EOP PAEDS 4TH ROTATION

Dr. Chief Complaint Provisional Dx & PE Discussion

Differential Dx

Dr Masri A 5 years old boy AGE Parameters to assess -what degree of dehydration the
Vomiting & diarrhea hydrational status (ada 10) patient is
(mild/moderate/severe)
Ass. with abdominal pain -what’s the most common
organism & other organism that
can cause AGE
-investigations
-management (plan A/B/C) then
describe
-antibiotics if the patient has
bloody diarrhea
-advice you wanna give to the
father
-complication E coli to the
kidney = HUS

Extra:
-Dr banyak tolong 😭
in good mood haritu
Doalah dr

-Jangan contact dr for eop, biar

dr masri contact duluuu
-Always try your best to answer
his questions
-Clerk in Malay, dr doesnt allow
to jot down, present in English
-Dr just ask to present case
summary & hopi
-Always be ready for eop bcs dr
can make sudden changes
hahaha
 -Dr suka orang relax

Dr Masri this is the scenario: Nephrotic Syndrome haritu eop online, and dr (1st of all, dr is WAYY too nice
didn’t give pictures or masa EOP. terkejut jugak
before start Fatin, a 6 y/o girl came in with anything. dr just tanya u sebenarnya cause waktu
clerking, dr would sudden onset facial swelling for 1 nak buat PE apa? and dia viva/cbd he was a bit scary.
give the scenario week associated with frothy urine mintak list down all masa eop he was really friendly,
first. expected findings. and tak sarcastic, helpful etc. most
explain how the dz leads importantly he didn’t make u
i think this is to the clinical findings. ok feel stupid)
super helpful jee no worries. dia tolong2 during discussion, he asked
cause u can terus if you panic or blur prov dx, differentials.
fikir the complications, pathophysiology,
differentials for management for newly
the chief diagnosed nephrotic syndrome
complaint :D as well as for those yang
steroid dependent & resistant.
(never thought i’d say this.. but
honestly i would say you’re
lucky if you got him for eop!
*wink)

Dr Masri 5 yo girl presented with complaint of
fever, cough and runny nose for the
past 3 days.
provisional diagnosis : Dr just tanya examination - dr bagi gambar xray
pneumonia apa nak buat. Findings of then minta interpret
pneumonia on auscultation - dr tanya investigations
● Ddx : asthma, i.e. reduced breath sound, i.e. fbc, esr/crp, renal
viral croup, bronchial breath sound, profile
pertussis, tb, coarse crackles - dr tanya most common
covid 19 organisms that cause
pneumonia in 5 y/o child
i.e. streptococcus,
klebsiella and
mycoplasma
pneumoniae
- dr tanya antibiotic for
specific organisms i.e.
 penicillin for strep,
macrolides for atypical
bacteria
- dr tanya yg last ni apa
nama pneumococcal
vaccine ;) korang google
la sendiri

Dr baik gila, didn’t expect him to

be that kind dah bye

Dr. Lim A 9 y/o girl presented with swelling PDx : Nephrotic Do respi and abdominal Ix - diagnostic test is morning
in the face and abdomen for 4 days, syndrome examination specimen of urine protein
progressively worsening creatinine index (UPCI) more
DDx : 1. Nephritic Relate it to nephrotic than 200 mg / mmol.
- Reduced urine output syndrome syndrome patient
- Reduced oral intake Full blood count - to detect
- Abdominal pain 2. Chronic kidney leukocytosis due to peritonitis
disease as the patient is having
abdominal pain
3. Chronic liver disease
Lipid profile for hyperlipidemia
4. Lupus nephritis
Liver function for
5. Congestive Heart hypoalbuminemia, less than
Failure 25g

Renal profile to assess

dehydration, such as raised
urea and creatinine. And to
detect electrolyte imbalances
due to reduced oral intake such
as hyponatremia and
hypocalcemia

Mx - 1. Human albumin infusion

 because patient's albumin is
low
2. IV furosemide to treat edema
3. Penicillin as prophylaxis for
spontaneous bacterial
peritonitis
4. Give steroid (prednisolone)
until remission. For how long
and how much, go back and
read. Sorry I don't remember
the exact number.

Criteria of nephrotic syndrome

Complication of nephrotic
syndrome (and how does it
occur for each one)

Pathophysiology of nephrotic
syndrome

Dr Lew 8 months old boy Tak present case terus PE : Respiratory Investigation
Cough and runny nose for 2 weeks bagitahu diagnosis and 1. Respiratory 1. To check for hydration
-clerk in malay (not too severe) (early present) point support then distress sign do what? - BUSE
boleh, english discuss 2. Auscultation finding
boleh Become more worse today (late in bronchiolitis, If suspect viral, what to do? =
presentation) PDx : acute pneumonia, nasopharyngeal swab
-dr banyak bronchiolitis asthma
membantu dan Cough Management
sangat baik - Chesty cough DDx PE : CVS 1. Main therapy what? -
- Has post tussive vomit 1. Covid-19 1. Sign of heart failure Supportive therapy (O2),
about 2-3 spoon 2. Pneumonia 2. Auscultation finding given by what
- Not bluish when coughing 3. Pertussis in HF
- No noisy coughing (barking) 4. Viral croup -preventive: give before ill;
5. Asthma Overall monoclonal antibody
Associated sx 6. HF 2nd CHD 1. Dehydration status palivizumab, causative agent is
 - Fever RSV; usually give in premature
- Noisy breathing Extra ques Extra ques baby with Chronic Lung
- Rapid breathing - What common -tachycardia value Disease
- Poor feeding organism for -tachypnea value
bronchiolitis? = -when fontanelle close Each Ddx need to ask what
Ada risk factor; preterm baby, stay RSV -what age apex beat at 5th (ayat dr ajar cara tanya) and
NICU - Risk factor to ICS point to support/against/ extra
get RSV? = ques
Dr says ; masa kat NICU, patut chronic lung 1. Covid-19 = close contact
tanya lebih, ada tak masukkan tube disease
kat peparu? - 8 months baby 2. Pneumonia = any noisy
dah dapat breathing/ first episode
vaccine apa? or not/ sick contact/
- Extra : not necessarily
bacteria, can also be
viral. So high grade
fever not a good reason

3. Pertussis = prolong
cough; ada tak anak
batuk lama2 sampai jadi
muka merah.
- Extra ques; what
condition coughing until
eyes become red? =
subconjunctival
hemorrhage, also can
lead to seizure when
coughing too severe

4. Viral croup = ada suara

jadi kasar, harsh cough,
noisy breathing

5. Asthma = must ask

interval symptom (masa
 sihat, malam2 ada batuk
tak, ahli keluarga ada
asthma tak)

6. HF = FTT, poor feeding,

prolonged feeding,
interrupted feeding,
sweating semua tu la
tanya.
- Extra ques : what
mother prob during
preggy can lead to chd?
= GDM

Dr Yusma 8 y/o presenting with rapid Severe AEBA in 2 VIDEOS ▹ Categories of AEBA, what
breathing and wheezing since last undiagnosed asthma criterias do we look at and
▹ dr has no night and cough since last evening. secondary to cold 1. Paradoxical which category is this patient in.
language drinks. breathing, doctor
preference - Chest recessions suruh describe ▹ Interval symptoms, categorise
- Could only speak in words Dr nak summary. what we see. Ada this patient Intermittent VS
▹ dr inform waktu “Dia jawab sepatah sepatah chest recessions Persistent.
i ada 2 minutes je” DDX: as well, but video
left je so time - Orthopnea I flopped sikit this part wasn’t very clear ▹ How do we diagnose asthma.
sendiri2 - Pallor because pt was afebrile so maybe ada
- Exposure to cold air / and a bit hard to find intercostal and ▹ Management for AEBA.
▹ before start drinking cold water DDX because from the sternal recessions - Know what drugs to use,
sempat borak2 - HX of yearly nebuliser start it was very clear but not 100% sure. why and different routes
gelak2 lagi then treatment at clinic (mild this was asthma. of administration also
start je EOP AEBA) 2. Audio, but I tak what justifies which
boom serious lol - Eczema - Pneumonia dengar apa-apa. route to choose.
- Family HX of asthma - Afebrile Maybe wheezing?
pneumonia??? ▹ Before discharged, what steps
would we take in this pt.
(Patient education, medication
to prescribe, how to use)

Dr Yusma 6y/o boy
CC: fever for 5 days
Ass symptom: this morning he is
lethagy, having mild vomiting,mild
gum bleeding during brushing teeth
and generalized abdominal pain
Further ques: no recent hx URTI,
appetite has been reduced since
past 5 day and yesterday only
urinate once. There is headache,
and myalgia no
diarrhea,constipation,dysuria,sob,
low, and no rash
1st dx: Dengue fever *Dr will ask you to tell what
with warning sign you need in PE then she
will give the finding.
After PE: Severe
dengue with ● Ask all PE in
decompensated shock dengue
● After dpt finding
this patient is in
decompensated
shock. Dia ada
respi distress,
hypotension, and
sign shock yg lain
1.Phase dengue kene tahu
describe
2. Apa sign shock
3.apa blood finding. Why
hct high
4.anemia in dengue
5.apa fx rehydration
therapy in dengue
6. Apa finding pleural
effusion
-
dr is very responsive during
discussion so if you nampak dia
angguk tu you know you’re on
the right track.
insyaAllah okay je ganbatte
malaysia!
Dr Yusma is very nice but she
did mention her expectation to
give student pass the eop is
high.
If she is your examiner, expect
common disease but dont
expect common question. Her
question is more on clinical
practice
Mx and ix must relate to
pathophysiology dont just give
what on textbook.
Dr banyak tanya ix and mx.
If takleh jwb try dulu if lama sgt
then ckp je sorry taktau nnti dr
akan korek tp jgn risau nice je.
At the end Dr akan tanya how
do you think your performance?
Then she will tell you pass baru
Dr akan berborak and gelak
gelak.
Dr Diyana ❖ 3 years old boy, unvaccinated
❖ Fever for 5 days
❖ Cough for 4 days
- Chesty
- Post-tussive vomiting
- Sputum (X blood, yellowish
colour)
❖ SOB for 1 day
- X noisy breathing
❖ Runny nose
❖ Poor oral intake
❖ Reduced activity
❖ Rashes for 3 days
❖ Conjunctivitis
Provisional dx: Dr tunjuk gambar, kita
Measles with describe apa yang kita
bronchopneumonia nampak
1. Thermometer with
DDx 39.5
1. Bronchiolitis 2. Koplik spots
2. Asthma 3. Maculopapular
3. Kawasaki rash dekat face,
4. Dengue neck and chest
Kena bagi 1 provisonal Kena plot and interpret
and 2 ddx. Kena bagi growth chart.. Better ada
points to support points sendiri but if takde dr bagi
to against. growth chart through Ms
Teams
Investigation
- Dr suruh interpret the data,
and Dr bagi normal range
except for vital signs (RR,
HR, BP).
- Desc in medical terms eg:
Low plaletet =
thrombocytopenia
- CXR: Hyperinflated lungs,
opacity [Findings for
bronchopneumonia]
Management
Penicillin (first line)
Questions:
1. Pt dah dapat measles,
should he get vaccinated?
Yes, ambik MMR sebab
can prevent Mumps and
Rubella
2. Common organism causing
pneumonia in a 3 years old
child? Streptococcus
pneumoniae
Comment:
- Dr baik sebab dr guide
sampai kita boleh jawab
soalan dr.
- Dr ajar how to interpret
Chest X ray findings
- I tanya in Eng tapi dr
jawab in Malay. So
tanya dulu nak clerk in
Eng or Malay

Dr Diyana 1 year 4 months old boy with cough
and rapid breathing for 2 days
associated with fever and noisy
breathing
Dr ada demonstrate mcm mana
bunyi cough tu tapi for noisy
breathing dia tak ckp la on
inspiratory or expiratory so it can be
either wheezing or stridor
Biggest clue that lead me to the
provi was that the cough was
aggravated at night, batuk mcm org
tua (bak kata dr), hoarseness of
voice and low grade fever
- Patient can come with 2
diagnosis!! Prepare
jelah kalau dapat dr
diyana :-))))
Provi: Viral Croup Dr tunjuk 4 videos related Before start eop i tanya dr nak
to viral croup pastu dia clerk in malay ke eng. Dia kata
Ddx: suruh interpret. clerk in malay but masa clerking
1. Bronchiolitis tu dia guna both eng and malay
2. Pneumonia Honestly i sumpah blur gila pastu i pun clerk in mix
masa ni sampai dr kena language jugak. Dr tak kisah
After case presentation repeat video tu 4 kali XD sangat :P
and summary, dr akan
proceed utk discuss She was a slightly Dr is really particular about
provi and ddx. Make frustrated w me tp mood patient’s specific age. So make
sure to list down all the dia terus improve lepas i sure tanya date of birth.
points supporting and jawab betul
points against for both Masa case presentation mesti
provi and ddx. Dr guna medical jargon!! Dr cakap
mintak 2 ddx je i shouldnt just repeat what the
mother said masa presentation
(ie chest infection= pneumonia,
breathing support=ventilator)
Dr suruh plot growth chart so
jgn lupa sediakan nanti. I takde
growth chart pstu dia bagi i thru
microsoft teams (shes so nice
TT tapi sambil dia hantar tu dia
bebel la kata as students
sepatutnya kita dah prepare all
this and tak boleh expect dr utk
sediakan everything XD)
For investigation just mostly
interpret the findings and result.

Dr Mazidah A 6 y/o comes with seizure
Prof Shafina 6 years 11 months old boy
presented with facial swelling since
-tak kisah clerk in 3 days ago and followed by bilateral
malay or english leg swelling and abdominal
:D swelling.
- jgn tiba2 Ni hao ma - Leg & abdomen start at day
sudah jkjk 2 - Congestive heart
- First noticed - facial swelling
in the morning
- Constant and did not resolve
at the end of the day.
- No bleeding, no itchiness,
no pain, only discomfort
- Frothy urine
- Loss appetite
Meningitis Need to know how to
interpret finding from cns
Sources of infection from
respi
Nephrotic syndrome Prof tunjuk gambar budak
kecik (siap diapers kayh
DDX tak padan umur 6 tahun
- Nephritic syndrome lol)
- Anaphylactic - What can you see?
reaction - Facial puffiness,
distended
failure abdomen with a flat
umbilical(?)
(ikutlah yg dlm fikiran,
asalkan make sense
and ada point to supprt
& against)
I takde discuss management.
Maybe sbb tak cukup masa kot
Note:
Dr baik tapi intimidating sikit.
She guided me a lot masa i tak
tahu jawapan so dont worry too
much! All the best ^^
Ix
Mx
Differences meningitis n
encephalitis
Pathophysiology
Dr baik, tpi strict dgn masa
Dr suruh cepat2
Masa hx dr korek betul2
- The most common Nephrotic
syndrome → Minimal Change
Dz
- The pathophysiology
- What can cause nephritic
syndrome? → Post-StrepGN
- The investigations to
differentiate between
Nephrotic & nephritic
- The managementtt - I forgot
to mention the mainstay
treatment which is STEROID!
- Prof baik sangat sebab dia
bagi clue utk aku jawab huhu.
- What is the dose for steroids?
- How about treatment for
 Prof gave 1 mins before presenting
the case.
Acute Bronchiolitis
Dr.Hafizah A 9 y/o girl with a chief complaint of Dengue fever with a Expected findings in
abdominal pain and vomiting warning sign abdominal examination
Dr will show gambar rash
and suruh kite interpret the
findings and also negative
findings
Dr. Hafizah 8 months old baby girl presented Thalassemia with heart - video of child in
with fever for 1 week and pallor for failure respiratory distress
2 weeks. - dr asked to
- mother had history of blood describe all
transfusion and took iron findings shown in
supplement due to low video
hemoglobin antenatally. - then dr asked what
expected findings
in your examination
- examination mostly
signs of anaemia
- the child also have
vital signs and x
ray finding
suggestive of heart
failure
nephritic syndrome? - aku
jawab penicillin huhu still prof terima
-ix
-mx
-definition and type of shock
Side note :
Before hx taking dr will show a
slide about the chief complaint
of case. Then dr bagi 2 mins
prepare before hx taking :)
Dr baik je jangan risau.. 😉
- dr asked the
investigation to be done
to confirm thalassemia
and what to expect in
the results
- pathogenesis of
thalassemia
- complication of
thalassemia
- how thalassemia causes
heart failure
- management of heart
failure
- comment: dr relax and
baik je and dr bagi
feedback after that, what
to improve and brush up
Dr Hafizah 4 y/o boy presented with eye & Relapse of Nephrotic Gambar budak with Pathophysiology
facial puffiness with known case Syndrome periorbital edema & facial
nephrotic syndrome puffiness & abdominal Define relapse & steroid
DDX distension dependent
CLD Remission semua
CHF Then explain je about PE
Kidney i.e. general exam & abdo Relevant investigations
full. & i did mention about
steroid toxicity & stigmata The criteria of nephrotic
of CLD syndrome