MNJ27-001
An 8-year-old child Mahesh presented with bilateral sudden loss of vision, motor weakness and seizures following upper respiratory infection. There is no significant family history. MRI finding of the child is shown here:

1. Describe the abnormality and diagnosis
2. Give a differential diagnosis.
3. How will you differentiate between the two?
4. What is the CSF finding?
5. What is the line of treatment?
6. What is the prognosis?

Answer

MNJ27-002
A 6-month-old child came to your clinic. Mother is complaining that child still not able to support his head, no smile and not able to sit. MRI brain was done:

Neurology 357 |

1. What are the MRI findings?
2. What could be the etiology?

Answer

MNJ27-003
A 12-year-old child has complaints of fever for last three months and backache and now he has problem in bending forward. MRI spine was done:

1. What 1s the likely diagnosis?
2. Which is the commonest site?

Answer

MNJ27-004

• | 358 OSCE Clinical Pediatrics

1. Diagnosis
2. By what gestahonal age would this defect occur?
3. What is preventive treatment, in what dose and started when?
4. Whats nsk factor for this disorder?

Answer

MNJ27-005
Parents of a 2-year-old child came to you that their child is not able to walk properly, he sway to one side when walk and from last 2 months he start to loss his previously acquired milestones and have abnormal hand movement throughout the day (myoclonic jerks). He had six episodes of respiratory infection in last one year. You examine the child and found some positive finding inhiseyes: **(Asked in exam)

1. Give the diagnosis of given condition.
2. State mode of inheritance
3. Name five important components.
4. Name most frequent immunological defect

Answer

MNJ27-006
A 6-year-old child admitted in hospital with complaints of intractable epilepsy, mental retardation and lesion on the face (shown below):

Neurology 359 |

1. What is the diagnosis of this condition?
2. Describe the lesions given in both images
3. Whatis the mode of inhentance and which chromosome is involve CNS?
4. Whatis CNS associahon?

Answer

MNJ27-007

1. Name the neurocutaneous marker seen.
2. In NF-1, what 1s the diagnostic criteria with respect to this marker?
3. Name a X-linked dominant neurocutaneous syndrome.
4. What are the three stages of syndrome in question 3?

Answer

MNJ27-008

• 4, What 1s the major ocular criteria for diagnosis?

| 360 OSCE Clinical Pediatrics | Q.9. A 4-year-old child admitted in hospital with complaints of intractable epilepsy. You

examine the child and found a birth lesion on face involving upper eyelid. Neuroimaging

• was done that shown below:

1. What is exhibited in the photographs A and B?
2. Diagnosis.
3. Whats the mode of inheritance?
4. Diagnose the condition according to climcal picture and images.
5. Whats the pattern of inheritance?
6. What 1s the characterise radiographic image called?
7. What 1s the ophthalmologic complication?

Answer

MNJ27-009
What is the classic triad of infantile spasms?

Answer

MNJ27-010
The examination of a newborn reveals a lump of soft tissue of size of 2 coin overlying the lower spine. There is no neurological deficit and child is moving both lower limbs well and knee and ankle reflexs are present:

• 4, What are the options for managing bladder incontinence im this condihion?

1. Whats the likely diagnosis?
2. What 1s likely risk of recurrence of disorder in future pregnancies?
3. What intervention started at what time and for how long, can reduce the risk of intervention?

Answer

MNJ27-011
Match the following sign/symptom with the expected location of the lesion in the brain:

• * Leakage of CSF from nose

a. Deafferented pupil * Nystagmus
f. Cribriform plate of ethmoid * Pinpoint pupils
b. Cerebellum * Toric deviation of the eye(s)
c. Ipsilateral cortex *® Marcus Gunn pupil
d. Midbrain tectum * Horner's syndrome
e. Pons * Midposition pupils

Answer

MNJ27-012
A3-year-old child Raju has complaints of weakness while playing, droping of eyelids in evening and not able to sustain his grip. You think a provision diagnosis myasthenia gravis:

1. What 1s the characteristic EMG in myasthenia?
2. Whats the chest X-ray finding in this condition?
3. Whats the clinical test for diagnosing myasthenia?
4. Which antibiotics can worsen the condition?
5. What drugs are used for treatment?

Answer

MNJ27-013
Examination of the cerebrospinal fluid of a 6-year-old child Arjun, mildly febrile child with nuchal rigidity and intermittent stupor for 3 weeks shows the following:

• * White blood cells 100/l (all lymphocytes)
• * Negative Gram stain
• ® Protem 750 mg/dl
• * Glucose 25 mg/dl

1. What are the likely differential diagnosis?
2. What drugs can be used to reduce intracranial tension?
3. Which cranial nerve 1s mvolved 1n false localizing sign?

Answer

MNJ27-014
Match the following:

Answer

MNJ27-015
A 9-year-old male child complaining of increasing weakness of all limbs x 3 days and URTI one week back. On examination bilateral facial nerve palsies, power grade 0-1 both legs; grade three arms, loss of deep tendon reflexs, no sensory deficit/papilloedema. On abdomen examination you find palpable midline mass arising from pelvis. Child is conscious and responding well your answers:

1. What 1s the likely diagnosis?
2. Mention three mvestigations to clinch diagnosis
3. What 1s the most sensitive measure of respiratory muscle involvement?
4. Mention three modalities of treatment.
5. Whats the midline mass, explain its significance and how should it be managed?

Answer

MNJ27-016
A 3-year-old boy was unconscious for 1 min following head injury after fall from bed. Now he is fully conscious but there is bruising on the left side of the head over the parietal bone. Skull X-rays are performed and he is admitted for neurological observations as advised by neurologist:

1. What chnical features would suggest requirement of CT skull and/or neurosurgical opmion?
2. What non-surgical temporary measures can be used to reduce raised intracranial pressure?
3. What advice needs to be given to parents if after 24 hours the child has remained well and is ready for discharge?
4. What does the imaging show and what 1s probable diagnosis?
5. What are the modalities of treatment?

Answer

MNJ27-017
This newborn presented with hepatosplenomegaly, jaundice and convulsions. His mother's Sabin-Feldman dye test was positive:

Neurology 363 |

1. Whatis the diagnosis?
2. Whats classic triad of signs in this condition?
3. What are the drugs used in treatment?

Answer

MNJ27-018
Nidhi is 5 months pregnant with her first child. Her 15-year-old brother Vijay began to have difficulty in climbing stairs at 4 years of age. He is now confined to a wheelchair. All other family members are normal. She is worried that her child may be affected and she reffered by a gynecologist to you for future advise:

1. What 1s the most likely clinical diagnosis of Vijay?
2. What 1s the inheritance pattern of this problem?
3. What are the chances that Sowmya could be affected with the same diasease?
4. What would you recommend for antenatal diagnosis?

Answer

MNJ27-019
10-year-old girl Shivani brought to emergency with history of fall from a height 4 hours back. After that she developed vomiting and GCS drops from 14/15 to 9/15. You advised a urgent CT scan in ER:

• 4, What 1s the differential diagnosis and how will you differentiate the two?

1. Describe the abnormality shown in CT.
2. Whats the diagnosis of this condition.
3. Which 1s the commonest site and vessel involved 1n this
4. What is the management?

Answer

MNJ27-020

1. Alumbar puncture 1s performed and the CSF is xanthochromatic. What are the four possible causes?
2. CSF protein levels are 400 mg/dl. What are the three possible causes for the same?
3. CSF glucose in 200 mg/dl and blood glucose is 112 mg/dl. List five causes for the same.
4. CSF is also cloudy, what does it imply?

Answer

MNJ27-021
Observe the images A and B given below and answer the following questions:

• 1. Identify image A/level i Identify the image B/level
• i. Give diagnosis ui, Give diagnosis
• in. Differential diagnosis (any four) ii. Mention other two diseases from the same group (metabolic)

1. 2
2. Identify image A/level i Identify the image B/level
   i. Give diagnosis ui, Give diagnosis

Answer

MNJ27-022
These are three skin manifestations of the same disease:

1. Name these all three skin manifestations.
2. Give diagnosis of this disorder
3. Write (two) other skin manifestations seen in this condition.

Answer

MNJ27-023
A 14-year-old female Anchal with history of recurrent seizures. Admitted in PICU with stroke 12 hours back. She was evaluated for same before 2 time. You order MRA (shown below):

1. Identify and describe the investigation.
2. What is the diagnosis?
3. What other disorder are associated with this disease?
4. Whats the treatment of choice?
5. What are syndromes associated with contralateral hemiplegia in children?

Answer

MNJ27-024

1. Identify the clinical sign and neuroimaging sign.
2. What abnormalities are hikely on motor system examunation?
3. Name the treatment options (any two)

Answer

MNJ27-025
An 8-year-old girl Priyanka came in emergency with history of rapidly progressive, both lower limb weakness since 3 days. She was apparently normal except for a history of sore throat and bilateral neck swelling with fever about 20 days back. Now she is very depressed because of illness as she has exam after 7 days. She started with difficulty while walking and not being able to pass urine despite of the sensation being there. On

examination: Normal sensorium and cranial nerves. Had normal neurology findings in both upper limb and shoulders examination. Lower limb, symmetrical flaccid paralysis; distal more than proximal. Deep tendon reflexs were exaggerated and planters were extensors. There was a sensory discrepancy below T8 and temp/light touch were affected. Vibration and position were normal. Her urinary bladder was palpable:

• 4, Name (any 2) causative factors for this condition

1. Whats your differential diagnosis?
2. What 1s the investigation of choice?
3. Treatment.

Answer

MNJ27-026
An 18-month-old male child Rahul presents with complaints of delayed milestone on examination HC was 42 cm and he still not developed all milestones according to his age:

• 3, What investigation you advice in this child?

1. Whats definition of microcephaly?
2. What are causes of primary microcephaly?

Answer

MNJ27-027
A 14-month-old male child Robert presents with cough, fever and one episode of generalized seizure for 4 minutes. He has history of similar episode in 2 months back:

1. What 1s most probable diagnosis?
2. What 1s risk for future epilepsy?
3. What are major risk factors for recurrence.
4. Will you do lumbar puncture in this patient?
5. What are indications of neuroimaging in this disease?
6. What is current status in use of clonazepam?

Answer

MNJ27-028
Match the common side effect of these drugs:

4. Valproic acid d Hirsuhsm

5. Carbamazepine a. Irreversible visual field defect

6. Lamotrigine b. Stevens-Johnson syndrome

7. Topiramate c. Weight gain

8. Vigabatrin e Hyperammonemia

9. Phenytoin f Glaucoma

Answer

MNJ27-029
A mother of 6-year-old child with refractory seizure came to you that she found on google that some special type of diet can stop seizure in children:

• 4, What 1s formulation of this diet?

1. What 1s this diet she 1s taking about?
2. What are indications to use this diet?
3. What are contraindications to use this?

Answer

MNJ27-030
**A 7-year-old male child came to hospital with complaints of ataxia from last 3 months along with dysarthric speech. On examination, Romberg test is positive. But DTR was absent and plantar is extensor and loss of vibration sense. Nystagmus is also present on examination:

(Asked in Exam)

[ Neurology 367 |

1. Whats probable diagnosis and what is inheritance?
2. Where parts of brain involve in this disease?
3. What are causes of recurrent ataxia?
4. Whats cause of death 1n this patient?

Answer

MNJ27-031
**A 9-year-old female child came with complaints of abnormal movement. Mother told that these movements are fast and increase when she is in stress and disappear in sleep. On examination, child has difficulty in keeping protruded tongue:

1. Whats probable diagnosis of this condition?
2. What are hallmark features of this?
3. What important inveshgation you will order?
4. Whats treatment for this?

Answer

MNJ27-032
This 3 yrs old female child geeta came with neuro-regression from early infancy with this (see in pic)jabnormal movements and autism, Her head circumference is also below 3rd percentile.

1. What 1s the diagnosis?
2. What is the hallmark of this disorder?
3. What 1s age of onset of neuro-regression?
4. Which are earliest neurological findings?
5. Which milestones are delayed.

Answer

MNJ27-033
Write down the age of attaining the milestones in month

Milestone

• * Follows moving object 180
• * Sustain social contact, listen to music
• * Polysyllable vowel sound
• * Creep or crawl
• * Plays simple ball game
• * Hope of feet
• * Name 4 colors
• * Make tower of 4 cubes
• * Dress and undress
• * Put 3 words together

Answer

MNJ27-034
A 32 weeks preterm baby with birth weight of 1.52 kg was born with HC of 26 cm (3rd centile). Otherwise stable baby has bilateral arthogryposis with fixed flexion deformity. He has episode of seizure at 6 hours of life which was difficult to control after routine AED. His CBC showed platelets count 56000 and low Hb. A cranial USG was done (Image below)

1. What 1s most likely diagnosis?
2. What three tests you will perform to confirm the diagnosis?
3. Elaborate findings in USG brain.
4. What are important sequelae?

Answer

MNJ27-035
A 4-month-old male baby presented in OPD for a prominent forehead. According to mother, this has always been the case through to a lesser extent then he was born. The baby is otherwise well, weight following the 0.4th centile, length along 9th centile and head circumference is at 50th centile. On examination baby has very small anterior fontanelle and frontal prominence. X-ray head was done (Image below)

| Neurology 369 |

1. What 1s skull X-ray shows images A and B?
2. What 1s possible diagnosis?
3. How will you make a management plan for this child?

Answer