NRE Step 2 Pediatrics: Mandatory OSCE Stations! – BilalMD

Kidney Problems in Kids: Nephrotic Syndrome

  • This is a kidney problem where a lot of protein leaks into the urine.
  • Signs:
    • A lot of protein in the urine (more than 3.5 grams a day).
    • Swelling, especially around the eyes.
    • Low protein in the blood.
    • High fat in the blood.
  • Causes:
    • Most common in children is “Minimal change disease”.
    • Other causes include “Focal segmental glomerulosclerosis” and “Membranous nephropathy”.
  • Symptoms: Swelling around the eyes, weight gain, poor nutrition.
  • Tests: Urine tests, blood tests (like kidney and liver function tests).
  • Treatment: Medicine called prednisolone.
  • Problems it can cause: Infections, poor growth, blood clots, and acute kidney injury (AKI).

Breathing Problems in Babies: NRDS (Hyaline Membrane Disease)

  • This happens when babies have trouble breathing because they don’t have enough “surfactant” in their lungs.
  • What is surfactant? It’s a special oily substance that helps keep the lungs from collapsing. It’s made by cells called pneumocytes.
  • Causes:
    • Not enough surfactant.
    • Being born too early (premature birth).
    • Not enough oxygen (hypoxia).
    • Being born by C-section.
  • Testing for surfactant: Doctors can check the amount of surfactant in the fluid around the baby before birth. If the ratio is low, there’s a risk of NRDS.
  • Symptoms: Fast breathing, grunting sounds, nose flaring, pulling in of skin between ribs when breathing.
  • Tests: Oxygen levels, chest X-ray (shows a “ground glass” look).
  • Treatment: Give oxygen, give surfactant, keep the baby stable.
  • Prevention: Mothers at risk can get a steroid shot (betamethasone) to help the baby’s lungs develop.

Stomach Problem in Babies: Hypertrophic Pyloric Stenosis

  • This is when the tube leaving the stomach gets too narrow, making it hard for food to pass through.
  • Symptoms (usually in babies 3-5 weeks old):
    • Forceful, non-green (non-bilious) vomiting.
    • Poor growth and weight gain.
    • Not getting enough nutrients.
  • Signs a doctor might find: Swollen belly, a non-tender lump (like an olive) in the belly.
  • Tests:
    • Blood tests might show a chemical imbalance.
    • Ultrasound can show a swollen stomach.
    • A special X-ray with barium might show a “string sign”.
  • Treatment: Stop feeding by mouth, fix any chemical imbalances, and then surgery to widen the tube.

Heart Problems in Babies: Congenital Heart Disease (Born with it)

  • These are heart problems that babies have from birth.
  • Types:
    • Acyanotic (baby usually looks pink): ASD (hole between top heart chambers), VSD (hole between bottom heart chambers), PDA (open blood vessel that should close after birth).
    • Cyanotic (baby might look blue): Transposition of Great Vessels, TOF (Tetralogy of Fallot), Truncus Arteriosus, Tricuspid Atresia.
  • Common Findings:
    • VSD: Causes a loud heart sound (holosystolic murmur).
    • TOF: X-rays might show a “boot-shaped heart”.
    • Transposition of Great Vessels: Can be seen in babies of diabetic mothers, X-ray might show “egg shell shape”.
    • PDA: Can be seen after a mother had Rubella infection.
    • ASD: Causes a specific heart sound (wide fixed splitting).
  • Best test to diagnose: Echocardiogram (Echo).
  • Treatment:
    • Small holes might close on their own.
    • Larger holes often need surgery.
    • Surgery is done for large holes that cause symptoms or if a child is older than 1 year with lung pressure.

Yellow Skin in Babies: Neonatal Jaundice

  • This is when a baby’s skin and eyes look yellow because of too much bilirubin (a yellow substance) in the blood.
  • Physiological Jaundice (Normal):
    • Shows up after 24 hours of birth.
    • Bilirubin levels usually don’t go higher than 15 mg/dl.
    • Usually goes away in less than 2 weeks.
  • Pathological Jaundice (Problematic):
    • Shows up within the first 24 hours of birth.
    • Bilirubin levels increase more than 15 mg/dl.
    • Lasts longer than 2 weeks.
  • How Bilirubin is processed: An enzyme helps change bilirubin from a bad form to a good form that the body can get rid of.
  • Problems with bilirubin processing:
    • Crigler-Najjar Syndrome: This enzyme is completely missing.
    • Gilbert Syndrome: This enzyme is partially missing.
    • Dubin-Johnson Syndrome: Problems with how bilirubin is moved out of the liver (completely missing).
    • Rotor Syndrome: Problems with how bilirubin is moved out of the liver (partially missing).

Diarrhea in Children (History questions)

  • Is it acute (less than 14 days) or chronic (more than 14 days)?
  • How often is the child having watery stools?
  • Does the child have fever or vomiting?
    • If yes, check for dehydration. This could be gastroenteritis.
  • Is the child allergic to any food?
    • Test with a skin prick test. Treatment is rehydration.
  • Does the child have belly pain with diarrhea after drinking milk?
    • This could be lactose intolerance. Test with a hydrogen breath test. Treatment is a lactose-free diet.
  • Does the child have trouble gaining weight or blood in their stool with breathing problems and cough?
    • This could be cystic fibrosis. Test with a sweat chloride test. Treatment is enzyme replacement and vitamins.
  • Does the child have belly pain and blood in their stool with tiredness?
    • This could be Inflammatory Bowel Disease (IBD). Test with a fecal calprotectin test. Treatment is steroids or mesalamine.
  • Does the child have watery, bloody, or mucus-filled stools?
    • This could be enterocolitis. Test with stool culture and sensitivity. Treatment is fluid replacement and antibiotics.

Fever with Seizures (Febrile Fits) – Questions to ask

  • Has the child had seizures with fever?
  • How high was the fever?
  • How long did the seizure last?
  • Does the child have ear pain or pus coming from the ear?
  • Does the child have burning or pus when they pee?
  • Is the child’s neck stiff or are they throwing up?
  • How many seizures have they had in a day?
  • Has anyone else in the family had seizures with fever at this age?
  • Are they awake and alert after the seizure?
  • Simple seizures: No brain damage, low chance of happening again.
  • Complex seizures: More than 15 minutes, multiple attacks in 24 hours, not fully awake after. Higher chance of happening again and possible brain damage.

History of Fever – More Questions

  • When did the fever start?
  • Have you checked the fever with a thermometer?
  • Does the child have a runny nose or sneezes?
  • Does the child have a cough or sore throat?
  • Does the child have vomiting or diarrhea with the fever?
  • Does the child have a stiff neck and seizures with the fever?

Pregnancy History (Ante Natal History)

  • Did you have regular doctor check-ups during pregnancy?
  • Did you have problems like sugar or high blood pressure?
  • Did you take any medicines during pregnancy?

Birth History (Delivery)

  • Where was the baby born?
  • Was it a normal birth or C-section?

After Birth History (Post Natal History)

  • How long after birth did the baby cry?
  • How much did the baby weigh?

Feeding History

  • What kind of milk do you give the baby?
  • If cow’s milk, how is it prepared?

Vaccination History

  • Has the child received all their vaccinations?
  • Do you have the vaccination card?

Growth Milestones

  • 3 months: Neck holding.
  • 6 months: Sits with support.
  • 9 months: Stands with support.
  • 12 months: Crawls, walks with support.
  • 15 months: Walks without support.
  • 3 years: Rides a tricycle.

APGAR Score (Baby’s health at birth)

  • 8-10: Good health.
  • 4-7: May need help breathing.
  • 0-3: Needs emergency help.

Dehydration Assessment

  • No dehydration (Plan A):
    • Alert, normal tears, wet mouth, drinks normally, skin pinch goes back quickly.
    • Treatment: Home treatment, zinc, continue feeding, follow up if not improving in 5 days or worsening in 2 days.
  • Some dehydration (Plan B):
    • Restless, sunken eyes, skin pinch goes back slowly, drinks eagerly, dry mouth, irritable.
    • Treatment: ORS (oral rehydration solution), fluids, zinc.
  • Severe dehydration (Plan C):
    • Floppy, skin pinch goes back very slowly, refuses to drink, dry tongue.
    • Treatment: Give ORS by mouth or IV fluids (Ringer’s Lactate and Dextrose), antibiotics (for cholera if older than 2), continue breastfeeding.

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