OSCE Pediatric Assessment 2 — Questions and Answers
Question 1: A 6-week-old infant presents with projectile vomiting after every feeding. On examination, you palpate an olive-shaped mass in the right upper quadrant. What is the most likely diagnosis?
- Gastroesophageal reflux disease
- Pyloric stenosis (Correct answer)
- Intussusception
- Hirschsprung disease
Correct answer: Pyloric stenosis
Pyloric stenosis classically presents at 3–6 weeks with projectile non-bilious vomiting and a palpable 'olive' in the right upper quadrant.
Question 2: When assessing a 2-year-old child's developmental milestones during an OSCE station, which of the following is a red flag?
- Says 50+ words
- Walks independently
- No two-word phrases by 24 months (Correct answer)
- Points to named pictures
Correct answer: No two-word phrases by 24 months
Absence of two-word phrases by 24 months is a developmental red flag requiring further evaluation.
Question 3: A 4-year-old is brought in with a 2-day history of high fever, drooling, and refusal to swallow. He sits leaning forward with neck extended. What is the priority action?
- Perform throat examination immediately
- Obtain lateral neck X-ray first
- Secure the airway and call senior support (Correct answer)
- Start oral antibiotics and observe
Correct answer: Secure the airway and call senior support
The tripod position with drooling and high fever suggests epiglottitis; securing the airway takes priority over examination or imaging.
Question 4: In a pediatric respiratory examination, which finding best indicates severe respiratory distress in a toddler?
- Respiratory rate of 30 breaths/min
- Subcostal and intercostal recessions (Correct answer)
- Mild nasal flaring
- Expiratory wheeze on auscultation
Correct answer: Subcostal and intercostal recessions
Subcostal and intercostal recessions reflect significant increased work of breathing and indicate severe respiratory distress.
Question 5: You are assessing hydration status in a 9-month-old with diarrhea. Which clinical sign best indicates 10% dehydration?
- Slightly dry mucous membranes
- Normal skin turgor
- Sunken fontanelle and absent tears (Correct answer)
- Heart rate of 120 bpm with normal capillary refill
Correct answer: Sunken fontanelle and absent tears
Sunken fontanelle and absent tears indicate severe (≥10%) dehydration in infants.
Question 6: During an OSCE, you examine a 3-year-old's abdomen and note distension with visible peristalsis. The child has not passed stool for 5 days. Which diagnosis should you consider first?
- Appendicitis
- Hirschsprung disease (Correct answer)
- Mesenteric adenitis
- Viral gastroenteritis
Correct answer: Hirschsprung disease
Hirschsprung disease presents with chronic constipation, abdominal distension, and visible peristalsis due to absence of ganglionic cells in the rectum.
Question 7: A 5-year-old child has a painful, swollen right knee with no history of trauma. He has been febrile for 2 days. What is the most important next step?
- Prescribe NSAIDs and review in 1 week
- Order an X-ray to rule out fracture
- Aspirate the joint and send fluid for culture (Correct answer)
- Start empirical antifungal therapy
Correct answer: Aspirate the joint and send fluid for culture
A hot swollen joint with fever in a child must be assumed septic arthritis until proven otherwise; joint aspiration for culture is urgent.
OSCE Pediatric Assessment 2
A 6-week-old infant presents with projectile vomiting after every feeding.
On examination, you palpate an olive-shaped mass in the right upper quadrant.
What is the most likely diagnosis?