Dr. Junaid was a former medical student of Smbbmc. He believes in simplicity of education in a very concised & easy language.
First Day: Start With Positive Vibes
Start your day with the name of Allah. Delete all distractions from your life. You have to be focused and attentive during these days. Gather all Pediatric Stuff on your table. Take some time for your room anatomy. Remove all other unrelated stuff. You don't need to be tensed for the things which are not in your vicinity. Make sure you already canceled all of your appointments with everyone.
There are different allocations of stations in different medical colleges. I have gone through practically from the exam system of Dow University, so I know its system. But these techniques are equally effective for any OSCE paper of Pediatric. Even if you are preparing for a simple ward test, or going through your specialization program, this manuscript will just take your 5 days and you will see guaranteed confidence in yourself.
For DUHS perspective, there are 15 stations including 9 static and 6 interactive. This is the biggest OSCE paper of entire MBBS. You should be focused and keen for every station in terms of preparation.
First Kick IMNCI- (6 Hours)
This is present as last section in paeds comprehensive. Never do it online because that maybe of previous version. Learn all of it by heart. You can skip HIV portion because it is not really important but its not that difficult as well. Diarrhea plans A, B and C must be done with fluid dosages because examiners might be interested in asking about that. Counseling of mother for breastfeeding is the most appreciated topic of pediatric OSCE. Never skip it, even if it came in past papers or not. Don't give more than 6 hours today, you will have another session for its revision in these 5 days.
If you want to read IMNCI online, here is the updated link from WHO IMNCI
Prepare History Stations: (4 Hours)
It is generally very easy station. All you have to do is to think of differentials and ask accordingly. If you have a moderate grip of internal medicine, you will ace it. If you forgot anything, just review these topics now from Parvez Akbar (Kundi) or Davidson. Even you can take help from internet, you can google its differentials. But you just need to prepare these topics today as these are most commonly asked history stations. There's no limits of medicine but you need to learn as much as you can. Even if you try counseling of each of them, it is highly appreciated.
- Generalized Tonic Clonic Seizures (Epilepsy)
- Pallor (Anemia)
- SOB (Asthma)
- Short stature (Dwarfism/Hypothyroidism/Familial/Turner's)
- Hepatitis B (Relevant contact history & management)
- Joint Pain (JRA, Reiters, Sickle)
- Unable to sit without support (Duchenee/Becker)
- Progressive wasting (Malnutrition)
That's all for today. You don't need to be nervous or dishearten if you didn't able to catch it. Doing something is still better than nothing. You have done well.
DUHS FORMAT SAYS...
There are almost 8 scenarios static stations. One of them is a picture-based diagnosis. This later is generally most misdiagnosed. You might think that you have to do whole book for it. But that's not the real story. Doing selective topics and getting mastery over it is the real wisdom behind.
First you have to give proper diagnosis, for that you have to learn the art of association. This is the pick-up line in the case. From now on I am giving a clue & its diagnosis. Dow usually gives only one-word for clue at times. You must have to learn this as equations. If these words come in a case, suddenly your mind will rush for its diagnosis.I put all equations in the format of Dow. There are so many stations at my time too. Once you have finished learning this, half of your tension will be released. This is NOT copied from any book or pointer. This is just OSCE style scenarios that will help you instant diagnosing of conditions.
2nd Day For Scenarios
These are simple equations. Just like 2+2=4. It is the best for early diagnosis!
Clues and Diagnosis (3 Hours)
- Jitterness + unable to feed= Neonatal Hypoglycemia
- Coarse facial features + large tongue + hoarse cry = Hypothyroidism
- Constipation + Dry skin + Umbilical Hernia = Hypothyroidism
- Tongue coated, toxic and Rt. Hypochondrial pain= Typhoid
- Urine++++ = Nephrotic Syndrome
- Cola-Colored Urine + periorbital edema= Post-Streptococcal Glomerulonephritis
- Tea colored Urine + clay colored stools = Childhood Cirrhosis
- Palpable kidneys, bladder & urine poor stream = Posterior Urethral Valves
- Unilateral joint pain + Fever = Septic Arthritis
- Projectile nonbilious Vomiting (milky in neonate) = Pyloric stenosis
- On & Off diarrhea, constipation + Mucus in stool = Chron's Disease
- Palpable purpura + IgA+ve + Normal platelets = Henoch Schonlein Purpura (HSP)
- Purpura + Orifice bleeding + Low platelets = Idiopathic Thrombocytopenic Purpura (ITP)
- Gum bleeding + bruising = Scurvy
- Swelling of all finger joints = Juvenile Rheumatoid Arthritis (JRA)
- Fever + migratory joint pain + swelling = Osteomyelitis
- Signs of meningism + Purpura + Hypotension = Meningococcal Meningitis
- Signs of meningism, clear labs= Viral meningitis
- Dark urine + Pale stools = Viral Hepatitis (Obstructive phase)
- Puffy cheeks + Plethora + BP High = Cushing's Syndrome
- Fever + Previous VSD = Endocarditis
- PPROM Mother + Lethargy (HR-high RR-low) = Respiratory Distress Syndrome
- Barking cough + Stridor = CROUP
- Dysphagia + Drooling + Fever = Epiglottitis
- Runny nose + Fine crackles = Bronchilitis
- Tachypnea + Extra-intercostal muscles use + Crackles/Wheezes + Fever = Pneumonia
- Chest tightness + Wheezes + Episodic = Asthma
- Chronic cough + Recurrent Pneumona + Sinusitis = Cystic fibrosis
- Bulky foul smelling stools + Abdominal distension + Rectal prolapse = Celiac disease
- Empty rectum + stools come after isertion of finger in rectum by doctor = Hirchsprung's disease
- Bleeding neonate PV and PR = Neonatal Hemorrhagic Disease
- HbF high, HbA low = Thalessemia major
- Jaudice + Splenomegaly + Osmotic fragility = Sickle cell Anemia
- Wide & Bounding Pulse + Machinery murmur = Patent Ductus Arteriosus
- Central cyanosis + clubbing + Squatting position = TOF
- BP more in U/L & less in L/L + headache= Coarctation of Aorta
Congratulations! Now you can pick one-liners easily. Once you done with it, brace yourself for the next 2 steps of today. That is relating to picture-based and theory-based stations. This will lastly followed by X-rays.You can get pictures from comprehensive and you can Google picture it. Either way, you have to do Parvez Akbar for its management and related features. It is damn important. Just diagnosing it is not necessary. You must write labs, investigations and management too. So get yourself ready fast and furious.
Picture-Based (2 hours):
- Measles(Child with rash),
- Erythema Nodosum(Parvovirus B-19),
- Legs purpura (HSP),
- Vit. A deficiency (Bitot spots),
- Flaky paint dermatitis (Kwarshiorker),
- Sun-setting sign of hydrocephalus.
- Chicken pox,
- Caput succedaneum,
Theory-Based (1 hour)
- Step of PPV in Neonatal resuscitation
- Asthma classification
- Vaccines diagnosis & dosages
X-Rays (2 hours)
- Chest X-Rays including consolidation, pneumonia and tuberculosis.
- Cardiomegaly including heart failure, valvular heart diseases, TOF and pericardial effusion.
- Bones like wrist and elbow X-rays usually points to rickets.
- Skull X-rays usually points to thalessemia
- Rarely, an abdominal X-Ray, if so, its mostly intestinal obstruction.
Today you have done a lot. Take proper rest and food. Never forget to pray.
3rd Day- Do or Die!
The beginning of 3rd day should signify as a theory of bedside. Although you know it from Medicine, but just part of examination is not enough. You should learn things from clinical bedside. For this, fortunately we Dowites have a book called “Bedside techniques” which is equally best for clinical knowledge and practice.
There are 3 stations of examination in Pediatrics. Normally examination time is 3 minutes and remaining 2 minutes are reserved for answering those questions in the list of examiner. There are often simple commands like "Palpate chest" or "Lower Limb Motor System". Sometimes, we are unable to pick the positive finding. If your technique is valid and your answers are correct, there is no way examiners can fail you. Picking positive findings is superb thing and everyone should work hard in wards for this. But we should not take pressure for that. Focus on what you can, otherwise if you create anxiety for not picking some rare sign, you might end-up in wrong diagnosis & that is not beneficial at all.
As today you have to learn the questions you should answer after clinical exam, you should not deviate your attention any other side. For easiness, I am giving the list of things you have to learn from Bedside technique!
Remember, You Must Remember!
Make mnemonics by adding first alphabets of your list.
Make associations like if you are learning "book, words, sentence, pages", you can associate words in a simple sentence that "A book having pages, pages contain sentences, sentences made of words". Now you don't need to cram all of it.
Allow your mind to make a story. For example, learning "car, phone, coffee, friend" is difficult when you learn it like words. Make a story like "I was driving a car while my I received my friend's phone asking for a coffee".
Don't hesitate to learn just because people say it is difficult to learn. A deaf frog climbed up from a depth just because he can't listen to those people who were saying, "you cannot do it".
Where's My Bedside?
- Causes of clubbing
- Causes of enlarged Lymph nodes
- Causes of Edema
- Causes of central and peripheral cyanosis
- 4 causes of wide collapsing pulse
- 4 causes of pulsus paradoxus
- Causes of shift of Apex beat
- Splitting types and causes
- Grades of Murmur
- Read this chapter as a whole and learn:
- Causes of mediastinal push and pull (shift of trachea)
- Causes of increased and decreased vocal fermitis
- Causes of different percussion notes
- Causes of bronchial breathing
- Causes of crepitations
- Differential Diagnosis of pleural rub and crepitations
- Causes of Hepatomegaly (Non-tender and tender)
- Causes of Splenomegaly
- Causes of Palpable gall bladder
- Causes of Palpable Kidney (Unilateral and Bilateral)
- Causes of Ascites
- Differentials b/w Spleen vs Left Kidney
Chapter-5 (Nervous System)
- Glasgow Coma Scale (E+M+V=15)
- Causes of Atrophy and Hypertrophy
- Grades of Power
- Reflexes and its Root value
- Causes of Increased and Decreased reflexes
- Differentials b/w sensory and cerebellar ataxia
- Romberg's sign
- Tremors and its types (They mostly ask difference b/w Intentional and Essential tremors)
- Differentials b/w L5 vs S1 root lesions
- Read Facial nerve in detail (Anatomy, branches and all)
- Weight &
- Height at different ages.
Note: Don't miss the values at birth, 6 months, 1 year, 3 years
That's it! If you still have time left, then go for one full read. That will give you confidence regarding the field of Pediatrics.
Now What Next?
You might not learn all of it in one-go. You can make mnemonics, stories and different such things to learn all those above-mentioned important things. Don't rush towards anything else before finishing this one. Stay focused and attentive, every minute you serve for learning, will definitely create easiness for you.
Can You Solve This OSCE?
For each question, choose the best answer. The answer key is below.
- A child came with periorbital edema and cola colored urine? Dx?
- Nephrotic Syndrome
- Post-Streptococcal Glomerulonephritis
- What will be the most appropriate set of investigations?
- ASO, Throat swab & culure, Urine DR, C3 Levels
- Proteinuria, Lipid profile & Renal biopsy
- How will you best manage?
- Renal transplantation
- Supportive, symptomatic and steroids
- Post-Streptococcal Glomerulonephritis
- ASO, Throat swab & culure, Urine DR, C3 Levels
- Supportive, symptomatic and steroids
Day-4, Real Learning Day
This day is reserved for revision of all scenarios stations that you learned in 2 days ago. You already did its tricks and pick-up lines. Now all you have to do is, open the standard text book of peds like Parvez Akbar & find the topic. You have to learn investigations and managements of all topics accordingly. Don’t waste time on extra things like epidemiology and even on all drug dosages. Remember that on all these stations, you have a limited 5-minutes time. So learn smart and quick accordingly.
- Neonatal Hypoglycemia
- Nephrotic Syndrome
- Posterior Urethral Valves
- Vesicoureteric Reflux
- Septic Arthritis
- Pyloric stenosis
- Chron's Disease
- Henoch Schonlein Purpura (HSP)
- Idiopathic Thrombocytopenic Purpura (ITP)
- Juvenile Rheumatoid Arthritis (JRA)
- Meningococcal Meningitis
- Viral meningitis
- Viral Hepatitis (Obstructive phase)
- Cushing's Syndrome
- Respiratory Distress Syndrome
- Cystic fibrosis
- Celiac disease
- Hirchsprung's disease
- Neonatal Hemorrhagic Disease
- Thalessemia major
- Sickle cell Anemia
- Patent Ductus Arteriosus
- Tetrology of Fellot
- Coarctation of Aorta
Its Never Too Late...
If you missed those topics in your college, now this is the time to cover it up. Learn more and more, call your colleagues for help & ask from your seniors about those diseases you lack understanding. Its never too late, its all about your determination.
Final Day! Doctor's Day Out :)
You cannot be a good cricketer with only learning the rules and regulations of cricket. Neither you can be famous by just learning all techniques. This is the time to expose yourself in the real pitch of medicine. You have to spend initial at least 8-10 hours today. Be confident, release your pressure and serve your one morning and one evening for shining your practical skills.
Reload your guns!
Take a box or pouch and tick this checklist.
- Pediatric Hammer (Small)
- Inch Tape
- Torch (Preferably with combined ear speculum)
- Cotton Wool
- 2 small Scales (Plastic only)
- Tuning fork
- Sharp tooth sticks (3-5)
- Perfumed bottle
- Hand sanitizer
- BP App with Pediatric Cuff (Better to have, otherwise ok)
Let’s Play Doctor-Patient
All you need is a kid of 5-10 years of age for practicing clinical examination. Your younger sibling or neighbor’s child is the best alternative. If you really don’t find anyone, move towards your own hospital’s pediatric ward and find a healthy looking cooperative child. A candy, biscuit or a chocolate can do miracles at times.
Start with Nervous System
It will include mainly sensory & motor. Simultaneously perform upper and lower limb. Try not to push hammer really hard if you don’t find reflexes. Be gentle and compassionate to your kid subject. Do not forget Cerebellar signs and Romberg’s test. They come frequently in OSCE stations.
Respiration, in and out!
Pay special attention to the steps of palpation, this is the most important pediatric station that frequently come in exam is “Palpate the chest” and tell positive findings. Never palpate trachea in an upright or semi sitting position, it should be always done with patient lying straight on bed without even a pillow's support. Rest all is most important in internal medicine.
Don’t take Lymph nodes easy!
Start with neck nodes, perform axillary on both sides and followed by inguinal and politeal. Never forget “epitrochlear" lymph nodes palpation in the elbow. One of my colleague has been disregarded by examiner on not completing all of them. So never miss it. And yes, you cannot palpate abdominal lymph nodes! A student has faced the music for this extra-efficiency. While palpating, take care of lymph node tenderness as well.
Precordium, listen LUB-DUB
Follow all steps of internal medicine. You must have good experience in catching different types of murmurs and associate with it. Well, this station is easier if you have already mastered its theoretical aspect yesterday. Most commonly, they will ask about splitting in pediatric OSCE.
This includes Fronto-Occipito-Circumference (FOC) and Mid Upper Arm Circumference (MUAC) and Height. While taking height, ask child to remove his foot-wears. This is a mistake that examiners love to point out. Also practice on WHO chart of plotting weight for height. This will also help in your understanding of standard deviations that come in the definition of malnutrition.
Abdominal, a real challenge!
Kids are never co-operative with the hands that press their tummy. So, this examination is generally avoided in OSCE stations. But that doesn’t mean its unimportant. You should know the internal medicine’s concepts of checking organomegaly. Things are easier for you if you have an ample ward’s exposure. Just repeat your medicine ward's exam here.
There are some others!
Some specific examinations regarding pediatric assessment can be your station. So, it’s the best thing ever! Believe me, it’s much easier than full-blown examinations. The key is General Physical Examination (GPE) first, followed by few specific targets of examination!
Malnutrition: GPE + Hepatosplenomegaly + Anthropometry (At-least mention)
Anemia: GPE + Hepatosplenomegaly + Precordium (for flow murmurs)
Heart Failure: GPE + JVP + Precordium
Liver Failure: GPE + Abdominal Examination
Meningococcal Meningitis: GPE + Skin assessment on legs + Kernings + Brudzinski + Bibinski
And yeah, sometimes, a simple command like “diplopia” or “facial nerve” can put you in doubt that if you never prepared for it. Don't confuse on these types of stubborn stations. That simply required your recall from that ward. All you need is to apply that skill appropriately.
Well, for “diplopia” you just need to check vision and perform extra-ocular muscles examination. Remember that “H” you made in ophthalmology rotations?
What's More For Big Day?
Now all you need is self-confidence. You can do good in any situation. Never shake your confidence on taking anxiety of other students. Its between you and your examiner. Do not study overnight, its not good to burn your body for no good reasons. Early to bed and early to rise, followed by recitation of Quran is the best of the best method to make yourself confident for the big task. Your good dressing attire, your clean pressed lab-coat & shiny foot-wears are contributing greatly to your performance. Stay hydrated, do a healthy breakfast, wear smile and think positive.
Pay attention to the commands given to you. If you are getting uncomfortable with any of your examiner's questions, say sorry politely and in humbleness. All of them know that you are a medical student and going through the toughest stage of life. So trust in Allah and believe in good things to happen! Best of luck for your upcoming exam. I welcome any of your corrections in this article. Please let me know without hesitations.
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© 2016 Junaid Ghani Durrani
Awais syed on June 16, 2017:
You are love JGD
Sarwat on December 16, 2016:
Hi, thanks for this, it is very very helpful!
But I have to ask one thing: wouldn't fever+migratory joint pain+swelling be rheumatic fever?
Junaid Ghani Durrani (author) from Karachi, Pakistan on November 20, 2016:
Wow. Awesome Nadia! All the best!
Nadia haider on October 17, 2016:
I did it man :) bravo