Pediatric OSCE

pictures
for
Undergraduates
By
Al Shaymaa Ahmed Ali
MD-MRCPCH
Assiss Prof Of Pediatric Cardiology
1-Normal Neonates.
2-Birth Injuries.
3-Surgical Problems.
4-Congenital Anomalies.
5-Malnutrition.
6-Endocrine Disorders.
7-Blood Disorders.
8-Infections.
9-Skin Rashes.
1-Normal Neonates.
2-Birth Injuries.
3-Surgical Problems.
4-Congenital Anomalies. 5-Malnutrition
6-Endocrine Disorders.
7-Blood Disorders.
8-Infections.
9-Skin Rashes.
 Vernix
Caseosa
-Whitish greasy
coat covers the
skin at birth.
-Produced by
epithelial cells
breakdown in
utero, sebum,
fatty acids
and amniotic
cells
-Protects the skin
from the
amniotic fluid.
Salmon Patches

Sometimes called stork bites or angel kisses, salmon patches are reddish or
pink patches. They are often found above the hairline at the back of the
neck, on the eyelids or between the eyes. These marks are caused by
collections of capillary blood vessels close to the skin.

Salmon patches may fade as the child grows, though patches at the nape
of the neck may be permanent. Salmon patches don't require any type of
treatment.
 Mongolian Spots

-Bluish discoloration
of areas of skin in the
lumbosacral
region.

-Of no significance,
& may be mistaken
for bruising.

-Fades gradually as
the infant grows.
 Milia

-White or pale yellow

epidermal cysts on the
nose, chin, and
forehead.

-Disappear
spontaneously within the
first few weeks of life.

- No treatment .
 Neonatel
Gynecomastia
- Occurs in both
sexes during the
first weeks of life.

- Should not be
squeezed .

- Disapears
spontaneously .
Moro Reflex
- common primitive
reflex normally elicited
in the newborn.

-Elicited by startling
the baby.
-Disappears by 4-6
months.
-Absent reflex
intracranial injury,
cerebral depression,
or prematurity.
1-Normal Neonates.

2-Birth Injuries.
3-Surgical Problems.
4-Congenital Anomalies. 5-Malnutrition.
6-Endocrine Disorders.
7-Blood Disorders.
8-Infections.
9-Skin Rashes.
CAPUT
SUCCEDANEUM
Chingon
• Soft swelling on
the baby’s scalp
• Can be pitting
• Swelling that cross
suture lines in the
scalp

• Swelling seen on
the presenting
part of the head
Cephalhematoma
-A subperiosteal
hemorrhage.

- Caput succedanium
is d.d.

-Treatment is
conservative,
aspiration is
contraindicated.
Rt. Facial Palsy
-Unilateral weakness
of facial muscles and
drooping of mouth.

-Caused by facial
nerve compression :
pressure from
forceps blades but
may occur after
normal delivery.

-Most cases resolve

within few weeks after
birth.
Left Erb’s
palsy

- Injury of 5 & 6 cervical

nerves.

-Absent Moro reflex on

the affected side, but
intact grasp reflex .

-Treatment :
physiotherapy from
second week
1-Normal Neonates.
2-Birth Injuries.

3-Surgical Problems.
4-Congenital Anomalies. 5-Malnutrition.
6-Endocrine Disorders.
7-Blood Disorders.
8-Infections.
9-Skin Rashes.
Umbilical
Granuloma
-A fleshy
protuberance with
persistent
serosangunious or
purulent discharge.

-Treatment :
local silver nitrate
or surgical
excision.
 Tongue Tie

-A short lingual
frenulum

-Rarely interferes
with eating or
speech.

-No treatment or
surgical excesion .
Umbilical Hernia
&
Rt. Inguinal Hernia
-The commonest
surgical condition
during infancy.
-Intermittent swelling
in the inguinal region
or scrotum, during
crying or straining.
-Surgical repair: soon
because the risk of
strangulation is high
in young infants.
Hypospadias
- Uretheral orifice is
on the ventral aspect
of penis proximal to
the normal opening.

- Circumcision is
delayed till
corrective surgery
(urethroplasty)done;
the prepuce is
needed .
Imperforate Anus

- Discovered during
routine examination
soon after birth.

-Other anomalies
in 60% of cases.

-Most cases need

colostomy in the
neonatal period.
Cleft Lip
&
Cleft Palate
-Complications :
feeding difficulties,
speech problems &
deafness
-Management :
Feeding by a large
teat, spoon or tube
feeding.
Surgical repair .
1-Normal Neonates.
2-Birth Injuries.
3-Surgical Problems.

4-Congenital Anomalies.
5-Malnutrition.
6-Endocrine Disorders.
7-Blood Disorders.
8-Infections.
9-Skin Rashes.
Microcephaly

-Head
circumference
< 3rd centile for
age & gestation.

-Congenital
infections are
considered.
Meningomyelocele

-Neural tube defect.

-Antenatal diagnosis
by ultrasound.
-Hydrocephalus in
most cases.
-First aid :
covering with sterile
dressing &
neurosurgical referral
for repair.
-Prevention: Folic acid
Hydrocephalu
-sIncreased CSF in cranial
cavity +/-high tention.

*Relative(Normotensive)
*Absolute(Hypertensive):
*Nonobstructive
(Communicating).
*Obstructive
(Noncommunicating).

- Causes:
*Congenital atresia or
stenosis
*Acquired 2ry to
tumors, meningitis ,hge.

- Treatment: Shunt
Talipes
equinovarus
(Club Foot)

-Differentiated from
positional talipes
because it can not
be passively corrected.

-Treatment :
splinting, but
surgical release may be
needed.
Simian Crease

-Complete or
incomplete

-Unilateral or
bilateral

- Sporadic

-Familial

-Trisomy21 (Down
Syndrome)
 Down
syndrome
(21 Trisomy)
1-Normal Neonates.
2-Birth Injuries.
3-Surgical Problems.
4-Congenital Anomalies.

5-Malnutrition.
6-Endocrine Disorders.
7-Blood Disorders.
8-Infections.
9-Skin Rashes.
Generalised Oedema
 Kwashiorkor
-A complication of
faulty weaning by
a low protein high
carbohydrate food.

-Constant features :
Edema,
growth failure,
mental changes
& disturbed muscle/fat ratio.

-Other features :
Hair & skin changes.

-Complications :
Hypoglycemia ,
hypo-thermia ,
electrolyte disturbances
& serious infections
Kwashiorkor
Skin changes

-Hyperpigmentation

-Hypopigmentation

-Cracking & fissuring

(Flaky Paint )

-Ulceration

-Hemorrhage

-Infection
 Marasmus
-Loss of weight(3 Types)

-Loss of subcutaneous
fat (3 degrees)

-Muscle wasting

-Skin :wrinkled , thin &

cold

Complications:
Recurrent infections
Hypothermia
Hypoglycemia
Edema
Dehydration
*Dehydration and its
complications are the
usual cause of death from
gastroenteritis.

*Clinical features : -
Depressed fontanelle
-Sunken eyes
-Dry tongue
-Loss of skin turgor
-Acute weight loss

*Dehydrated infants are at

risk because : Greater
surface area to weight ratio
& higher fluid requirement
(100
ml/kg ).
 Rickets
Rosary Beads
*Small palpable & visible swellings at
the costochondral junctions.

*Other skeletal manifestations: Boxy

skull , frontal bossing , Harrison’s sulcus,
everted costal margins, contracted
pelvis , enlarged epiphyses , Marfan’s
sign & deformities of long
bones, joints , chest & spine.

*Other manifestations of rickets:

-Muscular hypotonia : Abdominal
protrusion, hernias,visceroptosis
& deformities.
-Tetany (Why???)
 Rickets
Bow Legs
(genu varus)

Skeletal deformity of
long bones & joints
2ry to muscular
hypotonia
 Rickets
Knock knees
(geno
valgum)
Skeletal deformity of
long bones & joints
2ry to muscular
hypotonia
1-Normal Neonates.
2-Birth Injuries.
3-Surgical Problems.
4-Congenital Anomalies. 5-Malnutrition.

6-Endocrine Disorders.
7-Blood Disorders.
8-Infections.
9-Skin Rashes.
 Infant of
Diabetic Mother
- Large obese infants
due to poor control of
maternal diabetes.

- Complications :
hypoglycemia,
RDS,
polycythemia &
high incidence of
congenital
malformations.
Congenital
hypothyroidism
-coarse facies, large
protruding tongue
-& umbilical hernia.
:-Early diagnosis
Neonatal screening
soon after birth.
-Early treatment :
( Thyroxin )
to prevent
mental retardation.
Congenital hypothyroidism
1-Normal Neonates.
2-Birth Injuries.
3-Surgical Problems.
4-Congenital Anomalies. 5-Malnutrition.
6-Endocrine Disorders.

7-Blood Disorders.
8-Infections.

9-Skin Rashes.
Beta Thalassemia
 Purpura
Non-elevated,
non- itchy,
non-blanching,
+/-ecchymoses.
+/-int. or ext. bleeding

Types:
*Non-thrombocytopenic
(Thrombathenia)
*Thrombocytopenic
-Low production:
-High destruction
-Abn. distribution

Work Up:
-CBC.....Why?
-B.M.....Why?
-Platelets functions
 Henoch-Schonlein
purpura
-It is a vasculitis with a
normal platelet count.

-Elevated , itchy
purpuric rash involving
the lower limbs &
buttocks.
-Other features :
arthritis,
abdominal pain &
nephritis.
-Most cases recover
within few weeks.
Ecchymoses
-Causes:
Bleeding or
coagulation disorders
(e.g. Haemophilia )

-Work up:
-CBC
-Bleeding time
-Coagulation profile
 Haemophilia
Haemoarthrosis
of the left knee

-Diff . Diagnosis:
Septic
Rheumatic
Rheumatoid
Traumatic

--Work Up:
CBC
Sepsis screen
ANA, Rh.F.
Coagulation Profile
 Hydrops
Fetalis
-Uncommon since the
prevention of rhesus
disease with anti-D
immunoglobulin.

*Features :
pallor, generalized
oedema, ascites, and
heart failure.

*Treatment:
-Exchange transfusion
-Ventilatory support.
-Phototherapy
 Generalized
Lymphadenopathy
--Causes:
-Infections
Bacterial:
non-specific
specific (TB , $)
Viral (Inf. Mono. ,CMV, Toxpl.)
-Malignancy:
Leukemia ,
Hodgkin lymphoma s &
Non-Hodgkin lymphomas
-Collagen disease:
(SLE , JRA)

-Work Up:
CBC
Monospot test
L.N.Biobsy
Bone Marrow Biobsy
1-Normal Neonates.
2-Birth Injuries.
3-Surgical Problems.
4-Congenital Anomalies. 5-Malnutrition.
6-Endocrine Disorders.

8-Infections.
9-Skin Rashes.
7-Blood Disorders.
 Neonatal
Conjunctivitis
-Causes :
Chlamydia,
gonorrhea &
viruses.

-Minor sticky eye is

much more
common, usually
non-infective
and responds to
frequent eye washes
Impetigo
Staph.infection

-Superficial skin
infection resulting in
small pustules .

- Caused by gram
positive cocci e.g.
staphylococcus
aureus

-Extensive lesions
treated with systemic
flucloxacillin.
Oral Thrush
( moniliasis )

-fungal infection
caused by candida
albicans.

-White adherent
plaques on the
buccal mucosa and
tongue.

-Treatment is by
topical nystatin or
miconazole.
Napkin Rash
Perineal
moniliasis
-Bright red confluent rash
in the napkin area &/or
around the anus.

-Typically, there are

discrete satellite lesions
peripheral to the rash.

- Treatment by topical
nystatin cream.
Mumps
1-Normal Neonates.
2-Birth Injuries.
3-Surgical Problems.
4-Congenital Anomalies. 5-Malnutrition.
6-Endocrine Disorders.
7-Blood Disorders.
8-Infections.

9-Skin Rashes.
Urticaria
-Common allergic
manifestation.

-Itchy erythematous rash

with wheals, &/or edema
around the eyes and
mouth.
-Serious complication is
laryngeal edema &
airway obstruction.
-Treatment
-s.c. adrenaline &
-systemic steroids.
Urticaria
 Erythema Marginatum

Erythema marginatum is a
rare skin rash that spreads on
the trunk and limbs. The rash
is round, with a pale-pink
centre, surrounded by a
slightly raised red outline.

Wax and wane in intensity

Associated With:
1) Still's disease
2) Rheumatic fever (JONES
criteria)
 Atopic
Eczema
-Red rough skin+/- vesicles
or crusting.
-Infantile:
(2mo.-2ys) starts on
cheecks & scalp , then
trunk & lastly extensor
extremities
-Childhood :
(2ys-adoles.)in flexural
areas
-Adolescent :
(adol.-30y).

-Unknown cause.

-Other atopic diseases may

be associated.

-Treatment: Local &

systemic steroids.
 Systemic Lupus
Erythematosus
(Malar Rash)
-Multisystem inflammatory
disease of:
skin , joints , serous
membranes , kidneys & CNS.

-ANA in active untreated

disease is the most sensetive
diagnostic test

--Treatment:
-Systemic steroids ,
-immunosuppressants
(Azathioprine or
cyclophosphamide )
 Measles
(Rubeola)
-Maculopapular rash
(following & asso. with
high fever) starts
behind ears & on
face, then , down to
trunk & feet.
-Rash fades with
pigmentation &
desquamation.
-Koplick’s spots
preceed rash.

-Treatment :
symptomatic .
-complications :
mainly respiratory &
CNS .
Measles : Koplick’s Spots
Roseola
infantum
(Exanthem Subitum)
-caused by HHV-6

-Age: 6mo.-4y (90% <2y)

-Abrupt high fever (in mild ill

infant) up to 8 days (mean 4
days) wich drops
abruptly......followed
by maculopapular rash .

-Rash disappears in 2 days

without pigmentations
or desquamation

-A common d.d. of measles

-Symptomatic treatment
 Scarlet
Fever

-Bacterial disease
caused by toxin-
producing group A
beta hemolytic
streptococci.

-Diagnostic signs:
sore throat,
fine papular rash,
tongue changes,
Pastia’s lines &
congested eyes.

-Treatment: Penicillin
or Erythromycin
Scarlet
Fever
( Fine
maculopapul
ar rash )
Whooping
Cough
(Pertussis)
- Cough paroxysms, rise
intrathoracic pressure
sharply leading to
elevated capillary
pressure with
subconjunctival hge &
periorbital ecchymosis.

-Complication :
bronchopneumonia due
to secondary bacterial
infection.
-
Treatment : Erythromycin
+
symptomatic
Chickenpox
(Varicella)
-Vesiculopapular ,
pleomorphic &
centripetal rash -
appears in successive
crops.

-Complications :
-secondary infected
lesions
-pneumonia
-neurological
problems (e.g. acute
cerebellar ataxia).

-Treatment:
Acyclovair
(systemic & local)
Chickenpox
(Varicella)
Thank you