OSCE Pediatric Assessment 3 — Questions and Answers
Question 1: A 10-month-old is brought in with sudden-onset colicky abdominal pain, intermittent drawing up of legs, and one episode of 'redcurrant jelly' stool. What is the most likely diagnosis?
- Pyloric stenosis
- Volvulus
- Intussusception (Correct answer)
- Meckel's diverticulum
Correct answer: Intussusception
Intussusception classically presents in infants with intermittent colicky pain, drawing up of legs, and redcurrant jelly stools from mucosal ischemia.
Question 2: When calculating a fluid bolus for a pediatric patient in shock, what is the correct initial volume?
- 5 mL/kg of 0.9% NaCl
- 10 mL/kg of 5% dextrose
- 20 mL/kg of 0.9% NaCl (Correct answer)
- 50 mL/kg of Hartmann's solution
Correct answer: 20 mL/kg of 0.9% NaCl
The standard initial fluid bolus for a child in shock is 20 mL/kg of isotonic crystalloid (0.9% NaCl or Ringer's lactate).
Question 3: During a newborn examination, you note the infant's left hand has a simian crease, upslanting palpebral fissures, and sandal gap between the first and second toes. What syndrome should you suspect?
- Turner syndrome
- Trisomy 18
- Down syndrome (Trisomy 21) (Correct answer)
- Fragile X syndrome
Correct answer: Down syndrome (Trisomy 21)
Simian crease, upslanting palpebral fissures, and sandal gap are classic features of Down syndrome (Trisomy 21).
Question 4: A 7-year-old presents with a widespread purpuric rash on the lower limbs and buttocks, joint pain, and abdominal pain. His platelets are normal. What is the most likely diagnosis?
- Meningococcal septicemia
- Idiopathic thrombocytopenic purpura
- Henoch-Schönlein purpura (Correct answer)
- Reactive arthritis
Correct answer: Henoch-Schönlein purpura
Henoch-Schönlein purpura (IgA vasculitis) presents with palpable purpura on lower limbs/buttocks, arthralgia, and abdominal pain with normal platelet count.
Question 5: In assessing a child's Glasgow Coma Scale, which best describes a score of 8 or below?
- Mild impairment requiring monitoring
- Normal range for a sleeping toddler
- Severe impairment warranting airway protection (Correct answer)
- Moderate impairment managed conservatively
Correct answer: Severe impairment warranting airway protection
A GCS of 8 or below indicates severe neurological impairment and is the threshold requiring consideration of definitive airway management.
Question 6: You are examining a 12-year-old with a 3-week history of polyuria and polydipsia. His capillary blood glucose is 28 mmol/L. What complication must you actively rule out?
- Hypoglycemia
- Diabetic ketoacidosis (Correct answer)
- Hyponatremia
- Addisonian crisis
Correct answer: Diabetic ketoacidosis
A new presentation of type 1 diabetes with very high glucose requires urgent assessment for diabetic ketoacidosis (DKA) with blood gas and ketones.
Question 7: A 3-year-old is found unresponsive. After calling for help, what is the correct initial pediatric BLS action?
- Begin 30 chest compressions immediately
- Give 5 rescue breaths first (Correct answer)
- Check pulse for 10 seconds before acting
- Deliver 2 defibrillation shocks
Correct answer: Give 5 rescue breaths first
Pediatric BLS begins with 5 initial rescue breaths because cardiac arrest in children is usually secondary to respiratory arrest.
OSCE Pediatric Assessment 3
A 10-month-old is brought in with sudden-onset colicky abdominal pain, intermittent drawing up of legs, and one episode of 'redcurrant jelly' stool.
What is the most likely diagnosis?