PEDIATRICS

UNMANNED OSCE

Chest X-Ray showing cardiomegaly (inc. cardiothorasic

ratio) due to septal defect, valve lesions, cardiomyopathy

Abdominal X-Ray showing multiple air-fluid level and

dilated colon due to intestinal obstruction

Chest X-Ray showing intestinal coils present in the left

chest causing left lung hypoplasia due to left diaphragmatic
hernia.
Clinical signs: bowel sounds in left side of the chest,
scaphoid abdomen, shifted heart.

Abdominal X-Ray showing double bubble due to duodenal

atresia. Mostly seen in Down syndrome. Treatment: surgical
 Chest X-Ray showing esophageal atresia with trachea-
esophageal fistula hence the air in stomach.

Chest X-Ray showing ground glass appearance and air

bronchogram —> Hyaline membrane disease due to
decrease production of surfactant.

Abdominal X-Ray showing air in bowl wall (pneumatosis

intestinalalis) due to necrotizing enterocolitis
Chest X-Ray showing jet black area in the right side of the
chest with collapsed lung and shift in the mediastinum to
the opposite side due to right sided tension pneumothorax.
Treatment: intercostal tubal drainage.

Chest X-Ray showing homogenous opacity in the lower

zone of the left lung with centralized mediastinum due to
consolidation.

Wrist X-Ray showing cupping and frying of

metaphysical plates of ulna and radius due to rickets.
Investigations would show normal to low calcium level,
low PO4, high ALP, high PTH, low Fit D (Vit D
dependent rickets) Treatment: Vitamin D supplements.
 Chest X-Ray showing uplifted apex (boot-shaped heart),
oligemeic lungs which happen in Tetralogy of Fallot.
Complications: Cynotic spell, brain abscess, polycythemia.
Characteristic findings on auscultation is an ejection systolic
murmur on 2nd intercostal space and soft systolic component of
S2

Mangolian spot —> Reassure the parent that it would disappear

with time.

Ruptured meningomyelocele: need surgical correction. May lead

to hydrocephalus.

Neonatal hypotonia —> floppy infant syndrome

Pseudohypertrophy on both calves due to Duchenne muscular dystrophy.
X-linked. Investigations: CPK & muscle biopsy

Talipes equinovarus can improve by physiotherapy (if not

bony) or by surgery (if bony)

Hypoglycemic infant (<1.6) due to

familial, diabetic mother, Beckwith
Weideman syndrome.
May be complicated with: hypoglycemia,
respiratory distress, congenital heart
disease, transmit hypoparathyroidism

Right sided inguinal hernia (need surgical

correction) & Umblical hernia (can resolve
on its own)
Pleomorphic skin eruption in chickenpox/Varicella zoster.
Complications: varicella encephalitis, cerebral ataxia, pneumonia.
Prevention by vaccination. Treatment: supportive ( and Acyclovir for
immunocompromised patients)

Cleft & lip palate:

Cause eating problems.
May be complicated with ear infection and
hearing loss leading to speech delay/problems
Require surgical correction

Rocker-bottom foot. Commonly seen in Edward’s

Syndrome (Trisomy 18). Most common heart lesion
in this syndrome is Ventricular Septal Defect (VSD).

Baby probably having hydrocephalus. Confirmed

with Brain MRI. Picture showing sun-set
appearance of eyes, coverage squint, low set ears,
epicanthic fold, depressed nasal bridge.
 Clubbing and peripheral cyanosis. May be due to
cyanotic heart disease, cystic fibrosis,
bronchiactasis.

Peeling of skin: late manifestation of Kwasaki disease. Most

serious complication in this disease: coronary artery aneurysms
found by serial echocardiogram. Treatment: IV Immunoglobulin
(IVIG) & Asprin.

Bilateral foot edema. Common in Turner syndrome

(Monosomy 45 XO). Features: webbing of the neck, wide
carrying angle, coarctation of aorta (weak/absent femoral
pulse, Hypertension in upper limbs, radio-femoral delay)