Neonatal/Paediatrics

OSCE/Short Cases
For Year 5 Paeds Rotation
Session 2

Dr Amjad IMAM
Asst Prof Paediatrics AGU
 Y5 EXAM Paediatrics
 Continuous Assessment 25%
(+Portfolio)
 Clinical Examination: long case & Short Cases
30%
 Written 2 & ½ hr 35%
50 MCQ & 10 SAQ

 OSCE 10%
10 station of 3 min each+/- rest station
(Skin Rashes,syndrome(gentics),X-Rays, Growth
chart,congenital malformation,Prescription
writing,Immunization,Interpretation of Blood results,blood
films,ECG, instrument ect)
OSCE/short cases/Spot diagnosis

 Rashes(infection)?
 Neonatal spot cases?
 Common Syndromes?
 ECG?
 X-rays?
 Instruments?
 Blood Films
OSCE/Short cases/Spot diagnosis

Rashes/Infections
Know the Terminology of Rashes?
Terminology of SKIN Lesion
Description Example
 Macule; Flat lesion with alteration in colour Vitiligo,freckle
 Papule: Elevated lesion<0.5cm diameter Mulluscum contagiosum
 Nodule: Elevated lesion>0.5cn diameter Viral wart
 Plaque: Elevated area >2cm diameter Psoriasis
 Wheal: Transient dermal oedema Urticaria
 Vesicle:small fluid filled lesion<0.5cm diameter Herpes simplex
 Scales: Flakes of stratum corneum Icthyosis,Psorisis
 Excoriation: Damage to skin due to scratching Any pruritic(scabi)
 Lichenification: Thickening due to rubbing Chronic ECZEMA
 Ulcer : Loss of both dermis and epidermis Aphthous ulcer
 MaculoPapular: Rash containing both flat and raised
Lesion MEASLES
What's this rash?
 Milia

 Epidermal inclusion cysts

 Pearly, yellow, 1-3mm diameter
papules
 Face, chin, forehead
 50% newborns
 Usually resolve in first month without
treatment, but may persist for several
months
What is this rash?
 Mongolian blue spot

 Blue/black macular discolouration at

the base of spine and on the buttocks
 Occasionally on legs or other parts
 Usually in dark skin ,afro-Caribbean or
Asians
 Fades slowly over few days to 1 yr
 Reassurance
What is the white substance?
 Vernix Caseosa

 Whitish greasy coat is produced by

epithelial cell breakdown

 Ptotect skin from amniotic fluid in utero

What is the Rash?
 Erythema Toxicum

 Benign Common after 2-3 days

 Also called neonatal urticaria
 White pinpoint papule with
erythematous base
 Fluid contain eosinophil
 Come and go (Evanescent)
 Resolve without any treatment self
limiting in 2-4 days
What's this?
 Hemangioma
Strawberry Naevus
 Most common benign tumour of
infancy,more common in preterm
 Begin as barely visible telangiectasia
or red macules and grow in size until
9 month ,then regress
 60% occur on head and neck area
 All gone by age 5yrs
 Large one treated with steriods or
interferon-alpha.
What's this?
 Capillary malformations

2 common types-Salmon Patch & Portwine

Salmon patch (naevus simplex)
• Common (40% newborns)
• Small flat patches pink or red, poorly defined
borders
• Nape of neck (stork mark), forehead (angel kiss),
eyelids and sacrum
• Worse with crying
• Not associated with extracutaneous findings
• Fade during first month of life
Capillary malformations
 Port wine stain(naevus
flammeus)
• Less common but permanent
• Present at birth and darken
with age
• Large flat patch of purple or
dark red skin with well defined
borders
• Persist in childhood then
darkens and thickens
• Extracutaneous
defects(Association)
• Glaucoma
Along Trigeminal (sturge-weber
syndrome) may associate
with intracranial vascular
anomalies/epilepsy
• Laser Therapy for Cosmetic
What's are these 2 rashes?
 Nappy rashes
Irritant & Candidal
 Irritant rash(contact) most common occur when
nappies are not changed frequently (urine).
Skin Flexures (Intertriginous areas) usually spared
Treat with emollient(aquous cream), barrier
cream(Zinc oxide) Nappy free
period?Hydrocartisone cream?
 Candidal Rash involve skin flexures & associated
satellite lesions
Treat with topical antifungal agents+/- hydrocortisone
What's this rash?
 Cradle cap
 Greasy, yellow scaly patches over the scalp
 May spread to face, ear and nappy
area(infantileSeborrheic dermatitis )
 possibly due to overactive sebaceous glands in the
skin of newborn babies
 Not itchy(NO pruritis)
 Treatment with mild baby shampoos. Wash
regularly and brush softly to remove scales
 Baby oil can help soften scales (not olive oil!)
 Resolves by 6-12mths
 If fails to improve = Try topical steroids+/- antifungal
What is the abnormality
 Umbical Granuloma

 Cause seropurulent discharge

 Fleshy swelling
 Treat by local application of silver
nitrate
 Sometime surgery
What is the diagnosis?
 Meningococcemia

 Fulminant illness with acute onset and

rapid progression
 Maculopapular rash to petechial to
purpuric rash
 Rapid progess to septic Shock
 Traetment supportive(ICU) ,Antibiotics
 Prevention with rifampicin for close
contact
What is the Rash called?
HSP
Henoch-Schönlein Purpura

 Commonest vasculitis of children

 Triad of purpuric rash+ large joint
arthritis + abdominal pain +/- nephritis
 Age 3-10 yr
 Rash mainly on buttock and legs
 Renal involenent-haematuria
 Intussuscption can occur +/- malaena
What's the rash?
 Chicken pox
 Begins as an itchy red papules progressing to
vesicles on bright red base (dew drops on a rose
petal) on the stomach, back and face, and then
spreading to other parts of the body
 Central umbilication of blisters follows rapidly,
crusting and desquamation within 10 days
 Fever, sore throat, anorexia, malaise may precede
rash by several days
 Incubation 7-21 days
 symptomatic treatment in immunocompetent
• Cool compress, calamine lotion, antihistamines
 ?Vaccinate
What is this rash called?
 Impetigo
 Superficial bacterial skin infection
 2 types: Impetigo contagiosa & Bullous Impetiga
 Strep pyogenes or staph aureus
 Round/oval lesions, begin as small pustular areas
and rapidly extend
 Lesions rupture, with honey-coloured crust
 Advice about avoiding spread
 Localized lesion- topical antibiotic eg
Fucidin,mupircin cream-
 Remove crust with gentle washing
 Widespread infection - oral flucloxacillin or
erythromycin/augmentin
What's that rash?
 Measles
 Prodrome; fever, malasie, dry cough, coryza,
conjunctivitis, photophobia
 Koplik spots on buccal mucosa
 Rash 3-4th day of illness
 Starts on face as blanching red macules and
papules, non itchy
 Spreads down trunk and extremities
 Rash coincides with high fever
 Lesions become confluent, older lesions
develop rusty hue
 Contagious 4 days before rash and 4 days
after
Koplik Spot
What is the Rash?
 Roseola Infantum

 Also called exanthema subitum or sixth

syndrome
 Herpes virus 6
 High fever followed by macular rash
 Mild cervical lymph nodes
 MIS-diagnosed as measles or rubella
 Diagnose by serology
 Treat symptomatic
What is this Rash?
 Erythema Infectiosum

 Also called Slapped cheek syndrome

or Fifth disease
 Caused by parvovirus 19
 Young school aged children
 Usually asymptomatic
 aplastic crisis in haemolytic
anaemias(Sickle cell / Thalasemia)
 In pregnancy –fetal complications
What is the diagnosis?
 Kawasaki’s disease
 Uncommon acute multisystem disorder
 Affect children of 6 mo to 4 yr
 Common in japan
 Vasculitis –small and midium vessel
 Fever >5 days
 Conjunctivitis
 Cervical lymphadenopathy
 Red,crack lips
 Red and edematous palm & peeling of skin
 Kawasaki disease(Cont’d)

 High ESR/CRP
 Generally Benign and self-limiting
 Complication- Coronary aneurysm
and sudden death
 Treatment immunoglobulin and Aspirin
 ECHOcardiography to detect aneurysm
Infantile eczema
Atopic Eczema(Atopic Dermatitis)

 Infants
• Infants less than one year old often have
widely distributed eczema.
• The skin is often dry, scaly and red with
small scratch marks made by sharp baby
nails
• The cheeks of infants are often the first
place to be affected by eczema.
• Readly infected with Staph or Strep or
rarely herpes
Atopic Eczema(atopic dermatitis)

 Older Children: Elbow and Knee

flexures,wrist,neck+/- lechenification
 Complication:
Secondary bacterial infection: Staph/Strep
Viral Infection: Eczema herpeticum-HSV infection
Viral wart,Mulluscum contagiosum,Varicella
Growth Impairment: in sever eczema,associated enteropathy?
 Treatment of eczema
 Avoid irritant & precipitants –aviod soap,
loose cotton clothes, avoid wool, keep cool,
nails short, gloves in bed
 Emollients
 Antihistamines
 Topical steroids/oral steroids?Mild to Potent
Mild=hydrocortisone, Moderate=Eumovate,Potent=Betnovate
 Topical antibiotics/antiviral/tacrolimus
 Occlusive Bandages Wet Wrap(impregnated
with zinc/ Tar) for scratching
 Immunomodulator-topical tacrolimus
 Dietary elimination? Chinese herb?Photother
A healthy 6 yr old boy had developed multiple papules on arm.leg ,trunk
What is the Lesion??
MOLLUSCUM CONTAGIOSUM
 Common in school children with DNA pox virus
 Spread by contact and scratching lesions
 PEARLY Papule with cental UMBLICUS
 Spontaneous resolution in 6-9 mo(can last years)
 Advise to separate Towels and Bath

 Occasional Treated by CRYOTHERAPY

A 2 yr old girl is seen in HC with diffuse intense itching. All family
member are itching-Interdigital lesion ,papulovesicle
What is the Lesion??
 SCABIES
 An irritative reaction to female mite Sarcoptes scabiei
 Transmission by direct contact
 Scabies Burrows/Rash
 Widespread itchy reaction to mite,their egg and excreta after 4-6 wk
 Erythematous papule,pustule,excoriation

 Lab Diagnosis by removal of mite or egg by KOH soln over a burrow,

scraping with needle and see under MICROSCOPE
 Treatment
Treat patient and all close contact
Topical Scabicide: Permethrin cream after a bath to whole body(and
Head <2 yr)
Wash all bed linen and immediate clothes
A healthy adolescent developed a large scaly red patch followed by
widespread papulosquomous eruption-mostly on Trunk without itch
What is the Diagnosis?
 Pityriasis Rosea

 Common rash in adolescent

 Harald Patch-large pink annular lesion
with raised border
 Christmas Tree pattern
rash(cutenous cleavage line) on the
back follows harald patch
 Teatment by emollient only. Mild
topical steroid to speed resolution
A 6 yr old boy had painful nodular lesion after sore throat
over the shin
What is the lesion?
 Erythema Nodosum

 Painful shinny,hot red elevated oval nodule

over the shin, female>male
 Causes;
Infection: Strep,Mycoplasma,TB
IBD : Crohn , Ulcerative colitis
Autoimmune: Sarcoidosis,SLE
Drugs : Sulphonamides,oral contraceptive
 Treament: bedret,NSAID,Traet the cause
 OSCE

 Neonatal spot diagnosis?

What is the abnormality?
Umblical(UH) & Inguinal Hernia(IH)

UH
 Common in afro-Caribbean
 May increase in size in first few month
 Not painful, not tender, easily reducible
 Most disappear by 1 year
 Consider hypothyroidism (Cretin)
 Refer for surgery if persist by 4 yr
IH- an emergency-Refer to Surgeon
What is the diagnosis?
 Gastroschisis

 Opening in an abdominal wall present

to the right to the umbilicus
 Often diagnosed on prenatal
ultrasound
 Managed by placement of plastic bag
followed by surgical repair
What is the diagnosis?
Exomphalos(Omphalocele)

 abdominal contents protrude through

the umblical ring covered with intact
sac(wharton jelly)
 Often associated with other major
congenital abnormality—Congenital
heart & renal abnormality.
 Management is supportive followed by
surgical repair
What is the abnormality?
 Erb’s Palsy

 Follows a traumatic delivery or

shoulder presentation
 Traction of upper nerve roots of C5/C6
of Brachial Plexus
 Most resolve by physiotherapy
 Refer to orthopedics if not resolve by 6
week
What is this swelling?
 Cephalhaematoma

 Result from bleeding below the

periosteum
 Involve parietal bone
 Resolve over several weeks
 Complication-jaundice and infection
 Treatment is conservation
 D/D Caput Succedaneum
 Cephalhaematoma

 Cephalhematoma is haematoma from

bleeding below the periosteum ,limited
by skull sutures. Resolve over weeks
Complication: infection,hyperbilirub
 Caput Succedaneum is bruising and
edema of the presenting part extending
beyond the margin of skull bones.
Resolve over few days
Caput Succedaneum
What is the abnormality?
 Neonatal Gynecomastia

 Breast enlargement can occur normally

 Can occur in both sex (boys or girls)
Maternal hormone?
 Small amount of milk may be
discharged
 Resolves spontaneously
 Reassurance
What is the cause?
 Big Baby (Macrosomia)

 IDM

 Backwith- Wiedemann syndrome

 Infant of Diabetic Mother
IDM(Macrosomia)
 Fetus: congenital malformation—
cardiac,sacral agenesis, hypoplastic
left colon-IUGR-macrosomia (shoulder
dystocia,Erb’s palsy)
 Neonatal:hypoglycaemia,RDS,
Hypertrophic cardiomyopathy,
Polycythemia
Beckwith Wiedemann syndrome
 Backwith- Wiedemann syndrome
Gene at 11p Imprinting
Macrosomia+ Ear crease on ear lobule
Pacreatic hyperplasia and hypoglycemia
Omphalocele, Hemihypertrophy,
Wilms Tumour
What is the Sex of Baby?
 Ambiguous Genitalia
Congenital adrenal hyperplasia(CAH)
 CAH most common cause of ambiguous
genitalia
 21-Hydroxylase deficiency is the most
common
 Investigations: Karyotype,serum
electrolyte,abdominal ultrasound & hormone
assay

 Management:
Replace
harmone(cortisol/testosterone)+reconstructive
surgery
 OSCE/Short case

Common
Syndromes
List 3 Cranio- facial feature of
this syndrome
 Down Syndrome (Tri 21)

 Round face and flat nasal Bridge

 Upslanted plepebral fissures
 Epicanthic folds
 Brushfield spots in IRIS (pigmented spots)
 Small mouth and protruding tongue
 Small low set Ears
 Flat Occiput (Brachycephaly)
 Short neck (risk of atlantoaxial subluxation)
 Down syndrome
 Nondisjunction(95%),Translocation,robertsonian,Mosaic 1%
 Hypotonia(floppy,small stature,developmental delay,
 Short fingers,clinodactyly,single palmer crease,wide gap between 1st
and 2nd toes(sandal gap)
 Heart: 40% AVSD, vsd,PDA,ASD, valve prolapse
 Lung: increased chest infection
 Endocrine: hypothyroid,Diabetes
 SKIN: loose neck fold,dry skin. folliculitis in adolescent
 Infertility common
 Alzheimer late
What is this syndrome
 Edward(Trisomy 18)

 Overlapping of fingers
 Prominent occiput
 Rocker bottom feet
 Cardiac and renal malformation
What is the syndrome in 18yr girl?
 Turner Syndrome
Common Features

 Lymphoedema of hands and feet

 Short Stature
 Webbing of Neck
 Wide carrying Angle cubitus valgus)
 Coarctation of Aorta
 Delayed Puberty-Amenorrhea
 Ovarian dysgenesis (infertility)
 Hypothyroidism
 Renal Anomalies-horseshoe kidney

Same feature in MALE-------------NOONAN syndrome except Rt sided PS

What is the abnormality?
 Achondroplasia

 Autosomal dominant
 Most common skeletal dysplasia
 Short stature, macrocephaly,flat
midface with prominent forehead
 Associated hydrocephalus,dental
malocclusion,hearing loss
 Normal intelligence and normal life
spans
 Child with supravalvular aortic
stenosis, prominent lips,
developmental delay, and
hypercalcemia. This is indicative
of1. DiGeorge syndrome
2. Williams syndrome
3. Noonan syndrome
4. Down syndrome
5. Fetal alcohol syndrome

Answer: 2. Williams Sd
 Williams syndrome
 Moderate Dev. Delay (IQ41-
80)
 Typical personality (Cocktail)
 Characteristic facial features
• Periorbital fullness
• Stellate iris
• Prominent lips/open mouth
• Depressed nasal bridge
 Supravalvular aortic stenosis
 Hypercalcemia
 Renal anomalies
 Hoarse voice
 22q11microdeletion
Di George/VCFS
 Physical Birth Defects
(CHD, CL&P)
 Medical Complications
(endocrine, immune,
skeletal, neurologic, GI)
 Communication Disorders
(VPI, language delays)
 Developmental Delays / LD
 Social/Behavioural
Difficulties
 Increased risk for
psychiatric illness (25%
What is the diagnosis?
Fetal Alcohol Syndrome(FSH)

 Characteristic Facies born to mother

with ingestion of alcohol in pregnancy
 Saddle shaped nose
 Mid facial hypoplasia/microcephaly
 Maxillary hypoplasia
 Developmental delay
 ECG
What is the rhythm?
Supra-ventricular tachycardia
SVT
 Most common arrhythmia in children's
 Narrow QRS complex ,difficult to find P
wave.
 Heart rate >200 usually idiopathic-
Rarely Wolff-Parkinson syndrome
 Vagal stimulation—carotid sinus
message,cold ice pack to face
 I/V adenosine if stable and not in shock
 Synchronised DC shock if in shock?
X-Rays
 Child Abuse

Type of Abuse
 Physical (Non accidentalinjury)NAI
 Sexual
 Emotional & Neglect
 Fabricated (Munchausen syndrome by
proxy)
What is the diagnosis?
 Fracture of Rib

 Posterior rib fractures are diagnostic of

NAI
 Easy to MISS
Spiral and Metaphyseal fracture
 Fracture due to NAI

 Metaphyseal fracture
 Posterior rib fracture
 Spiral fracture of femur in Toddler
 Multiple fracture
 Fracture of different ages
 Complex & Linear skull fracture
A 3 year old boy presented to emergency with 7 day h/o cough and
wheeze after choking on some peanuts.
What is the diagnosis?
 Foreign body inhalation

Differential diagnosis
 Asthma
 Recurrent respiratory infection
 Recurrent aspiration(+/- GERD)
 Suppurative lung disease (CF)

Bronchoscopy –Fibro-optic and Rigid

What is the abnormality in normal
baby CXR?
 Thymus Sail Sign

 Thymus BIG in Neonates—T cell

 Absent in Di George syndrome/SCID

microdeletion Chromosome 22
Hypocalcemia,recurrent infection
Cleft palate, low set ear,learning
problems,Aortic arch anomalies(Rt sided
aortic arch, inturrepted AA
Trucal arteriosis,VSD,PDA,TOF
Enlarged Thymus-Sail Sign
What is the abnormality?
 Big Heart Shadow
Cardiomegely
 Heart failure
 HOCM/DCM
 Pericardial effusion
 Significant Lt to Rt shunts
 Ebstein Anomaly
What is the Cardiac Abnormality?
 Ventricular Septal Defect
VSD
CARDIOMEGELY & PULMONARY PLETHORA
 30% of CHD
Types?
 Inlet
 Muscular
 Perimembranous
 Outlet
Loud Pansystolic murmur LSE+Thrill (Mid-diastolic
if large defect due to increased mitral flow)
Loud P2 if pulmonary hypertention
What is the syndrome?
 Immotile Cilia Syndrome
Kartagener syndrome
 Group of inherited condition caused by
absence of dynein(ATPase) on the cilia
 SITUS Inversus(dextrcardia), Chronic
sinusitis,immotile cilia
 Neonatal respiratory syndrme,chronic sinusitis,otitis
media,male infertility
 Diagnosis by iltrastructural changes of dynein arms on
cilia(gold standerd)
 Nasal mucosal scrapping-motality decreased
 Ferguson E C et al. Radiographics 2007;27:1323-1334

©2007 by Radiological Society of North America

Transposition of great arteries
TGA
 Egg on side shaped
 Increased pulmonary marking
 Two parrallel circulation
 Survival due to mixing –PDA, Foramen
ovale, ASD,VSD
 What is the diagnosis?

Ferguson E C et al. Radiographics 2007;27:1323-1334

©2007 by Radiological Society of North America

 Figure. Tetralogy of Fallot.

Ferguson E C et al. Radiographics 2007;27:1323-1334

©2007 by Radiological Society of North America

 Tetralogy of Fallot (TOF)

 VSD
 RV outflow obstruction(valvular+infundibular stenosis)
 Overriding aorta
 RV hypertrophy
Associations:
Down syndrome
Di George
CHARGE
VACTERAL
 What does the Box shaped heart
mean?Diagnosis?

Ferguson E C et al. Radiographics 2007;27:1323-1334

©2007 by Radiological Society of North America

 Ebstein anomaly
BOX shaped Heart
EBSTEIN ANAMOLY
 Abnormal tricuspid valve(leaflet adherent to wall)
 Distally displaced TV
 Atrialization of Rt Ventricle
 ASD
 Functional pulmonary atresia
 WPW syndrome
 Ferguson E C et al. Radiographics 2007;27:1323-1334

©2007 by Radiological Society of North America

 Type I TAPVR. the classic snowman sign, sometimes referred to as a figure-of-eight sign.

Ferguson E C et al. Radiographics 2007;27:1323-1334

©2007 by Radiological Society of North America

 Total anomalous venous
drainage(TAPVD)
 All the pulmonary V. drain into Rt
Atrium
3 type:
1. Supracardiac
2. Cardiac
3. Infracardiac

Classical SNOWMAN SIGN or figure of 8

What is the diagnosis?
Cong. Diaphragmatic hernia

 Most common left side through

posterolateral foramen(Bockdalek)
85%
 Present with failure to respond to
resuscitation or resp distress
 Mortality high if lungs hypoplastic
 Rx=After stabilization—Surgical repair
What is diagnosis? Name 2 X-ray abnormalities?
 RICKETS
 Nutritional Rickets due to Vit D
Deficiency
 Xray shows cupping and fraying of
metaphyses & widened epiphyseal
plate
 Clinical feature include Failure to Thrive,Frontal bossing of skull,
Craniotabes(pingpong ball sensation of skull),Delayed closure of anterior
fontanelle,Delayed dentition,Rickety Rosary(prominent costochondral
junction).Harrison’s Sulcus(horizental depression on lower chest corresponding to
attachment of diaphram),Expansion of Metaphyses(especially
wrist),Hypotonia,Bowed Leg
 Blood test: Calcium is normal or low
Phosphorus is LOW
Alkaline Phosphatase is greatly increased
OSCE/Short Cases/Spot diagnosis

 INSTUMENTS
What is this instrument?
 AeroChamber with Mask

Used in Children for delivery of drugs in

Asthma (inhaled steroids/ventolin) with
inhalor.

Better coordination and deposition of

drugs in lung in small Kids
What is the name of this ?
 Disc inhaler for asthma

 Used for bigger children for Inhaled

steriods
 DISKUS-Dry powder inlalor
 Need good inspiraory flow
 Use in +4 yr old
 Portable
What is this instrument?
 SPACER

 MDI (Inhaler) with Spacer(Nebuhalor)

 Suitable for all ages
 Suitable for <2 with facemask
 Suitable for >2 without face mask
What is this instrument?
 Nebulizer

 All ages
 Used in acute asthma where oxygen is
needed in addition to inhaled drugs
 Occationaly used at home in acute
emergencies
Closed Incubator
 Growth Charts
Essential growth measurement:
 Single height(Ht), weight(Wt) & Head circumference(OFC)(<2yr)
 Growth pattern plotted over 6-12 mo assess rate of growth and
deviation across centiles
 Chart for Ht,Wt,and OFC from extreme prematurity(23weeks)
to 20 years.
There are 9 equidistant centile line 2/3rd of a standard deviation
apart=0.4th centile to 99.6th centile-equivalent to +/-2.67
standard deviation from mean
 WHO growth chart(Z score),CDC chart,RCPCH(British) chart,
 growth velocity chart-indicator of growth problem(2
measurement 4 month apart-the difference between 2 Ht is
devided by time interval between them= growth in cm/yr
 Down syndrome chart,Turner syndrome chart
Gestational Age: SGA/AGA/LGA
Failure to Thrive
Down syndrome growth chart
 OSCE/Short cases

 Blood Films
This is a peripheral blood film from a 3 yrs. old Africo-Caribbean child
with abdominal pain and mild jaundice

 1.Name 2 abnormality

 2.What is diagnosis

 3. How you confirm?

 4. What advise to family?

 Sickle cell disease

 1. Large proportion of Sickle cell, target cell,

Polychromasia

 2. Sickle cell disease

 3. HPLA
 A Sickle solubility screening test
 Hb Electrophoresis
 4. Educate family about prevention and treatment of
painful crises with analgesia+hydration
Pneumovax,H influ & HepB vacc
This 6 year old child had an abdominal operation following
trauma at the age of 4 yr

1.Name 2 abnormalities

2. What is the diagnosis?

3. What are long term complication?

 Hyposplenism

1. Target cell, Howell –Jolly bodies(blue staining

remnant of RBC) and crenated RBC
2. Hypospenism: Splenectomy is done in chr ITP
hereditary spherocytosis,sickle cell disease
3. Increased risk of pyogenic infection including
pneumonia,septicaemia & meningitis cause by
pneumococcus and other polyschcharide
encapsulated organisms(eg,H influenza TypeB,
Vaccine +Penicillin until adult life
This is a blood fil from a 18 mo old child on bottle feeding only with
pallor and poor apetite.

1. Name 2 abnormalities

2. What are the causes

3. How to confirm diagnosis?

Iron deficiency/beta Thal trait

 1. Hypochromic, microcytic RBC,Anisocytosis,Cigar

shaped RBC

 2. Iron def anaemia, beta thalacaemia Trait

Cigar shaped in iron def

3. Iron studies__-Serum ferritin,total iron binding

capacity
HPLC/Hb electrophoresis after iron
repletion
This is the blood film of 6 mo old infant who had history of
neonatal jaundice

1. What is the diagnosis?

2. Name 2 complication
3. How to treat?
Cong Hereditary Spherocytosis
1. Spherocytosis AD There are multiple small
densely staining spherocyte—large blue young
red cell –polychromatic
2. Hyperbilirubinaemia—prolong neonatal jaundice
Fluctuating jaundice,splenomegaly & gall stone

3. F/U for anaemia,monitor growth

Splenectomy if severe
anamia,hypersplenism,gallstone or failure to thrive
AD screen other family member
 Genetic Diagnosis

Diagnostic TIP
&
Diagnostic TRIAD
 Diagnostic TIP

 A.Mousy body odour?

 B. Maple Syrup odour

 C. Doll like facies?

 E. Elfin face?
 F. Red urine on exposure?
 E. Blue diaper
 Diagnostic TIP(Ans)

 A.Phenylketonuria
 B. Maple Syrup urine diseseas

 C.Glycogen storage disease(G-6 P def)

 D. William Syndrome
 E. Porphyria
 F. Tryptiphan malabsorption
 Diagnostic TIP

 A.Chipmunk facies?
 B.Fish like mouth with micrognathia
 C.Butterfly like facial rash
 D.Happy Puppet feature
 E. Blue sclera
 F. Hig pitched meowing cry
 Diagnostic TIPS(Ans)

 A. Thalasemia major
 B. Turner syndrome
 C. SLE
 D. Angleman syndrome
 E. Osteogenesis Imperfecta
 F. Cat Cry syndrome(maladie du cri du
chat)
 Diagnostic Triad

 A. typical facies+hypotonia+single
palmer crease?

 B. MR +Large ear+Large testes?

 C. male child+wadling gait+bulky calves?

 Diagnostic Triad(Ans)

 A. Down syndrome

 B. Fragile X syndrome

 C. DMD
 Diagnostic Triad

 A. Pallor+ Jaundice+ hepatomegaly?

 B. light brown skin patches+ skin

tumour+ axillary freckles?

 C. adenoma sebaceum+ MR+seizure

 Diagnostic Triad(Ans)

 A. Thalasemia Major

 B. NF1

 C. TS
 MNEMONICS
 6 T’s

 6 T’s(Cyanotic heart)
Transposition of great arteries
Tricuspid atresia
Total anomalous pulmonary venous drainage

Truncus arteriosis
Tetralogy of fallot’s
aTresia Pulmonary
 My HEART

 My HEART for Kawasaki

M Mucosa
H Hand extremity changes
E Eye changes
A Adenopathy
R Rash
T Temperature
 Refleses 1,2,3,4,5,7,8

 Reflexes 1,2,3,4,5,6,7,8

 Ankle S1,S2
 Knee L3,L4
 Biceps C5,C6
 Triceps C7,C8
 Fluid 4,2,1

 Fluid regimens
4,2,1
For children over 10 kg:
First 10 Kg they need 4ml/kg/hr
For next 10 kg they need 2ml/kg/hr
Thereafter per Kg they need 1ml/kg/hr
 CATCH 22

 Di George syndrome
CATCH 22
C Cardiac abnormalities
A abnormal facies
T Thymic abnormality
C Cleft palate
H hypocalcaemia
22 Microdeletion are on chromosome 22
 VACTERL

 VACTERL Syndrome
V Vertebral anomilies
A Anal
C cardiac
T Tracheal
E Esophageal
R Renal
L Limb
 Mnemonics

 APGAR score

A Appearance
P Pulse
G Grimace
A activity
R Respiratory rate
END of Year 5 Paediatrics Rotation

 Best of Luck for end of rotation EXAM

June 2014