Beruflich Dokumente
Kultur Dokumente
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
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)
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
IDM
Management:
Replace
harmone(cortisol/testosterone)+reconstructive
surgery
OSCE/Short case
Common
Syndromes
List 3 Cranio- facial feature of
this syndrome
Down Syndrome (Tri 21)
Overlapping of fingers
Prominent occiput
Rocker bottom feet
Cardiac and renal malformation
What is the syndrome in 18yr girl?
Turner Syndrome
Common Features
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)
Type of Abuse
Physical (Non accidentalinjury)NAI
Sexual
Emotional & Neglect
Fabricated (Munchausen syndrome by
proxy)
What is the diagnosis?
Fracture of Rib
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)
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?
INSTUMENTS
What is this instrument?
AeroChamber with Mask
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
1.Name 2 abnormalities
1. Name 2 abnormalities
Diagnostic TIP
&
Diagnostic TRIAD
Diagnostic TIP
E. Elfin face?
F. Red urine on exposure?
E. Blue diaper
Diagnostic TIP(Ans)
A.Phenylketonuria
B. Maple Syrup urine diseseas
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?
A. Down syndrome
B. Fragile X syndrome
C. DMD
Diagnostic Triad
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
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