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What primitive reflex has just been demonstrated?

Moros
Name

2 things you need to consider if the reflex is


asymetrical?

Nerve injury, fracture

When should this reflex disappear and what are the


implications if it persists beyond that age?

6 mths, cerebral palsy

Name 3 other primitive reflexes.

ATNR, palmar grasp, plantar grasp, stepping reflex, rooting

Describe the abnormalities.

Absent thumb, absent radius, radial displacement of hands

Give some differential diagnoses.

Holt-Oram, Fanconi Anaemia, VATER, TAR Syndrome

This child came to CE and you heard a cardiac


murmur with a fixed split of S2. What is the
diagnosis?

Holt-Oram with ASD

What is the inheritance?

AD

You see this chatty 5 year old boy in CE and his


mother tells you that he attends a special school.
The mother is worried because her GP said that
he heard a murmur when examining her son.
She comes to you for evaluation.

Describe what you see.

Elfin facies, blue eyes, wide set puffy eyes, thick lips, pointed chin,
friendly

What is your diagnosis?

Williams Syndrome

What would you expect to find in your CVS


examination and what is the murmur likely due to?

Ejection systolic murmur loudest at RUSE and radiating up to carotids,


Supra-valvular AS

What are the associated features?

Medial eyebrow flare, stellate calcification of iris, microcephaly, learning


difficulties, hypoplastic nails, renal artery stenosis, hypercalcaemia

Williams syndrome

Weight LBW, FTT


Iris Stellate
Loud hyperacusis, cocktail party speech
Large - mouth
Increased Calcium
Aortic Stenosis, supra-valvular + other stenoses
eg. PS
Mental retardation
Seven chromosome (7q)

Describe

what you see


What bedside test can you do to confirm the
diagnosis?

What

is the management?

What

is the diagnosis and what is the


management?

You

are called to see this newborn with


vomiting.
What is your diagnosis?
Management?

This

girl presented with a fever and the


following rash.
Give differential diagnosis

Infective endocarditis, vasculitis in autoimmune conditions,


meningococcaemia

This 1 year old girl was brought to CE by her


Aunty. Her parents are overseas on holiday and
this is the first time the aunty is looking after the
child. The Aunty is worried because the child
suddenly turned blue and unresponsive after
crying. She says that the child has a heart
condition and says that an operation has been
done. On examination you see a small left
thoracotomy scar and hear a continuous murmur.

What cardiac condition does the child have? What


operation was done? What is the diagnosis?

TOF, BT Shunt, TET spell

While examining the girl, she turns blue and quiet


right in front of you. What are you going to do?

Oxygen
Knee to chest
Drugs: sodium bicarbonate, propranolol, ketamine, morphine

This

is an AXR of a 6 month old baby with


vomiting. Describe what you see
What are the differential diagnoses?

What

is your management?

What

is the diagnosis?

Juvenile Arthritis

Name

the principles of management

Analgesia, control inflammation, physiotherapy/ maintain joint function

Describe

3 associated features

Uveitis, rash, lymphadenopathy, hepatosplenomegaly, growth failure

Give

differential diagnoses

Pauciarticular JA, haemophilia with haemarthrosis, trauma with


effusion, chronic infection e.g TB Knee

The

mother now tells you that this has been


there for 6 weeks and the child has got early
morning joint stiffness. Name a investigation
and screening assessment that should be
done to aid your diagnosis

ANA, Ophthlamology Screening

What

is the diagnosis?
What is the management?

This

child presented with prolonged fever,


rash and hepatosplenomegaly.
Give 3 differential diagnoses

Systemic onset JA, Haematological malignancy, infection (e.g. IMS,


CMV)

This

child has got chronic joint pain.


What are the lesions shown?

JA Subcutaneous nodules
?Gouty tophi

This 6 year old girl came to CE from Jakarta for a


second opinion. She has difficulty climbing stairs
and her mother says that a white substance
(which she called pus) came out of the knee
lesion a week ago.
What condition does the child have?

Dermatomyositis

Name the lesions on her fingers and name other


cutaneous manifestations of this disease.

Gottrons papules, heliotrope rash, skin atrophy, vasculitic lesions,


calcinosis, nail fold dilated capillaries, butterfly rash

Name investigations to do.

Muscle biopsy, Serum CK, EMG

This

child has haematuria and abdominal

pain.
What is the diagnosis?
Give a reason for the haematuria and
abdominal pain.
What complications to look out for?
Follow-up plans?

What

is your diagnosis.
How would you treat the child?

This

rash appeared after the patient took


NSAIDs.
What is your diagnosis?
What else would you look for in your physical
examination?
Name other causes for this rash.
What treatment is necessary?

This

rash developed after antibiotic therapy.


What is your diagnosis?
Outline general treatment principles.

This

7 year old presented with tender lesions


on her shins.
What are the lesions?
What is the aetiology?

What

Tinea/ringworm

How

is your diagnosis?

would you treat her?

Topical antifungals/systemic antifungals if not responsive

This

toddlers siblings also have a pruritic


rash.
What is the diagnosis?

Scabies

How

would you manage the child?

Antihistamines, malathion, treatment of contacts, wash all clothes and


bedlinen

Describe

Scaling, erythema, sparing of creases.

What

is your diagnosis?

Irritant Diaper Dermatitis

What

the features of the rash.

is your treament?

Barrier ointment, regular nappy change

What

must you consider if this rash is


intractable and does not respond to
treatment?

Psoriasis
Candidiasis look for satellite lesions

This

14 year old girl presented with


secondary ammenorrhoea
Describe what you see

Lid retraction, goitre

What

Graves Disease

What

is the diagnosis?
is the treatment?

Propanolol to treat symptoms


Definitive treatment with PTU or carbimazole - different regimes
May require thyroidectomy

You see this short 10 year old child in CE. He


attends a specia school and he presents with
diplopia and carpopedal spasms.
What is the cause of his symptoms?

Hypocalcaemic tetany

His spasms are still present and he is distressed.


How would you treat him?

10% calcium gluconate

You

check his old lab results and see that he


has been tested for serum calcium,
phosphate and PTH. Do you expect these
values to be normal, elevated or decreased?

Low Ca, High PO4, High PTH

What

is his diagnosis?

Pseudohypoparathyroidism

What

is the diagnosis?

Cushings Syndrome

Name

some causes.

Exogenous Steroids, pituitary adenoma, adrenal adenoma or


carcinoma, ectopic ACTH production

He

is not on any medication. Name 3 tests


that can be done to aid the diagnosis

Midnight blood cortisol level, (low and high dose)


dexamethasone supression test, adrenal and pituitary imaging

Cushing
Syndrome

This

2 week old baby was brought in to the


CE resus room in shock. You find this on
examination.
Describe 2 abnormal features.

Ambiguous genitalia, hyperpigmentation

Describe

3 abnormalities you would expect to


find on ME.

Low Na, High K, acidosis, hypoglycaemia

This 1 week old baby is brought from Tanjong


Pinang. The parents are anxious about the
appearance of the external genitalia.
What single most important clinical sign must be
elicited?

Presence or absence of testes

What is the most common and serious condition to


exclude when this is seen and why?

CAH due to 21-alpha-hydroxylase deficiency; salt losing crisis

This 6 week old baby boy has just been fed. He has
been vomiting for the past 2 days after every feed and
is dehydrated.
What is shown?

Peristaltic waves after a feed

What is your diagnosis?

Pyloric Stenosis

What metabolic picture would you expect the child to


have?

Hypochloraemic Hypokalemic Metabolic Alkalosis

What is the definitive treatment?

Ramstedts Pyloromyotomy

This

4 month old boy was lethargic.


What is the most likely diagnosis?

Intussuseption

What

procedure is the child


undergoing?

Reduction with barium enema


Besides barium, what other modalities of reduction can be used?

Give

2 indications for surgery.

Non-operative reduction fails, perforation/peritonitis

This patient is jaundiced.


What is the physical finding?

Spider Naevus

How many must you see for it to be significant? More


than 3

What condition is it associated with?

Chronic Liver Disease

What other associated features would you look out


for?

Clubbing, leukonychia, palmar erythema, gynaecomastia, bruising, parotid swelling,


dilated abdominal veins, scratch marks, xanthomata, ascites

Describe

3 abnormalities.

Abd distension, dilated abdominal wall vessels, abdominal scar

The

child has finger clubbing and has


haematemesis. What can explain the
current findings?

Chronic liver disease with portal hypertension

What

is the childs underlying condition and


what operative procedure has been done?

Biliary Atresia, Kasai hepatoportoenterostomy

This 3 year old stays in an old home in the UK. He is


being investigated for hypochromic microcytic
anaemia. He also has behavioural and
communicative problems. He now presents with
abdominal pain and an AXR is done.
Describe the abnormality.

Widespread radio-opaque speckling throughout abdomen likely within bowel

How can you tie everything together into one


diagnosis?

Lead poisoning, ingestion of lead containing paint chips (pica)

This baby presented to CE for easy bruising and


petechiae. The lesion on the face has been present
since birth but has been rapidly enlarging. What is the
lesion on the face?

Haemangioma

What complication has arisen (name the syndrome)?

Kassabach Merritt Syndrome

If the child is breathless, what else must you suspect?

Airway compromise
High output cardiac failure