Oral Pediatrics – Sama

Ghaith Hourani

1st station
A case of short stature came to ur clinic , other than endocrine causes what would you look for ?
Dysmorphic features
Q.name syndromes ?
Down turner brader wili
Q.What Dysmorphic features would you see in them ?
......
Q. Ok , what other causes you know?
Constitutional ,familial
Others ? I dunno --> metabolic
Q.We have proportional and disproportional cases, what do I mean by disproportional ?
Long extremities and short trunk
Q.Inverse disproportional ?
Long trunk nd short extremities
Q what is the cause of each ?
I dunno.. he mentioned names of metabolic disorders
After he finished asking he said u didn't attend my lectures , and maybe I went deep

Dr. Dawoud
3yrs gastroenteritis, most common cause?
Rotavirus
Others?
Campylobacter salmonella shigella
How can he get salmonella?
Eggs ,poultry
Do we give ABs ?
No
Why ?
More duration of illness maybe
When do we give Abs?
I dunno
What AB can be given ?
3rd generation cephalosporin

Station 2
Lebanese Dr & Dr Mahmoud
They asked about epiglotittis management?
Abc, Oxygen anesthesia intubation steroid ABs
How would you check for the air way ?
Signs of distress maybe
What are they ?
.... , but there is something important in the vitals ? And it was the O2 Saturation , he told me it was normal
does it need intubation ? no
How do we give steroid ?
Inhalation , other route ?IM, differential ? Laryngomalacia croup thracheitis retropharyngeal abscess,
Presentation of retropharyngeal abscess ?I dunno
Q. foreign body how to dx? CXR. If you found something radio opaque in the glottis? Rigid bronchoscopy , dr
but some might be radio Lucent right ? Yes
Q: what differentials are you afraid of?
??? , aren't you affraid of tracheitis or diphteria ? Yes
Which parts are affected by diphteria?
Pharynx , ok else ?? Ran el jaras el7amdulillah 

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Abdulrahman Al-Nuwedir

Station 1; Dr. Samah abu ra7ma & Nisreen (BRH)

A 9 months old came to the ER with Loss of conciousness..
Approach .. DDx? How do u know if he's hypoglycemic ?
What's the first thing you want to check ? ABC's ... Then ? Vitals ...
If i assumed he had suizure.. Questions u want to ask the mother ?
If he's playing in the garden between trees and then came inside home and lost his conciousness , whats this
?
If he's in ‫ الغور‬and lost his conciousness .. Wts this ?
Whats types of dehydration u know ? .. How to differenciate between mild and moderate by physical ?
Definision of oliguria?
Station 2 ; dr. Anas abu hazeem & from BRH
A 8 month old came the ER with high grade Fever and vomiting ..
Approach ..
DDx ?
Most thing you're afraid from ? Meningitis .. ;;
How to know by physical exam in this patient (8m) that he's having meningitis ?
How to diagnose ? .. How to perform a LP?
What do u see in normal Csf? Viral ? Bacterial ?
If you see RBC's .. Ddx ?
Other invistagations other than lp?
Complications of meningitis ?
Treatment ? Why vanco? Duration for each micoorganism
Prophylax? For whom ?
MOA of vancomycin?
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Marwa Omran

Station 1; Dr. Mahmood Al shayeb and other dr from Lebanon

1 year old come to you with drooling and cough what do you think ?
Epiglottitis ,croup and foreign body aspiration
Then what you will do (approach )
Hx , PE , investigation in detailed
How you will prepare pt for bronchoscope ?
Treatment of croup ?
And other Qs but I can't remember

Station 2 ; Dr Dawod and other from jesh

3 month male complain from vomiting and diarrhea what is ur differential ?
Pyloric stenosis
GERD
Lactose intolerance
Duodenal atresia
Malrotation
Then he asked how to differentiate btw gerd and pyloric stenosis clinically
What is ur treatment for pyloric stenosis ?
How you will do the incision ? Transverse or longitudinal ?
Important lab test you have to do ‫؟‬
When baby should start feeding ?

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Zafirah Zauddin

Station 1A
Doc Dawoud and Doc from Amman.
A 1day old patient, term in NICU presenting with poor feeding , hypoactive.
Ddx.
1) neonatal sepsis
2) inborn error of metabolism .
3) renal shutdown
4)RDS

After investigation,you found out that the patient has Na :120

K+: 7
What are you thinking about
Primary adrenal insufficiency. Ok you find out that the pt has enlarge clitoromegaly.
Ddx:Congenital adrenal hyperplasia. How you manage this patient.

What is your management regarding hyperkalemia. And mechanism of each drug/ method that you use.
What is the s/e of calcium gluconate.
Ok about inborn error of metabolism . What do you see in galactosemia. What system did it affect and the
manifestation. It is associated to what kind of sepsis?
Station 1 B
Doc from Lubnan & Mahmoud Sheyab.

A 1 month old pt presenting to you at ER with vomiting

What is your ddx.
-Neonatal sepsis.
-Gastroenteritis.
-Meningitis
-UTI
-Inborn error of metabolism .
-Mechanical obstruction such as pyloric stenosis.

DR : Ok . What investigation for each ddx. Tell me about septic work out.
DR: Ok during LP,there is increase RBC. What do you think.
- Trauma from LP,intracranial hemorrhage. Can infection cause it? Hemorrhagic infection(?)
Dr: Ok . When you do p/e, there is mid upper abdominal mass. What do you think? Pyloric stenosis.
DR: What do you do when suspect pyloric stenosis. -Ultrasound and GI contrast study (barium study). What
is your management.

Ok. If the pt has bilious vomiting what is your ddx.

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Norfarihin MH

[ Dr Hala & Dr Mubarak ]

4 years old presented with colicky abdominal pain since 2 days ago and vomiting. How do you approach this
patient ?

By (brief) history repeated vomiting no blood, polyuria, no family history of chronic diseases . Dx -> DKA

Very detail management of Dka fluid, insulin, potassium , monitoring every hr, doses and route

[ Dr Rola & Dr PRH ]

7 months old came with few hours onset of sudden cough and difficulty breathing
-hx : FBA
-pe : gen appearance, vital signs, cyanosis, what will you examine on auscultation ?
1) breathing sound
2) abnormal sound = wheeze

-investigation: CXR and rigid bronchoscopy

Finding on xray : foreign body, decrease air translucency, lung collapse -\+

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Sana Nazar Rabeeah

First station.. Dr. Miral and dr. Ma b3rafo...
u r in the delivery room what u do to assess a newborn? ABGAR score w kol el componente... If u found it 3
at first min what u will do? nasal tube suction and oxygen.. w repeat it after 5 mins.
What is prematurity and it's complications? what is postmaturity and it's complications?... how to check for
brachial injury? by asymmetric moro reflex how u do it.. how u check for clavicular fracture?
LGA and SGA numbers...

Second station..Dr. Waal and from military hospital..

Pt came in with N.V, abdominal pain, fever
Take hx. pe. Investigations w s2l 3nhom sho bshof.. eza mn hx. It's hepatitis A... prevention...
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Mukmin Sabahan

dr faisal & dr rahma

5 days old infant come with yellowish discoloration. your approach.

- dont forget to ask about blood group. he wants to hear this.

then stridor. its about croup.

dr waddah & dr askari

3 months baby come with fever and generalized petechial rash.
your ddx. and its about meningococcemia.

other case : baby 3 months, heart rate 300, blood pressure normal. your diagnosis : svt. management.
mechanism of action of adenosine.

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Qusai Tamimi

First station(dr.dawod):

-mention beta-lactam abx?

-what is the tx for meningitis and common caustive agents?
-that is the tx of tonsillitis and most common cause?
-treatment of p.arguinosa (4 abx)?
-3 uses of 3rd generation cephalosporins? mention 2 iv and 2 oral?
-vancomycin way of administration? When to give orally? For which organism?

Then dr.faisel qutaish started asking:

-Ddx for Abdominal pain?
-How to treat dka?
-if the ph was 7 do you give bicarbonate?
-what do you fear when you give bicarbonate?
-how to calculate osmolarity?
- normal range of osmolarity?trn trn trn trn

2nd station (dr.sheyab and external examiner):

Acute abdominal pain for 3 years old?
How to diagnose intersussepsion?
How to treat it? Another presentation? Common site? Complication if not treated?
Same question were asked about volvuloes, then we started to talk about herschbrung disease? Congenital
or acquired? Pathology? Treatment? Trn trn trn trn

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Rif'ah Rahim

Station 1: Dr Mahmoud Shiab & Dr Wahan from Iowa University.

A 1 yr old ptn came to the ER with his mother. She told you that her son didn't get up from sleep.

What do you think could be the condition?

-Infection, cns hemorrhage, poisoning/toxicity

What exam would you do?

-General, sign of dehydration, respiratory distress/depress, vital signs

What lab investigations would you order?

-CBC, blood culture, TOXIC SCREEN (this is what they want)

What do you screen for? What do you think could be the cause of toxicity?
-I answered CO and drugs (opioids)

The mother said that her son play with phenobarb and acetaminophen. Which one could be the cause?
-I answered phenobarb but both can cause it.

How do you screen phenobarb?

-serum phenobarb level

What would you give to this ptn?

-Charcoal

Can you do gastric lavage?

-Yes

If the drug was acetoaminophen, what could be the complication of it?

-Liver toxicity

How do you treat liver toxicity?

-Liver transplant

Then Dr Mahmoud asked me about how to rule out infection (LP), what are the contraindications for doing
it, what will you find.
2nd station: Dr Dawood and I forgot the name of the other one.

They asked me about hypochromic microcytic anemia. They wanted all the DDX and how to differentiate and
what are the specific characteristics for each one of them.

Then they asked me about mx of IDA (elemental and supplemental iron, the doses), and a little bit
counselling about breast vs bottle feeding.

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Zainab Anwar

Station 1 ( dr rola + ra7ma Dr)

1.5 years old pt with a hx of poor appetite and pallor for 3 months
What is your approach ? ( history , physical, investigations)
Where do u check for pallor ?
Investigations CBC Hb 9 , MCV 55 , RDW 20% ( normal up to 15%)
Ddx
1- IDA
2- thalassemia etc .. and how to differentiate

Station 2 ( dr. halah remawi + ra7ma DR)

6 years presented to Er with abdominal pain and vomiting for 2 days
Approach ( history )
What in the history is indicating DKA ? ( the fact that he has polyuria and dehydration)
Does it make a difference if the glucose was 200 or 500 ? ( the Dr said yes unusual that DKA with 200 so look
for other cases )
Treatment
How much fluid ( what is the order to the nurse ?!)
When do you start insulin ? how much ? wt type ? >> regular insulin
Check glucose hourly
Why not start insulin immediately ? risk of cerebral edema, he will not respond to it if dehydrated
What electrolyte abnormality ? other than hypokalemia
Do you give bicarb ?

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Amirun Shukri

Dr Miral
all about meningitis:
-type bacteria cause meningitis
-difference bacterial & viral meningitis
-value of normal CSF
-how to know partially treated meningitis?
-drugs & for how long we give the tt?
-complication of meningitis

Dr Wael
Patient with hep A
-hx(fever,jaundice,vomiting,pale stool,tea colored urine,RUQ pain)
-PE(hepatomegaly 14cm)
-investigation(LFT,IgM),
-treatment & vaccine

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Sara Al-zou'bi

2 stations..
Station 1 with dr samah abu rahmeh and dr kifah from jesh..
Dr samah asked me about red urine how to approach.. hx, p/e, investigations.. what's the cause of recurrent
hematuria? Alport, g6pd, IgA nephropathy..

Dr kifah asked me about pt with seizure and fever .. how to apprach ..

Station 2 with dr wa'el and dr from lebanon..

They asked me about pt with diarhea of 2 days duration how to approch.. hx ( was bloody with low grade
fever, no vomitting) then p/e ( has moderate dehydration)
Then investigation..

Ddx.. infectious GE ( bacterial, viral, ameba, giardiasis), IBD.. they wanted meckels diverticulum and how to
investigate ( nuclear scan and they asked me how is it done?)

What's ur tt.. iv fluids and hydration.. they asked me would u give antibiotis, i answered no bcz we don't
know what's the causative agent since some bacteria we can't give antibiotics

Then dr wa2el asked if pt develop tachypnea but clear chest and ph 7.24 with plt 80000.. what do u think?
What other investigations u do? .. end

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Asma Abu-salah
2 stations First : dr. Rula 1 month old baby with mild edema edema , Approach and possible ddx
investigations for each differential
2nd station : dr Hala Rimawi 4 days old with bloody diarrhea , Ddx ; hemorrhagic disease of new born , NEC
Investigation and treatment for each
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Dina Kara'in

1st station dr Wa'el.. a case about a child who went to sleep and his parents are unable to wake him up.. he
asked about hx , physical, investigations and what would I do for him in the ER.. I was asked about ddx and
how would I approch each of them.. the he asked me about LP and C/I for it and about CSF analysis. .

2nd station dr samah abu rahma and d kifah.. they asked me about hematuria.. hx and physical
investigations and ddx.. they also asked about hx, physical , investigations and ddx for a child with limping of
2 days duration
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Randa Zayed
dr miral and another dr:
6 years old pt with periorbotal lower limbs edema :
1) ddx? nephrotic, liver disease, heart disease
2) investigations? UA, dipstick, kft, 24 hour urine collection, lft...
3)management? fluid and salt restriction, iv albumim, steroids (which one? prednisolone,dose?? side effects
of steroid and what to monitor? hyperglycemia,hypertension, immunocompression,)
most common cause of nephrotic? when to do kidney biopsy?
4)hyperkalemia, how to diagnose? management?
dr wadah and dr khaled okour (military):
-pt with fever what to do?
cold compressors, antipyretic which one?I said paracetamol, another one?ibuprofen, if the pt has liver
disease which one to use? does ibuprofen cause ranal toxity?
-what are the differences between asthma and bronchiolitis?clinical? age? cause? diagnisis? x-ray findings?
management for both?
-dr wadah wanted to ask me about coma but time was out! luckily
good luck everyone
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Deeb Zahran

My examiners were Dr. Samah & a military Dr. ... The other was with Dr. Wael & a Dr. From lebanon.

Dr samah asked: a 2 year old came to the ER with low level of consciousness (comatozed) .. Take Hx, do
physical examination, order investigations, and how to deal with him at the ER.

I put [ ITS COMA] in mind ..

(In history)
•Infections (ex. Meningitis): i asked about fever & vomiting before the event.
•trauma: did he get a trauma?
• Seizure: did he has an abnormal movements?
• CVA: is he diagnosed with any heart disease?
• Overdose: i asked what he was doing before the event?
• Metabolic (hypoglycemia) : is he diagnosed with DM1 before?
•Alcohol: omit it

(In examination) .. According to the above causes

• meningeal signs, temperature, RR, cyanosis.
• Any evidence of trauma
• examen the pupil, if it was constricted => organophosphate toxicity ( Dr samah wanted to hear this and
said YESS)

Investigation
She wanted me to order a fast investigation, i said glucocheck.
She said consider you found hypoglycemia, what investigations and treatment you are worried about (she
wanted me to dig more about the causes of hypoglycemia).

What other lab tests?

I said: KFT ... Why? To check if the cause is uremia.
What else? ... LFT ... Why? .. The cause maybe hepatic encephalopathy.

The military Dr gave another case of 9 months boy with sudden SOB .. What you will ask in history? .. I said i
should ask about foreign body aspiration ... Terrrrrrn .

The other station with dr. Wael ... It case was about bloody diarrhea ... What Diff. i should think of and Hx
about each.... They asked every thing about gastroenteritis ... And then asked some questions about
meckel's diverticulum.

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Salah Dwiekat

First Room ---> Dr.Hala Al Rimawi

A 10 year old girl was brought to ER after having an IM injection of Penicillin... She developed tingling in her
lips, hoarseness of voice & rash
What do we call this condition? Anaphylaxis
How to approach this patient? Since it's an emergency , start safely with ABC , Check airways, Breathing &
Circulation
Airways : She focused on having Stridor as an indication of upper airway obstruction
Breathing : RS examination and when I said "Wheezes" she said excellent so focus on it
Circulatory: You check pulse, Capillary refill, BP and CVS exam

How to manage this patient? O2 supplementation, S/C Epinephrine (mention the route) & Steroids

What type of Hypersensitivity reaction is this? Type 1

Mention all Hypersensitivity reactions and their pathophysiology?
Type 1 ---> IgE Mediated
Type 2 ---> Cytotoxic
Type 3 ---> Immune complexes
Type 4 ---> Delayed hypersensitivity reaction

Counsel her parents about her condition? You have to tell them that this condition is an allergy to Penicillin
and Cephalosporins and she has to warn the DRs that she goes to about that. Egg shell, fish and Peanut may
precipitate the anaphylaxis. I will teach the parents how to use S/C Epinephrine in case of another
emergency to give it to the child before arriving to ER

Then she said Ok we have 2 minutes left,,, Let's have another case!
A 2 day old baby came to you with JAUNDICE! How to asses the severity of his jaundice clinically? By the look
of the patient...
Head alone ---> 5 mg/dL
To umbilicus ---> 10 mg/dL
To the knees ---> 15 mg/dL
To the feet ---> 20 mg/dL (tell her these are approximations not true values)
What to do if it's 15 mg/dL ? Phototherapy
What to do if it's more than that? Exchange transfusion
Principle of Phototherapy? Changes insoluble bilirubin to soluble bilirubin to be excreted in urine

Then the bell rang

Room 2 : Dr Rola Al Saq'an

Baby 1 week old only irritability
What important points you have to ask about in history? You can ask about any differential that comes to
your mind she will consider it right
P/E : To be on the safe side... Say from head to toe
Investigations: According to your DDx
If your CBC .... High WBC , low platelets, and the child has 38.2 C axillary... What do you think? Sepsis
Will you discharge him home? No --> Why? To do the full septic work up
What's septic work up? Mention them
Prophylactic treatment of Sepsis? I said Gentamycin and Ampicillin
Why these two?
Ampicillin ---> To cover Listeria
Gentamycin ---> Synergistic effect

She said thank you ... You can leave

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Arwa Zioud

1st :doctor Miral

a 6 year old girl previously healthy come with her family to the ER bcz she was unable to move his lower
limbs
what to do ? Hx most important two Qs any URTI in one to two weeks
if she got any vaccine lately
then she asked why you ask about this what are you thinking about : acute flaccid paralysis "
doctor:give me Ddx
-: guillain barre syndrome and poliomyelitis
what the presentation for each one
it's lower motor or upper it's lower
what you see signs in lower and what you see in upper
upper hyperreflixa , hypertonia and spasticity
lower motor 3akes.hen
what do you see in CBC about proteins and WBC
do you addmited her to icu or to the floor
i answered to ICU bcz she may get respiratory failure

2nd station :Doctor Waddah , Doctor Raggad

doctor waddah
diffierent between life threating asthma and execrbation of asthma
hypercapnia hypoxia silent chest and so on
a 9 month baby with fever what to give paracetamol rectally , why rectally not orally < i have no idea
9 month old baby what to tell the mother to do if he have fever at home
cold water compressor , mn el 7anfyeh aw mn el freza , mn el 7anfyeh doctor mn el 7anfyeh !!
doctor raggad: gave me a picture of consanguinity marriage
shu bensami shajret el 3ele be mos6al7atna el 6abyyeh
what disease you see with consanguinity marriage autosomal recessive
and it should be skipped generations both genders wfe aman sha3'le bs naset.ha
what the percentage to have a normal baby 75% a baby with disease 25%
give example about autosomal recessive disease CF

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Mohammad Jibril

1st station : ( Dr. khalid okour & Dr. faisal Qteesh )

do you know Rheumatic fever?
which age group? (5-15 yrs) school age
how to diagnose? jones criteria and asking about each one of criteria
which microorganism?
what is antibiotic of choice?
4 yrs old child with periorbital edema for 1 day duration
whats your approach?
in history there is dark colored urine and URTI 2 weeks ago
whats your diagnosis?
management? salt and fluid restriction
how much fluid you will give him? insensible loss + urine output
what is the complications? renal failure
what is the % of Renal failure in post streptococcal GN?

2nd station ( Dr. wael hyajneh & external Dr.)

asking about vaccines , added vaccines , types
HPV vaccine
shingles vaccine
then about nutriotion
Nido milk in 6 months baby? its not given before age of 1 yr
exclusive breast milk feeding for 1 year? IDA
how you diagnose IDA?
Whats your advice?
2 months baby with bloody stool? ur Ddx.
about protein milk allergy ? how u diagnose? treatment
Good Luck

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Fayez Alsharief

Station1 Dr.Miral
A 7year old male complaining of fever of 10 days. What is your approach?
If you know that he developed rash as well what do you think of differential?
Can you tell me the criteria to diagnose Kawasaki ?
What are the investigations?
What is the treatment?
What are the side effects of giving IVIg?
Station 2 Dr. Waddah and Dr. Okour
A 9 month old male child has received his regular check up at the healthcare centre and his CBC showed
Hb=7 gm/dl. What is the first thing you look for in the investigations ?
If you are given that he has Microcytic anemia, what are the types of this category?
How do you differentiate between Iron deficiency anemia and Thalassemia?
Q.2 How do you differentiate between bronchiolitis and bronchial asthma clinically?
What is the role of steroid prescribing in each case ?

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Ahmed Obaidi

Room 1 ( dr Qutish + dr Abu Rahma )

1. Persistent vomiting ?
Ddx ( bdo pyloric stenosis )
Finding on examination
Treatment
2. Lower GI bleeding
Ddx
Gastroenteritis ( causes)
Salmonella typhoid dx test ( widal test ) and treatment doxycycline or fluoroquinilone
Other qs I don't remember
ROOM 2
Dr. Anas
He is the one who asked me
5 days old came with irritability poor feeding and vomiting
DDx sepsis : septic work up
Lp and lp contraindications
Galactosemia case treatment presentation early in life
Ask about coarctation of aorta
Dx and presentation: early in life