Pediatrics mini-osce

الصعاليك

the thugs crew

in the following image1.

a. mention two clinical findings in this patient? - Clubbing - Cyanosis

b. What system do you want to examine for this patient? - CVS or RS

2. Infant with head bulging

in the first week of life :

a. what is the diagnosis?

Cephalhematoma.

b. mention two complication

That may occur in that patient?

Anemia , Jaundice

-What’s your dx ?

- What are the complications that may

occur ?

- cephalohematoma.

- Jaundice, Anemia, Hypotension,

Osteomyelitis, Meningitis.

Caput succendanum

cephalohematoma

Cephalohematoma is a subperiosteal accumulation of blood that DOESN’T cross sutures.Complications are anemia and jaundice.

Caput succendanum is an extraperiosteal bleeding that DOES cross the sutures lines.Usually benign.

Turner Syndrome

NO Mental Retardation

Appearancelow-set, mildly malformed ears

a triangular-appearing face

flattened nasal bridge

and epicanthal folds

There is webbing of the neck, with or without cystic hygroma

Shield like chest with widened internipple distance

and puffiness of the hands and feet

•Coarctation of the aorta

•bicuspid aortic valve

Features

Lymphoedema of hands and feet in neonate, which may persist Spooned shaped nails Short stature - cardinal feature Neck webbing or thick neck Wide carrying angle (cubitus valgus) Widely spaced nipples Congenital heart defects (particularly coarctation of the aorta) Delayed puberty Ovarian dysgenesis resulting in infertility, although pregnancy may be possible

with in-vitro fertilisation (IVF) with donated ova Hypothyroidism Renal anomalies Pigmented moles Recurrent otitis media Normal intellectual function in most

• Turner

• Most common abortion chromosomal cause 99%

• PATERNAL chromosome (no role of maternal age )

• Presentation

• neonate : cong.heart D +dysmorphology

• Child : short stature

• Puberty : Amenorrhea

• Congenital heart D : Bicuspid aortic valve (1st)

Coarctation of aorta

• Mentally retarted (spatial)

• Treatment Estrogen replacement therapy (combined)

2 month female infant presented to you with non pitting edema ….

1- name this sign ?nonpitting (lymphedema)2- What is the syndrome that causes this feature?

Turner syndrome

Name 3 features. (web neck, wide spaced nipples, lymphedema of limbs)Single best test to diagnose. (karyotyping)

turner syndrome

Q: In the following picture A: what is the name of this syndrome?

B: what is the main cardiovascular abnormality in this patient? Ans:

A: Turner syndrome. B: bicuspid aortic valve(mc) and coarctation of aorta

Noonan syndrome

Its Autosomal dominant Noonan syndrome shares numerous clinical features with Turner

syndrome So a boy with turner features is Noonan syndromeHere there is Mental Retardation Don’t forget it occurs in girls as well

ApearanceHypertelorism down-slanting eyeswebbed neck short stature and chest deformity.

Approximately 25% of individuals with Noonan syndrome have mental retardation.

Pulmonary stenosis

Klinefelter Syndrome

Most common genetic cause of hypogonadism and infertility in men and is caused by the presence of an extra X chromosome

The increasing number of X chromosomes is associated with increasing risk of mental retardation and more dysmorphic features.

Prepubertal boys with Klinefelter syndrome appear normaldevelopment of pubic and axillary hair in the presence of

testicular volume that remains at infantile levelsTend to be tall, with long arms and legs. During adolescence or adulthood, gynecomastia occurs

Because of failure of growth and maturation of the testes, males with Klinefelter syndrome have testosterone deficiency and failure to produce viable sperm.

Production of testosterone is low; this results in failure to develop later secondary sexual characteristics, such as development of facial hair, deepening of the voice, and libido.

In adulthood, osteopenia and osteoporosis develop. Because of these findings, testosterone supplementation is

indicated. Most men with Klinefelter syndrome are infertile because

they produce few viable sperm.

• Infertility - most common presentation

• Hypogonadism with small testes

• Pubertal development apparently normal (some males benefit from testosterone therapy)

• Gynaecomastia in adolescence

• Tall stature

• Intelligence - usually in the normal range, but may have educational and psychological problems

• Klinefelter

• Presentation : infertlity

• Mental retardation (verbal)

Fragile X syndrome

characteristic craniofacial findings (large head; prominent forehead, jaw, and ears);

macro-orchidism with testicular volume twice that expected in adulthood; a mild connective tissue disorder including joint

laxity, patulous eustachian tubes, and mitral valve prolapse; characteristic neurobehavioral profile, including

mental retardation (ranging from mild to profound), autistic-spectrum disordes, and pervasive developmental disorder.

• Moderate-severe learning difficulty (IQ 20-80, mean 50)

• Macrocephaly

• Macro-orchidism - postpubertal

• Characteristic facies - long face, large everted ears, prominent mandible and broad forehead, most evident in affected adults.

• Other features - mitral valve prolapse, joint laxity, scoliosis, autism, hyperactivity

2- What is the most likely Diagnosis?Fragile X syndrome large ear large jaw and macroorchidism

Prader-Willi syndrome

• Characteristic facies

• Hypotonia

• Neonatal feeding difficulties

• Failure to thrive in infancy

• Obesity in later childhood

• Hypogonadism

• Developmental delay

• Learning difficulties

2- What is the most likely Diagnosis?

Prdader wili syndrome

Angelman syndrome

• characteristic facial appearance

• moderate to severe mental retardation

• absence of speech

• ataxic movements of the arms and legs

• a characteristic craniofacial appearance

• and a seizure disorder that is characterized by laughter.

2- What is the most likely Diagnosis?Angleman syndrome

Williams' syndrome

• Short stature

• Characteristic facies

• Transient neonatal hypercalcaemia (occasionally)

• Congenital heart disease (supravalvular aortic stenosis)

• Mild to moderate learning difficulties

Down syndrome

• Most common chromosomal cause of mental retardation

• 2/3 of abortions are due to this syndrome.

• Down syndrome is the most common of all the abnormalities of chromosomal number.

Clinical features

Infants have normal birth weight and length. Usually has hypotonia Common characteristics and facial appearance

Brachycephaly Flattened occiput Hypoplastic midface Macroglossia Flattened nasal bridge Upward slanting palpebral fissures Epicanthal folds Small ears Low set ears Large protruding tongue Short broad hands often with a transverse palmar crease clinodactyly Wide gap between the first and second toes Severe hypotonia may cause feeding problems and decreased activity Brushfield spot in iris and Heterochromia

Some Features

Well Know Complications

Polycythemia at birthCongenital heart diseaseEndocardial cushion defect

AV canal ASD, VSD

Lax jointsStructural abnormalities of the bowel (eg. duodenal

atresia)Central hypotoniaDelayed closure of fontanelsStatistically increased risk for leukemia, Alzheimer disease,

hypothyroidism

AV canal

ASD, VSD

Diagnosis

• Through pregnancy

– Markers (maternal serum AFP, ue3, inhibin A, and HCG), this identifies mothers at increased risk

– Amniocentesis is diagnostic

– Nuchal translucency

a. what is the main abnormality you can find it in this patient? - CVS abnormality (Endocaridal cushion defect)

b. name the test you want to confirm your diagnosis? - cytogenetic test

1- What is your Diagnosis?

2- Give other 4 physical findings related to this disorder ? (not seen in the image) …

• Down Syndrome

• Mention the diseases that are of high frequency in this syndrome in the future of this baby ? Hypothyroidisim , Alzehiemer, recurrent chest infections,ALL .

• What is the specific Cong.Heart Disease in this syndrome ? ECD

• What is the most common cause of this syndrome ? nondisjunction

• Most important risk factor ? Maternal Age

• Cause of death ? Heart disease

Trisomy 18

Small for gestational age. Clinical features include HypertoniaProminent occiputSmall faceReceding jawLow-set and malformed earsShort sternumRocker-bottom feetHypoplastic nailsAnd characteristic clenching of fists-the second and fifth

digits overlap the third and fourth digits

VSD

• Edwards

• Distinguishing features ? Clenched fist , rocker-bottom feet

• Specific GI anomaly ? Omphalocele while its duodenal atresia in down’s

• Prognosis ? 10% only survive first year , 95% aborted

1- what’s the name of this sign ?

2- What is the most likely Diagnosis?

3- Give other 2 physical findings related to this

disorder ? (not seen in the image) …

1- what’s the name of this sign ?

2- What is the most likely Diagnosis?

3- Give other 2 physical findings related to this

disorder ? (not seen in the image) …

Trisomy 13

cutis aplasia (missing portion of the skin/hair)mental & motor challengedmicrocephalyholoprosencephaly (failure of the forebrain to divide

properly). structural eye defects, including microphthalmia, Peters

anomaly, cataract, iris and/or fundus (coloboma), retinal dysplasia or retinal detachment, sensory nystagmus, cortical visual loss, and optic nerve hypoplasia

cleft palate low-set ears

polydactyly (extra digits)abnormal palm patternoverlapping of fingers over thumbheart defectskidney defectsomphalocele (abdominal defect)meningomyelocele (a spinal defect)abnormal genitaliaprominent heelRocker-bottom feet OR club foot

Cutis aplasia

• Patau

• Pathognemonic feature ? Aplasia cutis congenita

• More likely to have polydactaly

• Midline defects and holoprosencephaly are specific to this syndrome

• Prognosis ? Only 8% survive first year

a. what is your diagnosis? - Mangolian spots

macular blue-gray pigmentation usually on the sacral area of healthy infants. is usually present at birth or appears within the first weeks of life. Mongolian spot

typically disappears spontaneously within 4 years but can persist for life.

What is the most likely Diagnosis?

Mongolian spot

What is the treatment ?

No treatment usually resolves by 4-5 years of

age

a. what is your diagnosis? - Facial Palsy

b. mention the cause of that problem? - Birth injury (Injury To facial nerve)

a. mention two clinical findings in the physical examination? - Head Lag - C-shape or Drapes over in horizontal suspension

b. what is the cause of these manifestations? - Hypotonia

in the following image. a. what is the most likely diagnosis?

- Shingles b. mention the causative agent of that disease?

- Varicella zoster virus

What is your diagnosis?What is the criteria?

This child presented to your clinic with a hx of cough, conjunctivitis one day before the rash..hewas also found to have high grade fever. Whats

your diagnosis

What is this? And whats ur diagnosis

This child presented with a 3 day rash that started on his face and then spread caudally,he also had mild fever,

1.mention the diagnosis2.what are the likely finding on physical exam?

Spot diagnosis

1- what’s the name of this sign ?slapped cheek2- What is the most likely Diagnosis?

Fifth diasease

3- name the causing microorganism .. ?

Parvovirus b19

This child presented with a history of fever, rash, and

upper respiratory symptomsthe fever was documented

as 40 degrees and the mother noticed abnormal

movements.What is your diagnosis?What are the possible

complications?

Spot diagnosis!!Name causative organism

This child presented with this rash, rash on his face, and anemia

1- What is the most likely Diagnosis?

2- name the causing microorganism .. ?

Q: picture of patient with purpuric rash in the lower limbs? A: what is the diagnosis?

B: mention 2 other clinical findings in this patient? Ans: A: HSP

B: 1.Arthralgia 2. Abdominal pain

4 year patient presented with rash, abdominal pain and ankle pain

What is the most likely Diagnosis?

-What’s the finding ?

-What’s your dx ?

- Koplik's spot.

- Measles.

Spot diagnosis

This child presented with fever, and rash what's the name of this sign? And the diagnosis?

This child presented with oral ulcers and this rash…what is this rash and whats your diagnosis

Child with 6 days fever

-What’s your dx ?

-Scarlet fever.

-What’s your dx ?

-Impetigo.

-What’s your dx ?

-Kawasazi Disease.

-What’s your dx ?

-Dermatitis herpetiformis.

-What’s your dx ?

-Warts.

-What’s your dx ?

-Fifth Disease.

Presentation: fever and vomiting

a. name the lesion that you see in this Xray? - Consolidation in the right lung / or collapse in the same lung

b. what is your diagnosis? - Pneumonia / or obstruction by foreign body

Csf analysis.

• slide 6 ::• history of child with meningites , treated for 3 day with cefetriaxone , but after

that we do CSF analysis WBC=2500 ,rbc 20 ,• culture = gram +ve cocci• CT : FRONTAL COLLECTION .

• :• 1- WHAT IS YOUR NEXT STEP ?• add vancomicin to the treatment .

• 2- whats the organism ?• s. pnuemonia.

Q: this anemic child comes to you with splenomegaly. A: What is the type of his anemia? B: what is the diagnostic test in this case? Ans: A: Thalassemia (Microcytic hypochromic anemia) B:

Hemoglobin electrophoresis

Q: in the following image: A: what is the name of this sign? B: what is the next examination?

Ans: A: sunset eyes (setting sun sign). B: Head circumference.

6 year old boy came to your clinic complaining of cough and fever …

1- mention the prominent finding ?

2-What is the most likely Diagnosis?

3- name the most common microorganism .. ?

1 day old newborn presented with respiratory distress and cyanosis in the first hour of life

1- mention the prominent finding ?

Bowel loops in the chest

2-What is the most likely Diagnosis?

Diaphragmatic hernia

• 1- mention the prominent finding ?

• 2-What is the most likely Diagnosis?

• 1- mention the name of this sign?

• Ground glass appearance

• 2-What is the most likely Diagnosis? RDS

• Hint : premature 34 weeks….

• 1- mention the name of this sign?

• 2-What is the most likely Diagnosis?

• 1- mention the name of this sign?

• Frog leg sign

• 2- mention 4 causes ?

• 1- mention the name of this sign? scissoring2- mention 4 causes ?

What is the name of those reflexes ?1.parachute2.asymmetrical tonic reflex

1 2 3

1- what’s the name of this sign ?Double bubble sign2- What is the most likely Diagnosis?

Duodenal atresia

3- What other signs do you expect on examination?

Abdominal distention /?

1 month old infant presented to you with a history of week cry and hypoactivity since birth this is cretinism..

1- name 3 signs ? Macroglossia –omphalocele-hypotonia2- What is the most likely Diagnosis? Congenital hypothroidism

Hint : TSH , T4

mother with graves disease , give a child , he was lethargic and so and so , if hyperthyroidism was suspected .... whats your

comment on TSH , T4 ???

VERY LOW TSH ,VERY HIGH T4.

The Jordanian National Immunization Program

Age Recommended Vaccines

First Month BCG

61 Days DPT-HBV-Hib IPV

91 Days DPT-HBV-Hib IPV OPV

121 Days DPT-HBV-Hib OPV

9 Months Measles OPV

18 Months DPT OPV MMR

6 Years (First Grade) Td OPV

15 Years (10th Grade) Td

Cont till 6 years

Mention 3 moderate side effects for DTP

What is his age ?18 months

A B

Q7: what’s the expected age in :

A : 4 months

B : 9 months

What is his age ?10 months

What is his age ?3 months

What is his age ?9 months

What is his age ?8-9 months

What is his age ?10 months-pincer grip

1: what’s the name of this test??Babinski 2: mention two abnormalities you expect to find in the lower extremities of this child?

1: what is the most likely diagnosis?myelomeningocele2: what do you expect to find in his lower extremities?

Hypotonia, absent reflexes, urine and fecal incontence

Q6: In the followingpicture :

A : whats the most likely diagnosis??

myelomeningocele.

B: what do you expect to find in his lower extremities?

hypotonia.

Q: What is THE MOST PROMINENT FEATURE IN THIS CHILD?Muscle wasting

1: what is the most likely diagnosis?Cushing syndrome2: mention two abnormal vital signs in this baby?Hypertension and high temp.

• Imperforated anus

• Family pedigree

• Growth chart

• Cushing

1- WHATS your diagnosis ??

erythema nodosum.

2- 2 organisms could cause such case ??

mycobacrteria TB AND group a streptococcus

1- whats th diagnosis ?pnuemopericarduim

2- whas the treatment ?pericardiocentesis.

this is the mouth of 3 monthes old baby , on breast feeding ....

1- whats th diagnosis ?oral thrush .

2- whats the organism ?candida albicans.

• Asthmatic child comes to the ER complaining from S.O.B , his ABG

• Ph = 7.15 ,, pco2 = 55 ,, hco3 = 15 , po2 = 70%

• whats your interpretation ??

• its mixed respiratory and metabolic acidosis with hypoxemia .

Q2: In the next X-ray A: what is the test you will ask for?

Serum Ca+ and phosphate level.

B: what is the treatment in this case?

Vitamin D with Ca+ supplement

Q: In the following pictures :

A: what is the name of this syndrome?

Turner syndrome .Note the webbing of the neck

B: what is the main cardiovascular abnormality inthis patient?

Bicuspid aortic valve COA

1. whats the most likely diagnosis ?

cushing syndrome.

2. mention tow abnormal vital signs in this baby ?

high body temperature, high blood pressure, high heart rate

Q1: what’s the name of this test ?

babinski sign.

Q2: mention tow abnormalities youexpect to find in the lower extremities of this child?

clonus, hyperreflexia “brisk tendon reflexes”

Q : See the Growth chart of 3 year old boy :

A: what is the 3 abnormalities in this Growth chart?

B : what is the most appropriate

diagnosis?

Celiac disease.

1. in this image:

a. mention two clinicalfindings in this patient?

Clubbing - Cyanosis

b. What system do youwant to examine for thispatient?

CVS or RS

to differentiate between resp or cardio causes of cyanosis we do hyperoxia test(100% oxygen should increase the po2 to 100mm\hg in respiratory if not then it’ s cardio.

3. in the following image:

a. what is the main abnormality

You can find it in this patient?

CVS abnormality (VSD).

b. name the test you want to

Confirm your diagnosis?

cytogenetic test

4. in the following image:

a. what is your diagnosis?

Mangolian spots

b. what you want to do for thatpatient, & why?

Nothing, because it normallydisappears 3 – 5 years after birth

5. in the following image:

a. what is your diagnosis?

Facial Palsy .

b. mention the cause of thatproblem?

Birth injury (Injury To facial nerve)

6. in the following image:

a. mention two clinical findings in the physicalexamination?

Head Lag .C-shape or Drapes over in horizontal suspension.

b. what is the cause of thesemanifestations?

Hypotonia

8. In this X-ray:

a. name the lesion that you see in this X ray?

- Consolidation in the right lung / orcollapse in the same lung

b. what is your diagnosis?

- Pneumonia / or obstruction by foreignbody

9. Case with CSF analysis:

In that analysis was Leukocytosis, high protein concentration, High glucose concentration, High number of neutrophils.

What is your diagnosis?

- Bacterial Meningitis

What is this reflex ?

Tonic neck reflexes

disappears by 3-4

months

Syndromes …

-What syndrome is this ?

- What is the

chromosomal defect here ?

- Name 2 congenital defects

that are associated with

this condition.

- Down‘s Syndrome

- the presence of an extra copy of genetic material on the 21st

chromosome, either in whole (trisomy 21) or part (such as due

to translocations) .

- AV canal (aka endocardial cushion defect), VSD, ASD, valvular

disease, duodenal atresia, annular pancreas, & imperforate anus

‚Nelson p179‛.

-What syndrome is this ?

- Name 2 congenital defects

that are associated with

this condition.

- Turner Syndrome

-Coarctation of the aorta ‚most common‛, bicuspid aortic valve;

later in life, poststenotic aortic dilation with aneurysm may

develop. Also renal anomalies e.g. horseshoe kidney. ‚Nelson

p181‛.

-What syndrome is this ?

- What is the

chromosomal defect here ?

- Name 2 congenital defects that

are associated with this

condition.

- Williams Syndrome

- a small deletion of chromosome 7q11.

- Supravalvular aortic & pulmonic stenosis and

peripheral pulmonic stenosis.. ‚Nelson p181‛.

-What syndrome is this ?

- What is the

chromosomal defect here ?

- male : female ratio of

incidence is ?

- Noonan Syndrome (sometimes desrcribed as ‚the

male version of Turner's syndrome‛).

- autosomal dominant (AD) congenital disorder .

- 1 : 1 … as it’s AD.

-What syndrome is this ?

- Name 2 clinical

manifestaions maybe found

in this pt.

- Goldenhar syndrome.

- limbal dermoids, preauricular skin tags,

and strabismus .

- Note: ‚Chief markers of Goldenhar syndrome are

incomplete development of the ear, nose, soft palate,

lip, and mandible on usually one side of the body‛ …

Wiki

-What syndrome is

this ?

- Name 2 clinical

manifestaions

maybe found in this

pt.

- Crouzon syndrome.

- Low-set ears, brachycephaly, Exophthalmos,

hypertelorism, hypoplastic maxilla … etc.

Congenital Cushing’s syndrome

- What could this pt have ?

X – Rays …

Upper right lobe pneumonia.

- What could this pt have ?

Lower right lobe pneumonia.

- What could this pt have ?

Pneumopericardium.

- What could this pt have ?

-pneumomediastinum.- sail or bat wing sign.

- What could this pt have ?- what’s the finding that the arrow is pointing to ?

reticulogranular pattern(ground glass appearance), seen in RDS.

- What is the finding seen in this x-ray?

Intestinal obstruction

- What does this indicate ?

Massive pleural effusion

- What’s your dx ?

Congenital diaphragmatic hernia

- What is your dx ?

Middle right lobe pneumonia.

- What could this pt have ?

Development and primitive reflexes

-what’s the name of

this reflex ?

when does it appear

/ disappear ?

-landau reflex.

- It develops at 3-10 months and lost at

36 months. ‚in the lec.‛

What is his age ?18 months

A B

Q7: what’s the expected age in :

A : 4 months

B : 9 months

What is his age ?10 months

What is his age ?3 months

What is his age ?9 months

What is his age ?8-9 months

What is his age ?10 months-pincer grip

-what’s the name of

this gross motor ?

Around what age

does it appear ?

-Mouthing.

- It develops around (4 -5) months.

-what’s your rough estimation of this child’s

age ?

-Around ( 9 – 11 ) months.

-When does this reflex appear ?

-Around ( 6 - 7) months.

Symmetrical tonic neck reflex.

Oral reflexes A

1.Sucking >>A

2. Rooting >>B

> Both disappear at 3rd month

> Significant for feeding

B

Grasp reflexes

1.Palmar grasp > disappear at 3rd m

2.Planter grasp > disappear at 6th m

note: in the palmar grasp:

>> the ulnar grasp appear before the

radial .

<<the radial grasp is more sensitive

Moro reflex

>> disappear at 3rd month

>> sudden drop the head of the babe lead to

sudden abduction follow by adduction of the

arms and the legs , followed by fanning of the

fingers.

>> Persistent Moro associated with

emotional difficulties: anxiety, excessive

reaction to stimuli, overreacting and

dominating

Tonic neck reflexes

1. Asymmetrical tonic neck reflex (ATNR)

>> disappear at 3rd -4th month

>> when we turn the head to one side the

extension of the upper and lower extremities on

the same side , and flexion in the other side

>>Persistent ATNR leads to poor hand eye

coordination, poor handwriting, difficulty

crossing the midline, mixed lateratliy, and

difficulty crossing the midline

Tonic neck reflexes

2.Symmetrical tonic neck reflex (STNR)

>> start to appear at 6-7th month.

>> disappear with crawling

>> extension of the neck result in extension

of the upper limb and flexion of the lower

limb .

>>Persistent STNR interferes with hand use

as the head moves, results in “clumsy child

syndrome”, and slumping when sitting at a

desk

Tonic neck reflexes3. Landaue reflex:

>> it develops at 3-10 month and lost at 36

months

>> in ventral suspension of the baby , extension

of the neck and lower limb.

>> both landaue and symmetrical tonic neck

reflexes are “ Bridging reflexes “

Trunk incurvation ( gallant’s reflex )

>> disappear at 9-18 months

>> stroking of the skin along the edge of the

vertebra produce curvature of the spine with

apex opposite to direction of stroke.

>> Persistent Galant associated with fidgeting,

bedwetting, poor concentration and short term

memory.

Placing and walking reflexes

>>disappear at 5-6 weeks

>> infant place foot on examining surface when

the dorsum of foot is brought into contact with the

edge of surface,

Note >> all primitive reflexes are primary reflexes that should be

lost during development , they are automatic and involuntary

movement ……these reflex are controlled by brainstem and

inhibited by cortical maturation.

POSTURAL AND PROTECTIVE REFLEXES

Righting reflexes

Occulo-head righting reflex

Labyrinthine-head righting reflex

Body righting

>> they organize the relationship between the head, neck and the trunk.

>> when u turn the baby for one side he starts to move his head to other side; in order to maintain a horizontal vision.

Parachute reflex

>> appear at 6th – 9th month.

>> persists through life.

>> when you hold the baby on his

abdomen and u drop him suddenly he

will extend his hand in front of him.

>> it is important as defense

mechanisms against postural reaction.

Red flags in motor development

ABNORMAL SPONTANEOUS POSTURES

Frog leg

>> Both knees touching the bed at the

same time

>> usually seen in hypotonic babies.

scissoring

Opisthotonusstate of a severe hyperextension and

spasticity in which an individual's head, neck

and spinal column enter into a complete

"bridging" or "arching" position.This abnormal

posturing is an extrapyramidal effect and is

caused by spasm of the axial muscles along

the spinal column.

>> seen in some cases of severe cerebral

palsy and traumatic brain injury or as a result

of the severe muscular spasms associated

with tetanus.

Nursery

& NICU …

-What’s the dx ?

-What other

findings could be

found in this pt?

- Omphalocele.

- cardiac defects, Beckwith-Wiedemann syndrome

(somatic overgrowth, hyperinsulinemic

hypoglycemia, risk for Wilms tumor), and

intestinal complications.

-What’s the dx ?

- What’s the

importance of this

condition?

- Gastroschisis.

- its association with intestinal necrosis; although

it’s not associated with extraintestinal anomalies,

but segments of intestinal atresia are common.

-What’s the dx ?

- When it’s seen ?

- Neonatal jaundice.

- when Bilirubin levels > 5 mg / dL.

-What’s the dx ?

- what findings could this pt present?

- Meningomyelocele.

- total paralysis, loss of sensation in the legs and

incontinence of bowel and bladder. In addition, affected

children usually have an associated Arnold-Chiari

malformation of the brainstem that may result in

hydrocephalus and weakness of face and swallowing.

-What’s the dx ?

- what are the risk

factors to have this

condition?

- what’s the treatment?

& when to be

performed?

- Unilateral complete cleft lip.

- *a strong genetic component (the risk is highest in children with affected

first-degree relatives, Monozygotic twins are affected with only 60% concordance,

suggesting other nongenomic factors). *Environmental factors during

gestation also increase risk, including drugs (phenytoin,

valproic acid, thalidomide), maternal alcohol and tobacco

use, dioxins and other herbicides, and possibly high

altitude.

- Surgical closure; is usually done by 3 months of

age.

-What’s your dx ?

- Ankyloglossia, commonly known as

tongue tied.

-What’s your dx ?

- What’s the etiology 4 this

condition?

- What are the

complications of both

treated or untreated pt.s ?

- CLUB FOOT (TALIPES EQUINOVARUS).

- can be congenital, teratologic, or positional. Congenital clubfoot

(75% of all cases) is usually an isolated abnormality. Teratologic clubfoot is associated with

a neuromuscular disorder, such as myelomeningocele, arthrogryposis, or other syndromes.

Positional clubfoot is a normal foot that was held in the deformed position in utero.

- Complications of untreated clubfoot include severe

disability. Complications of treated clubfoot include

recurrence and stiffness.

-A (2-4) wk old newborn presented with this

finding, What’s the dx ?

- Why does it occur?

- Neonatal acne.

- Is thought to be a response to maternal

androgens, ‚occurs in about 20% of normal

newborns‛.

-What’s the dx ?

- female : male ratio is ?

- what complication may develop ?

- Hemangiomas.- ( 3 : 1 ).

- Ulceration, the most frequent complication, can

be painful and increases the risk of infection,

hemorrhage, and scarring

Micellaneous …

-What’s your dx ?

- Acute follicular tonsilitis.

-What’s your dx ?

-Angioedema.

-What’s the finding?

-What does it indicate?

-Raccoon eyes.

-A closed-head injury that results in a

basilar skull fracture.

-What’s the finding?

-Hair on end appearance in chronic

hemolytic anemia.

-What’s your dx ?

-Microcephaly.

-What’s your dx ?

-Erb’s palsy.

-What’s your dx ?

-Kwashiorkor.

-What’s your dx ?

-Left hypoglossal nerve palsy.

-What’s your dx ?

-Left vagus nerve paralysis.

-What’s your dx ?

-Serous otitis media.

-What’s the finding?

-Frog-like position.

-What’s your dx ?

-Henoch-schonlein-purpura

-What’s the finding?

-Angular cheilitis.

-What’s your dx ?

-Mastoiditis.

-What’s your dx ?

-Hydrocephalus.

-What’s your dx ?

-Nasal Polyp.

-What’s your dx ?

-Holoprosencephaly.

-What’s the finding ?

-What does it indicate ?

- Sunset eyes.

- Increased intracranial pressure.

1. Give 2 differential diagnosis.

2. What is the most important pre-op step of management?

• In exam there were arrows indicating P waves.

1. What is the diagnosis?

2. Mention one cause.

1. What is the diagnosis?

2. Mention 2 signs on physical exam.

These CXRs for a premature newborn with respiratory symptoms…, the 2ed is after receiving management.

1. What is the management he received?

2. Mention 2 radiological signs?

1st 2ed

1. Mention 2 radiological signs.

2. What is the diagnosis?

Hx: Mentally retarded, his brother has similar condition (Autosomal Dominant)

1. Mention 2 signs.

2. What is the diagnosis?

Hx: infant with recurrent vomiting.

1. Mention 2 signs rather than signs of dehydration?

2. Mention one diagnostic test.

• ABGs for a patient with chronic renal failure on diuretics: pH increased, bicarbonate increased, PaCO2 increased, K decreased.

1. What is the diagnosis?

2. What is the cause?

CSF profile: results go with viral meningitis, RBC +ve, he had one attack of convulsion.

1. What is the causative agent?

2. What is the treatment?

3. Is there need for anticonvulsants?

A mother of 6-month old baby comes to you on summer asking about vaccinations:

1. Mention 3 vaccines not in JNP you can give him.

2. She asks about vaccine prevents gastroenteritis, do you give him?

3. He did not receive his BCG, do you give him now?

Blood films

This patient presented with jaundice, splenomegaly, and family history of the same condition. 1. What is the diagnosis?

2. Give one diagnostic test for this patient?

patient presented with pallor, lower limb nubmness, vitiligo, what is the diagnosis?

This patient is anemic, and have abdominal & lower limb pain. What’s your diagnosis?

What is your diagnosis?

This patient suffered from parasthesia and weakness in her lower limbs, what is your diagnosis?

21 YO male patient presented with dark urine & mild jaundice.What is the diagnosis?

Pt presented with anemia & splenomegaly with family Hx of Anemia, what is the Dx?

Hair on end appearance-sickle cell anemia

.A. What is this type of treatment? Phototherapy B. What is the mechanism of action in the body? Isomiration of bilirubin to

lumirubin(water soluble) to excrete it in urine out the body !

10. What are these signs and what is the disease that causes them? 1. Gower sign and pseudohypertrophy2. duchenne muscle dystrophy(xlinked)

13 month old has an abdominal mass.

What's your diagnosis? (Neuroblastoma)Mention 2 non-radiological tests for confirmation. (VMA, bone marrow biopsy)

What's the diagnosis? (Pericardial effusion!)flask shaped heart2 things you'll hear by auscultation. (Friction rub, muffled heart sounds)

Dx. (Congenital cataract)2 causes. (Rubella, galactosemia)

leucocoria:congenital cataract , rop, retinolastoma

Q1 : What sign do you see in this film ?

Q2 : What does it indicate ?

Q3 : What is the usual cause ?

Q4 : What is the device seen in this film ?

Q1 : Ground Glass (salt pepper appearance ) . Q2 : It indicates RDS .Q3 : Meconium aspiration .Q4 : endotracheal tube ( E )

E

Ground Glass ( salt-pepper ) sign : areas of hyperinflation near a collapsed area . The cause usually meconium aspiration , when meconium is trapped in small airways and block it ( collapsed ) , then the adjacent area will receive much air and become hyperinflated .

RDS

Q1 : Identify the condition ?

Q2 : mention 2 causes ?Q1 : pneumothorax .

As you see there is prominent seperation between the rt. lung tissue & sourrounding pneumothorax .

Q2 : trauma , infection .

Pneumothorax is the accumulation of extrapulmonary air within the chest. It is uncommon during childhood. Most often, pneumothorax results from leakage of air from within the lung. Air leaks can be primary or secondary ( Asthma , bronchiolitis , pulm. Hypoplasia , infection , lung abcess , ….. ) and can be spontaneous, traumatic ( penetrating or blunt trauma ), or iatrogenic ( thoracotomy , tracheostomy , …. ) .

Q1 : Identify the condition ?

Q1 : Pneumopericardium ( air surrounding the heart ) as the arrow show .

Q1 : Identify the condition ?

Q2 : mention 2 possible causes ?

Q1 : Hepatomegaly , as you see there is upward disposition of right hemidiaphragm .

Q2 : 1- infection ( hepatitis )

2- CHF

3- metabolic

4- veno-occlusive diseases

5- sickle cell crises

A 13 year old male pt. known to have CF , presented to ER complaining of severe productive cough & fever . From these 2 pictures :

Q1 : What is the possible diagnosis ?Q2 : What is the sign seen in his hand ?Q3 : Mention 2 other respiratory manifestation pt. with CF can present ?

Q1 : Bronchiectasis

Q2 : finger clubbing .

Q3 : 1- recurrent bacterial infection .

2- pneumothorax .

3- nasal polyps

Cystic Fibrosis

Cystic fibrosis (CF) is an autosomal recessive genetic disease that affects the exocrine function of the lungs, liver, pancreas and small bowel resulting in progressive disability and multi-system failure .

the presence of cystic fibrosis is tested for immediately at birth with a sweat test (positive sweat chloride test Cl > 60 mEq/L) .

Cystic fibrosis is due to a defect of the Cystic Fibrosis Transmembrane Regulator (CFTR) (gene on chromosome 7q31.2) which is responsible for regulating chloride passage across cell membranes.

The diagnosis usually becomes evident in infancy, with presentations including:

meconium ileus

rectal prolapse

recurrent pulmonary infection

Q1 : Identify the condition ?

Q2 : Mention 2 abnormalities seen in the film supported your diagnosis ?

Q1 : congenital diaphragmatic hernia

Q2 : 1- Right hemithorax is filled with cystlike structures (loops of bowel) .

2- the mediastinum is shifted to the left .

3- the abdomen is relatively devoid of gas .

There are two main types of congenital diaphragmatic hernias : 1- Bochdalek hernia : most common, located posteriorly and usually present in infancy 2- Morgagni hernia : smaller, anterior and presents later

• This is left diaphragmatic hernia . The intestinal loops ( which are on the left side ) will compress the lung and cause hypoplasia .

• There is tracheal shift to the right .

• NG tube is clear in this image ( not ET tube ) .

A 14-month-old boy had high fever and cough for 3 days prior to admission , depending on CXR :

Q1 : What is your diagnosis ?Q2 : What is the most common cause ?Q3 : Mention 3 complications ?

Q1 : Lobar pneumonia

Q2 : Bacteria infection ( esp. pneumococcal pneumonia )

Q3 : 1- pleural effusion

2- empyema

3- pericarditis

This is a child with severe RDS ( as you see , the left lung is whitish in color

because a lot of mucus is accumulated ) .

The cause of RDS here is patent foramen ovale .

As you see, there is a catheter that inters through the umblical lines ( U ) , go to the heart , and pass through the patent foramen ovale .

You can see also ET tube ( E )

U

E

• This is a pt. with chronic lung disease caused by PDA .

• The PDA is corrected by ligation ( as you see the clips are clear )

Surgical emphysema

Q1 : Identify the sign ?

Q2 : What does it indicate ?

Q3 : What symptoms Pt. can present with ?

Q1 : double bubble sign .

Q2 : Doudenal atresia .

Q3 : 1- vomiting .

2- delayed meconium illeus .

3- abd. Distention .

Necrotizing Enterocolitis

Pneumatosis Intestinalis

What is this sign and what disease it’s associated with?Port wine stain- sturge weber disease

• It’s very high yield to know how to determine the pattern of inheritance and the most common examples on it.

What type on inheritance is this?Give two examples?

Autosomal dominant-hereditary spheocytosis and achondroplasia

What’s the type of inheritance and mention examples.Autosomal recessive

CYSTIC FIBROSIS sickle cell anemia

Patient presents with drooling ,dysphagia and distress tripod position

thumb sign on LATERAL xrayepiglottitis caused by haemophilus inflenza b

Croup : barking cough, inspiratory stridor and distress.Steeple sign on xray

caused most commonly by parainfleunza virusmanaged by racemic nebulized epinephrine

Jaundice in infants.

a child with frothy urine developed periorbital edema THEN lower limb edema what other abnormalities you could find?

Whats the diagnosis??

• Important about growth parameters:-birth weight should be 2.5-4(avg:3)doubled at 6m tripled at 12m-length and height:at birth 50 cm doubles at age of 4 years-head circumference at birth is should be 35cm by the end of 1st year its 47

TOF >>boot shaped heart.

Snowman sign(figure of 8)total anomalous pulmonary venous return

Egg shaped cardiac silhouettetransposition of great vessels.

• GOOD LUCK :)