EOP Stream 1

Short Case Signs Diagnosis

1 1 and half year old Patient is sleeping

Malay boy came in before examination Acute bronhiolitis
with rapid breathing. start. However he
Please do started to cry once
Respiratory mother waking him
examination up. Patient was fretful
when approached
and refuse to be
examine. *he was on
nasal prong, iv
cannula on his left
dorsum

I was unable to do
proper and complete
examination (limited
inspection, unable to
do palpation,
percussion). I spent
most of the time
helping mother to
calm him down and
play with him. He
literally cried for the
whole 10 minutes. No
need to position the
patient. Do
opportunistic
examination! Dr
asked mother to
dukung the child, and
I quickly auscultate
his lungs - rhonchi
and crepitations
heard on lower zone
of both anterior and
posterior

Question :
1. Provisional
diagnosis and
why?
Differential
diagnosis and
why not?
2. Common
organisms
 causing lung
infection in
this age group
3. Investigations
to confirm
diagnosis?
How is it
done?

2 3 y/o chinese girl with Obvious distension Biliary atresia

distended abdomen. without obvious mass
Perform abdominal and no shifting
examination. dullness. A
transverse “rooftop”
scar (kasai
procedure) extending
from left to right
hypochondriac area.
Hepatomegaly (7cm
below costal margin)
and splenomegaly
with Traube’s space
dullness.
Provisional diagnosis
of biliary atresia ddx
of post-hepatic
transplant,
thalassemia/hemolyti
c anaemia

Able to describe the

characteristic of
spleen and liver.
rooftop→ Kasai
Mercedes benz
sign→ liver
transplant

3 13 years old Malay Looks thin and tall Mitral regurgitation

girl compared to her age Marfan syndrome
Perform a CVS dorsiflexion(?) of her
examination thumb, was asked
what’s wrong with her
*others kena same fingers
patient but to assess Clinodactyl
growth instead of Finger clubbing
CVS High arched palate,
 braces on, probably
due to crowding teeth
Pectus carinatum
Hyperdynamic
precordium
Apex beat displaced
to 5th ICS medial to
MCL
Pansystolic murmur
grade 3 best heard at
mitral radiating to
axilla

Assess growth:
Measure arm to
height span
Tanner staging for
breast
Measure head
circumference-
dolicocephaly
Plot growth chart

4 3 years old boy. Phenotypic features Down Syndrome with

Inspect and tell what of Down syndrome: Speech delay
you see. Upslanting eyes,
epicanthal fold, flat
Mainly observation nasal bridge, inward
and discussion with folding of ears,
lecturers. Some have protruding tongue,
to do developmental single palmar crease,
assessment sandal gap

Complications of
Down syndrome,
how to diagnosis and
everything related

As for Developmental
-obvious speech
delay

5 3 years old Malay girl. Patient generally Upper motor neuron

Neurological well, sit on the bed. lesion most probably
examination of lower Wheelchair on the cerebral palsy
limb bedside.
No dysmorphic *read details about
features. LMNL and UMNL.
Inspection of lower They might ask other
 limb normal with no condition in both
muscle wasting or categories and where
scar. is the lesion based on
Tone- hypertonia on clinical findings.
both ankle
Power- at least grade
1 which has very
minimal movement
Reflexes-
hyperreflexia of
bilateral knee, ankle
reflexes couldn’t be
elicited due to tendon
stiffness.
Positive bilateral
clonus
Positive bilateral
babinski sign

6 15 y/o indian girl. Do Patient generally Pulmonary atresia

CVS examination well, lying on the bed. with VSD
Positive of clubbing
Guy, please say you and peripheral She also have
want chaperone cyanotic scoliosis
Have parasternal
heaves
Got systolic murmur
over the LLSE

Question
1-differential
diagnosis
2-grade of clubbing

7 20 year old Malay Generally well patient Thalassemia

girl. Examine her with scleral jaundice
abdomen and conjunctiva pallor
Hepatospleeno
megally
Chelation scar and
periumbilical
hyperpigmentation

Question
1- Ddx
2- name of the scar &
ways to measure the
liver
 3- types of chelation
and how frequent are
they given

21 Dextrocardia

22 14 year old Indian Lying 45 at bed Dextrocardia

boy comfortably, alert, no with bronchiectasis
Perform a CVS sign of respiratory (Kartagener
examination distress. Syndrome)
Height appropriate to
age. But for his
weight, he seems to
be over nourished.
No dysmorphic
features. No medical
adjuncts.
No finger clubbing,
palmar pallor, cap
refill 1s.
No scleral jaundice,
conjunctival
pallor.Good oral
hygiene, no high arch
palate.
Scar at right
parasternal,
4cm.(what is your
impression (I don’t
know))
No deformities or
hyperdynamic chest.
Unable to locate the
apex beat on left side
even in left lateral
position. Not felt on
the right side.
No thrill, parasternal
heave, palpable heart
sound.
Heart sounds heard
better on right site.
Bilateral lung
crepitation.
Liver not palpable
and resonance on
percussion.(absent
on right site?)
No pedal oedema.
 Investigation to order:
CXR
Showed dextrocardia.

27 a 4 year old indian Generally well patient Biliary atresia ?

girl with conjunctiva
Examine her pallor.
abdomen Spleenomegaly
A transverse “rooftop”
scar (kasai
procedure) extending
from left to right
hypochondriac area.

OSCE Station 1 (Communication skills)

1. 6 months old baby presented with vomiting. Take history from mother. No need to report
to examiner.

OSCE Station 2 (Growth chart)

A boy born in 2010 with underlying nephrotic syndrome the height of x cm ( 2013 - x1 cm, 2014
- x2 cm, 2015- x3 cm), weight of y kg( 2013 - y1 kg, 2014 - y2 kg, 2015 -y3 kg).

1. Please plot a growth chart and state 2 observations that you could obtain from the chart.
2. Explain the likely cause of the growth chart pattern
3. State the complication of this illness or treatment which can cause ……..? (cant
remember the exact question)

Remedial

OSCE Station 1 (Communication skills)

1. 2 years old girl presented to the hospital with fever and rashes. Take history from
parents. No need to report to examiner
Possible diagnosis : Kawasaki disease, dengue fever, measles

OSCE Station 2 (Down Syndrome)

Provided with a karyotype
1. State the karyotyping of this condition. Ans : 46XX+21
2. What is this condition called? Ans : Trisomy 21/Down Syndrome
3. State the mechanism of this condition. Ans : Non-dysjunctional miosis
4. State 1 risk factor of this condition. Ans: late marriage
5. Gastrointestinal anomaly associated with this condition. Ans : Hishprung, duodenal
atresia,..... So many can put…