PEDIA2 OSCE Flashcards
Sheila, a 15-month-old girl, presents with pallor during a well-baby checkup.
History reveals a diet consisting of six 8-oz glasses of whole cow’s milk per day since the age of 9 months.
A Peripheral Blood Smear (PBS) was performed.
QUESTIONS:
1. Describe the findings in the blood smear
2. List 3 investigations helpful in the diagnosis
A term newborn is noted to be grunting shortly after birth. The baby is tachypneic and has marked chest retractions.
The following chest X-ray has been obtained.
- Interpret the Chest radiograph
- What is the most likely diagnosis?
- What is the management?
- Diagnostic Work-Up
1. Urinalysis (UA): - Hematuria (RBCs, often with tea or cola-colored urine)
- RBC casts (diagnostic for glomerular bleeding)
- Proteinuria (usually mild to moderate)
- Polymorphonuclear leukocytes (may indicate inflammation)
2. Complete Blood Count (CBC): - May reveal mild normochromic, normocytic anemia
- Helps assess for infection, inflammation, or anemia from chronic disease
3. Serum Complement C3 Level: - Decreased C3 is found in >90% of cases of APSGN
- Returns to normal within 6-8 weeks (useful for follow-up and confirming diagnosis)
Questions:
Question 1: What is the Apgar score at 1 minute? _______
Question 2: What is the Apgar score at 5 minutes? _______
👶 STATION 9
Instructions to students:
Study the photo carefully, then answer the following question:
Question:
What birth injury was sustained by this newborn infant during labor and delivery?
🧠 STATION 25
Instructions to student:
Study the photo carefully.
In the examination of the head of this neonate born after a difficult delivery, identify the abnormality noted.
Question:
What abnormality is seen in this newborn’s head following birth trauma?
👩⚕️👶 STATION 15
Instructions to student:
During the Pediatric Physical Examination, what information should you include in the General Survey?
Test the integrity of Cranial Nerves II, III, IV, and VI on a simulated patient.
Instruction to students:
Test the integrity of Cranial Nerves IX, X, XI, and XII using a simulated patient.
Instruction to student:
Test the integrity of Cranial Nerves V, VII, and VIII on a simulated patient.
🧸 STATION 28
Instruction to Student:
Read the short case history of a patient shown in the photo and then answer the following question.
Case:
This is a 3-day-old, full-term infant delivered via normal spontaneous delivery (NSD) who presents with the following physical finding on the back:
(Refer to the image above)
Question 1:
Identify the abnormal finding present in this newborn:
→ ___________________________
✅ Answer Key (Q&A Format)
Q: What is the abnormal skin finding seen on the lower back of this newborn?
A: Mongolian Spot
Q: How is a Mongolian spot described?
A: A dark blue or purple bruise-like macular lesion, usually located over the sacral or gluteal region.
Q: Is a Mongolian spot pathologic?
A: No. It is a benign, congenital dermal melanocytosis that typically fades with age.
👶 STATION 29
Instruction to student:
Study the photo of this newborn infant carefully, then answer the following questions:
Case:
You have elicited the Moro’s reflex in this newborn infant.
Question 1:
Moro’s reflex disappears in most normal babies at what age?
A. 10–12 months
B. 8–10 months
C. 4–6 months
Question 2:
An asymmetric Moro response may signify what possible condition?
→ _______________________________________________________
👶 STATION 39
Instruction to Student:
Study the photo carefully and read the short case history. Then answer the following questions.
Case:
A full-term baby was born to a G1P0 mother via normal spontaneous delivery (NSD). During the newborn assessment, you observe facial asymmetry when the baby cries.
Question 1:
What aspects of history do you need to ask from the mother to evaluate this condition?
Question 2:
What neurologic finding is present in this baby?
🩻 STATION 34
Instruction to Student:
Interpret the chest radiograph of a 3-year-old boy who was admitted for fever, cough, and increasing respiratory difficulty for the past 2 days.
Question:
What is the most likely radiologic diagnosis based on the clinical context and chest X-ray?
👂 STATION 31
Instruction to student:
Examine the tympanic membrane of this patient using an otoscope.
🦶 STATION 24: Babinski Reflex
Instruction to student:
Perform the Babinski reflex on this patient. (Simulated patient – doll)
🍼 STATION 22: Primitive Reflexes
Instruction to student:
Perform the following primitive reflexes of the newborn using a simulated patient (doll):
A. Moro’s Reflex
B. Palmar and Plantar Grasp Reflex
📏 STATION 12: Anthropometric Measurements
Instruction to student:
Take and record the following anthropometric measurements on the simulated patient (doll).
Q&A Reference for Review
Q1: How do you measure head circumference in infants?
A: Use a non-stretchable tape around the head at the occipital protuberance and supraorbital ridge (OFC).
Q2: How should weight be recorded in neonates and infants?
A:
* Use an infant scale
* Measure naked or with minimal clothing
* Record to the nearest 10 grams
Q3: What’s the correct technique for length or height measurement?
* <2 years: Use an infantometer with the baby lying supine, legs extended
* ≥2 years: Use a stadiometer with the child standing straight against the wall
Q4: When and how do you measure chest circumference?
A:
* Measure at the nipple line, during mid-respiration, with arms relaxed at sides
Q5: How is abdominal circumference measured in pediatrics?
A:
* Tape is placed horizontally around the umbilical level, ensuring it is not compressing the abdomen
📊 STATION 4: Pediatric Growth and Height Assessment
Instruction to student:
Read the case below carefully and answer the following questions. Use WHO growth standards to determine height status.
Case Scenario:
Gwen is a 3-year-old girl.
Her actual height/body length is 95 cm.
Questions:
**1. Plot the actual height of this girl on the WHO growth chart and determine the corresponding Z-score for Height-for-Age:
→ ___________________________
**2. Compute the ideal body height for this girl in cm. (Show your computation)
→ __________________________________________________________
→ __________________________________________________________
🧠 Discussion (Q&A Format)
Q1: What is your initial diagnostic impression?
✅ Answer:
Most likely Gastroesophageal Reflux (GER) — a common physiologic condition in infants 1–3 months old, characterized by frequent non-bilious regurgitation, often after feeds. The child is active and thriving, which supports a benign etiology.
Q2: What serious conditions must still be ruled out in a vomiting infant?
✅ Answer:
* Pyloric stenosis (especially with projectile vomiting)
* Duodenal atresia or malrotation with volvulus (bilious vomiting)
* Tracheoesophageal fistula
* Sepsis, metabolic, neurologic, or intracranial pathology
Q3: What is your initial work-up plan?
✅ Answer:
Clinical:
* Full history and detailed physical exam, especially abdominal and neurologic exam
Labs:
* CBC, Electrolytes, BUN/Creatinine, Glucose, LFTs, Urinalysis
* If concern for infection: Blood culture, urine culture, lumbar puncture
Imaging:
* Abdominal ultrasound to rule out pyloric stenosis
* Abdominal X-ray if suspecting obstruction
* Consider upper GI contrast study or CT abdomen for malrotation
🧸 STATION 14: Acute Abdominal Emergency in an Infant
Case Scenario:
Thomas, a 7-month-old infant, is brought to the ER by his very concerned mother.
Over the past 24 hours, he has become frequently distressed, crying in pain, and drawing his legs up.
He has vomited several times.
On examination, his abdomen is distended, and while no mass is palpated, there is tenderness in the right hypochondrium.
A plain abdominal X-ray was obtained.
Questions:
1. What abnormal findings are seen on the abdominal X-ray?
→ ______________________________________________________
2. What is the most likely diagnosis?
→ ______________________________________________________
**3. Name two diagnostic tests to confirm your diagnosis.
→ ______________________________________________________
👦🏽 STATION 21: Pediatric Fever & Rash
Case Scenario:
Jonathan, a 7-year-old boy, presents with fever and sore throat.
Examinee Tasks:
1. What are the findings in these 2 photos?
→
2. What is your clinical diagnosis?
→
3. What is the drug of choice and for how long?
→
🩺 STATION 22: Red Umbilicus in a Newborn
📘 Instruction to Student:
Study the photo carefully of the abdomen of this 8-day-old newborn infant delivered at home by a midwife. The infant now presents with poor sucking.
✍️ Questions:
1. Describe the infant’s physical findings on the abdomen.
→
- Classify the disease.
→
👶 STATION 26: Scabies in a Child
🧾 Case Scenario:
A 2-year-old child presents with intense pruritus, especially at night. On examination, characteristic skin lesions are noted. The mother reports that other family members are also experiencing similar symptoms.
👩⚕️ Examinee’s Tasks:
1. What is the diagnosis?
2. Name the causative organism.
🩺 STATION 27: Asthma Exacerbation in a 7-Year-Old
👧🏻 Case Scenario:
Lyka, a 7-year-old girl, is brought to the ER by her father due to an acute asthma exacerbation.
👩⚕️ Examinee Task:
1. What immediate physical signs would you look for when you meet Lyka on arrival at the ER?
2. Perform your initial approach according to checklist standards.
🧑⚕️ STATION 28: Pediatric Diarrhea - Focused History & Differential Diagnosis
👧🏻 Case:
Mrs. Cruz brought her 2-year-old daughter, Lisa, to the ER due to diarrhea for 3 days.
The ER team has stabilized the child in the next room.
📌 Examinee’s Tasks:
Take a focused history from the mother regarding the diarrhea.
State the differential diagnoses for diarrhea in children.
STATION 29
Instruction to Student:
Study the photo and read the short clinical history. Then answer the following questions.
Kevin, a 16-day-old boy, was born by a normal vaginal delivery. He presents with dysmorphic features, appeared dusky at birth, and was noted to have a murmur.
Questions:
What is the most likely chromosomal disorder?
List 2 common congenital heart diseases (CHDs) associated with this patient.
✅ Answers for Checking
Question 1:
What is the most likely chromosomal disorder?
➡️ Trisomy 21 (Down Syndrome)
Rationale:
The child has classic dysmorphic features of Down Syndrome and a congenital heart murmur, both highly suggestive of Trisomy 21.
Question 2:
List 2 common congenital heart diseases (CHDs) associated with this patient.
➡️ 1. Atrioventricular Septal Defect (AVSD)
➡️ 2. Ventricular Septal Defect (VSD)
Rationale:
AVSD is the most common CHD in Down Syndrome. VSDs are also commonly seen. Others may include ASD or less commonly, Tetralogy of Fallot.
STATION 31
Instruction to Student:
You are called to the nursery to evaluate a 2-hour-old term newborn who has developed tachypnea and respiratory distress.
Examinee’s TASK:
What will you do first?
What differential diagnoses will you consider for a newborn infant presenting with respiratory distress?
👶 Rapid Infant Assessment Script
“I’ll check if air is moving in and out.”
“Is the baby crying?”
“Is the chest rising and falling?”
“I’ll listen for breath sounds—air entry on both sides.”
“Any signs of cyanosis?”
“What’s the oxygen saturation?”
“I’ll check capillary refill time.”
“What’s the heart rate?”
STATION 32
Instruction to Student:
A 5-year-old patient presents with fever, cough, and dyspnea of 1-week duration.
On physical exam, there is:
* Asymmetrical chest expansion
* Diminished breath sounds at the right lung field
* Dullness to percussion
* Decreased tactile fremitus
A chest X-ray is obtained for further evaluation.
Question:
Interpret the chest X-ray (CXR) findings in this patient.
(Include descriptions of findings and your diagnostic impression.)
