Pediatrics OSCE pictures

1. Year 5 – Pediatrics
Pediatrics Pictures (Part-2)
Prepared by: Shahd AlAli
Edited by: Ali Alhashli

2. Nutritional Deficiencies

3. Glossitis
Vitamin B9 (Folate) Vitamin B12 deficiency

4. Vitamin B2 (Riboflavin) Deficiency

5. Vitamin C Deficiency

6. Zinc Deficiency
Acrodermatitis enteropathica
Results in delayed wound healing,
anosmia and dysgeusia (lack of taste)

7. Niacin Deficiency B3 (Pellagra)
Diarrhea, dermatitis and dementia

8. Vitamin A Deficiency
Bitot’s spots

9. Rheumatology

10. Pauci-Articular Early Onset
Rheumatoid Arthritis
•ANA+
•(1-5 years)
•More in females
•Uveitis
•No systemic symptoms

11. Still’s Disease
•Fever afternoon or night
•>39
•HSM, lymphadenopathy, weight loss and FTT
•Salmon patch during the episode of fever

12. Heliotrope Rash of Dermatomyositis
Gottron’s
Papule

13. Genetic Syndromes

14. Down Syndrome

15. Trisomy 18 (Edward’s Syndrome)
•2nd most common trisomy
•MR, Hypertonia, small faces, clenched hands, rocket bottom feet. Survival ~ 1
year

16. Patu Syndrome (Trisomy 13)
•Mid-line defects
•Severe MR, colobomas, microophthalmia
•Cleft lip palate
•Prognosis is poor, dead within the 1st month of life

17. Turner Syndrome
•Incidence: 1:2000
•Short webbed neck, short stature, broad chest, swelling of hand and foot,
ovarian dysgenesis, horse-shoe kidney, Bicuspid aortic valve and
coarctation of aorta

18. Fragile X –Syndrome (Martin-Bell
Syndrome)
•X-linked caused by CGG repeat, trinucelotide repeat. Its more severe in male. Most
common inherited cause of MR
•Incidence 1:1250 in males and 1:2500 females
•Mild to severe MR, Large ears, macocephaly
•Large testes, autism, ADHD, diagnosis by chromosomal analysis

19. Fragile X

20. Klinefelter Syndrome
•XXY
•Most common cause of male hypogonadism and infertility, increased risk with maternal
age
•Incidence 1:500 male births !!!
•Tall with tall extremities, hypogonadism with delayed puberty, gynecomastia, variable
intelligence, antisocial

21. Fetal Alcohol Syndrome
IUGR, FTT, Microcephaly, long smooth philtrum,
Smooth upper lip, MR, Hyperactivity and VSD

22. Osteogenesis Imperfecta
•AD. Defect in type I Collagen
•Blue sclera, fragile bones, yellow-blue teeth, easy bruising
•Diagnosis: clinical features + low collagen type 1 in fibroblast
•Complications: hearing loss, skeletal deformities, genu valgum (knocked-knee)

23. Williams Syndrome
•Deletion on chromosome 7 AD. Gene for elastin
•Elfin faces: short palpebral fissure, flat nasal bridge and round cheeks
•Mental retardation
•Aortic stenosis
•Hypercalcemia in infancy
•Diagnosis: FISH

24. Cornelia De Lange Syndrome
•Inheritance is mostly sporadic but can be AD
•Single eye bow, microcephaly, micrognathia
•Short stature
•Infantile hypertonia & Mental retardation
•Cardiac problems

25. Cornelia De Lange Syndrome
SGA, Micrognathia, hypertonia, microcephaly, MR, Cardiac defects
Sporadic or AD

26. Russel-Silver Syndrome
•Short stature with normal HC
•Skeletal asymmetry &
• excessive sweating
•SGA, café-au lait spots

27. Pierre Robbin Syndrome
•Micrognahthia
•Cleft lip palate
•Large tongue
Complications:
•Airway obstruction
•Recurrent otitis media

28. Cri-Du-Chat
•Partial deletion on the short arm of chromosome 5 sporadic.
•Microcephaly, downslanting palpebral fissure, cat like cry
•Mental retardation

29. Wolf Hirschhorn Syndrome
•Results from the deletion of the short arm of
chromosome 4
•Craniofacial: microcephaly, micrognathia and
short philtrum, dysplastic ears and periauricular
tags
•Neuro: growth retardation, hypotonia, seizures
•CHD
•Antibodies: deficiency of IgA

30. Prune Belly Syndrome
• A partial or complete lack of abdominal wall
muscles. There may be wrinkly folds of skin
covering the abdomen.
• Cryptorchidism (undescended testicles) in males
• Urinary tract abnormality such as unusually
large ureters, distended bladder, accumulation
and backflow of urine from the bladder to the
ureters and the kidneys (vesicoureteral reflux)
• Frequent urinary tract infections due to the
inability to properly expel urine.
• Ventricular septal defect
• Malrotation of the gut
• Club foot
• Later in life, a common symptom is post-
ejaculatory discomfort. Most likely a bladder
spasm, it lasts about two hours.
• Musculoskeletal abnormalities

31. Potter Syndrome

32. Sturge Weber Syndrome
•Sporadic disorder with a port-wine stain in the distribution of the trigeminal nerve
associated with a lesion intracranially. The ophthalmic deviation of the V nerve is always
involved
•Intracranial calcification on skull X-ray
•Can result in epilepsy, MR and hemiplegia. High risk of glaucoma!!

33. Beckwith-Wiedemann Syndrome
•Large for gestational age
•Visceromegaly
•Hemihypertrophy
•Macroglossia
•Umbilical hernia
•Omphalocele
•Hypoglycemia < 2.7

34. Alagille Syndrome

35. Hurler Syndrome
Mucopolysaccharidosis autosomal disease
Baby present with developmental delay, hepatosplenomegaly with coarse facial features
Death is common in childhood as a result of respiratory/pulmonary compromise

36. Hurler Syndrome

37. Achondroplasia
It is the most common genetic form of skeletal dysplasia. Prominent
forehead, stubby fingers, lumbar lordosis and intelligence is normal
Complications: hydrocephalus, apnea and sudden death 2ry to bony over
growth at foramen magnum

38. Marfan Syndrome (AD)
Lens subluxation
Aortic root dilation

39. Waardenburg Syndrome

40. Elhers-Danlos Syndrome
Gorlin sign

41. Chédiak-Higashi Syndrome
•Autosomal recessive
•Oculocutanous albinism
•Neutropenia
•Recurrent pyogenic infections by staphylococci and
streptococci, partial albinism, peripheral neuropathy,
progressive neurodegeneration, infiltrative lymphohistiocytosis

42. DDx for Café-Du-Late Spot
• Fanconi’s anemia
• Neurofibromatosis
• Russel-silver syndrome
• Wiskott-aldrich syndrome
• Chediak-Higashi syndrome
• Ataxia-Telangictesia

43. X-Rays

44. •Small volume lungs
•Homogenous "ground glass" opacity
•Air bronchograms
Respiratory Distress Syndrome

45. Pneumothorax

46. • Increased central
vascular markings ("star-
burst" appearance)
• Hyperaeration
• Evidence of interstitial
and pleural fluid
• Prominent interlobar
fissures
• Cardiomegaly
TTN

47. There is coarse opacity of both lungs
but particularly of the right side.
Pnuemonia

48. •Coarse infiltrates
•Widespread
consolidation
•Hyperinflation
•Pleural effusions are
not uncommon
•Pneumothorax and
pneumomediastinum
may be present
MAS

49. Pulmonary Hemorrhage

50. Chronic Lung Disease
Hyperinflation
Atelectasis
Cystic radiodensities

51. Right Lower Lobe Pneumonia

52. Lobar Pneumonia

53. Multilobar Consolidation + Pleural
Effusion
Caused by Staphylococcal pneumonia

54. Pulmonary Pneumatocele
(S. aureus)

55. Pulmonary Edema

56. Pleural Effusion

57. Kartagener Syndrome (AR)
Immotile Cilia Syndrome
•Dyfunctional cilia resulting in abnormal airway clearance.
•Patients with KS will have (Situs inversus, chronic sinusitis, otitis media and airway
disease) – they usually have a normal life span

63. Primary TB Gohn’s Complex

64. Tuberculosis

65. Tuberculosis

66. Retropharyngeal Abscess
•Infection between the posterior
pharyngeal wall and the prevertebral
fascia results in a retrophryngeal
abscess. The most common organisms
are S. aureus and GABS
•History of pharyngitis, fever, sore
throat, drooling
•Rx: incision and drainage

67. Retropharyngeal Abscess
Stiff neck, difficulty swallowing and malaise

68. Croup

69. Epiglottitis

70. Ewing Sarcoma

71. Abdominal xray showing:
Dilated loops with pneumatosis
intestinalis
Necrotizing Entrocolitis

72. Diaphragmatic Hernia

73. Duodenal Atresia

74. ECG

75. Complete Heart Block

76. Torsades de pointes with Long QT =
LETHAL

77. Supraventricular Tachycardia
•Rate ~ 250 bp/min
Management:
•Vagal stimulation: ice-pack to face, unilateral carotid massage, place child upside
down, pressure in the orbit convert it to sinus tachycardia
•IV adenosine: to convert it to sinus rhythm
•Chronic medical Rx: digoxin, propanolol,
•Radiofreq catheter ablation: to destroy the accessory pathway.

78. Supraventricular Tachycarida
The P wave is in the T wave and is difficult to see

79. Paroxysmal Supraventricular
Tachycardia

80. Wolf Parkinson White Disease
Palpitations
SOB
Altered level of consciousness

81. Heart Block
•Interruption in the conduction of the SA or AV impulses into the
ventricle.
•We have 1st, 2nd and 3rd degree heart block

82. First Degree Heart Block
Prolonged PR only

83. 2nd Degree Heart Block
(Mobitz-I)
Progressive lengthening of the PR wave until we skip a QRS (skip a beat),
usually asymptomatic

84. 2nd Degree Heart Block
(Mobitz-II)
PR is the same will not lengthen just a sudden drop in the beat

85. 3rd Degree Heart Block
Complete Block of the AV Node (No Conduction
From Atrium to Ventricle)
Atria and ventricle beats independently of each other
Caused by maternal SLE

86. ETIOLOGY of Heart Block
•Post surgical AV block
•Bacterial endocarditis can result in AV block
•Clinical features: syncope, fatigue, sudden death
•Rx: Pacemaker for symptomatic AV block

87. Right Axis Deviation

88. Left Axis Deviation

89. Hyperkalemia

90. Hyperkalemia
Hyperkalaemia is defined as a potassium level > 5.5 mEq/L
Moderate hyperkalaemia is a serum potassium > 6.0 mEq/L
Severe hyperkalaemia is a serum potassium > 7.0 mE/L

91. Hypokalemia

92. Hypokalmeia

93. Wide QRS
Causes
• Bundle branch block
• Hyperkalaemia
• Poisoning with sodium-channel blocking
agents (e.g. tricyclic antidepressants)
• Pre-excitation (i.e. Wolff-Parkinson-White
syndrome)
• Ventricular pacing
• Hypothermia
• Intermittent aberrancy (e.g. rate-related
aberrancy)

94. Hypocalcemia
•Prolonged QT interval
•Clinical features
•Tetanus, parasthesia & seizures

95. Hypocalcemia

96. Pericardial Effusion (Small QRS)

97. Pericarditis ECG

98. Right Bundle Branch Block

99. Endocrinology

100. Rickets
Craniotabes the earliest sign in rickets
Genu varus
Cupping
DDx of craniotabes:
• OI
• Syphilis
• Hydrocephalus
• Premature infant
• Thalassemia

101. Richitic Rosary
Prophylactic: vitamin D (400 IU)
Treatment of rickets:
1500 IU
Monitor rickets by
alkaline phosphatase

102. Congenital Hypothyroidism

103. Ectopic Thyroid Gland
•One of the causes of congenital
Hypothyroidism accounting for
1/3 of cases of
•Thyroid dysgenesis (90% of
congenital hypothyroidism)

104. Thyroglossal Duct Cyst

105. Lipohypertrophy/Lipoatrophy
Insulin

106. Buccal Pigmentation (Addison’s)

107. Type-1 Glycogen Storage Disease

108. Ambiguous Genitalia

109. CP
Cortical thumb

110. Random Stuff

111. E: peak flow meter
F:
G: insulin pen
H: spacer
i: enuresis alarm

112. Candida Nappy Rash

113. Child Abuse
Spiral fracture
Retinal hemorrhage

114. Marasmus & Kwashiorkor

115. Growth Charts

116. Ataxia Telangictesia
It’s an autosomal recessive disorder
Problems with DNA repair
1- Ataxia 
2-Low IgA
3- Increased risk of ALL 10%
4- High serum alfa-feto-protein

117. Gray Baby Syndrome
Gray baby syndrome = chloramphenicol toxicity
Inability to metabolize the drug due to reduced
activity of the enzyme UDGT (Glucoronyl
Transferase) in neonates (especially premature)

118. Craniosynstosis
Can result in Increased intracranial pressure

119. Allergic Rhinitis
Allergic shiners: due to venous congestions
Allergic Salute Dennie lines

120. Intraosseus Access

121. Fibro-Optic Blanket

123. Heel Prick Test
Usually done at day 5, it’s a screening test for:
•Galactosemia
•Immunoreactive trypsinogen to detect cystic fibrosis.
•Maple syrup urine disease
•MCADD
•PKU
•SCD
•Congential hypothyroidism

124. Peak Flow Cytometer Chart

125. Aerochamber

126. Ambu Bag

127. Dr.Amjad’s Review

128. What Is This Rash?
Cradle cap

129. Cradle Cap
•Greasy, yellow scaly patches over the scalp
•May spread to face, ear and nappy area(infantileSeborrheic dermatitis )
•Possibly due to overactive sebaceous glands in the skin of newborn babies
•Not itchy (NO pruritis)
•Treatment with mild baby shampoos. Wash regularly and brush softly to remove
scales
•Baby oil can help soften scales (not olive oil!)
•Resolves by 6-12mths
•If fails to improve = Try topical steroids+/- antifungal

130. What Is The Abnormality

131. Umbical Granuloma
•Cause seropurulent discharge
•Fleshy swelling
•Treat by local application of silver nitrate
•Sometime surgery

132. What Is This Rash?

133. Chickenpox
•Begins as an itchy red papules progressing to vesicles on bright red base (dew
drops on a rose petal) on the stomach, back and face, and then spreading to other
parts of the body
•Central umbilication of blisters follows rapidly, crusting and desquamation
within 10 days
•Fever, sore throat, anorexia, malaise may precede rash by several days
•Incubation 7-21 days
•Symptomatic treatment in immunocompetent
• Cool compress, calamine lotion, antihistamines

135. Measles
•Prodrome; fever, malasie, dry cough, coryza,
conjunctivitis, photophobia
•Koplik spots on buccal mucosa
•Rash 3-4th day of illness
•Starts on face as blanching red macules and
papules, non itchy
•Spreads down trunk and extremities
•Rash coincides with high fever
•Lesions become confluent, older lesions develop
rusty hue
•Contagious 4 days before rash and 4 days after

136. Roseola Infantum
•Also called exanthema subitum or sixth
syndrome
•Herpes virus 6
•High fever followed by macular rash
•Mild cervical lymph nodes
•MIS-diagnosed as measles or rubella
•Diagnose by serology
•Treat symptomatic

137. Erythema Infectiosum
•Also called Slapped cheek syndrome or Fifth
disease
•Caused by parvovirus 19
•Young school aged children
•Usually asymptomatic
•Aplastic crisis in haemolytic anaemias(Sickle cell
/ Thalasemia)
•In pregnancy –fetal complications

138. Infantile Eczema

139. 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

140. Ahealthy 6 yr old boy had developed multiple papules on arm.leg ,trunk
What is the lesion ?

141. MOLLUSCUM CONTAGIOSUM
•Common in school children with DNA pox virus
•Spread by contact and scratching lesions
•PEARLY Papule with cental UMBLICUS
•Spontaneous resolution in 6-9 mo(can last years)
•Advise to separate Towels and Bath
•Occasional Treated by CRYOTHERAPY

142. A2 yr old girl is seen in HC with diffuse intense itching.All family member
are itching-Interdigital lesion , papulovesicle
What is the lesion?

143. SCABIES
•An irritative reaction to female mite Sarcoptes scabiei
•Transmission by direct contact
•Scabies Burrows/Rash
•Widespread itchy reaction to mite,their egg and excreta after 4-6 wk
•Erythematous papule,pustule,excoriation
•Lab Diagnosis by removal of mite or egg by KOH soln over a burrow, scraping with
needle and see under MICROSCOPE
Treatment
• Treat patient and all close contact
• Topical Scabicide: Permethrin cream after a bath to whole body(and Head <2 yr)
• Wash all bed linen and immediate clothes

144. A6 yr old boy had painful nodular lesion after sore throat over the shin
What is the lesion?

145. Erythema Nodosum
•Painful shinny,hot red elevated oval nodule over the shin, female>male
Causes:
• Infection: Strep,Mycoplasma,TB
• IBD: Crohn , Ulcerative colitis
• Autoimmune: Sarcoidosis, SLE
• Drugs: Sulphonamides,oral contraceptive
•Treament: bed rest, NSAID, treat the cause

146. Umblical (UH) & Inguinal Hernia (IH)
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

147. Gastroschisis
•Opening in an abdominal wall present to the right to the umbilicus
•Often diagnosed on prenatal ultrasound
•Managed by placement of plastic bag followed by surgical repair

148. Ambiguous Genitalia
Congenital Adrenal Hyperplasia (CAH)
•CAH most common cause of ambiguous genitalia
•21-Hydroxylase deficiency is the most common
•Investigations:karyotype, serum electrolyte, abdominal
ultrasound & hormone assay
Management:
•Replace hormone (cortisol/testosterone)+
reconstructive surgery

149. Beckwith-Wiedemann Syndrome
• Backwith- Wiedemann syndrome
• Gene at 11p imprinting
• Macrosomia + Ear crease on ear lobule
• Pacreatic hyperplasia and hypoglycemia
• Omphalocele, Hemihypertrophy,
• Wilms Tumour

150. 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
Microdeletion 7q11.3

151. Achondroplasia
•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

152. What Is The Rhythm?

153. Supra-Ventricular Tachycardia
•Most common arrhythmia in children's
•Narrow QRS complex ,difficult to find P wave.
•Heart rate >200 usually idiopathic-Rarely Wolff-Parkinson syndrome
•Vagal stimulation—carotid sinus message,cold ice pack to face
•I/V adenosine if stable and not in shock
•Synchronised DC shock if in shock?

154. What Is The Abnormality?

155. Big Heart Shadow
Cardiomegely
•Heart failure
•HOCM/DCM
•Pericardial effusion
•Significant Lt to Rt shunts
•Ebstein Anomaly

156. What Is This Instrument?

157. AeroChamber with Mask
•Used in Children for delivery of drugs in Asthma (inhaled steroids/ventolin) with
inhalor.
•Better coordination and deposition of drugs in lung in small Kids

158. Neonatology Dr. Reem Review

159. Mongolian Spots

160. Flat Hemangioma

161. Raised Hemangioma

162. Erythema Toxicum
Erythematous rash, the vesicular fluid showed presence of eosinophils

163. Milia

164. Cephalhematoma

165. Caput Succedaneum

166. Chignon
Edema and bruising from ventouse delivery

167. Omphalocele

168. Gastroschisis

169. Erb’s Palsy