Osce 6

1.

a. Right middle lobe infiltrate and left lower lobe infiltrate.

b. Blood cultures, Antibiotics, Early follow-up by primary care physician.

c. Mycoplasm pneumoniae.
2. a. Right-sided circular density.
b. 46 weeks.
c. Hilar adenopathy, Upper lobe cavitary lesion, Diffuse (13 mm) nodules,
Pleural effusion.
3. a. Pneumomediastinum.
b. Asthma, Severe coughing event, Valsalva maneuvers.
4. a. Increased interstitial markings.
b. Airway assessment and management, C-spine protection, Treatment of
hypoxia.
5. a. Right pleural effusion.
b. Bilateral pleural effusions.
6. a. Esophageal foreign body.
b. Airway compromise, Esophageal rupture, Heavy metal poisoning.
c. Emergent endoscopy for removal.
d. Cricopharyngeal narrowing at level C6, Tracheal bifurcation at level T6,
Hiatal narrowing of esophageal valve.
e. Greater than 80%.
7.
a. Intussusception.
b. Absent liver edge.
c. Contrast enema.
d. Episodic cramping pain, Vomiting, Passage of bloody, mucusy stool,
Sausage-shaped mass in the right quadrant.
8.
a. Pyloric stenosis.
b. Between 2 and 8 weeks of age, Palpable mass in the epigastrium,Possible
weight loss.
c. Ultrasound.
d. Dehydration, Hypochloremic alkalosis, Hyponatremia, Hypokalemia.
e. Surgery.
9. a. Ileus.
b. Recent abdominal surgery.
c. Inflammatory process (i.e., sepsis, pneumonia, appendicitis).
d. Obstruction
10. a. Esophagus.
b. Gastroesophageal junction.
11.a. Nonspecific.
b. Upper gastrointestinal or barium enema.
c. Prompt surgical evaluation, Fluid resuscitation, Admission to the hospital,
Nasogastric tube placement.
d. Midgut volvulus.
12. a. Obstruction.
b. Herniorrhaphy.

13.a. Ileus versus small bowel obstruction.

b. Appendiceal abscess.
c. Surgery.
14. a. Ileus.
b. Obstruction.
c. Ileus
d. Obstruction.
15. a. Normal bowel gas, no free air.
b. Lots of stool, Faint calcifications in right upper quadrant.
c. Ask parents about possible heavy metal ingestion.
d. Send patient home with vomiting and abdominal pain instructions, outpatient
follow-up.a.
16. a. Fecalith.
b. Appendicitis.
c. Appendicolith, Dilated loops of bowel in right lower quadrant, Non-specific gas
distribution, Obliteration of psoas shadow.
17. a. NEC.
b. Pneumatosis intestinalis.
c. Nothing by mouth, nasogastric tube decompression, intravenous fluids, intravenous
antibiotics,
plan culture, and possible surgical repair.
18.a. Normal gas pattern, medially displaced ascending colon.
b. Gastric.
c. Painless intestinal bleeding.
d. Meckels scan with radioisotope for gastric mucosa.
e. Surgical removal only if ectopic tissue present.
19. a. No acute abdominal pathology.
b. Pulse oximetry.
c. Antibiotics, admit if ill-appearing, follow up in 1 day.
d. Pneumonia.
20. a. Bowel obstruction.
b. Intussusception, Inguinal hernia, Malrotation, Hirschsprungs disease.
c. Bowel obstruction secondary to Hirschsprungs disease.
d. Nasogastric tube (NGT) decompression, antibiotics, saline enemas, and colostomy.