particularly those involving obstruction to blood flow from the right ventricle to the pulmonary artery. One possible diagnosis could be Tetralogy of Fallot (TOF ). 2. PARTICULAR DIAGNOSIS? PULMONARY ATRESIA AND VENTRICULAR SEPTAL DEFECT (right to left SHUNT) 3. TREATMENT? The treatment of Tetralogy of Fallot (TOF) typically involves a combination of medical management and surgical intervention. Here's an overview: Medical Management: Before surgical repair, infants with TOF may require medical management to optimize their condition. This may include medications to manage symptoms such as cyanosis or congestive heart failure. Common medications used may include diuretics to reduce fluid buildup in the body, and prostaglandins to keep the ductus arteriosus open to maintain blood flow to the lungs. Surgical Repair: The definitive treatment for TOF is surgical repair. This usually occurs in the first year of life, often in the first few months. The specific timing of surgery depends on various factors, including the severity of the symptoms and the overall health of the child. The surgical procedure typically involves: Closing the ventricular septal defect (VSD). Enlarging the narrowed pulmonary outflow tract ( infundibulum ). Repairing or replacing the pulmonary valve if necessary. Addressing any other associated abnormalities. The goal of surgery is to relieve the obstruction to blood flow to the lungs and improve oxygenation.

4. STATION 2: QUESTION : BABY PRESENT WITH THE PALLOR FACE IRRITABLE AND EASILY FATIGABLE AND A PICTURE WAS ATTACHED OF SPOON SHAPED NAILS. 1.ANY ONE FINDING? Based on the symptoms of pallor, irritability, and easy fatigability in a baby , the symptoms of pallor, irritability, and easy fatigability can also occur in iron deficiency anemia, especially in infants and young children KOILONYCIA ,POOR WEIGHTGAIN, GI SYMPTOMS , BLOOD TESTS . 2. DIAGNOSIS : IRON DEFICIENCY ANEMIA 3. TREATMENT: Iron Supplementation; Dietary Modifications; Breastfeeding Support; Vitamin C Supplementation; Identifying and Addressing Underlying Causes.

5. STATION 3 1. DIAGNOSIS: Given the symptoms described, malaria would indeed be a pertinent consideration, especially in areas where the disease is prevalent 2. POSSIBLE INVESTIGATIONS: Malaria Rapid Diagnostic Test (RDT ) ; Blood Smear for Malaria Parasites; Complete Blood Count (CBC ) ; Serological Tests : 3. TREATMENT: The treatment for malaria depends on several factors, including the species of Plasmodium causing the infection, the severity of the illness, the patient's age, pregnancy status, and any underlying health conditions. Treatment should be initiated promptly upon suspicion or confirmation of malaria to prevent complications and reduce morbidity and mortality. Here are the general principles of treatment: Antimalarial Medications ; Supportive Care; Hospitalization; Preventive Measures

6. Station 4 1. diagnosis : The presentation of a 5-year-old child with prolonged fever, yellow discoloration (jaundice) for 7 months, abdominal distention for 6 months, and a positive fluid thrill suggests a chronic and serious underlying medical condition. Given the combination of symptoms, several possible diagnoses need to be considered : a. Chronic liver diseases can present with jaundice, abdominal distention, and ascites (fluid accumulation in the abdomen), leading to a positive fluid thrill. B. Portal Hypertension: Portal hypertension, often secondary to liver disease, can result in ascites and abdominal distention. It can also lead to splenomegaly and collateral circulation, contributing to a positive fluid thrill. 2. causes of this condition : Causes of chronic liver disease in children include viral hepatitis (especially hepatitis B and C), autoimmune hepatitis, metabolic liver diseases, biliary atresia , and others . 3. investigations: Blood Tests: Complete Blood Count (CBC): To assess for anemia, leukocytosis , or thrombocytopenia. Liver Function Tests (LFTs): Including serum bilirubin (total and direct), transaminases (AST, ALT), alkaline phosphatase (ALP), and albumin levels. Coagulation Profile: To evaluate for abnormalities in clotting factors, which may indicate liver dysfunction. Viral Hepatitis Serology: Testing for hepatitis A, B, and C viruses to determine if viral hepatitis is the cause of liver dysfunction. Autoimmune Markers: Testing for autoimmune hepatitis antibodies (ANA, ASMA, LKM) if autoimmune liver disease is suspected. Imaging Studies; Liver Biopsy; Ascitic Fluid Analysis

7. Station 5: 1. diagnosis: Persistent Split S2 : A persistent split S2 that does not vary with respiration may indicate other conditions, such as: Right Bundle Branch Block (RBBB) : Delayed closure of the pulmonic valve due to a conduction delay in the right bundle branch can cause a persistent split S2. Pulmonary Hypertension : Increased pressure in the pulmonary artery can delay closure of the pulmonic valve, leading to a split S2. Atrial Septal Defect (ASD ) : An ASD allows blood to flow from the left atrium to the right atrium, causing increased right ventricular volume and delaying closure of the pulmonic valve. Pulmonary Valve Stenosis : Narrowing of the pulmonary valve can result in delayed closure of the valve and a split S2. Other Congenital Heart Defects : Certain congenital heart defects may cause abnormal blood flow patterns and result in a split S2. Other Heart Conditions : In addition to the above, various other cardiac conditions may present with a split S2, including atrial septal defects, ventricular septal defects, and other valvular abnormalities. Given the complexity of cardiac evaluations, a thorough assessment by a pediatric cardiologist is recommended for any child with a split S2, especially if it is persistent or associated with other symptoms or clinical findings. Diagnostic tests such as echocardiography may be necessary to further evaluate the underlying cause and determine the appropriate management plan . Ans is ASD . 2.TYPES? : Secundum ASD, Primum ASD, Sinus Venosus ASD, Coronary Sinus ASD, Unroofed Coronary Sinus 3. INVESTIGATIONS: Diagnostic Imaging : Imaging techniques such as echocardiography, including transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE ), Cardiac Catheterization ; Cardiac MRI; Genetic Studies

8. STATION:6 1. DIAGNOSIS: the symptoms described, including generalized swelling (edema), blood in the urine ( hematuria ), a history of a recent sore throat, and elevated blood pressure, are consistent with nephritic syndrome . 2. IVESTIGATIONS: urinalysis, blood tests (to assess kidney function and inflammatory markers), and possibly imaging studies, to confirm the diagnosis and determine the severity of the condition . 3. TREATMENT: Treatment for nephritic syndrome typically involves addressing the underlying cause (such as treating any ongoing infection) and managing symptoms to prevent complications and promote kidney function recovery. This may include medications to control blood pressure and reduce inflammation, as well as dietary modifications to limit salt and fluid intake.

9. STATION:2 1. DIAGNOSIS: The continuous murmur heard at the second left intercostal space in a newborn could potentially be indicative of a congenital heart defect known as Patent Ductus Arteriosus (PDA ) 2. TREATMENT?: The treatment for PDA may involve medication like NSAIDS(such as indomethacin or ibuprofen) to encourage closure of the ductus arteriosus or, in some cases, surgical closure may be necessary. Early detection and appropriate management of PDA are crucial to prevent complications and ensure the baby's optimal health and development . 3. associations: Prematurity ; Other Congenital Heart Defects : PDA may occur in conjunction with other congenital heart defects, such as atrial septal defect (ASD), ventricular septal defect (VSD), coarctation of the aorta, or tetralogy of Fallot ; Rubella Infection (German Measles ) ; Respiratory Distress Syndrome (RDS)

10. Station 8: 1 . diagnosis ?: Given the information provided, the presentation suggests a child with chronic hemolytic anemia, likely due to a genetic disorder. The history of recurrent blood transfusions, severe anemia, and palpable spleen and liver are indicative of a hemolytic process. The fact that the child is a product of consanguineous marriage raises the suspicion of an inherited disorder like: Beta-Thalassemia Major 2. investigations?: Peripheral Blood Smear, Hemoglobin Electrophoresis, Genetic Testing, Complete Blood Count (CBC ) 3. therapy? : Blood Transfusions , Iron Chelation Therapy , Folic Acid Supplementation, Gene Therapy, Bone Marrow Transplantation, Hydroxyurea

11. Station 9: 1:identify a. Pigeon chest ( pectus carinatum ) b. Wrist widening c. Knock knees ( genu valgum ) 2: diagnosis : rickets 3. investigations? : Blood Tests : . Serum Calcium Levels , Serum Phosphate Levels , Serum Alkaline Phosphatase (ALP) Levels , 25-Hydroxyvitamin D Levels. xrays . Physical Examination : A thorough physical examination may reveal signs and symptoms suggestive of rickets. Bone Mineral Density (BMD) Testing . Genetic Testing . Urinalysis .Bone Biopsy (Rarely Used)

12. Station 10: 1. diagnosis :the possible diagnosis for a 5-year-old child presenting with abdominal pain for 3 days, fever (102°F), coated tongue, palpable hepatomegaly (enlarged liver), and splenomegaly (enlarged spleen) could be : Viral Hepatitis ; Mononucleosis (Epstein-Barr Virus ) ; Typhoid Fever 2.ivestigation(typhoid): Blood Culture; Widal Test ; Stool Culture; Complete Blood Count (CBC ); Liver Function Tests (LFTs ); Serological Tests 3. treatment: Antibiotics; Supportive Care : Supportive care is important to manage symptoms and prevent complications. This may include: Fever management with antipyretic medications such as acetaminophen ( paracetamol ). Adequate hydration with oral rehydration solutions or intravenous fluids if necessary, especially if there is vomiting or diarrhea. Rest to conserve energy and promote recovery. Nutritious diet to maintain adequate nutrition, although certain foods may need to be avoided during the acute phase of illness Monitoring : Close monitoring of the patient's condition is essential throughout the course of treatment. This may involve regular temperature checks, assessment of hydration status, and monitoring for signs of complications such as intestinal perforation . Isolation and Hygiene Measures ; Vaccination