Asrar - Ped - Clinical - DMP3

:
: : : :

.
.
MP3
history taking techniques tricks
) ( how to
deal with such cases .
) (
.
.
OSCE STATION

INNOVATION : FACEBOOK
facebook.com/groups/ INNOVATION.AZHARMED
Abo El Asrar Clinical Pediatrics

:

history taking History antenatal Natal neonatal period

) (
activites
75%
activity

activity

) (

research

research
research data show

end round exam

stations
Page | 2
:

stations
stations examiner

observe

history
examination
x-ray
stations clinical sense

stations 2stations history

2stations examination
2 stations X-ray
History

X-ray

history

stop watch

Page | 3
:

within three minutes stations
examination

.... comment
examination
Paper

examiner finding
data

stations

stations examiner Switched off

observer
examiner
examination
examination examiner

....

examiner

....

diagnosis
history

examiner
Page | 4
:

history personal history

personal history
complaint
history of present illness
disease

history of present illness !!!!!
Past history

past history antenatal history Intra utrine
full sheet
antenatal history

antenatal history :
fever and rash
Page | 5
:

Infection STORCH infection
S for syphilis
T for toxoplasma
R for rubella
C for cytomegalo virus
H for herpes
epstein-barr virus others HIV and Hepatitis

teratogenesis
teratogenesis
drugs Irradiation
teratogenesis malformation baby

chronic disease
Maternal disease

antenatal history
antenatal history

antenatal history History
fever and rash .1

.2 teratogenesis
.3 maternal diseases
??

..
facial expression
X-ray

facial expression
Page | 6
:

) (
) (
: ) (
) ( ) ........ (

...

history

:

...
) (

)
(

stations

Page | 7
:
antenatal

)
(

: )
(

:

:
: ...

rash
:
.... .... STORCH infection

..... STORCH STORCH
:
: sore throat
sore throat
: ..
fever
:

fever fever
Page | 8
:

:

: ....
:

:

...
first trimester second
rd
first trimester teratogenesis

last trimester Post natal defect
... malformation
... bleeding tendency
Malformation
teratogenesis 3

...

:

Page | 9
:

: ... ...

irridation

...
...
:

:
no history of maternal disease during this stage

antenatal history

...

....
:
:
:

:

: rash
fever
:
P a g e | 10
:

:
:
:
:

:
) (

:
:
: ...

:
Maternal disease
there is no history of fever and rash , there is history of exposure to teratogenesis

..... History of maternal disease

....

antenatal history
antenatal history

P a g e | 11
:

How to deal

) :::: ,
::: (
once ...
natal history

Natal history
site of delivery

) ( ..

Infection
Infection neonatal sepsis

vaginal delivery cesarean section

... vaginal
duration
Prolonged labor asphyxia cerebral anoxia

: .... method
: history of birth truma

: Onset of first cry ...
central hypoxia Neonatology

cyanosis
P a g e | 12
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cesarean section Indication of cesarean section cesarean section

....
sever hypertension ... toxemia of pregnancy
cesarean section vaginal resuscitation

ventilator

full term Preterm

) (

:
:
:

:
:
....

Infection premature rupture of membrane

sac aminonitic fluid
sac complelelty sterile
sac maximum 12
sac 18 18
Infection vagina a neuritis neonatal sepsis

P a g e | 13
:

:

: ...

12
Premature rupture of the membrane

) (

!!!!!

18 Infection premature rupture of the membrane

Once termination

Infection

:

12
, 12
utrine contraction separation of the placenta
Hypoxia
12
: ....

P a g e | 14
:

(

: ...
) (

:

: 1,800 -1,900 2.5
birth weight
full term
pre term

Indication of cesarean section

full term
pre term
cesarean section !!!!
) (
delivered at hospital by doctor , there is no history of infection or
P a g e | 15
:

premature rupture of membrane , vaginal delivery and duration
No tools used vaginal delivery

No history of birth truma
Onset of first cry
cyanosis Resuscitation birth weight
full term preterm
comment
normal birth weight 3-3.5

neonatal history
) (

) (
) )
( ....
.... ) ....
( (
neonatal history
neonatal history
neonatal 28
Neonatal period
neonatal period

points Neonatal history
... History of jaundice neonatal jaundice

convulsion Neonatology
bleeding
respiratory distress
P a g e | 16
:
admission to Neonatal intensive care unit NICU
History of jaundice or convulsion bleeding
respiratory distress admission to NICU

:
:
: ...
)
(

... ...

:
:
:
physiological jaundice
: ... ...
: ... photo therapy

NICU

: Rh
Rh incompatibility

:
:
P a g e | 17
:

:
:
:
epilepsy
convulsion
:

convulsion
: :

) ( Lol

:
:

Hemophilia
bleeding bleeding

: ... duration

neonatal history
history of physiological jaundice

No history of convulsion, no history of bleeding tendency , no history of respiratory distress
P a g e | 18
:

history of admission to NICU

NICU

NICU
cerebral palsy
sequelae
History of jaundice and admitted to NICU and received phototherapy
physiological jaundice
physiological
NICU NICU

direct hyperbilirubinemia
golden yellow in direct

.... Obstructive
indirect
dietic history

dietic history

:
:
:
P a g e | 19
:

:

one side or two sides

On need On need

On need

:
:
:

:
....

minimum

satisfied or not
:
:
P a g e | 20
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:
:
:
:
:
:

Intake

polyurea diarrhea

sever dehydration

Obese

diarrhea

:
:
:

:

:
:

oliguria under feeding constipation under feeding

poly uria diarrhea Over feeding

P a g e | 21
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:

:
:
:
Under
:

:
:
:
: ) (

diluation
:

P a g e | 22
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Over diluation
:
concentrated formeula

100

:

:

sterilization

) (
sterilization
:

contamination

age

) ( 180
8 100 + 10 180

P a g e | 23
:

) (

powder milk

F 60
60

F 30

30

8 100 + 10 180
120
Mursmus

concentration

: 120
120
) (

P a g e | 24
:

120
diluted
diluted
180

:
frequency

:
:
:

Under feeding
complementary P
:

supplementary
supplementary

artificial milk
P a g e | 25
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weaning
: ........
weaning
: .........

Developmental Milestones
Social & Language

vocalization vocal cords

Bubbling
) ... .....
(
Double Bubbling

... :

....

...
...
P a g e | 26
:

...

) (

electronics

electronics
) ( :
: ....

...
...
..
: KG1

....

..
!!!!!
P a g e | 27
:

:

mental growth
)
(
5
automatic bladder
automatic bladder evacuation of the bladder rectum

conditioned reflex
conditioned reflex

!! !! ) (
buttocks
control
control Order bladder

ascending fibers maturation
P a g e | 28
:

aware bladder full suppression
bladder

Oriented control
control

:

) (

developmental history

P a g e | 29
:
neck support
:

:

supported
:

:

:
.... !!!!!
:

) (

) (

P a g e | 30
:

mental
social

Mental
sphincteric control
stool
developmental history
P a g e | 31
:

examination
staff cranial
examination

:
Abdominal Examination
abdomen
station Inspection of the abdomen
Inspection of the abdomen
contour of the abdomen
bulge scaphoid abdomen flat abdomen
sternal angle obtuse acute
epigastrium pulsation Pulsation
umblicus umblicus
shifted side down ward mid way
flat or bulge
discharge umblicus
umbilical nodule

skin
skin
o dilated tortuous vein
o scars
o abnormal pigmentation
o bleeding under the skin Purpura
abnormal rash o

divercation of recti
Inguinal region Umblicus
Hernia
genitalia
superficial palpation
P a g e | 32
:

superficial palpation tenderness regedity Mass
mass intra extra abdominal
hernia Inspection palpation
umblicus
palpation Liver spleen kidney

renal splenomegaly hepatomegaly
percussion of the abdomen
) (

examination skull
rickets
P a g e | 33
:
General Examination
EXAMINATION OF THE HEAD
SHAPE

antero posterior brachycephaly

plagiocephaly
abnormal shape abnormal shape
examination of the head fontanelle

fontanelle
anterior fontanelle
fontanelle
suture
sutures
sutures skull
skull
.1 suture Metopic suture
Metopic suture anterior fontanelle
.2
.3
.4
.5
coronal suture
sagittal suture
lambdoid suture
frontal bone , parietal bone , occipital bone
anterior fontanelle and posterior fontanelle
sutures
Hydrocephalus suture sutures
P a g e | 34
:
craniotabes
rickets
hydrocephalus sutures craniotabes
craniotabes bone of the skull

craniotabes
fontanelle torch transillumination test
) () / (
Macewen's sign
Macewen's sign sign percussion bone hydrocephalus sutures
fontanelle resonant
percussion
hydrocephalus
hydrocepalus dilated untortous scalp veins
scalp dilated veins scalp

...
...
ear
nose
mouth

No No
abnormality
.1 eye brow
outer third of the eye borw Lost
P a g e | 35
:

outer third of the eye brow
Hypo thyrodism
.2 eye lashes
chronic toxemia T.B.
very long eye lashes
general
.3 puffiness
renal edema massive edema
renal edema
bilateral puffiness
=< unilateral puffiness
unilateral puffiness
.4 sunken eye
sunken eye dehydration
.5 sclera

Jaundice
Jaundice
sclera
congenital glaucoma
osteogenesis imperfecta X-ray
osteogenesis imperfecta blue sclera
sub conjunctival hemorrhage
hemorrhage
bleeding tendency
.6 Pupil cataract
galactosemia
rickets
congenital rubella cataract
Pupil Light pupillary reaction
direct indirect
P a g e | 36
:

.7

.... nystagmus
squint
.8 upper part of the cornea covered by upper eyelid

lower part of the cornea covered by the lower eye lid sunset appearance

Negative

... nystagmus
divergent squint
divergent squint and no abnormal finding in the eye

ear

.1 position of the ear

Normal
lateral canthus of the eye Occiput
tragus
tragus tragus tragus
normal position of the ear
Occiput tragus
Low set ear

.2 shape of the ear

malformed
P a g e | 37
:

.3 size ear

.4 discharge
ear

.5

nose
.1 nasal obstruction
.2 snoring

... unilateral or bilateral
mentally awared
Mentally not awared compression
compression
Unilateral or bilateral
.3 nasal discharge
.4 nasal bridge
depressed nasal bridge prominent nasal bridge Normal
Mouth
Mouth
.1 pallor Pallor
cyanosis cyanosis
.2 anomaly hare lip
.3 maceration
Maceration angle lip
lip
P a g e | 38
:

.4 Mouth odor
Mouth odor aceton odor DKA

.5

anomaly
.6 tongue throat

monillia
Oral thrush white coated tongue

scarlet fever white strawberry tongue
thorat
hair
comment
.1 black
.2 texture coarse hair
.3 integrity
) ( Normal integrity
kwashiorkor easy pickable hair
.4 anterior hair line
posterior hair line
anterior hair line normal
posterior hair line Normal
abnormal
cretinism anterior hair line

turner
low posterior hair line

hair black in color , coarse hair , normal intergrity , normal anterior and posterior
hair line
P a g e | 39
:
examine head

examination skull
.1

forehead eye brow anterior hair line

Occiput
59.5
skull circumference 59.5

.2 shape of the skull

Large skull no specific shape
.3 fontanelle fontanelle
closed depression anterior fontanelle

.4 sutures
depression
closure

Metopic suture depression

sagittal suture
coronal suture depression
sutures closed depression
.5 craniotabes
craniotabes
P a g e | 40
:
craniotabes :
.6 Hair
full comment on skull

:
trans illumination test
... fontanelle closed

Macewen's sign
percussion Index finger bone fontanelle
fontanelle
) (
divergent squint
abnormality
Nose snoring
bulbar affection
obstruction
One side
) ( I think
bulbar
snoring
bulbar
nasal discharge
nasal septum
ears
ear
lateral angle of the eye occiput
ear
low set ear
Low set ear
...
ear low set ear
P a g e | 41
:

ear discharge site
) (
Mouth
pallor
pallor cyanosis
dryness Lips
torch
abnormal

......
: shunt
bypass CSF lateral ventricle Peritoneum
shunt scalp valves
shunt ventricluo peritoneum shunt hydro cephalus
Occiput most prominent part of the bone
15 chronic hemolytic anemia

head and examine it

examine face of the chronic hemolytic anemia

skull circumferences
) : (

skull circumference
15
fontanelle sutures

P a g e | 42
:

comment

jaundice
lower fornix jaundice
jaundice chronic hemolytic anemia
Liver affection biliary system affection
just Lower fornix compensation Liver
tinge of jaundice
Puffiness
no abnormal finding detected
Nose
depressed nasal bridge
nasal discharge snoring
bone zygomatic bone hyper active bone marrow Prominent
upper jaw
Hyper active bone marrow
upper jaw lower jaw
upper jaw prominent Lower jaw

Lips
pallor
tongue

hemosidrosis
iron deposit skin
muddy coloration
Muddy collection pallor jaundice iron deposit
iron deposit
Iron deposit
inspection examination of the abdomen spleen
Hypersplenism spleen
P a g e | 43
:

scar splenoectomy
Liver abdominal examinatioin
examination of the head
skin examination
skin examination

LIMBS EXAMINATION
rickets
finding rickets rickets
rickets
bone cortex medulla

cortex and medulla
Medulla hematology
rickets cortex
cortex

protein part osteoid tissue

minerals parts Minerals parts calcium
protien part bone osteoporosis
mineral part bone osteomalacia rickets
rickets
minerals protein part
Mineral part
rickets defective on mineralization
defect bone mineralization
Mineral part
P a g e | 44
:

rickets Mineral part

simple way rickets
) (
bone
bone bone
) KuRr)uJ)|)KK))m)a)J

bone
) csJ))K|cKt)UP)UKXK[)a
bone

bone bone
bone

rickets bone deformity

bone deformities

rickets

) ( bowing bowing
trunk
bowing

gross motor development

....

genu valgum deformity

ankle ankle knee
2 knees

P a g e | 45
:
knock knee genu valgum deformity

genu varum deformity

2 knees
genu varum deformity

curvature tibia
tibia curve
curvature tibia
anterior curvature lateral
ribs
ribs bone
ribs diaphragm
all the time Lower part of the ribs
ribs .... groove sulcus
horizontal sulcus Harrison's sulcus

negative pressure of the thorax ribs
longitudinal sulcus

Mineral part of the bone
Integrity of the bone

deformity

bone
suppression osteoid tissue deposit

excess protein deposit

P a g e | 46
:

Over protein
protien soft tissue excess deposit
Over deposition of protein
flat bone of the skull
frontal bossing pareital bossing
frontal bossing pareital bossing
Osteoid tissue deposit

box shaped skull

cartilage
cartilage
cartilage
Over growth of the cartilage cartilage proliferation
bone Over growth of the cartilage
Over growth of the cartilage
broadening
broadening ... cartilage
cupping X-ray
broadening cartilage proliferation cupping of the bone
pressue effect

broadening

tibia fibula
emberyology tibia medial malleolus
fibula lateral malleolus
malleoli 2 separate bones
cartilage
cartilage
proliferation of the cartilage tibia Medial malleolus
lateral malleolus fibula
broadening
P a g e | 47
:

groove groove
groove Marfan Marfan sign

Marfan sign
two points of growth in cartilage malleolus Lower shaft of the tibia

Lower shaft of the fibula

rickets

para thormone hormone

parathormone hormone compensation para thyroid hormone
para thyroid hormone serum calcium

rickets
serum phosphate
source of energy adenosine triphosphate

ATP

ATP
muscles
ATP muscle power
generalized muscle weakness and hypotonia
generalized muscle weakness and hypotonia delayed motor development

growth motor development

Hypotonia

P a g e | 48
:

hernia ptosis Organs

kyphosis
kyphosis
correctable kyphosis
rickets

Marfan sign
medial and lateral malleolus

two knee genu valgum deformity
frontal bossing Paraietal bossing
fontanelle fontanelle still opened

delayed closure of the fontanelle

first molar
first molar
delayed dentation

Lateral chest wall rachitic rosary
retraction
Harrison's sulcus
kyphosis
kyphosis
Umblical hernia Pot belly abdomen

examine the extremities

Positive findings
extermities
Upper limb broadening
trunk bone deformity
lower limb Marfan sign
Genu valgum deformity
P a g e | 49
:

clubbing
clubbing
color pallor jaundice cyanosis
pallor jaundice cyanosis
edema dorsum of the hand and the dorsum of the foot

edema
edema level Unilateral bilateral pitting non pitting
abnormal movement chorea
abnormal movement tremors

temors
Purpura Ulcers scars

examine the extremities

P a g e | 50
:

neck examination
lymph node examination duchenne myopathy

neurological examination

frame

NECK EXAMINATION
examine the neck
examination of the neck
goals examination of the neck
.1 shape of the neck

.2
webbing
webbing fold of the skin
webbing syndrome
.3
neck pulsation
Pulsation neck
.4
swelling
swelling Neck
swelling
swelling thyroid swelling butterfly shaped
thyroglossal cyst hyoid bone cyst in the middle line
lymph node

examination of the neck
P a g e | 51
:

shape of the neck

neck Normal shape
Down
Down short neck
examine the neck Down shape of the neck normal

webbing
no webbing
by inspection
pulsation swellings

pulsation
Pulsation Pulsation
arterial pulsation venous pulsation
Pulsation ) ( 45
venous pulsation Normal level of the clavicle
45
Neck
pulsation
) (
neck sterno mastoid muscle

pulsation
above the sterno mastoid muscle
pulsation arterial venous
arterial pulsation venous pulsation neck

arterial pulsation medial to sternomastoid
venous pulsation lateral to sternomastoid

arterial pulsation
venous wave

P a g e | 52
:

root of the neck
Pulsation venous
Pulsation arterial pulsation
neck
pulsation
root of the neck compression

pulsation venous
pulsation arterial pulsation
swelling
swelling
thyroid
thyroglossal cyst
lymph node

neutral position

Inspection neck

swelling thyroid swelling thyroid swelling

thyroid swelling

swelling protrosion of the tongue
swelling thyroglossal cyst

thyroglossal cyst
thyroid swelling
surgical
lymph node
Lymph node
Lymph node of the neck
P a g e | 53
:

upper part of the sternum percussion

Index finger
bone direct
retro sterna goiter

....

retro sterna goiter Upper part of the sternum
thyroid swelling
bruit thyroid
aortic stenosis along the carotid artery root of the neck
systolic murmur propagated to the neck
root of the neck propagation of the arotic stenosis
comment
venous pulsation arterial pulsation webbing Normal shape of the neck
thyroglossal cyst thyroid swelling

Lymph node swelling
surface site which lymph node
site Lymph node comment
preauricular jugulo digastrics submandibular submental which group site

post auricular mastoid process

occipital goup of lymph node occiput
Upper deep cervical sterno mastoid muscle
Lower deep cervical
clavicle supra claviclar lymph node

horizontal group
post auricular preauricular jugulo digastric submandibular submental .... horizontal group
occipital
P a g e | 54
:
longitudinal group
upper deep cervical Lower deep cervical
supra claviclar lymph node
Lymph node site group
size
lymph node

lymph nodes smooth surface

consistency
Lymph node firm in consistency
Hard lymph node soft lymph node
tenderness
not tenderness
) tender lymph node (
relation
relation
skin
Lymph node
Lymph node
skin is not attached to the lymph node
lymph node is not attached to the overlying skin
underlying muscle
) ( sternomastoid muscle
Lymph node horizontal and vertical
contraction Muscle

not attached to the underlying muscle
P a g e | 55
:

muscle
relation to the underlying muscle and the overlying skin

muscle
Lymph node freely mobile freely mobile not attached to the over
lying skin or underlying muscle
) (
Lymph node draining area

jugulo digastric lymph node

examination axillary lymph node

examination epitrochlear lymph node
examination inguinal lymph node
lymph node examination
lymph node of the neck Neck examination

examine the lymph node neck epitrochlear lymph node inguinal axillary
lymph node
lymph node

:

) (

) (

Neck
shape of the neck Normal long short neck
P a g e | 56
:

webbing

swelling ... thyroid swelling

.... swelling
thyroglossal cyst thyroid swelling

Percussion manubrium sterni

Middle finger

sterno mastoid muscle

) ( pulsation
pulsation
venous pulsation
level venous pulsation

Lymph node
Lymph node

Lymph node

:

) tone
......... (

submental submandibular tip of the fingers against bone
Mandibule
P a g e | 57
:

jugulo digastric
preauricular Post auricular occipital
medial part of sterno mastoid rolling

Upper deep cervical

Lower deep cervical
supra clavicular clavicle

rolling
Upper deep cervical contraction muscle

lymph node

submandibular
jugulo digastric
preauricular
Post auricular
occipital
Upper deep cervical upper deep cervical
lower deep cervical lower deep cervical
supra clavicular

jugulo digastric lymph node

freely mobile
not tender
firm in consistency

auscultation
neck murmur propagated to the neck
P a g e | 58
:

Inspection, palpation, percussion and auscultation

examine the axillary lymph node

axillary lymph node

axillary lymph node

abduction
Left axilla

exposure axilla

anterior fold of the axilla rubbing lymph node
chest wall Medial group

apical group
palpation against upper end of the humerus lateral group
groups
anterior group medial group apical group
lateral group

anterior group medial group apical group

lateral group
Posterior group
Posterior group posterior fold of the axilla

epitrochlear
P a g e | 59
:

Posterior aspect of the arm

thumb
epitrochlear thumb rolling
elbow semi flexed
rolling thumb

Inguinal
exposure

Inguinal lymph node semi flexion
Inguinal ligament
inguinal ligament

examination of the lymph node

examination neck examination Lymph node

Skin examination
Purpura
.... skin examination
.1 color of the skin
Pallor jaundice cyanosis

.2 skin texture
goose skin
P a g e | 60
:

vitamin A deficiency

texture Normal texture

.3skin elasticity
skin elasticity
fold skin Normal skin elasticity

dehydrated
.4 skin rash

raised above the level of the skin
raised ) macule primary

lesions secondary lesions (

) papule Papule palpable p p Papule (
macule Not raised above the surface of the skin .... discoloration
Papule
papule
serous fluid
vesicle
vesicle secondary bacterial infection Pus Pustule
Pustule vesicle

crust
crust deep injury Inflammatory scar
rash
P a g e | 61
:

macula popular scarlet fever macule papule
roseloa infuntum
maculo popular rash
vesicular rash

rash Infectious
chicken pox
.5 abnormal pigmentation
abnormal pigmentation hyper pigmented
hypo pigmented

.6 scar
inflammatory scar scar
scar
scar

.7 bleeding under skin

petechiae ecchymosis purpura
petechiae Insect bite
bleech of the skin Insect bite
petechiae Purpura

.8 edema
edema
edema
dorsum of the hand Pitting edema
dorsum of the foot Pitting edema
20-30
chin of the tibia
chin of the tibia
edema
P a g e | 62
:

thigh upper limb ) pinching
edema skin edema (
skin
edema
abdominal wall cone
edema abdominal wall

Puffiness
skin examination
positive data
color of the skin pallor Jaundice cyanosis
Normal color
normal texture, normal skin elasticity, no rash, no abnormal pigmentation , no scars

fallot tetralogy
squatting position
: fallot
: ""
... cyanosis
fallot cyanosis

Infundibulum Hypertrophy cyanosis

squatting position
P a g e | 63
:

central cyanosis
) (
heart
sub valvular stenosis
sub valvular pulmonary stenosis thrill
Murmur
ejection systolic
ejection systolic
murmur
murmur systole
heart sounds Murmur

murmur of Fallot of maximum intensity Pulmonary area

Pulmonary area
2nd left inter costal space
left para sterna area
propagated
murmur
NEUROLOGICAL EXAMINATION

duchenne myopathy

X-linked
X-linked common
male female
common in male
duchenne myopathy
ATP energy supply of the muscle
P a g e | 64
:

muscle ATP glucose mitochondrium

..... glycolysis ATP
ATP muscle Metabolism

Mitochondrium
endoplasmic reticulum
endoplasmic reticulum generator Muscle
generator
mitochondrium ATP
ATP muscle
creatine creatinine
creatine creatinine
ATP
...... creatine phosphokinase
CPK creatine phosphokinase

creatine phosphokinase endoplasmic reticulum creatine creatinine

membrane endoplasmic reticulum
membrane carrier protein
dystrophin
duchenne dystrophin
dystrophin creatine phosphokinase

creatine creatinine
ATP

mitochondrium
mitochondrium endoplasmic reticulum
P a g e | 65
:

muscle ATP ATP

degeneration muscle fibers

:

proximal muscles

proximal muscle
18 20

cardiomyopathy heart failure

renal affection renal failure
duchenne
duchenne
degeneration Muscle fibers
deposit of fibrofatty tissue functionally

impaired
pseudo hypertrophy

muscle disease
Upper motor neuron lesion lower motor neuron lesion
Lower motor neuron lesion
Muscle weakness
hypo tonia
Hypo reflexia

pseudo hypertrophy
P a g e | 66
:

sensation Intact

Motor system examination

examination of the motor system

inspection
percussion

) (motor and reflexes Motor system

reflexes motor system

station station examine motor system in both
lower limbs
examine the motor system of the right side of the body
examine the motor system
Motor system Motor reflexs
reflexes Motor system

examine the motor system Motor system
reflexes Motor system reflexes

reflexes motor system Motor system
Inspection ... Palpation, percussion , power, coordination
.... motor system

reflexes
Motor system reflexes
motor system inspection, palpation, percussion, power,
P a g e | 67
:

coordination
Inspection muscle status spastic hemi plegia flexed right upper limb
and hyper extended right lower limb, no wasting, no trophic changes or deformity
comment Inspection
palpation clasp knife spasticity on the right side with normo tonia on the left side
percussion No fasciculation, no myotonia
power
complete paralysis of the right side of the body with normal power on the left side of the body
Motor system
coordination
Motor system
coordination

............ coordination
hemiplegia ........ coordination on the left side is intact and on the right
side not examined
examine!!!!!
examination paralysed
reflexes
Patient by inspection, by palpation, by
percussion, power
coordination
coordination .............
reflexes superficial and deep

reflexes
A B
A superficial deep reflexes B
P a g e | 68
:

superficial reflexes corneal cranial nerves
abdominal and planter
cremastric

superficial reflexes
positive babiniski on right side
negative on left side ) negative ( planter response on the left side
abdominal reflex is lost on the right side
superficial reflexes
deep reflexes
hyper reflexia on the right side
hyper reflexia Upper limb Lower limb
reflexes Upper limb triceps , brachio radialis and biceps
centres
biceps centre brachio radialis centre triceps centre
Lower limb knee ankle centres

) Normo reflexia (
Pathological reflexes and clonus on the right side

finger flexion supra spinatus Patellar adductor
centres

reflexes

muscle state atrophy pseudo hypertrophy
P a g e | 69
:

calf muscles pseudo hypertrophy

function

muscle tone
examination muscle tone
Upper and lower limbs

lower limb
) ( D:
Upper limb shaking wrist
tone
tone upper limb

shaking hands
extension flexion forearm elbow joint
shoulder flexion extension

circumduction shoulder tone shoulder

wrist shoulder
gower method
gower sign
lower limb tone

shaking side to side

flexion extension knee
circumduction hip joint
tone

hypo tonia
examination
generalized hypo tonia ... muslce tone bilateral
Proximal more than distal
P a g e | 70
:
Muscle tone muscle power

)
against resistence (

wrist

adductor
trunk muscle
gower sign

winging of the scapula

serratus anterior Prominent scapula

sensations
superficial deep
pathological reflexes embryological
superficial refelexes
abdominal reflex
planter Upper motor lower motor
deep tendon reflexes
upper limb
triceps , brachio radialis and biceps
triceps elbow
120 reflex brachio radialis and biceps
tendon tricepis and brachio radialis
index of your finger bicepis
brachio radialis reflex supination

P a g e | 71
:

wrist
)
(
Lower limb ankle Knee reflex

reflex
ankle eversion
P a g e | 72
:

Asrar - Ped - Clinical - DMP3

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Abo El Asrar Clinical Pediatrics

history taking History antenatal Natal neonatal period

research data show

end round exam

Abo El Asrar Clinical Pediatrics

stations clinical sense

stations 2stations history

Abo El Asrar Clinical Pediatrics

stations examiner Switched off

Abo El Asrar Clinical Pediatrics

history personal history

Abo El Asrar Clinical Pediatrics

fever and rash .1

Abo El Asrar Clinical Pediatrics

Abo El Asrar Clinical Pediatrics

.... .... STORCH infection

Abo El Asrar Clinical Pediatrics

first trimester teratogenesis

Abo El Asrar Clinical Pediatrics

no history of maternal disease during this stage

Abo El Asrar Clinical Pediatrics

there is no history of fever and rash , there is history of exposure to teratogenesis

Abo El Asrar Clinical Pediatrics

Prolonged labor asphyxia cerebral anoxia

central hypoxia Neonatology

Abo El Asrar Clinical Pediatrics

cesarean section vaginal resuscitation

full term Preterm

Infection premature rupture of membrane

Abo El Asrar Clinical Pediatrics

Premature rupture of the membrane

18 Infection premature rupture of the membrane

Abo El Asrar Clinical Pediatrics

Indication of cesarean section

delivered at hospital by doctor , there is no history of infection or

Abo El Asrar Clinical Pediatrics

No tools used vaginal delivery

... History of jaundice neonatal jaundice

Abo El Asrar Clinical Pediatrics

admission to Neonatal intensive care unit NICU

History of jaundice or convulsion bleeding

respiratory distress admission to NICU

: ... photo therapy

Abo El Asrar Clinical Pediatrics

Abo El Asrar Clinical Pediatrics

Abo El Asrar Clinical Pediatrics

one side or two sides

Abo El Asrar Clinical Pediatrics

oliguria under feeding constipation under feeding

Abo El Asrar Clinical Pediatrics

Abo El Asrar Clinical Pediatrics

Abo El Asrar Clinical Pediatrics

Abo El Asrar Clinical Pediatrics

Abo El Asrar Clinical Pediatrics

vocalization vocal cords

Abo El Asrar Clinical Pediatrics

Abo El Asrar Clinical Pediatrics

ascending fibers maturation

Abo El Asrar Clinical Pediatrics

Abo El Asrar Clinical Pediatrics

Abo El Asrar Clinical Pediatrics

Abo El Asrar Clinical Pediatrics