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Now I have all the information needed to answer all 5 OSCE questions. Here are the complete answers:
OSCE Answers
Station 1 — 2-year-old with fever, barking cough, stridor, subcostal & intercostal retractions
1. Diagnosis: Croup (Acute Laryngotracheobronchitis)
- Caused most commonly by Parainfluenza virus
- Classic presentation: preceding URTI (runny nose), then barking ("seal-like") cough, inspiratory stridor, and respiratory retractions in a toddler
2. Diagnostic X-ray sign: Steeple Sign (Church Steeple Sign)
- Seen on AP neck/chest X-ray — subglottic narrowing gives the trachea a pointed, steeple-like appearance (in contrast to the normal "shoulder" shape)
Station 2 — Infant with enlarged head, prominent scalp veins, downward-deviated eyes
(Image shows macrocephaly with "sunset sign" — eyes deviated downward, prominent scalp veins, large domed skull)
1. Diagnosis: Hydrocephalus
2. Clinical sign: "Sunset Sign" (Setting Sun Sign)
- Downward deviation of the eyes with visible sclera above the iris, caused by pressure on the pretectal area (Parinaud syndrome equivalent in infants due to raised ICP)
Station 3 — Image shows knee-chest position manoeuvre being performed on an infant
(Image shows a child being held in knee-chest / squatting position)
1. Condition: Tetralogy of Fallot (TOF) — specifically used during a hypercyanotic spell (Tet spell / blue spell)
- The knee-chest position increases systemic vascular resistance (SVR), decreases venous return of desaturated blood, and reduces right-to-left shunting → improves oxygenation
2. Two drugs used to treat this condition (Tet spell):
- Morphine — reduces hyperpnea and infundibular spasm, decreases sympathetic drive
- Propranolol (IV/oral) — reduces infundibular spasm by blocking β-adrenergic stimulation
(Other acceptable answers: IV fluids for volume, Phenylephrine/noradrenaline to raise SVR, Sodium bicarbonate for acidosis)
Station 4 — Peripheral blood film showing sickle-shaped red blood cells
(Image shows a blood smear with elongated sickle cells and target cells)
1. Diagnosis: Sickle Cell Anaemia (Sickle Cell Disease)
- Caused by homozygous HbS mutation (Glu → Val at position 6 of β-globin chain)
2. Two complications:
- Vaso-occlusive (painful) crisis — ischaemia and infarction in bones, organs, soft tissue
- Acute chest syndrome — fever, chest pain, hypoxia, new pulmonary infiltrate (life-threatening)
(Other valid answers: stroke/CVA, splenic sequestration, aplastic crisis, avascular necrosis, dactylitis, priapism, renal papillary necrosis, increased susceptibility to encapsulated organisms)
Station 5 — Image of a snake bite on the hand
1. Purely neurotoxic snake: Krait (Bungarus species)
- Produces pure neurotoxicity (pre- and post-synaptic neurotoxins); no significant local tissue damage or haematotoxicity
- (Mamba is also acceptable in some curricula)
2. Bedside test used in haemotoxic snake bite: 20-Minute Whole Blood Clotting Test (20WBCT)
- Place 2–3 mL fresh venous blood in a clean dry glass tube; leave undisturbed for 20 minutes
- If blood is unclotted → coagulopathy (haemotoxic envenomation, e.g., viper bite) → treat with antivenom
- Simple, cheap, no equipment required — standard WHO-recommended bedside test
Summary table:
| Station | Diagnosis / Answer |
|---|---|
| 1 | Croup; Steeple sign on X-ray |
| 2 | Hydrocephalus; Sunset sign |
| 3 | Tetralogy of Fallot (Tet spell); Morphine + Propranolol |
| 4 | Sickle Cell Anaemia; Vaso-occlusive crisis + Acute chest syndrome |
| 5 | Krait (purely neurotoxic); 20-Minute Whole Blood Clotting Test (20WBCT) |
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