Vous êtes sur la page 1sur 6

PAEDIATRICS OSCE CASES (DR.

MAHA)
HEMATOLOGY DEPARTMENT

CASE 1 : Patient with dyspnea & poor feeding since birth. Please
auscultate the heart.
1. How to present case of VSD?
Case of congenital acyanotic heart disease most probably VSD, not
complicated, compensated (should know what does it means by
compensated, know the complications)
Compensation may also be due to treatment (lasix)

CASE 2 : A years old patient named _____________ . With history of perinatal


asphyxia, who has developmental delay and convulsions. Please elicit deep tendon
reflex and plantar reflex and comment on them.
1. What is your observation regarding the plantar reflex in cerebral palsy?
2. What are types of spascity?
Clasp knife
Cork wheel
Lead pipe
3. What is definition of tone?
4. How to examine tone of muscle?
5. What are other causes of UMNL other than CP in paediatric?
Stroke
Intracranial haemorrhage
Subdural effusion
6. How to assess for muscle strength in mental retardation or cerebral palsy
child?
Elicit painful stimuli on the opposite site of the intended muscle (eg: painful
stimuli to extensor aspect of arm to assess muscle strength of the flexor
aspect)

CASE 3: Please test for lower limb edema and ascites.


1. What
a.
b.
c.
d.
e.

are the sites of oedema in nephrotic syndrome?


Periorbital
Anterior abdominal wall
Sacrum
Labia or scrotal
Lower limb

2. Difference between anterior abdominal wall edema and obesity?


See the marking trouser and put stethoscope cone. Anterior abdominal
wall edema leave a marking sign
3. What are causes of periorbital puffiness other than NS?
a. Allergy
b. Malnutrition kwashiorkor
c. Cardiac
d. Iatrogenic (IV fluid)
4. Signs of pleural effusion (tell all signs that can be find in
inspection,palpatation, percussion, auscultation)
5. How to test for ascites
6. What are causes of ascites in paediatric
a. Portal hypertension
b. Wilson disease
7. What are the possible findings in chest x-ray of the patient?

CASE 4 : A __ years old child, named _______ . His mother noticed pallor of his face,
yellowish discoloration, dark urine & progressive abdominal distention since the age
of one year ( chronic case)
Please examine the liver and comment on your findings.
1.

Diagnosis : Chronic hemolytic anemia (most common thalassemia)

2.

How to examine hepatomegaly? And give your comment.

3. Causes of tender hepatomegaly in thalassemia?


Congestive heart disease
Hepatitis
gall stone (maybe with cholecystitis)
4. Curative treatment in thalassemia? : bone marrow transplantation
5. Is it normal to palpate childs liver up to 2 years old? Why? : Yes, due to
slightly enlarged due to extramedullary hematopoeisis, especially if the child
is anemic.
6. Never forget to palpate the left lobe of liver, size in cm. (right lobe-liver span)
Left lobe of liver palpable= PATHOLOGY
7. Normal upper border of the liver and if it is elevated higher, what is the
cause? : Enlarged liver
8. Shrinkage of spleen in sickle cell anemia take 4-5 years to occur
9. Case of:
-child taking blood transfusion regularly
-spleen palpable
= sickle thalassemia (as, HBS only need blood transfusion when crises occur ,
and spleen palpable in thalassemia)
10.Causes of tender splenomegaly
11.If the case is the same except for the course is acute (ie not since 1 year old)
the diagnosis will differ. It is most probably HEPATITIS.

CASE 5 :
1. Pathophysiology of meningeal signs:
Due to irritation of nerve roots affecting nerve endings arising from the
nerve roots
2. Meningeal signs- as child is sitting, check for: tripod signs, neck stiffness
1. let chin touches the chest.
2. In mental retardation child, show something so that the child follows the
thing and moves the head.
3. in an uncooperate child : Do at the end of the bed
3.

Other causes of neck stiffness:


cerebral palsy
tetanus
upper lobar pneumonia
rheumatoid arthritis
retropharyngeal and parapharyngeal abcess

4. Should know to explain how test for meningeal signs is done (Neck stiffness,
Kernig, Brudenizki)

Vous aimerez peut-être aussi