1
Photos discussion
■ Mongolian spots
- What is the diagnosis of this condition?
Mongolian spot in lumbosacral area
Bluish discoloration of an area of skin, it is of no significance.
- What is the differential diagnosis of this condition?
1- Bruises (due to trauma or child abuse)
2- Ecchymoses(due to bleeding tendency)
- What is the treatment?
No thing as it fades gradually as the infant grows older,
so what is needed is reassurance
■ Neonatal gynecomastia
- What is the diagnosis of this condition?
Neonatal gynecomastia : breast enlargement in both sexes during the first weeks of
life due to transplacental passage of maternal hormones
- What is the treatment
No thing except reassurance and -It should not be squeezed.
■ Normal newborn : vernix caseosa
- What is the diagnosis of this condition? Vernix caseosa
- What is the nature of this layer
Whitish greasy coat
- What is the etiology?
It is produced in utero by epithelial cell breakdown
- What is the function of this layer?
.It protects the skin from the amniotic fluids.
■ Milia
- What is the diagnosis of this condition? Milia
- What is the nature of this condition?
It is epidermal cysts (white or yellow in color) found on
the nose, chin and forehead
- What is the prognosis?
It is benign lesion , it exfoliate and disappear spontaneously
within the first weeks , no treatment is necessary
■ Moro reflex
- It is the most common neonatal primitive reflex
- How can you elicit ?
. Dropping the head with the examiner’s hand
supporting the body.
. Making a loud noise near the infant’s ear.
. Sudden withdrawal of the blankets from
underneath the infant.
- What are the significance of this reflex
- Normal response à normal CNS
- Absent à serious CNS affection
. Intracranial birth injury
. Cerebral depression by drugs
. Asphyxia or prematurity
- Asymmetrical response
. Fracture clavicle . Erb’s palsy
- Persistence of the reflex beyond 6 months
. Cerebral palsy
■ Cephalhematoma
- What is the diagnosis of this condition?
1- Cephalhematoma
2- Rt parietal cephalhematoma and vacum extraction site
It is a subperiosteal hemorrhage, limited by suture lines,
due to traumatic delivery or ventous
- What are the expected clinical manifestations:
Anemia, jaundice
- What is the treatment
Conservative, and aspiration is contraindicated
■ Erb's palsy
- What is the diagnosis of this condition?
Flaccid paralysis of the left upper limb.
It is held in adduction, internal rotation and pronation
(policeman tip). Moro reflex is absent on the affected side, but
grasp reflex is intact.
- What is the etiology of this condition?
It results from injury of 5th and 6th cervical nerve usually due
to traumatic delivery.
- What is the treatment of this condition?
Physiotherapy from second week.
■ Facial palsy
- What is the diagnosis of this condition?
1 - Left facial palsy
2 - Right facial palsy
Weakness of facial muscles, drooping of mouth and inability to close the eye on the affected side.
- What is the etiology of this condition?
Compression of facial nerve by pressure from forceps blades but may occur after normal delivery
- What is the treatment? Physiotherapy
- What is the prognosis? Good, most cases resolve within a few weeks after birth
■ Umbilical granuloma
- What is wrong with this umbilicus?
Umbilical granuloma presents as a persistent serosangunious discharge and a fleshy protuberance from the base.
- - What is the treatment of this condition?
Local application of silver nitrate or rarely by surgical excision or ligation.
■ Infant of diabetic mother
- What is the diagnosis of this condition?
Infant of diabetic mother: large obese infants
due to poor control of maternal diabetes.
- What are the complications of this condition?
. Metabolic complications : hypoglycemia,
and hypoclcemia
. Respiratory distress syndrome
. Polycythemia
. High incidence of congenital malformations.
- What are the laboratory investigations that should be done in his case?
Magnesium and hematcrite. Blood glucose , calcium,
■ Congenital hypothyroidism
- What is the diagnosis of this condition?
Congenital hypothyroidism
- What are the clinical features of this condition?
Coarse facies, large protruding tongue and
umbilical hernia.
- How to prevent this condition?
Routine screening of all newborns within a few days of birth
■ Hydropes fetalis
- What is the diagnosis of this condition?
Hydropes fetalis
- What are the clinical features of this condition?
Gross generalized edema, ascites, and heart failure.
- - How to prevent - why this condition becoming uncommon?
Uncommon since the prevention of disease with
anti-D immunoglobulin.
- What is the treatment of this condition?
. Exchange transfusion and ventilatory support
■ Phototherapy
- What are the type of phototherapy ?
White , blue, or green (wave length :450-460 nm)
-What is the indication?
Bilirubin level above 15 mg% (full term -unconjugated Jaundice)
- What are the side effects?
Hyperthermia, dehydration, loose stool, and skin rash
■ Necrotizing enterocloitis
- What is the etiology of this condition?
It is common in preterm infant .It is due to
ischemia of the bowel wall and infecting organism.
May be accelerated by early feeding
- What is the treatment of this condition?
Stop oral feeding and give antibiotics
■ Inguinal hernia and umbilical hernia
- What is the diagnosis of this condition?
Inguinal hernia , it is the commonest condition requiring surgery during
infancy. Umbilical hernia subside spontaneously
- What are the clinical features of this condition(inguinal hernia)
It presents as an intermittent swelling in the inguinal region or scrotum, noticed during crying or straining.
- What is the treatment of this condition(inguinal hernia)?
Surgical repair should be done as soon as possible, because the risk of
strangulation is high in young infants.
■ Imperforate anus
- What is the diagnosis of this condition?
Imperforate anus.
- How to diagnose this condition?
It is usually diagnosed during routine examination
immediately after birth.
- What to do after its diagnosis?
. Detailed examination as other anomalies are found
in 60% of cases.
. Most cases need colostomy performed in the neonatal period.
. Surgical repair is performed later on.
■ Hypospadias
- What is the diagnosis of this condition?
Hypospadias: the uretheral orifice is situated on
the ventral aspect of the penis at a site proximal
to the normal opening.
- - What is the treatment of this condition?
- - What to advise the parents
Circumcision should be delayed until corrective
surgery is done, as the prepuce may be needed for urethroplasty.
■ Cleft lip and palate
- What is the diagnosis of this condition? Cleft lip and palate (1,2 ) cleft lip (3).
- What are the complications of this condition?
. Feeding difficulties.
. Aspiration pneumonia
. Speech problems and deafness
- What is the management of this condition
. Feeding by a large teat, spoon or tube feeding.
. Surgical repair usually gives excellent results.
■ Tongue tie
- What is the diagnosis of this condition?
Tongue tie
- What is etiology of this condition?
It is due to short lingual frenulum.
- What are the problem of this condition ?
No problems, it rarely interferes with eating
or speech – generally need no treatment
■ Talipes equinovarus (Club foot)
- What is the diagnosis of this condition? Talibes equinovarus
- What is the differential diagnosis of this condition?
Positional talipes (2) foot can be fully dorsiflexed to touch the front of the lower
leg. (can be passively corrected).
- What is the treatment of this condition?
Splinting, but surgical release may be needed. 2
1
■ Microcephaly
- What is the diagnosis of this condition?
Microcephaly ( head circumference below the 3rd centile for age).
- What are the causes of this condition?
. Congenital infections. TORCH
. Causes of cerebral palsy : enumerate some causes
■ Meningomyelocele
- What is the diagnosis of this condition?
. Meningomyelocele
- How to diagnose the condition antenatally?
Ultrasound examination.à It is a neural tube defect.:
- What are the complications of this condition?
. Hydrocephalus occurs in most of the cases - infections - paraparesis
- What is the treatment of this condition?
First aid includes covering by sterile dressing and neurosurgical referral.
■ Oral moniliasis
- What is the diagnosis of this condition?:
Oral moniliasis: white adherent plaques on the buccal mucosa and tongue.
- What is the cause of this condition?
It is a fungal infection caused by candida albicans.
- What is the main presentations of this condition?
Refusal of suckling and crying.
- What is the treatment of this condition?
Treatment is by topical nystatin or miconazole.
■ Perineal moniliasis
- What is the diagnosis of this condition?
Perineal moniliasis
- What is the lesion shown?
Bright red confluent rash in the napkin area and around the anus
Typically, there are discrete satellite lesions lying peripheral to the rash
- What is the cause ? - What is the treatment? as oral moniliasis
■ Neonatal conjunctivitis
- What is the diagnosis of this condition?
- What are the causes of this condition
Chlamydia, gonorrhea and viruses.
- Minor sticky eye is much more common,
usually non-infective and responds to frequent eye washes
■ Measles
- What is the type of rash shown ?
Maculopapular rash- koplik spots
- Enumerate 3 possible causes?
. Measles : rash starts behind the ears and on the face, then spread downward
. German measles
. Roseola infantum: human herpes virus-6, infants 6 months to 2 years.).
- What are the complications of this condition?
. Respiratory : bronchitis, bronchiolitis and pneumonia.
. Neurological: encephalitis, subscute sclerosing panencephalitis.
- What is the treatment of this condition?
- Symptomatic i.e. antipyretics for the high fever.
■ Roseola infantum
- What is the type of rash shown ?
Maculopapular rash
- Enumerate 3 possible causes? as above
- What is the treatment of this condition?
- Symptomatic i.e. antipyretics for the high fever.
■ Scarlet fever
- What is the diagnosis of this condition?
Scarlet fever: infection by group A beta hemolytic streptococci.
- What are the diagnostic features of this condition?
. Sore throat
. Fine popular rash
. Tongue changes (white, then red strawberry)
- What are the possible complications?
. Early : sinusitis- mastoiditis- otitis media
. Late : glomerulonephritis - rheumatic fever
Skin peeling
■ Chickenpox
- What is the type of rash shown?
Papulovesicular rash.
- What is the most possible cause?
Varicella : successive crops, is centripetal in distribution and pleomorphic.
- What are the possible complications ?
. Secondary bacterial infection of lesions and pneumonia.
. Neurological problems e.g. acute cerebellar ataxia.
■ Impetigo contagiosa
- What is the diagnosis of this condition?
. Impetigo contagiosa
- What is the etiology of this condition?
Infection by gram positive cocci e.g.
staphylococcus aureus.
- What is the treatment of this condition?
. Local fucidenic acid cream
. Extensive lesions should be treated with systemic flucloxacillin
■ Urticaria
- What is the diagnosis of this condition?
Urticaria -It is a common allergic manifestation.
- What are the possible causes?
Exposure to allergens : insect bite, drugs, certain foods.
- What are the other features of the disease?
Itching, wheals, and edema around the eyes and mouth.
- What are the possible complications?
Laryngeal edema and airway obstruction.
- What is the treatment of this condition?
Subcutaneous adrenaline and systemic steroids.
■ Henoch-Schonlein purpura
- What is the diagnosis of this condition?
Henoch Schonlein purpura ; It is a vasculitis with a normal platelet count.
- What is the characteristic lesion shown?
Purpuric rash involving the lower limbs and buttocks.
- What are the other features of this condition?
Other features include arthritis, abdominal pain and nephritis.
- What is the prognosis?
Most cases recover within few weeks.
■ Purpura
- What is the diagnosis of this condition?
Purpura for differential diagnosis.
- What are the possible causes? causes of pupura
. ITP, aplastic anemia, and leukemia
■ Purpura fulminans
- What is the diagnosis of this condition?
Purpura fulminans
- What is the characteristic lesion
This is large ecchymoses with irregular shapes evolving into
hemorrhagic bullae and then into black necrotic lesions
- What are ther possible causes?
. Sepsis : meningococcal septicemia
. Malignancy
. Massive trauma.
- What is the prognosis?
High mortality rate and intensive care management is urgently needed.
■ Atopic eczema
What is the main symptom of this condition? : Itching
What re the common sites for this condition?
Face in infants- in children : skin flexures cubital and popliteal fossa
What is the treatment ?
Avoiding irritants, topical mild steroids and creams
■ Scabies
What is the etiology?
Infestation with a mite
What is the main symptom of this condition?
Itching
Usually other members in the family have
the disease and have itching
What re the common sites for this condition?
Palm, soles, and trunk
What is the treatment ?
Permethrin cream 5%
■ Systemic lupus
- What is the etiology of this condition? autoimmune disease
- What are the clinical features ?
Multisystem affection: malar rash, mouth ulcers, arthritis, nephritis,
pericarditis, and nephritis
- What is the treatment of this condition?
Anti inflammatory drugs and steroids
■ Hemophilia
- What is the etiology of this condition?