Sei sulla pagina 1di 14

Pead recall 2016

1. teen 13 with sore throat fever bilat tonsillitis with exudate: history PE diagnosis differential
management

2. Mother comes with baby (3 months old boy i think), baby had been crying non-stop
for 2 days. Mother noticed bruise/rash on right/left cheek. She and her partner are uni
students (23-25 yrs old). Physical exam- all normal except for the bruise on cheek.
Task- Hx, Dx and Mx. Somewhat like Karens notes. Hx points towards NAI. Role
player was very good, into her role. When I suggested that it may be abuse, her voice
raised as she said ‘ that is quite an accusation!’ and she stood up when i spoke about
informing the authorities ‘ I don't want them to take my baby!’. So you have to calm
her down and reassure her.

3 Herpes stomatitis
4 Global developmental delay; 18m cannot walk
5 Head banding
6 SIDS
7 . 8 years old with headache , sore throat and no other signs healthy balance diet,
vitamin c, continuous , take care of hygiene. red flag, jerky movement high temp,
8 leukemia and fever
9 5y got diagnosied with Asthma, was discharged , talk to patient about further
management
10 4.5yp booy with speech and behaviour problems - autism
11 6 w boy, unimmunized and homebirth , presented with SOB and unable to feed -
Heart failure due to VSD
12 16 yo girl with anorexia , Hx PE , explain and reason
13 5y got diagnosied with Asthma, was discharged , 2nd day come to gp for further
advice about asthma and control measure.
14 Hospital gave a 3 day course of prednisolone tablet and emergency been managed
with Neb salbutamol in hospital (baby is at home)Task :Take further h.o from mother
No examination Explain and write AAP( paper is given on desk) and further advice.
15 H/O asthma mild attached at home often use puffer with spacer,3 time admission
since last 3 year(diagnosed at 18 month of age), also history of eczema mild control
with cream,F/h- mother had child hood asthma and getting mild as grow old.Rest all
F/h is fine

16 Rural Hospital setting – as HMO – Mother came with C/o first child ,6 w old, boy,
unimmunized and homebirth , presented with SOB and unable to brestfeed , sob
constant No other complainTask – further focused history P/E : finding from
examiner Explain patient diagnosis and dd and immediate management to mother.H/o
given, 1st visit to Dr after birth, no antenatal visit – NVD at home , no complication as
suchWas fine since birth since few days not feedingPositive on finding – bil basal
creps, heart sound not audible as of creps,murmur ( no particular type),hepatomegaly
of 2 cm, no ascites,pedal odema, not passed urine and stool today as of no feeding
(other wise no complain of such)
I think it is heart failure due to congenital heart disease bt ruled out other causes also

Hla Than need to ask thorough history to reveal progress of cannot eating, SOB, chest indrawing, cyanosis, delivery,
immunization in history taking and physical examination asking from examiner. then talk with mother for
hospitalization, immunization, further investigation like ECG, ECHO, CXR, fluid and A/B treatment, child
specialist.....PDx is congenital heart disease complicated with pneumonia
The first and most important DDs is sepsis which needs admission and sepsis work up.
17 16 yo girl with anorexia , Hx PE , explain and reason (asked by mother to see gp)
Typical case
18 Gp set up - 5yp booy with speech and behaviour problems –
19 autism Self centred, often fight with other kids at kindergarden, mother understand
speech but no other person understand well
20 Delayed started speech.(Sibling and parental history is ok)
21 Behaviour of ADHDTask – History taking 5-6 min Further advice to mother abt
diagnosis or DD and management
22 4 yr old child come to gp with mother. She attended ed yesterday with asthma attack
associated with viral infection. Now she has no more symptom.
Task: take the further history from the mother
Develop the appropriate management plan
Explain the plan to the mother
23 6 wk old child come with mother because of reduced feeding within last few weeks.
She did not eat anything yesterday.
Task: take the further history from the mother
Tell the possible cause to the mother
Explain the further assessment and management plan
24 16 yr old girl come with mother as she list 6 kg within few weeks and complaint of
dizziness and faint. She missed some school days due to this.
Task: take the history from the patient
Ask the findings from the examiner
Tell the possible condition to the examiner with the reasons
25 Tension headache- school Bullying. Mother s concerned bot brain tumor.. Hx, dx
26 4 m old Bronchiolitis- karensHx, pef, dx, mx
27 7yo boy with headache, fever, sorethroat, myalgia task: hx, pe from examiner, dx
28 mom with 6weeks old baby, neighbour died of SIDS. asking for prevention of sids
task: counselling
29 3.) nasal discharge on a boy prev had chemotherapy (1week ago) task: hx, pe from
examiner, dx, mgt
30 PEDS Whooping coughChild had viral infection 2 w resolved no with cough and
vomiting and becomes red, then cough and cough gasp no fever, irritable and crying a
lot father had a similar symptoms ,
31 6w old baby bother not immunized and mother is okay. Hx had already been given
and your task is to Dx and and Mx the case
32 Child with abdo pain,10 yo F intermitent abdo pain 6 m followed by URTI-
psychogenic No fever no , alternating constipation and diarrhea, no fam hx of ppl on
speacial diet, no Psy factors, PE was all normal. Dx and advice the patient about
33 Vasal vasal Ask for PE - girl running marathon and loss conscious and it was hyp
oglycaemia, BSL, 3.0 TASK: mother is concerned, talk to mother about Hx, Mx and
PE from the examiner, no postural hypotension.
34 sids counselling
35 post chemotherapy fever, 11yo dx with ALL had last chemo last week. (+) fever
runny nose. Hx PE dx diff mgt
36 headache due to URTI...7yo headache. (+) fever muscle aches and pains. Injected
throat. Hx PE dx diff
37 Paediatrics Whooping cough
Child had viral infection 2 w resolved no with cough and vomiting and becomes red,
then cough and cough gasp no fever, irritable and crying a lot father had a similar
symptoms , 6w old baby bother not immunized and mother is okay. Hx had already
been given and your task is to Dx and and Mx the case
38 Child with abdo pain, 10 yo F intermitent abdo pain 6 m followed by URTI-
psychogenic
No fever no , alternating constipation and diarrhea, no fam hx of ppl on speacial diet,
no Psy factors, PE was all normal. Dx and advice the patient about
39 Vasal vasal
Ask for PE - girl running marathon and loss conscious and it was hyp oglycaemia,
BSL, 3.0
TASK: mother is concerned, talk to mother about Hx, Mx and PE from the examiner,
no postural hypotension.
40 Morning session1)a father of a child came to you as the child was running
temperature for last 2 days.he had his chemotherapy last week.previously he was
diagnosed as acute lymphoblastic leukaemia.
41 You are working as HMO in a seaside hospital which is 200 km away from tertiary
hospital.Tasks are ask physical examination findings tell your probable diagnosis and
management to the father2 min thinking : its post chemotherapy fever.admit the child
8 min : i shook hand with both role players and examiners.both of them were very
cooperative.I talked to the examiner and positive findings were little bit congestion on
ear and throat.temp 39°C everything else was normal.I explained the father what is
going on.chemotherapy can reduce the wbc count which fights against infection.thats
why he is having fever.this can be life threatening as his immunity is quite low at this
moment.i would like to give panadol 1 dose of antibiotic now after taking blood for
culture and will arrange ambulance to send him to tertiary hospital.there he will be
given antibiotics and fluid as well and full septic work up will be done such as blood
and urine test,cxr etcI asked whether he knows about the ALL.he said yes.I asked for
support . reassured again.finished early.Feedback:FeverStatus:Pass

42 2)a lady came to your gp clinic with her 6 wk old baby.she was concerned about SIDS
as one of her neighbors lost baby because of SIDS.Tasks are take focused
history,discuss preventive measures and counsell the mother2 min thinking: i need to
talk about smoking,breast feeding,immunization et8 min: the mother was holding a
small cute dummy of a baby 😝 she was holding the baby so carefully as if the baby
will cry otherwise.nice roleplayer.I thanked her and appreciated for coming.I
congratulated her on being mum.I asked about baby’s feeding,waterworks,poo,wt
gain,birth history,wt at birth,term or premature,1st child or not.Then i started
explaining modifiable and non modifiable risk factors.Both of them were
smokers.counselled about it.asked to avoid overwraping the child . immunization and
breast feeding as these are protective.talked about sleeping pattern.She looked happy
about the management.Finished early.appreciated her once again and thanked both the
patient and examiner.Feedback:preventive health careStatus: pass
43 3)mother of a 6 yr old child has come to your gp clinic with complaints of the
daughter having headache since morning,the girl was having fever,runny nose,sore
throat,myalgia for last 2 days.Your task is to take further history,ask physical
examination findings from examiner,give your diagnosis and management.2 min
thinking: rule out all ddx of headache.dont forget viral.ask contact history8 min: asked
about all pain questions.pain was all over the headache,no radiation,no vomiting,no
episodes of fit,relieved by panadolNo stress at school or home Fhx of migraine
No history of traumaNo problem with vision or hearingNo wt loss.growing
well.immunized.eating and drinking well.Asked about sore throat,runny nose and
tiredness.No rash anywhere,No contact historyPhysical exam:temp 38°c other vital
signs normal.no pallor dehydration or rash.No neck stiffness or lymphadenopathy
ENT examination shows mild congestion on ear and throatAll other findings normalI
explained about the headache most likely due to viralURTI.no investigation is
required.ask to give panadol and plenty of fluid.reassured.gave red flags.
Feedback: headache Status:pass
44 Whooping cough
Child had viral infection 2 w resolved no with cough and vomiting and becomes red,
then cough and cough gasp no fever, irritable and crying a lot father had a similar
symptoms , 6w old baby bother not immunized and mother is okay. Hx had already
been given and your task is to Dx and and Mx the case
45 Child with abdo pain, 10 yo F intermitent abdo pain 6 m followed by URTI-
psychogenic
No fever no , alternating constipation and diarrhea, no fam hx of ppl on speacial diet,
no Psy factors, PE was all normal. Dx and advice the patient about
46 Vasal vasal
Ask for PE - girl running marathon and loss conscious and it was hyp oglycaemia,
BSL, 3.0
TASK: mother is concerned, talk to mother about Hx, Mx and PE from the examiner,
no postural hypotension.
47 Asthma- a mother come with 18m old child that got diagnosied with ASTHMA and
got admitted into the hospital , now she comes in the GP clinic. Task : severity of
asthma by taking hx, assess the use of the puffer by the mother , teach her how to do it
, and talk about the management

48 Child fever 38,5 , sore throat , muscle tiredness) no lympho node , rash , neck
stiffness; virus???
49 sIDS( 10 wks baby )
50 7yr Postchemotherapy fever(39) in the rural hospitals.
51 Had to plot a growth chart weight below 5th percentile. Everything normal in Hx
except diarrhea.
52 15. A child with pain in legs and high fever. No swelling or obvious redness. Had to
take Hx and everything. Tenderness and warmth in the legs specifically below knee.
Picture given. Child's lips. Painful rash with fever for 2 days. History & management.
? Herpes
16. Enuresis
53 Autistic disorder
Fuzzy eater
Intusseption
54 ADHD Hx and Mx- text book case word to word,
55 UTI CHILD
56 .delayed walking 19 month old
2.umbilical hernea plus inguinal hernea(paed)
3.scfe in 9 yr old
57 knee pain thigh pain 9 year old and 6-7 months duration of pain was described
Got an injury or fall at that time while playing basketball.Task ask physical
examination Ask X Ray from patient
Explain X Ray
Management
58 Start GA VS and Be aware of BMI while asking examiner it was 30
And knee exam normal and hip was limited in IR and ABDuction
and 2 slides of hip joint and knee joint were given
And you guys know what is going on
59 SCFE
60 5) 19 months delay walking
History 2m 2s normal can hold and stand except walking , term pregnancy heel prick
normal hearing vision haven't done yet or not sure
Physical examination no dysmorphic feature, GC HC 50% and other normal including
CNS
61 Focal delay walking normal variant) as in Karen ( holy new for me) right undecended
testis right inguinal hernia cough on pulse and inguinal hernia in seven month old.
This age is real age in exam.
Task inform and explain
Explain management
Tasks were much more this were what I did and remember.
62

2017

1. Irritable Child
2. Jaundice Ix explanation
3. Child with Lymphaednopathy(EBV)
4. Down counselling
5. Abdominal pain for 6 m ( no organic cause, psychic the kid is perfectionist)
6. Tender LN lt side of the neck dd and management
7. 1. Atopic rash- Child with rash all over the body and itching.Take history PE Management
8. 1. 18 months old uses rt arm and leg more than left.Mother is concerned.Task is to take
history,PE from examiner,diagnosis and management.
9. 2. 3 yrs old with h/o recurrent otitis media now comes with snoring.Take history ,PE from
examiner ,diagnosis and management.
10. 3. 10yrs old with severe tummy pain in ED.take history,PE from examiner,likely cause and
investigations.
11. . 11 yo female inflammed tonsils, started on amoxicillin, developed rashmaculopapular,
weight loss, 38 degree fever- Mononucleosis • PEFE • No other hematological disease •
Generalized lymphadenopathy, feels like rubberyinguinal, cervical, axillary • DDx with
reason • Mx
12. . Biliary atresia- 3 day old jaundice baby, regained birth weight, well, no fever, directed
bilirubin raised given, blood group given Rh –ve • Hx • Mx
13. Young mother, alone with 6 week baby boy, father works a lot • Hx (4 minutes) • Baby
weight normal • Mother not doing well • PEFE from sheet (all normal) • Mx
14. 3year old fever,stidor ..dx mx
15. PSGN kid with facial puffiness
16. inguninal hernia- 3 month girl with intermitt screams ,vomiting

1st March 2017

Paed

1. Continuous nasal discharge for 12 months ( Typical case of allergic rhinitis, clear nasal
discharge for 12 months, all the nasal examination go with allergic rhinitis

2. Irritable baby, ?Hernia


Incarcerated inguinal hernia.

3. Pallor with low Hb, 4y old boy, was on a trip, cold and GP there noted pallor and FBC done.
low Hb. the father brought his child they came back from holiday. they child had flu like /s.
blood test- HMA. ( introduce food I ask specifically wheat, oat, barley rye he said not sure. the
dad said stool greasy, bulk smelly and hard to flush. growth 50 down to 15. sounds like iron
deficiency secondary to malabsorption.). Coeliac

7. Croup ( child with inspiratory stridor, but with drooling. I told epiglotitis as the ddx )
8. Oral trush in 6months old baby and anal excoriations with weight loss
Picture was given with oral thrush, hx PEFE, dx and dads with reason, mx. ( weight loss since 4
months. solids started at 5 months, thrush since 2 weeks of age, diarrhoea since 4 months.
9. Diplegic cp

3.mother brought 8 months child because of cough x18 days.


Task:h/o, Ask pe,explain dx, explain mx
(Findings:mom was very restless when enter room. Calmed mom down. Cough suggestive of
Whooping cough, father had similar symptom, no respiratory distress, no fever, child can eat
and sleep well, but cough with whoop like sound at end at each cough, BINDS normal. Had to
reassure many times in between, start to act restless when ask about respiratory distress
questions.. Mx as usual..

Eating disorder, Bulemia


8mth baby 16 days cough, Whooping cough
1. Breath holding attacks3 yr old boy brought by concerned mother because of sudden loss of
consciousness and trembling of hands 1 hour ago. On examination he's well and active and you
noticed bruises on two fingers of the hand. Task : Hx, PDx, imme Mx to mother No generalized
jerking of limbs, no rolling of eye, no incontinence, cried after the episode,healthy child, cousin
has epilepsy
2. Vulvovaginitis -3 yr old girl bb concerned mother due to rash in the vulva. She is divorced and
thinks that her ex husband abuses the child. Task: Hx, PEFE card, Dx and mx to mom No
discharges no fever no dysuria no behavior changes like nightmares etc just said she's very
clingy to the mother Rash in vulva and vagina no bleeding or oozing.
3. Diarrhea in 4 yr old for about 4 weeks. Patents have restricted food and increased fluids buy
still it's there. Task: hx, PEFE card ( all normal )Dx, Mx to momStool not floppy not hard to flush
not sticky not frothy, no food particles. No increased consumption of milk or juice. no ulcers
rashes no loss of weightNo antibiotics used, Healthy and active.I gave ddx of Toddlers, Celiac,
giardiasis, antibiotic and arranged investigations including Celiac 4. 36/52 primig presenting to
GP with headache. All AN checks so far normal. Task: hx, PEFE ask for specific from examiner,
Dx and mx to patient Headache since 6 hours, blurring vision, upper abdomen pain, Bp180/100
tender hepatic area, edema up-to tibia and puffy eyes. Urine dipstick 4+While saying the dx she
started fitting. That's what the examiner told me.
This is exactly what I said. When the examiner told me the blood pressure on physical
examination, I said I would like to take my patient to treatment room, open iv lines,take blood
for initial investigations and then proceed with the examination. So when she did fit, I already
had iv access for iv diazepam.

diarrhea and V in unimmunized child


5- boy convulsions at school teacher say passed urine eyes rolled.counsel with differential
6- worried mom about neck lumb after 3 weeks of infection... Reactive lymphadenitis
09th march 2017:
paediatrics:
1.Cystic fibrosis already diagnosed. explain to mother. wt chart and FEV1 graph was given.

There were 2 charts:First one is FEV1 versus age over 5 years: it showed progressive decline of
fev1 over the year

The 2nd chart showed also progressive decline in weight over the same period.

Tasks were: interpret and counsel mother, tell mother about the cause of decrease school
performance of her baby.... Hx showed multiple recent hospital admission, recurrent chest
infection but mother denied any diarrhea.

2.Knee pain
3.Bee sting now stable. Imme & future Mx

7 days old baby, poor feeding & sleepy


9. 8 yr old boy, recurrent abdominal pain
10.Irritable child with groin lumb.
14)mom with 7 days old baby girl who is sleepy and not feeding well.

Task history
physical examination from examiner
most likely diagnosis and other possibilities
positive findings..
1)sleepy baby , not feeding well, light stools (rest every thing negative)
2)examination ; jaundice only positive

15)mom with 6 week old baby girl having lump in groin .

history
physical examination findings
diagnosis and
mangement

positive findings=
1) baby cry sometimes and brings leg up .. (rest every thing negative)
2)examinater gave picture of inguinal hernia that is freely moveable)

12-ITP/HSP ( child rash on lower leg )


Pedes :
5.Young boy bicycle ? Testicular torsion, HX,PEFE,MX,PD and DD i guess
young boy was riding bicycle and started having pain in lower tummy,had same episode few
days back which resolved by itself.on PE red swollen scrotum.I asked about relief of pain on
lifting scrotum,the examiner said not given.

6.Poor feeding jaundice 4 day old nil fever not feeding well , pale stools ,dark urine,mom doesn't
no about blood group,nvd in hospital,no issue in pregnancy,tasks, HX,PEFE,causes and MX

7.Post urti sob and wheeze


Positive fhx of asthma
Hx Pe and Dx
flu and runny nose since couple of days,cough since last night,wheezes are there,and fever as
well,family hx of hay fever,asthma.

Pedes :
Young boy bicycle ? Testicular torsion

Poor feeding jaundice 4 day old nil fever not feeding well
Yellow pale stools
Hx Mx

Post urti sob and wheeze


Positive fhx of asthma
Hx Pe and Dx
?asthma
Paeds.
1. Fever running nose and another symptom forgot.
History. Baby siter was sick as well.
Most likely diagnosis and management.
Explained about viral fever and management.
2. Acute tonsillitis.
Sore throat 12 years old.
History. Febrile as well.
PEFE. Enlarge tonsils plus exudate.
Explained about bacterial tonsillitis. At the end examiner asked what other causes can causes
can cause this said viruses. He specifically asked which virus I said EBV.
3. Limping. 2 years old baby.
Tasks
History. Positive for flu like symptoms 1 to 2 weeks ago. Brother was also sick.
PEFE. All normal except baby is limping.
Investigations. Said will do both knee and hips xrays.
Diagnosis and D/D.
Forgot to mentioned about transient tenosynovitis.
Said reactive, post viral. Other D/D. I mentioned septic arthritis.
4. Testicular torsion.
I think some young boy. Might be adult. Sudden onset of testicular pain. Pic given.
Tasks.
History.
PEFE.
Most likely diagnosis and management.
Nothing positive in history.
PEFE and pic positive for testicular torsion.

13. Umbilical hernia 1.5 cm n undescended testis 7 month old .. implicatipns of it,
managemnet.

I cant remember the rest.. got confused in few cases .. guys please pray for me ..

Meconium ileus or 2 yearvomiting with xray .. diagnosis with differentials

3. Headache migraine dd n dx

4. Persistent cough .. nth in history ix -wid dust mite 4mm wheal fam history separated
parents

24 april

3. 2.5 years old baby girl Angie came with her mother. ( in history baby got high fever didn't
control with Panadol for 5 days, sore throat, rash, didn't eat n drink, ). No. if wet nappy reduced,
no pass of bowel as she w Task : history, physical examination from examiner, possible cause In
examination: temperature high, conjunctivitis, red strawberry tongue ( pic given) rash over lower
trunk, not sand paper like rash,cracked lips, (I forgot lymph nodes either I asked or not)
In rural hospital, mom Victoria gave birth a premature baby( <34 week, I forgot the exact
gestational age) with birth weight 1.9 kg , now the baby got respiratory distress. ( the role player
was very anxious, about to cry, husband was outside, no problem of support, wanna go to
tertiary hospital with her baby)Task : counselling mother
A child who was pale on a trip, was ordered a FBE, which showed Iron deficiency anemia. Now
his father is here to discuss the result
child is on cows milk
Task: take history 2. Tel whats the cause 3. Management
His appetide was good and eat everything
Had 6 cup of milk everyday
6. A 2y child with limping from last night which got worse today... mother is here to discuss the
issue
Task: 1. Take history
2. Ask examination from examiner specificaly
3. Ask examiner any investigation you need
4. Tell the mother the cause of limping
diagnose spiral fracture of tibia
DrNabila Javed http://www.rch.org.au/.../fractures/tibial_shaft_emergency/

Admit..cuz spiral fracture is unusual in a child! Suspect abuse!

Natasha Riaz No need for admition it's one of the most common fracture and that is why it's called toddlers fracture,
toddlers fall off things and twist it at its axis . It's need supportive care back slab and above knee cast with procedure
sedation.

Natasha Riaz Suspect abuse in druggie parents , or if suspicion in history if other injuries and bruises . In this case
patient parent brought him in promto

Sanjana Shah Parikh Although early reports 5 suggested that tibial toddler fractures were indicative of non-
accidental injury, subsequent work has suggested that this is not the case and that the vast majority are not
suspicious
thank u!
Spiral fracture can happen mainly due twisting or direct blow to area. So abuse can be a reason
Like
· Reply · 10 May at 10:38

Natasha Riaz True, it's a fine balance picking abuse in real life you don't want to offend healthy families but in exam
it will be more clear picture ones history is explored ..
But suspect abuse in all cases of non weight bearing children rule it out

. Summary
Fracture type ED management Follow-up
Toddler fracture Treatment is supportive. A backslab can be Fracture clinic in 2 weeks
applied. An above-knee walking cast for 4 with x-ray
weeks is optional
Undisplaced tibial shaft No reduction is needed. Above-knee cast Fracture clinic in 1 week
fracture for 4-6 weeks (age and healing-dependent) with x-ray
Patient would benefit from procedural
sedation for application of the cast
Displaced tibial shaft See acceptable reduction parameters Fracture clinic in 1 week
fracture + / - fibular shaft with x-ray
fracture
Fracture type ED management Follow-up
Closed reduction with above-knee cast for
4-6 weeks (age and healing-dependent),
non-weight bearing
Unstable fractures may require general
anaesthesic, manipulation and plaster
GAMP) or fixation in theatre

2. How are they classified?


Tibial shaft (diaphyseal) fractures can be classified by:
a). location - proximal, middle, or distal third
b). fracture pattern - transverse, spiral/oblique, comminuted or open
c). involvement of the fibula

3. How common are they and how do they occur?


Tibial shaft fractures are the third most common long bone fracture in children and adolescents.
Fractures of the shaft of the tibia can result from a direct blow or a rotational force. Direct trauma
frequently produces a transverse fracture or segmental fracture pattern, whereas rotational forces
typically result in an oblique or spiral fracture.
! Thirty percent of tibial shaft fractures are associated with a fibula fracture

4. What do they look like - clinically?


The child will present with pain, swelling and/or deformity in the lower leg. The child will not want to
weight bear on the injured leg.

5. What is a toddler fracture?


Toddler fractures occur in young ambulatory children (from 9 months to 3 years). A toddler's fracture
is a spiral or oblique undisplaced fracture of the distal shaft of the tibia with an intact fibula. The
periosteum remains intact and the bone is stable. These fractures occur as a result of a twisting
injury. Septic arthritis and osteomyelitis should be excluded.

6. What radiological investigations should be ordered?


Anteroposterior (AP) and lateral x-rays of the tibia and fibula to include knee and ankle joints should
be ordered.

7. What do they look like on x-ray?


 Toddler fracture
7. A child who had sore throat 3 days ago and was given amoxicillin by another doctor is brought
now with worsening symptoms and rash all over his body. His mother is here and concerned....
Task: 1. Take history
2. Ask examination from examiner
3. Tel the most likely cause of the rash to mother
Infectious mononeculosis
8. A 12y child presented with long time cough. She was not responsive to asthma medication
and all investigation for asthma were negative....
Task: 1. Take history
2. Tel the mother the likely cause of the cough
Psychogenic cough after change her school
13. Toddlers diarrhoea - this case both role player and examiner are gud..2 year
old have diarrhoea.. binds ques all normal.. happy child.. growth normal..
examination findings examiner gave to hand..all normal.. so explained all findings
are normal it's more common for kids in this age group they like to play a lot and they
have more temper tantrums and have wat they like .. as having fruit juices he is not
having food properly.. give him 3 meals... if ur concerned I will do some tests like
celiac serology it's for gluten sensitive problems but it's not nessessary for him..if
anytime u feel he is not growing well.. not playing well.. no eating come back to
me.thanked both of them and came..
- a 15 y/o girl who has fainted in school is in ED. She has multiple
faints in last 3months.
Task:
1- take further hx from the patient
2- ask about the physical findings and investigations that you want
from the examiner.
3- explain for the patient about the possible diagnosis.
Dx: sinus bradycardia

8- 18m girl has been brought by her mom.her mom believes that
she is not well since 2days ago. She does not eating and drinking
well. T=37.7.
A urine sample with bag has been taken that shows leucicyte 3+, no
other cells , no nitrite.
Task:
1-Explain for the mother the most probable diagnosis
2- talk about the management
3- talk about the further measures( if necessary)

]unwell ,febrile child without ffeeding should be assesd thorougly,histroy should be taken a to z/ ,dd,from simple
URTI TO OTHER SEPTIC condition should be evaluated, childs stability ,hydration/ Then need of urgent emperical
antibiotics,prior specimen collection in this 1st visit at gp level can be determined,2]urine bag sample can be used
only for dipstick uti screening ,it is not used to diagnose uti,/ leucocyte in urine sample can be seen n febile condition
like RTI,meningitis ETC, IT SHOUD BE explained to mum,3] If hx ex suggestive of red flags,and confirmed the unwell
ill baby admission for further managment is necessary.

10- a midwife trainee comes and is concerned about the condition


of a newborn (born yesterday) who vomits frequently.
Task:
1- ask further history from the midwife trainee
2- ask the relevant physical findings and investigations from
examiner
3- explain the most probable diagnosis for the midwife
12 months old left side not moving. Task history,PE on the card. Explain DDx. On history everything
fine except mother fever during delivery and child not moving left side. Mile stone okay as well.

6 weeks old baby with projectile vomiting - pyloric stenosis

10 may
4 yr old child e swelling of eyes n face for 1 week brought in by mother. Task: hx, ask PEFE,
most likely diagnosis n cause
15. 18 month old child comes in ED with breathing difficulty n unable to swallow for last one day.
Task: short hx, ask PEFE, likely diagnosis, immediate management
3 month old child with intermittent bad cry for a day. Brother has gastro1 week back task: take
relevant hx, ask PEFE, tell likely diagnosis n other possible diagnosis
. 20 april
18 months old boy with refused to walk
I failed this case
AMC's feedback- joint pain- failed
tation no 16
Paed.. preterm with respiratory difficulty
Stable in the 40% oxygen head box
Mom was super anxious and restlessness
(fatigued after this station ) 😖

AMC's feedback- health review- pass


Kawasaki child
High Fever for five days + CRUSH

AMC's feedback-fever in a child- pass

So.. as it happened.
Clinicals 25/8/2017
Paeds:
1) Bee sting child with redness around sting. No anaphylaxis symptoms (you have to ask from
history). Mom has already removed bee sting.
• Explain initial and long term management.
2) 7yr CP with spastic quadriplegia brought by carer. Screaming continuously last 2 days. Carer
is new to case and does not know past history. Spent weekend with ?parents but they only rarely
visit. Child very skinny and not growing. ( Positive spitral fracture on tibial Xray) 7yr CP with spastic
quadriplegia brought by carer at long term care facility. Screaming continuously last 2 days. Spent weekend with
parents but they only rarely visit. Take history, ask for examination findings from examiner,(Swelling and redness
in one leg with Positive spiral fracture, subcutaneous swelling and osteopenia on tibial Xray) and explain the
diagnosis

3) 4 days old Neonate. Mom brings with jaundice and poor feeding. Stools green.
28 August retest
paed.
6 wks baby with vometing
>>>>> pyloric stenosis

Potrebbero piacerti anche