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PEDI OSPE SOLVE SHEET

STATION 1

X RAY OF PNEUMONIA

1. My diagnosis is Pneumonia

2. Other investigation

CBC - Neutrophilic leukocytosis ( 15,000-40,000/mm3)

3. Rx
a. Antibiotic Rx
In Severe Pneumonia
Parental Antibiotic Ampicillin + Gentamicin once for 5 days
 if the condition not improves then switch to cloxacillin as an
alternative to ampicillin and continue 3 weeks + continue
Gentamicin for total 7 days
 if not improve or first line drugs fails switch to inj. ceftriaxone for
5- 7 days

In pneumonia
Oral Antibiotic Amoxicillin 2 times for 3days
b. Supportive Rx
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 O2 therapy

 Removal of thick secretion of nose / throat.

 Paracetamol for fever

 Salbutamol for wheeze

 Clearing nose with normal saline.

 soothing the throat by warm water tulshi leaf juice lemon tea

 Avoidance of Over hydration

STATION 2

X RAY OF TETROLOGY OF FALLOT

1. The most probable dx is Tetralogy of Fallot (TOF)

2. This is the X-ray of chest P/A view that reveals

 Boot shaped heart

 Concavity of pulmonary conus
 Oligemic (deep black) lung field

3. Other investigation to support this Diagnosis

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 Echocardiography - Findings

# VSD # Overriding of the aorta # RVH # Right ventricular outflow

obstruction
 ECG - RVH
 CBC - Polycythemia.

STATION 3

X RAY OF SCURVEY

1. The most probable dx is Scurvy / Vit C deficiency

2. This is a x-ray of both knee joint P/ A view that reveals

 Wimberger sign/ Ring sign- Ground glass appearance of the

shaft of the bones and are
surrounded by a white ring
 Pencil point thickness of the cortex

 Fraenkel's line of calcification - A dense white line of

calcification appears at the epiphyseal ends of the bones.

3. Three important clinical sign

 Crying on handling e.g. dressing, bathing etc.

 Generalizes tenderness especially in legs resulting in pseudo -

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paralysis and legs assume typical frog position

 Bluish purple, spongy swelling of gum mucosa is seen when teeth

is erupted

STATION 4
X RAY OF RICKETS

1. The most probable dx is RICKETS / Vit D deficiency

2. This is a x-ray of both hands A/P view that reveals

 Widening, Cupping and fraying of metaphysis

 Wide gap between epiphysis and metaphysis
 Density of shaft of bones is reduced (osteopenia)
 Green stick fracture may be present
 Deformity of long bone may be present.

3. Three important clinical signs to support this dx

 Short stature, listlessness, protruded abdomen, muscle

weakness of the children
 Head - Box like square head, Hot cross burn appearance of
skull and delayed closure of fontanels and sutures
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 Pigeon chest deformity, painless rachitic rosary at

costochondral junction Harrison sulcus

STATION 5
SEVERE DEHYDRATION

1. Severe dehydration

2. Mx

100 ml/kg fluid is given for first 10 kg body wt for next 10 kg body
wt 50 ml/kg is given
Choice is cholera saline

FIRST GIVE 30 ml/Kg OVER 1 HOUR

THEN 70 ml/ Kg OVER 5 HOURS

3. Specific rx :

 Antibiotic where needed

 Rehydration according to status

 Zinc supplementation
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 If fever paracetamol

Preventive rx

 Safe water supply

 Personal hygiene

 Use if sanitary latrine

 Health education

 Literacy

 Proper immunization.

STATION 6
Severe malnutrition probably kwashiorkor

1.Most probable dx is Severe malnutrition probably kwashiorkor 5

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2.Dx criteria

Presence of severe wasting e.g. low wt for ht/WHZ < -3, MUAC(Mid upper
arm circumference) < 115 mm and/or bipedal edema

Indicator Measure Cut off

Severe wasting Wt for Ht < - 3 SD
severe wasting Mid upper arm circumference <115
Bipedal edema clinical sign present

3. Mx of diarrhea in that case

1 st 2 hours : Give ReSoMal 5ml/kg orally/ through N-G tube at

30 min interval

Next 4-10 hours : Give ReSoMal 5 ml/kg/hour alternatively

with F-75 therapeutic milk

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STATION 7

INSTRUMENT – LUMBER PUNCTURE NEEDLE

1. The supplied specimen is Lumber Puncture Needle

2. Parts
 Cannula
 Cap
 Trocar

2. Uses of Lumber Puncture Needle

Diagnostic
o Meningitis
o Encephalitis
o Sub arachnid Hemorrhage
o Gillian Barre Syndrome
o Multiple Sclerosis

Therapeutic
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o Intrathecal methotrexate in acute Lymphoblastic

leukemia [ALL]
o Spinal Anesthesia
o Removal of CSF in benign Intracranial Hypertension.

STATION -8

INSTRUMENT - BONE MARROW ASPIRATION NEEDLE

1. The supplied specimen is Bone marrow aspiration needle/

sternal puncture needle
2. Parts

 Trocer

 Cannula

 Adjustable guard
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3. Uses
 Aplastic Anemia
 Megaloblastic Anemia
 Macrocytic Anemia due to any cause
 Leukemia
 Myelofibrosis
 Multiple Myeloma
 Pancytopenia due to any cause
 Immune thrombocytopenic purpura (ITP)
 Kala azar to see Leishman Donovan(LD) bodies

STATION – 9

ACUTE GLOMERULONEPHRITIS

1. My most probable Dx is Acute Glomerulonephritis

2. Three important clinical sign
# Puffy face due to swelling of eyelids, face and mild pallor,
#Edema present
# High blood pressure

3.Three important immediate complication

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# Acute Pulmonary Edema

# Acute Renal failure
# Hypertensive encephalopathy

STATION – 10

ACUTE PYOGENIC BACTERIAL MENINGITIS

1. Dx Acute pyogenic Meningitis

2. Treatment

Supportive Rx

 Counselling

 ABC Mx

 Inj, Phenytoin/ phosphenytoin IV or Per - rectal to stop convulsion

 NPO

 IV fluid (Dextrose)

 Paracetamol and tepid sponging if fever

 NG tube feeding when patient become stable.

 Monitoring of the vital sign

 Eye care, Bladder, Bowel care and Skin care

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Specific Rx

 Empirical Antibiotic Ceftriaxone+ Vancomycin untill the C/S report

comes
 Anti-inflammatory : IV Dexamethasone
 Rx of Complication: by IV mannitol & Volume expander..

3. Three important complication

 SIADH
 Raised ICP
 Cerebral palsy