Pediatrics Short Cases 2012

Row Labels
19/12/04 9:09
RS-pleura effusion
Pujitha sir,harris sir
(blank)
(blank)
Abdomen-splenomgely due to cirrhosis
Shyaman sir,sarojini medam (LRH)
(blank)
(blank)
19/12/04 12:28
Vsd
Examine this 3 month old baby's CVS and do the relevant examination
Harsh pansystolic murmur in left lower sternal edge
What's the size of the defect
Is there any complications
Is there any hepatomegaly or cardiomegaly
Features of pulumonary htn?
Bilateral Pleural effusion
Examine this child's rs system
Bilateral Pleural effusion
Why is it bilateral?what's the cause?
Dengue
How about the rash what's it called
Where does it occur
In which part of dengue infection the child is in
As a HO what wd u do(the legal thing?
Notification
19/12/04 12:32
Abd
Shyaman sir.. external madam
Billiary atresia boy. Kasai done.. splenomegaly
Liver enlarged? Sir said it is shrunken
Didnt ask questions. Finished 2 3 mins earlier and waited for the 2nd one
(blank)
Cp
Lucas madam and external
Do gait examination and proceed
Bilateral spastic. Scissorring
Bl spastic lower limbs
Upper limbs were spastic.
Presented.. asked me whether i examined ofc. Said i didnt. Sir showed me that he has a
squint..and a tendon release scar �. What type of cp? Why diplegic.. sir said its quadraplegic. Madam was very
supportive..
19/12/04 12:32
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 (blank)
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(blank)
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19/12/04 14:15
Abdomen
Lucas madam and Devan sir
Febrile patient with large splenomegaly
Only Devan sir asked questions
Present your findings
Specially asked for the size of the spleen
If this patient is presenting with 7 day fever what are the DDs?
What is the disease that present like this and is transmitted from foods(Typhoid)
CVS
Shyaman sir and external madam
3 month old febrile child,in respiratory distress(recessions and scaphoid abdomen) with a
pansystolic murmur at LLSE.
Present your findings
(I presented as a VSD.don't if it's correct)
They asked whether there is any abnormality in heart sounds?I said no.Seemed like they wanted some other
answer.
What is reason for the tachypnoea?
Didn't allow me to tell about investigations.Sir said "okay,go" even there was about 2 mints left.
19/12/04 14:33
Neurology
Lucas madam.
Spastic Diplegic. Syndromic features.
Asked about cognitive level.
CVS
(blank)
VSD with HF
Why she is breathless ?, 2 causes
19/12/04 14:34
Rickets
Dr Nishani Lucas
Bow legs
Hypertrophy of chostochondral junctions
How to investigate
Cerebral palsy
Examine the gait and proceed
Scissoring gait
UMN weakness in BL LL and UL LL> UL
i missed a tenotomy scare in the groin
Examination findings
What is your diagnosis
Why do you say so
19/12/04 14:49
Neuro - 11 year old boy presented with acute onset difficulty in walking. Do the relevant examinations.
No need to do sensory.
 Prof Jithangi & External Examiner
R/ spastic hemiegia
Present the findings
What is your diagnosis (Spastic paralysis of R/ upper & lower limbs)
What else do you want to do to find the anatomical location. (Sensory & Cranial Nerves)
Where could be the lesion (internal capsule?)
Rickets - Do the general examination of this 2 year old clild.
Prof Shamya de Silva & External Examiner
Baby was sleeping. Hypotonic.Look short, Frontal bossing, non-fused anterior fontenelle,
Bow legs, Widened wrist. No other findings.
What is the diagnosis
What could be the reason
Other features
What are the investigations
What is the more important to find the etiology for rickets (Calcium or Phosphate - Answer is phosphate)
What happens to ALP level
How do you manage this child
How do you assess the response for the medocation (ALP level)
19/12/04 15:01
Abdomen
Lukus madam and Devan Mendis sir
Pale. hepato splenomegaly. Kasai scar.
Condition and procedure done?
Sx done at 6 weeks so is it extra or intrahepatic lesion
Is it decompensated
CVS
Jithangi madam
VSD with parasternal trill
Advices to mother and how do you assess the severity
19/12/04 15:02
Cvs VSD with Eisenmengers syndrome
Ramya madam
Well looking child
Peripheral cyanosis, clubbing
Pansystolic murmur.
Pulmonary HT
No heart failure
Present findings.
Why clubbing and cyanosis? Eisenmengers
What can be the other DDs
Why can't this be TOF, no ejection systolic murmur.
In TOF what is the second hard sound.
What happens in Eisenmengers syndrome.
What will be the P2
RS. R/S Plueral effution
Jithagi madam
7years old. I'll look looking child, with cannula insitu. cervical Lymphadenopathy, right
side plural effusion
Present findings.
What are the differential diagnosis.
Ix.
What favours TB.
19/12/04 15:21
 CVS
Dr Lucus and Dr Dewan mendis
3 yr old girl with cyanosis and ejection systolic murmur. My diagnosis was TOF
What is the typical murmur that heard in TOF? (I said ejection systolic at pulmonary area, but it wasn't
the answer he expected)
Is there a BT shunt? (No)
Did u check it? Where to check for the scar? (Infrascapular area)
Does this child has heart failure features?
At what age it should be corrected? (6 months)
Abdomen
Shyaman sir and external examiner
Febrile child not pale or not icteric.Kasai scar with hepatospenomegaly and free fluid.
Present ur findings. What is the diagnosis? (Uncompansated kasai procedure) Why he has
splenomegaly? (Portal hypertension)
19/12/04 16:22
RS
Randula sir Kumudu madam
1yr6m boy
B/L Coarse crepts all over, Respi.distress
No clubbing
Case was Broncho Pneumonia
I Messed up interpreting.
CP
Samya madam and Ext sir
Diplegic Spastic CP.
ULs normal
Presented findings and diagnosis
Why do yo say Diplegic Spastic CP?
What else suggests it Diplegic?...
What about his higher function? Preserved.
Did You Do Cranial Ex? NO
What else you look for in this child?
What Is The Prognosis Of Diplegic CP?
What Supplementation You Will Give him?
19/12/04 19:00
CVS
Shyaman sir and external madam
pansystolic murmur
Acyanotic congenital ventricular septal defect not complicated with heart failure .
No question asked�
Abdomeb
Randula sir and kumudu madam
Febrile Isolated splenomegaly and lymphnode enlargement
IMN and proceed with that IX and diagnosis .
I think it was CMV ( later got to know)
19/12/04 19:08
Rickets
Shyamya madam and sir
(For me) Frontal bossing, bow legs, and widened wrist
No harrisons sulcus and rickety rosary
Abdomen - no ballotable masses or palpable bladder
Command was to do the general
2 year old girl
Frontal bossing was obvious, child was sleeping and febrile and cough was there. I was clueless and said frontal
bossing and examiners asked do do limbs again.
There was bow legs, (***may not be obvious when child is sleeping with legs flexed***)

After rickets dx asked do relevant system examination

I did abdomen looking for ballotable masses - kidney pathology
They expected palpable bladder. Asked why? I said obstructive uropathy causing renal failure. Kind of accepted
that but not sure*

Asked about investigations

Said ca, po4, alp
Expected ALP, what happend to ALP - very high
X ray wrist and features
To find the aetiology what is important- I said po4 and explained difference in nutritional and renal failure po4
How to monitor response - said clinical and xray, they expected alp levels becoming low
Treatments- depending on aeitology giving forms of vit d
Abdomen
Randula sir and madam
Pale not icteric
Abdomen slightly distended
Non tender
Transverse scar
Hepato splenomegaly
Horse shoe dullness
Present findings
Possibilities
Is it compensated or decompensated
Why pallor in this child
What is the investigation you would do for pallor
19/12/04 21:24
CVS
Shayman sir and external examiner ( very supportive )
Harsh systolic murmer and thrill at lower L Sternal edge.Parasternal heave and palpable P2.Loud
P2.Lung bases clear.child not dyspnic.Growth looks adequate.
Diagnosis-VSD complicated with pulmonary hypertension
Shayman sir- we dont have anything more to ask.
Abdomen
Pujitha sir and external examiner madam
Febrile, icteric, hepatomegaly and ascites
Findings and diagnosis?
Isolated hepatomegaly
How do you check for spleen?
Did you check in both ways? Yes,but I couldnt feel
What can be the cause?
Infections- hepatitis, CMV, EBV
ALL
Storage disorder but fever unlikely - prof why storage disorder child doesnot get fever?? :p
19/12/05 14:17
Abdomen
Randula sir and a Madam
1yr 8 months
Pallor, icterus, grade 4 clubbing
No lymphadenopathy
Distended abdomen
Massive hepatosplenomegaly
diagnosis- clcd
Why pallor?
How to confirm
CVS
Nishani Lucas and external sir
5yrs, Pure ASD with pulmonary hypertension
How to confirm?
What is the plan?
Why cant we watch and weight?
Management options
19/12/05 14:49
Developmental assessment
Sumudu madam and external madam
9 month old baby. Normal development
Presented findings. No special questions.
CVS
Shamya madam and external madam
VSD in a syndromic baby
Findings. Dx. What will you do?
19/12/05 15:19
Neurology
Ruwangi madam and external
Bilateral flaccid lower limbs, bilateral ankle contractures with absent reflexes. Repaired spinal
cord lesion probably a meningomyelocele. Upper limbs normal.
I was confused with the presentation of the child. So discussion went on differentiating UMN and LMN
signs and pathophysiology. Then they asked what are u looking at the head. Level of the lesion etc. Messed up,
so didn't go beyond that.
CVS
Randula sir and External madam
5 year old girl, typical VSD murmur. Missed mild clubbing and peripheral cyanosis which
was prominent on toes.
Presented as a VSD, then sir asked to look at hands and feet again under sunlight. Then only
saw the clubbing and cyanosis. Then I said this could be a congenital cyanotic heart disease. Complex or
simple? I said simple one now coming with decompensation as child didn't have a sign of previous corrective
surgery. Had it been a complex one child wouldn't have survived upto 5 years with out a surgical scar. Don't
know whether they accepted it.
19/12/05 16:03
RS
Sumudu madam and external madam
Pleural effeussion
Asked ex findings and dd
Causes for the pleural effusion
Lower limbs
Randula sir and external madam
1 and half year girl No wasting fasiculations no scars tendon release bilaterl hypotonia
absent reflex and zero power Right side contracture there
Asked what could be
Upper limbs moves normally facial expressions were there no CP looking
So tell could be lesion in the spinal cord so what could be?? I missed the back examination sir asked to check?
�� meningomyocele repaire was there later on what could be associated ?? I told midline defects so asked
what about Arnold chiary malformation then told hydrocephalus and madam asked what else u check in
abdomen??? Palpable bladder and fecal masses ��
19/12/05 17:58
RS
Sumudu madam
Plural effusion
Causes,how to differentiate frm consolidation,
CVS
Ruwangi madam
ASD
Why do u say so
How to differentiate it from PS
19/12/05 18:21
Abdomen
Randula sir and external
Hepato splenomegaly
Ddx, how will you do investigate?
Rs
Sumudu madam and external
Pleural effusion
They expected it is consolidation!
19/12/05 19:47
Cns- duchenne
Randula sir and external madam
9y boy, waddling gait, pseudohypertrophy, proximal more than distal weakness. Child could not
do gowers. Absent knee jerk. Ankle jerk present. Sensory normal
Initially I presented as tiptoe gait as I didnt see waddling or pseudohypertrophy. Then they asked to look
again. I told as myopathy probably dmd.
What other system u would like to examine? Cvs, developemnt
Cvs- complex cyanotic hd
Lucas madam and external sir
5y girl, growth not adequate, cyanosis, clubbing, plethora, no cardiomegaly or heart
failure, loud p2, pansystolic murmur at llse.
Why this is not tof? What are the differences? Basically asked about pathophysiology.
19/12/05 19:58
CVS - ASD complicated with pulmonary hypertension and right ventricular hypertrophy
Dr. Nishani Lucas
Pulse rate 88 bpm, Chest normal No scars, Para-sternal heave, P2 loud Fixed split of S2,
No ejection systolic murmur
1 Diagnosis
2 How pulmonary hypertension develops
3 How would you manage
ABD
Dr. Randula Ranawaka
1.5 years old, Deep jaundice, Clubbing, No bleeding manifestations
Abdomen is symmetrically distended
Hepatomegaly and splenomegaly with free fluid
1 Diagnosis
2 Why do you say there is portal hypertension
3 What are the other complication of portal hypertension?
4 What are the nutrition problems which can occur?
5 How would you investigate
19/12/05 21:29
CVS
 Shamya madam
ASD
I presented as ASD complicated with Pulmonary HTN without heart failure...madam asked what next I
told echo to confirm and also ECG? asked for changes in ECG? other mam asked is pulmonary HTN common in
ASD ? ..BELL rang
Neuro
Ruwangi
Child with B/L club feet with a repaired meningomyelocele...command was do the lower
limbs and relevant general..
(blank)
19/12/06 6:43
CVS 5year old girl
Dr Nishani lucas and external sir
ASD cokolicated with right ventricular hypertropy and pulmonary hypertension
Asked whether p2 was loud
What would you do ?( septal repair
Why ? She can develop eisenmenger sin 2nd decade otherwise
Rs
Prof Shamya and prof madam from ruhuna
I presented as right side pleural effusion but asked to reassess vocal resonance
I think it s right lower lobe consolidarion
Difference between consolidation and pleural effusion
How to manage pneumonia as HO ( investigations drugs )
If not resolving after 48 hrs wht is investigation to do (they expected US scan )
19/12/06 9:04
(blank)
(blank)
Multiple healed puncture marks on the post. Chest , stony dullness in both left and right . More in
right .also reduce air entry and reduce vocal resonance in B/L lower zones .. BUT increase vocal
resonance heard over R/s middle and some extent to Lower zone ..
Present as pleural effusion. Not mention about consolidation..told me that she present with fever and
cough and ask about etiology. (Pneumonia)
(blank)
(blank)
Short ejection systolic murmur best heard at ULSE with fixed splitting of s2.Parasternal
heave present .no palpable p2
Diagnosis ASD and Ix to confirm 2D echo
19/12/06 14:34
Do the motor cranial nerves examination
Ruwangi madam and external madam
Isolated lower motor neuron type right side facial nerve palsy
Present your findings.
What do you think it is?
Why do you say it’s lower motor type?
So what is the management?
What can you do about the eye? (Artificial tears, plaster it close when sleeping)
General examination and the relevant
Prof. Pujitha & external madam
8yr old
Generalized oedema, peri orbital involvement.
No ballotable masses, no organomegally
No features of fluid overload
Present your findings
What do you think it is?
Could this be liver failure? (No LF other features)
Could this be protein losing enteropathy? (Child seems adequately grown, no other nutritional deficiency
features)
Could this be relapsing steroid resistant nephrotic or the first presentation? (Child has no features of steroid
toxicity)
What do you do to confirm it’s nephrotic? (Ward test, UFR, UPCR, lipid profile)
What are the components in lipid profile? (LDH,HDL,TG, Total Cholesterol)
19/12/06 15:14
RS
Shaman sir & external examiner
Bilateral Pleural effusion in DHF patient
No questions were asked
Development assessment
Ruwangu madam and external examiner
Gross- 12
Fine 12-15
Social -9-12
Speech- 12
Conclusion-12 months
How can you asses the hearing in this age
19/12/06 15:41
CVS
Jithangi Wanigasooriya
Papable p2
Para sternal heave
Loud second heart sound
Pansystolic murmur best heard at the LLSE.
Findings?
Ask me to do examination four times
Each time corrected following things
cyanosis, clubbing, murmur best heard at the pulmonary area.
Not a good case, difficult to pickup the above findings, they convinced me that the above findings are there, so i
said yes sir and yes madam.
Tell me your diagnosis for the last time ?
Tried every diagnosis.
Development assessment
Prof. Pujitha Wickramasinghe
All domains 9 m , Prof said ඔයා නිකම් මැජික් කාරයයක් වයෙයි යෙ
Findings ?
Age was 11 months.
I didnt give a range. But sir was ok with that.
19/12/06 15:49
(blank)
(blank)
Bilateral Pleural effusion in DHF patient
No questions were asked
(blank)
(blank)
Gross- 12
Fine 12-15
Social -9-12
Speech- 12
Conclusion-12 months
How can you asses the hearing in this age
19/12/06 17:35
RS
Pujitha sir
6yr old,
BCG scar absent,
B/L pleural effusions
Presented as Dengue.
If child fever free for 2days,but not in critical phase,having pleural effusion,
how do u manage?
How to discharge?If mother says BCG scar was there earlier what will u do?
Abdomen
Jithangi madam
Jaundice n hepatospleenomegaly
DDx- biliary atresia,choledocal cyst,neonatal hepatitis xd, Why do u think it is biliary
atresia?what r the presenting features of neonatal hepatitis xd?
19/12/06 22:10
Abdomen
Pujitha sir and external madam
Horse shoe dullness in abdomen
Genatal oedema
Pleural effusion
What is the prabable diagnosis
Is it first episide or relapse??
What else it could be?? (nephritic)
What other things to be asked in that case?
How woild you differntiate grom prtein loosing enteropathy??
Motor cranial nerves
Jithangi madam and external
LMN type facial nerve palsy
Causes for LMN type facial nerve palsy
What is the specific name?? Bell's palsy
19/12/07 7:52
Abdomen
Nishani lucas
Hepatosplenomegaly,jaundice,ascites
Do the general and proceed
Present your findings
What is your diagnosis_ clcd complicated with portal hypertension
What could be the cause for clcd in 1 a 4 month old
Cerebral palsy
Prof shaman
This 1.5 yr ofld child is having difficulty walking, you can examine
I started doing development assesment� but was told to proceed with ll if you hv time only can do
others

cerebral palsy Spastic quadraokegia

Normal cp presentation. Ak
Sked about ofc, what could he the cause- periventricular leucomalasia,
If the perinatal period was normal what wcould be the cause-i said meningitis of encephalitis- said okay you can
go
19/12/07 9:48
 cvs
Ruwangi and external madam
ASD
How are you gonna investigate the patient.
What age are gonna operate the child?
Isolated spleenomegaly
Lucus and external sir
Isolated spleenomegaly and one lymph node
Asked about the dd. Portal vein thrombosis (accepted ) then told about lymphoma and
hereditary spherocytosis ( asked about features against that) then finally gave storage diseases ( but child was 9
years old). Then asked about the complications of spleenomegaly( thrombosis and rupture, the hematamesis
and malena due to portal hypertension)
19/12/09 12:54
CVS
Ruwangi madam + external madam
4 month old with respiratory distress, FTT, pan systolic harsh murmur at LLSE. Dx - VSD
Tell the findings.
What is your diagnosis
Why do you say so
What is the grade of the murmur
How will you manage
Does the child have pulmonary hypertension
Does the child have heart failure
How will you manage heart failure
Abdomen
Pujitha sir + external madam
10 year old boy. Jaundice + pallor + generalized clubbing + wasting + ankle edema. No
CLN. Abdomen distended with Kasai scar and distended veins. Hepatomegaly + Free fluid.
Tell the findings.
What is your diagnosis - Failed Kasai with chronic liver failure and malnutrition
How will you manage
Liver transplantation preparation how to do
19/12/09 13:20
TOF
Dr ruwangi and external madam
Cyanosis
Clubbing
Thrill
Ejection systolic murmur over pulmonary area
What are the complications of TOF
How do you manage hypercyanotic spells
Nephrotic syndrome with ascites and pleural effusion
Prof pujitha and external madam
Facial oedema
Pallor
Gross ascites with the thrill
Effusion
What do you think the diagnosis is
Where else you expect the oedema
Why not sacral
19/12/09 14:55
General and RS
Randula sir
 Downs syndrome general ex and pneumonia
What is the diagnosis
General
Shamya madam
Bowing of legs. Rickets
Types of rickets.investigations. Consanguinity and rickets
19/12/09 17:23
Lower Limbs
Ruwangi Madam and External Examiner
Spastic lower limbs with exaggerated reflexes. Upper limbs were also spastic.
Only asked the diagnosis. I said Quadriplegic Cerebral Palsy.
Developmental assesment
Shamya Madam and External Examiner
Can stand on his own, has inferior Pincer grasp, stranger anxiety, did not talk any words
Developmental age, does the child look well or ill, why do you think the child is in the ward
(Child had a cannula and they accepted UTI as the answer)
19/12/09 18:12
CVS
RR, ex madam
VSD, Tachypnoeic, intercostal subcostal recessions.
Wt is diagnosis, wt are complications of vsd
Abdomen
Pw,external
distended ab, Kasai scar, hepatomegaly , sm, flank, shifting , horse shoe dullness
Diagnosis? Wt will you do? How to prepare for liver transplant?
19/12/09 19:46
Abdomen
Ruwangi madam ans external
Small baby started crying. Madam asked mother to breastfeed. Asked me to examine while being
breastfed cz baby was inconsolable. Had icterus and hepatosplenomegaly
Asked for what would i examine for if baby was not crying. Then about DDs. What would i
do.investigations. possible findings. They stopped the case before the bell rang as they ran out of questions to
ask�
General and RS
Prof pujitha and external
Child with trisomy 21. No resp distress. Widespread coarse crepts and rhonchi. No other
findings. While i gave the child a teddy initially, mother told not to give as child has asthma :D
Infective exacerbation of bronchial asthma. Asked specifically what. Bronchopneumonia.
Asked how I would manage. Antibiotics to start. They are very helpful
19/12/09 19:51
Spastic quadriparesis (CP)
Prof. Shamya
Classic findings
Just the presentation and diagnosis. No further questions asked
Development assessment
Dr. Randula
Development milestones of 8 - 9 months
Asked how I'd do the distraction test.
19/12/09 20:55
CVS
Shaman sir
 Uncomplicated VSD
No questions asked
Abdomen
Ruwangi madam
deep jaundice with Hepatosplenomegaly
Findings
Ddx
19/12/10 13:21
CVS
JIthangi madam
PS, loud p2, cyanosis, plethora
Diagnosis- TOF?/ complex HD
Respi
Ruwangi madam
Trisomy 21, mild dyspnoea, NO diffuse coarse crepts.
DDs
19/12/10 13:21
(blank)
(blank)
PS, loud p2, cyanosis, plethora
Diagnosis- TOF?/ complex HD
(blank)
(blank)
Trisomy 21, mild dyspnoea, NO diffuse coarse crepts.
DDs
19/12/10 13:27
Diplegic CP
Randula sir and external
Spastic, ex reflex, contractures more in ll than ul
What diagnosis, reason, mx, whether managed properly, cognition?
Effusion
Pujitha sir and external madam
Effusion and all over crepts
Diagnosis, why effusion why not consolidation how to differentiate both, ix
19/12/10 13:58
CVS
PROF SHAMYA
pan systolic murmur in the apex with parasternal heave and pul hypertension
diagnosis
aetiology
what other valves can get affected
is she currently having rheumatic fever?
Rs
Randula sir
bilateral pleural effusions. febrile child
after telling diagnosis and dengue as probable aetiology asked whether i examined the
convalascent rash. ( i didn't)
what is the difference between DF and DHF
what is the pathophysiology of leaking
19/12/10 14:23
CVS
 Lucas madam and external
Mitral regurgitation with PHT
causes of MR,
Rheumatic fever criteria
Abdomen
Pujitha sir and external
Puffy face, pallor,
Fluid thrill,
Acitis
What's the cause (nephrotic cz angiooedema),
What will you do for the child?
Why wouldn't you do paracentesis? (Cz child has no complications such as respiratory distress),
Do you think it's the first episode or relapse? (Relapse identified by steroid toxicity features, they asked me to
name some)
19/12/10 15:51
RS
JW
Bilateral pleural effusion
Etiology
CVS
Samya madam
Complex cyanotic heart disease
Complications, Presentation
19/12/10 15:58
Abdomen
randula
infant, pallor with hapatospleemegaly forgot offer geneital examination as a routine case�
what are DD 's how will u investigate
Possibly rickets
Jithangi madam
short staure.,frontal bossing ,larde head, forgot the fontennelles� other positves were
pectos carinatum and wideded upper limb jonits no bow legs ricket rossaray�
was not sure abot the diagnosis finaly said as rickets asked about the positives for the
diagnosis time ran out..
19/12/10 17:21
Spastic diplegic cp with wind swept sign
SDS And external
Upper limb also reflecxes brisk , lower limb bilateral clonus
Causes, aetiology, mx
Nephrotic with acites
Nishani lucas
Pale, leukonykia, and horse shoe dullness with bilateral pitting ankle oedema, facial
puffiness i couldnt appreciate
I told CLCD, they drag me to Nephrotic
19/12/10 17:23
Abdomen
Pujitha sir
Hepatosplenomegaly following kasai procedure
Complications of PHT
Neuro
Jithangi madam
 Diplegic spastic CP
What could be the cause( preterm) ..
19/12/10 17:24
Child with difficult in walking
Lucas madam , external examiner
High OFC, suteres abnormally closed, generalized macula papular rash more in periphery.
Diplegia. On feeding tube, b/l crepts, abdominal sx scar.
Findings . What do u think.
What about upper limbs
CVS
Shamya madam, external
Deviation of apex, visibile apex beat, precordial bulging ,parasternal heave, palpable p2,
pan systolic murmur radiation to axilla, loud p2,
Findings , DD , other causes, if this is rheumatic heart disease what other findings ? Did u
check abdomen , lungs.
19/12/10 18:13
CVS
Pujitha sir
Cyanosis, BT shunt scar, I did not hear a murmur
What is the diagnosis
How do you know that BT shunt is working
Generalized oedema. Do the general and relavent examination.
Jithangi madam
Genaralized oedema, not pale not icterus, no LN , free fluid in abd , no effusion, no
organomegaly
What is your diagnosis
What other things you want to examine
19/12/10 18:16
CVS - TOF
Dr jithangi
Dysmorphic,fever,plethora,cyanosis, clubbing , pulse nl 66bpm.
RS lateral thoracotomy scar
Apex nl
Could not hear anything .
Lungs clear,no hepatomegaly.
Presented as cyanotic congenital HD -TOF without HF.
Findings
What abnormalities there in TOF
What r the complications
How they get HF
CNS- diplegic CP
Dr.Randula
Cannot walk,lies on bed,no orthoses near by,muscle wasting,contracture release
scar.contractures.
Hypertonic,hyperreflexia,babinski positive
BL UL and LL both , UL <<LL
Offered for sensory examination
Diaper,no palpable bladder,spine nl
Findings
What type of CP and why?
How this occurs? ( preterm and PVL thus LL >> UL )
What about cognitive function?
Why are u saying it is nl?
Has the child been adequately followed up?
What he needs ? ( wanted the word MDT)
19/12/10 19:30
Development assessmnet
Shyamya madam
Gross motor- can stand with support
Fine motor - mature pincer grasp
Speech - monosylabbalic babble
Hearing - asked not to do the distraction test
Social - no stranger anxiety. Has a social smile
What is the age group for each domain and the overall age
Diplegic cerebral palsy
Randula sir
Spastic diplegia
Had tendon release scars
What is you diagnosis
Commenst cause for it
Is this child properly followed up
How is the cognition
What is your plan for this patient
19/12/10 22:15
RS-b/l pleural effusion
Jithangi madam+external
B/l pleural effusion
BCG scar present/not
I told dengue leaking phase is possible
Why pnemonia can't be a cause
Told that there are no crepts heard
Other causes for b/l effusion
Single Ix to be done on discharge
Hx from parent when child is admitted- they expected hx regarding dengue
CVS-Grade 4 MR+ PHTN,no features of HF
Lucas madam+ external
MR+PHTN+parasternal heave
Possible cause
Any findings of rheumatic fever
Where does the subcutaneous nodules present
Features of IE
Where are the oslers nodes?
What else you examine-joints
19/12/10 22:20
CVS
Shamya madam
Febrile plethoric cyanosis clubbing P2 loud BT shunt functioning
What is ur dx
What are the indications for BT shunt
Is it functioning
Why not TOF in this case
If TOf what are the findings
Why murmur inTOf
Why did u look for hepatomegaly splenomegaly(ask me to do cvs and relevant)
What are the complications this child can present with
Neuro
Randula sir
 Spastic lower limb with exaggerated reflexes a
Upper limb also same .but comparatively upper limb better
Bladder bowel incontinence
Higher function normal
No pressure sore
Contractures
What are ur findings
What is ur dx
Is contractures dynamic or fixed
How will u manage
Is child have been given adequate physiotherapy
What else in the management
19/12/10 22:40
CVS
Jithangi madam and external
Developmental delay
Dysmorphic features??Cyanosis and clubbing
Right back transverse thoracotomy scar
No murmurs
Loud P2
Diagnosis
TOF??
BT shunt scar
Shunting working or not
Abdomen
Lucas madam and external
Febrile
Pallor
Tinge of jaundice
Clubbing
No ankle oedema
Distended abdomen
Dilated veins
No scars
Massive hepatomegaly
Moderate splenomegaly
No FF
Diagnosis
CLCD with PHT
19/12/10 22:54
9 year old boy can't walk.do motor system examination
Dr. Randula and Dr. Anura Jayawardena
BL lower limbs tone increased, exaggerated reflexes, clonus. Contractures in knees. Upper limb
also same. Less than the lower limbs
Diplegic cerebral palsy
Causes?
Management?
Do general examination of 8 year old girl
Prof. Pujitha and Dr. Yapa
Frontal bossing, Harrison sulcus, prominent chest, distended abdomen, deformed
bilateral forearm
Rickets
features are not obvious ones
What are the investigations?
19/12/11 12:42
RS
pujitha sir and madam
reduce air entry in r side mainly ... dull to percuss
present. why u say so? what will be the cause ....
CVS
jithangi madam and a sir
6y ,dysmorphic features like turner , unable to speak , r side , plethoric , central cyanosis
, clubbing +, axillary scar , loud p2 , pain systolic murmur in pulmonary area
present ... as complex cyanotic heart disease with phy and alleviated by sx , and having
speech delay ...
what is the syndromic features? Turner xd ..
what are the cardiac lesions associate with that ...
( always ask for hand washing , even though there is no hand scrubs near , they r expecting for us to ask , )
even though u don't get proper dd , they r guiding, so try to stay calm , smile and answer # best of luck
19/12/12 14:39
TOF
Randula sir and a Madam
Peripheral cyanosis.
BT shunt scar.
Parasternal heave.
Ejection systolic murmur.
Present.what is the diagnosis.
what are the cardinal features.
so from ur ex what could u get to support this diagnosis.
What are the complications.
B/L pleural effusion
Lucus madam and another madam
dull on percussion on b/l lower lung zones.
Reduced breath sounds.
diminished vocal resonance.
Present.diagnosis.
What are the clues from ex to support dhf.
So did u check finger tips for pcv and for dengue rash.
How to ix for dengue.
What will u look in FBC.
What do u look in this child for nephrotic xn.
How to ix for nephrotic xn.

19/12/12 14:50
Neurology
Shamya madam
She came with difficult in walking
Do the ex
Gait circumduction gait,
L side foot drop
Arm swing reduce
LL exam r side nl
L side spastic paralysis ul ll
What could be the reason,
I told cp, madam told its present recently
So i told stroke,
Madam ask to ecamine the hands
Clubbing was there
Cyanosis also there
TOF. They gibe the same pt as cvs case for others
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2 skin rashes
Lucas madam
1 is urticaria
Other one is hsv
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19/12/12 14:53
CVS
Shamya madam ,and external examiner
ASD
Findings,ASD signs,
Cerebral palsy Lower limb examination
Randula sir and external examiner madam
Spastic paraplegic ,with static contractures
Causes for Cerebral palsy ,asked about child's head size
19/12/12 14:57
Abdomen
Sumudu madam ans devaka sir
Hepatospeenomegaly with normal general examination
Dd??
Rs
Poojitha sir
Left sided pleural effusion
Dd??
19/12/12 16:07
CVS
Shamya madam and External sir
TOF with L/S hemiplegia,
loud p2
central and peripheral cyanosis
Diagnosis
Rs
Lucas madam and external
B/L pleural effusion
DD's
Why u think effusion
Causes for effusion
What could be the cause in this child
19/12/12 16:14
ASD
Pujitha sir
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Hemiplegia,cyanosis and clubbing,
Shamya madam
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Hemiplegia due to emboli
19/12/12 16:24
Cyanotic heart disease
Randula sir
Cyanosed, not adequately grown, Child. No clubbing. No Edema. Not warm to touch. Not icteric.
Not dysmorphic. No midline defects. BT shunt scar seen. Apex not deviated.
What is your diagnosis ? Are BT shunts only used for TOF ? Where else are they used ? What are the
abnormalities in TOF ? What are the complications this boy can have ?
Rashes. HSP and a past Urticarial rash (looked a lot like Eruthema Multiforme though )
Shamya madame
Baby 1 - HSP
Child 2 - Rash looked a lot like Multiforme. But it’s an Urticarial rash it seems.
HSP - what is your diagnosis ? What else you want to see ? Why should you examine genitalia
? What other complications can occur ?

Urticarial rash - what’s your diagnosis ? Why Marginatum ? Describe the rash ? She got this after a drug
ingestion. What can it be ? She Has some LRTI symptoms. What can it be ? What conditions you get
marginatum and Multiforme ? The rash is itchy. What could it possibly be ? How can you treat it ?
19/12/12 17:34
CVS
Pujitha sr and external
Nothing � child continued to talk with herself throughout the auscultation.couldnt hear anything
Present ur findings
Diagnosis (acyanotic heart disease with probable PHTN )
How do u going to manage ?
What is the ix to confirm pulmonary hypertension ?
Do u think that she is having PHTN ? No � why ? As she is active and well loking
Neonatal examination
Sumudu madam and devan sr
Asked to do full neonatal examination
Child was irritable
Urine discharging sinus ( vesicostomy) a rash around groin
Bilateral scrotal swelling some penile abnormality
Present ur findings
What is the rash ?
What is the scrotal swelling ? Why didnt u transilluminate it ?
19/12/12 17:36
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19/12/12 21:03
Abdomen
Lucas madam
Hepato splenomegaly with mild icterus in a 3 yr old child
With no kasai scar,
Couldn't percuss bcz there was abdominal tenderness
No LN or pallor
Presented the findings
Clcd with features of decompensation such as splenomegaly
due to portal HTN, probably biliary atresia (i noted their expressions were
changed) so i quickly told that however it is unlikely
Bcz not deeply icteric, no kasai scar.
Haematological malignancy can present like this but there
were no LN enlargement
Lucas madam -
what other causes -it can be due to metabolic diseases
(the word 'glycogen storage diseases'
didn't come to my mouth) �
Developmental assessment
Shamya madam
All the development domains in between 9-12 months
Discussion didn't go much. During the discussion,
child was cruising and only that time i noticed that
And madam asked me to look at that �
19/12/20 18:03
RS
Shaman sir
Bilateral pleural effusion
Dds
Cvs
Randula sir
Vsd
Features of HF parasternal heave y loud p2 y eisenmenger
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Grand Total