Paediatric Posting Stage 3.
1: End of Posting Questions @ December 2015
Short Case
Developmental Assessment:
A 2.5 years old boy is brought to you
as his mother is concerned about his
development. Please examine his
gross motor and fine motor
components.
Lower Limb examination:
A 11 years old boys was sent to
hospital. Please do a general
inspection and lower limb
examination
Abdominal:
A 11 year old boy presented to the
hospital. Please do a general
inspection. Suggest an area you
would want to examine and examine
him. (I proceeded with abdominal
examination)
Lower limb:
Gait assessment and lower limb
Sign Diagnosis
Patient is alert and appeared to be Developmental
small for his age. He was on delay due to
nasogastric tube and central venous chronic illness
catheter was inserted at his chest. (prolonged
Gross motor: bedbound). I
not able to stand and walk without would like to plot
support. able to pull to stand and the growth chart
cruise along the chair. gross motor age (must know other
about 10 months old causes of
Fine Motor: developmetal
able to build a tower of 6. hold pen delay!).
with a palmar grasp. able to scribble
randomly and imitate a straight line
but not draw a circle. able to flip page
randomly but not page by page. fine
motor age 2 years old.
Patient appear conscious, alert. Diabetes
He was obesity ( must know cause and cushing syndrome
complication of obesity) scurvy
Lower limb:
Tone : normal
Power 5/5
Reflex: cannot get because obesity
Sensory: not enough time to do
Walk and stand: Stand balance but
walk unbalance with leg bowing
Patient appear conscious and alert. Obese
He looks obese (must say would like to
measure height and weight and plot it
against a growth chart)
Abdominal:
Striae seen around inverted umbilicus.
Other examination show normal
findings.
Start with gait assessment: Hemiplegic
Abnormal, Hemiplegic gait cerebral palsy
examination of an 8-year old boy Lower limb examination:
Muscle wasting of left calf. Upper
motor neuron lesion signs- hypertonic,
hyperreflexic, upgoing plantar
reflex/Babinski sign. Muscle power of
grade 4.

Cardiovascular: 1.General; Marfan’s

12 years old girl, the tallest girl in the Long limbs and digits, thin and tall syndrome with
class. Examine her praecordium. body type, crowded teeth, pectus mitral
carinatum. regurgitation
2.Praecordium:
Murmur- pansystolic, grade not sure,
loudest at mitral, radiation to axilla.

Cardiovascular Dextrocardia

Neurology Neurofibromatosis

Facial nerve’s
palsy

Neurological examination (lower General Cerebral

limb) - microcephaly palsy/Seckel
Trigger: This is an 18-year old girl. - looks small for her age disease
Please do a neurological examination - wheelchair by her bedside
on her lower limbs. Lower limbs
- muscle wasting
- windswept deformity
- knee joint constantly flexed
- hypertonia (cannot fully extend knee
joint)
- hyperreflexia
- Babinski: upgoing plantar reflex
- muscle power: less than ⅗
#UMN lesion with microcephaly#

Remedial

Respiratory Respiratory distress, rhonchi, AEBA 2’ to

crepitations pneumonia

Abdominal Hepatomegaly Dengue

OSCE station 1:
A 3 years old boy with the height of 90cm ( 6 months before: 87cm), weight of 14kg( 6 months before:
13.5kg) and head circumference of 53cm came in to your ward with symptoms of URTI. Please plot a
growth chart and state 2 observations that you could obtain from the chart. Please state 2 questions
that you would like to ask the parents.
Observation:
1. Both of his weight and height are on/ have been on the 25th percentile of the chart.
2. His head circumference has been large and is currently on the 97th percentile which is not
appropriate for his weight and height.
Questions you would like to ask:
1. Any symptoms of increased intracranial pressure such as headache, confusion, nausea and
vomiting?
2. Any family history of macrocephaly( big head)?
*Meningitis is not possible in this case as the head circumference is too big.
OSCE station 2:
A 10 months old child is brought to you. Please obtain the developmental history from the parent.
Points to get mark:
remember to ask the language of preference from parent
ask component by component, do not mess thing up
if the child could do a 10 months old milestone, ask further for developmental milestone of
older age like 12 months old instead of going backwards and ask the developmental milestone
of younger age.
summarise your finding by component

REMEDIAL
OSCE 1:
Given a patient with age, weight, and percentage of dehydration.
Given 5 types of solution
-Choose appropriate solution
-Calculate fluid requirement
OSCE 2:
History taking of chronic cough