Khidir Development

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Prepared by Dr.Mohammed Abdalla Khidir

HOW TO ASSESS DEVELOPMENT IN THE CLINICAL EXAM
INTRODUCTION:
- Wash your hands
- Great examiner and listen carefully to your task.
- Greet mother, introduce yourself, and take permission to play (not say
examine) with her child.
.‫ اليوم حاألعب مع (على) ابنك‬, ‫انا دكتور دمحم طبيب أطفال‬,‫السالم عليكم ياأم على‬
- Observations : Stand and look don't disturb , just give look for 30 sec. for
dysmorphic pictures , gait , any abnormal fingers , left handed or right
handed.
- Rapport : Go to the child level and try to play with him.
- Demonstrate for him and ask to do.
‫شوف (على) انا اسوى كده انت تقدر تسوى زى‬
(1) GROSS MOTOR DEVELOPMENTAL ASSESSMENT
i. MORE THANE 1YEAR:
A)movements( Ask him to walk/run/jump/stand):

 WAIKING(7 TYPES):
- Walks Forward (supported)………12 months.
- Walks Forward (steadily) ………..18 months.
- Walks Backward………………….2-3 years
- Walks Sideway…………………... 3 years
- Walks Tip toe…………………… 3 years
- Walks Forward Tandem………….. 4 years
- Walks Backward Tandem………... 5 years
- walks hold toy …..
 RUNNING (3TYPES):
- Runs stiffly…………….. 2 years
- Runs smoothly (fast)…… 3 years
- Runs tip toe……………... 4 years
 JUMPING (4TYPES):
- Jumps (in place)…………….. 2 year
- jump forward/hopes two foot ………………..3years
- Hops on one foot……… …….4 years
- Skips )‫………………)نط الحبل‬. 5 years
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 STANDING (5TYPES):
- Stands supported…………….9months
- Stands unsupported ………….12months.
- Stands tip toe………………… 2-2.5 years
- Stands on one foot for 1 sec…. 3 years
- Stands on one foot for 5 sec…… 4 years
B) Give him a Ball:

- Kicks a ball (standing)…….. 2 years
- Kicks a ball (running)……... 4 years
- Throws a ball………………. 2 years
- Throws a ball over head……..4years.
- Catches a ball:
Front out stretched arm…………… 3 years
Up out stretched arm……………… 4 years
Near to the body (front of the chest)..5 years
- Bounces )‫……………………)ينطط الكره‬. 5 years
- SCORING :
C) Ask him to climb stairs:

- Climbs stairs backward
- Climbs and down stairs with assistance……………………. 1.6 years
- Climbs stairs unaided in a child manner……………………. 2 years
- Down stairs unaided in a child manner…………………… 2.6 years
- Climbs in adult manner …… ……………………………..…..3 years
- Climb and down stairs in adult manner………………………. 4 years
- running stairs…………………………………………………...5 years
N/B: child manner…….2feet/step.

adult manner…….1foot/step.
D)Ask him to ride a tricycle:

- sitting but can not pedal ……2years.
- Rides Tricycle……………… 3 years.
E) climb furtunre (CHAIR or TABLE):

- climb chair ………………. 18 m.
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- coming down from chair …….2yr.
F ) squate and stand (through toy in the floor and ask him to take , observe how
baby took toy) :
- Squatting with support of hand ….15-18month.
- Squatting without support of hand……..2yr.
ii. LESS THAN 1YEAR:
a) 180 TEST pull baby from lying flat to sit then to stand (to test for tone and
power ) then prone
6weeks
 Head in line with body.
3months:
 No head lag.
 In prone lifts upper chest up.
6months:
 Sits with support..
 In prone lifts chest on extended arms.
 Rolls from front (prone) to back (supine)
7month :
 Sit without support .
 Rolls from back to front.
9months:
 stand. Holding onto object.
12 months
 Crawling.
 Puls to stand
 Cruises around furniture.
 Walking e hand held
b) Test the primitive reflexes basic 8 (2each):

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- Head and neck…….Rooting and tonic neck.
- Arms…………. grasp and moro
- Trunk ………..galant and parachute
- Legs…………..stepping and walking.
(2) FINE MOTOR DEVELOPMENTAL AND VISION

ASSESSMENT
1. MORE THAN 1YEAR:

Ask About the age if the examiner did not tell you.
CCS 3B
A)Cubes:
1) Building of tower:
 Bangs and casting cubes together………12 month.
 Tower of 2-3 cubes …………………. 15 month.
 Tower of 3-4 cubes and puts cubes in container and gets it out
…………………………………………18 month.
 Tower of 6 cubes ………………………2years
 Tower of 9 cubes ………………………3years.
 Tower of 12 cubes ……………………..4 years.
 Tower of 15 cubes………………………5years.
2) Building of bridge/ train and steps:

 Bridge of 3cubes and make train….3years.
 3steps of 6 cubes…………………………..4years.
 4steps of 10 cubes……………………. ……5years.
B)Crayon and paper: (you must observe the way he hold the
crayon … and mention in your presentation)
1) Draw shapes:
 To and fro scribbles …………………15 month.
 Circular scribbles ………………….18 month.
 Vertical line( │ ),write T/V letters .............2 years.
 Horizontal line( ▬ )………………………..2.6years.
 Copy circle ,write T/V/H letters ……..3 years.
 Copy cross ,write X /O letters…………….4years.
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 Copy square ………………………………4.6 years.
 Copy triangle, write C/U/Y/L/A letters …. 5years.
 Copy diamond …………………………….6years.
2) Draw-a-man test: 3+ (
n/4) : n=parts of body baby can draw.
 Draws 3 parts in draw a man test…..3years.
 Draws 4parts(+head) in draw a man test…..4years.
 Draws 8parts(+head) in draw a man test….5years.

N.B: observe for pencil holding:
- immature Tripod(cylindrical) grasp (whole hand )…1-1.6 year.
- good tripod(digital) grasp ………………….2 - 3year.
- dynamic tripod(modified) grasp …………….. 31/2-4 year.
- adult fashion (tripod) grasp ……………………..41/2 - 7 year.
- good control + paint brush ………5 year.
C)Scissors and paper:

 Cannot cut the paper straight……..2y-2.6 years.
 Can cut the paper straight ………..3years.
D) Beads and threads:

 Lace large threads in large hole beads…..3years.
 Lace small threads in small hole beads….4years.
E)Book of pictures:
 Turns many pages together and points to picture in book
…………………………..……….18month.
 Turns one page ………………….2years.
F)Board:
 Fix 2 simple shapes :circle and square……2years.

 Fix 3simple shapes: circle , square and triangle…….3years.
 Fix 6 simple shapes and complex shapes …………4years.
Plus:
G) Pincer grip (Hundreds and thousands , or make a small paper):
 Palmar grasp…………….6month.
 Crude or early pincer grip……9month..
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 Fine , mature or neat pincer grip……1year.
2. LESS THAN 1YEAR:

 6 weeks :
- fix and follow to 90.
- Grasp reflex .
 3month:
- fix and follows to 180 .
- hold rattles.
 6months:
- Transfer objects.
- Shaking rattles.
- Mouthing objects.
- Palmar grasp.
 9months:
- EARLY PINCER GRIP
- Reaches for small objects.
- Release objects.
- Looks for fallen objects.
 1year:
- Mature pincer grip.
- Points by index finger.
- Object permanence.
N.B: in fine motor assessment it is important to ask mother about any concern regarding
vision.?
(3) ASSESSMENT OF SOCIAL MILESTONES
1. MORE THANE 1YEAR:

A) Feeding (by examination):
- Drinks from cup……………………….12 m.
- Uses cup and spoon……………………18 m.
- feeds with spoon and fork……………..2years.
- eats with spoon and fork(+/-knife) ……. 3 years.
- Uses spoon, fork and knife……………… 5 years.
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B) Play (by examination):
1. play peek-a-boo……………………9month
2. Waves bye bye, pat-a-cake………..1year.
3. Solitary play(he plays alone)………..0 -2year

 solitary and Symbolic play (‫ )اللعب الرمزى بمفرده‬e.g. feed a doll and
explores environment……………… 1.6 year
‫اللعب الرمزى عندما تصبح االلعاب رموزا الشياء اخرى‬
 Solitary and pretend play (‫ )اللعب التخيلى بمفرده‬e.g. cooking tray or
mobile talking………….. 2 years
4. spectator play (observe other children play but not play
with them)………………………………..2-2.6 years.
5. Parallel Play/make believe play (along others not with them)
…….... 2.6 - 3 years.
6. associate play (start to interact with other in their play and
there may be co-operation , they play in mixed sex
groups)………..3- 4 years
7. co-operative play (play together with shared aims of play with
Others , they play in single sex group )/pretend play (mum and
dad) ….4-6 years
8. competitive play (play involve games with rules and clear
winner) …………..6+ years
C) Care (by history only):

- Indicates need (not by crying) ………..1 year
- Indicates toilet need………………… 18 m.
- Dry by day………………………….. 2 years
- Uses toilet alone……………………. 3 years
- Brushes teeth, wash and dry hands……4 years
- Mostly dry by night…………………… 5 years
D) Dressing ( by examination):
- Takes off shoes and socks………….. 18 m.
- Helps in dressing…………………….. 2 years
- Able to undress………………………. 3 years
- Dress with supervision……………….. 4 years
- dress without supervision…………….5 years
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LESS THAN 1 YEAR:
 6 weeks :
- Smiles.
 3 month :
- Laughs and squeals.(‫)ينتحب‬
 6month :
- Laughs and screams.
- Enjoy mirror.
 9month :
- Stranger anxiety.
- Plays peek-a-boo.
- Understand (no ) and bye/bye.
 12 month :
- Plays pat-a-cake………….12m
- Waves bye-bye………..12m
- Finger feeds…………12m
(4) ASSESSMENT OF HEARING AND SPEECH

a) MORE THAN 1YEAR:
A) Ask the child about his name, age, sex, address and ask him to count from 1-
10:
1. Call him by name (from behind):

 If turn to his name ……….. 1year.
 If not turn ,tell that you want to ask the mother about any concerns regarding his
hearing.
2. Ask him what is your name?
 If tell one name ……………..2year.
 If tell full name ……………..3years.
3. Ask about sex? Boy or girl.
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 Know sex ……….3years.
4. Ask about age?
 Know age………3years.
5. Ask about address?
 Know ………… 4years.
6. Ask about birthday
 Say birthday…………..5years.
7. Ask him to count from 1 to 10.

 Know to count from 1 to 10 by one hand ……4years.
 Know to count by 2hands ……………………5 years.
 Points to 3parts of body " name 3 body parts "…..18 month.

 5 body parts ………………………………………..3yrs.
B) say and understanding of words:
 Understands words and say only mam - bab……….1year.

 Understands many words(200) ………2years.
 Say 2words sentence and uses plurals (books)…2years.
e.g: Ask when you wake from sleep what you do?
Drink tea (2 words sentence)
 Says 3 words sentence ……………3years.
e.g: When I wake up I drink tea
 Says prepositions eg: up and down…3years.
 Says nursery rhymes (songs)………3years.
e.g can you read quran for me
 Says 4 words sentence…………….4years.
C) Assess concentration and attention:

Give him a colored object and ask him to point to an object with the same color.
 If know 3 colours……….3years.
 If know 4 colours………4years.
D) Assess picture recognition and selection:

 e.g. Ask him about the picture of the duck: what is this?
He know things in books......3years.
 If he did not answer, tell him can you show me the picture of the duck? Points
to pictures …….2years.
E) commands:
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a) A single task: e.g. take the horse ……..18 month.
b) Double task: e.g. take the horse and give it to your mother
c) Triple task: e.g. take the horse, put it behind your back and give it to your mother.
b) LESS THAN 1YEAR:
 6weeks:
- Cries/coos
- Startles to noise
 3 months:
- Quites to parent voice
- Turns to sound.
 6months:
- Bubling
- Says vowels A E I O U
 9months:
- Say mama dada non specifically.
 12 months:
- Understand simple command
- Says few words.
Finally:
 Thank the mother and turn to the examiner.
 Present the case:
- Summarise your finding in four major areas.
- Mention what things child did and what things he cannot did.
- Example: Achild is …….years old
- All these findings are in keeping with developmental delay in areas of
………..to the age of ………..
- Iwant to ask the mother some questions:
 Any concern about hearing or vision?
 What exactly he can say?
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 Eating and drinking ?
 Dressing?
 Cleaning and toilet?
 How the child play?
 Any abnormal behavior?
 School type and achievement?
 Discussion of the case
- Carefull listening to the examiner questions.

- Answer questions confidently.
What investigation of the child?

1. Refer pt. to development team for assessment and investigations.
2. Speech assessment
3. Hearing assessment
4. Play therapy assessment
5. Social assessment
6. Occupational assessment.
What is management plan?

Multidisciplinary team: (developmental team)
- community pediatrician.
- Physiotherapist………………….for gross motor problem.
- Occupational therapist…………..for fine motor problem.
- Speech and language therapist……..for speech problem.
- Educational psychologist…………for learning problem
- Nursery Teacher
- Play therapist .
- Social worker
- Health visitors
- Pre-school therapist.
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 Thank the examiner and exit.
Common cases in development station
- Down syndrome
- Autism.
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INTRODUCTION:
- Wash your hands
- Greet mother, introduce yourself, and take permission to play (not say examine) with her
child.
- Collect your tools for task. CCS 3B:
 Cubes (1-5yrs)
 Cryons/paper (1-6yrs)
 Scissor (2-3yrs)
 Board (2-4yrs)
 Beads /thread.(3-4yrs)
 Book. (18m-2yrs).
- Observations : Stand and look don't disturb , just give look for 30 sec. for dysmorphic
pictures , gait , any abnormal fingers , left handed or right handed.
- bring child to table and sit in front of child not beside child.
(5) FINE MOTOR DEVELOPMENTAL AND VISION ASSESSMENT
6. MORE THAN 1YEAR:
Ask About the age if the examiner did not tell you.
H) Cubes:
3) Building of tower:
 Bangs and casting cubes together………12 month.
 Tower of 2-3 cubes …………………. 15 month.
 Tower of 3-4 cubes and puts cubes in container and gets it out
…………………………………………18 month.
 Tower of 6 cubes ………………………2years
 Tower of 9 cubes ………………………3years.
 Tower of 12 cubes ……………………..4 years.
 Tower of 15 cubes………………………5years.
4) Building of bridge/ train and steps:

 Bridge of 3cubes and make train….3years.
 3steps of 6 cubes…………………………..4years.
 4steps of 10 cubes……………………. ……5years.
I) Crayon and paper: (you must observe the way he hold the crayon … and mention in your
presentation)
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3) Draw shapes:
 To and fro scribbles …………………15 month.
 Circular scribbles ………………….18 month.
 Vertical line( │ ),write T/V letters .............2 years.
 Horizontal line( ▬ )………………………..2.6years.
 Copy circle ,write T/V/H letters ……..3 years.
 Copy cross ,write X /O letters…………….4years.
 Copy square ………………………………4.6 years.
 Copy triangle, write C/U/Y/L/A letters …. 5years.
 Copy diamond …………………………….6years.
4) Draw-a-man test: 3+ ( n/4) : n=parts of body baby can draw.
 Draws 3 parts in draw a man test…..3years.
 Draws 4parts(+head) in draw a man test…..4years.
 Draws 8parts(+head) in draw a man test….5years.
N.B: observe for pencil holding:
 cylindrical grasp (whole hand )………………1-1.6 year.
 digital grasp …………………………………….2 - 3year.
 Modified tripod grasp (dynamic) …………….. …..31/2 -4 year.
 tripod grasp (adult fashion) ………………………..41/2 - 7 year.
 good control + paint brush …………………………5 year.
J) Scissors and paper:

 Cannot cut the paper straight……..2y-2.6 years.
 Can cut the paper straight ………..3years.
K) Beads and threads:

 Lace large threads in large hole beads…..3years.
 Lace small threads in small hole beads….4years.
L) Book of pictures:
 Turns many pages together and points to picture in book
…………………………..……….18month.
 Turns one page ………………….2years.
M) Board:
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 Fix 2 simple shapes :circle and square……2years.
 Fix 3simple shapes: circle , square and triangle…….3years.
 Fix 6 simple shapes and complex shapes …………4years.
Plus:
7. LESS THAN 1YEAR:
N) Pincer grip (Hundreds and thousands , or make a small paper):

 Palmar grasp…………….6month.
 Crude or early pincer grip……9month..
 Fine , mature or neat pincer grip……1year.
f) rattles :
 Hold rattles …….3month
 Shaking , transfer and mouthing rattles ……6month
 Release and looking if fall …….9month.
 6 weeks :
- fix and follow to 90.
- Grasp reflex .
 3month:
- fix and follows to 180 .
- hold rattles.
 6months:
- Transfer objects.
- Shaking rattles.
- Mouthing objects.
- Palmar grasp.
 9months:
- EARLY PINCER GRIP
- Reaches for small objects.
- Release objects.
- Looks for fallen objects.
 1year:
- Mature pincer grip.
- Points by index finger.
- Object permanence.
- Bangs and casting cubes together………12 month.
- immature Tripod(cylindrical) grasp (whole hand )…1-1.6 year
N.B: in fine motor assessment it is important to ask mother about any concern regarding
vision.?
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Finally:
- Example: today I examined ali 5years old , which having distinct features
consistent with down syndrome . he :
 able to build tower of 9 cubes , bulid bridge and train but not able to
make steps .
 able to draw circle but could not draw cross., he holding the cryon
in modified tripod fashion.
 He cut paper with scissor smoothly.
 He insert /lace thread in large bead but not in small one.
 He fix 3 shape in simple board
 He turn page one by one on the book
- All these findings are in keeping with age of 3 yrs in area of fine motor
.
- I want to ask the mother some questions:to assess other areas of development
 socially : Eating and drinking ?Dressing? Cleaning and toilet? How the child play?
 School type and achievement? Normal , special or integrated .
Discussion of the case



- community pediatrician…….is the key person and team leader.

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Speech and language therapist……..for speech problem.
-
Educational psychologist…………for learning and intellicous problem
-
-
Others : Nursery Teacher , Pre-school therapist, Play therapist , Social worker , Health
visitors .
Thank the examiner and exit.
Common cases in development station
Down syndrome , William syndrome., Sanjet -sakatti syndrome ., Autism.

INTRODUCTION:
- Wash your hands
child.
- Prepare your equipments for gross motor which are :
 Ball (big/small)…( 2-4yrs).
 Rope stepping…..(5yrs)
 Use chair ……….(1.6-2yrs ).
 Steps…………. ..(2-5yrs)
 Tricycle……….. (2-3yrs)
(6) GROSS MOTOR DEVELOPMENTAL ASSESSMENT
iii. MORE THANE 1YEAR:
A)movements( Ask him to walk/run/jump/stand):

 WAIKING(7 TYPES):
 Walks Forward (supported)………12 months.
 Walks Forward (steadily) ………..18 months.
 Walks Backward………………….3 years
 Walks Sideway…………………... 3 years
 Walks Tip toe…………………… 3 years
 Walks Forward Tandem………….. 4 years
 Walks Backward Tandem………... 5 years
 walks hold toy …..
 RUNNING (3TYPES):
 Runs stiffly…………….. 2 years
 Runs smoothly (fast)…… 3 years
 Runs tip toe……………... 4 years
 JUMPING (4TYPES):
 Jumps (in place)…………….. …..2 year
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 jump forward/hopes two foot ….3years
 Hops on one foot……… …………4 years
 Skips )‫………………)نط الحبل‬. ……5 years
 STANDING (5TYPES):
 Stands supported…………….9months
 Stands unsupported ………….12months.
 Stands tip toe………………… 2-2.5 years
 Stands on one foot for 1 sec…. 3 years
 Stands on one foot for 5 sec…… 4 years.
B) Give him a Ball:
- Kicks a ball :
 Standing …….. ………………………2 years
 Running …….................................. 4 years
- Throws a ball :
 From front stretch hand ……………………2 years.
 From over head…………………………….4years.
- Catches a ball:
 Front out stretched arm………………. 3 years
 Up out stretched arm…………………. 4 years
 Near to the body (front of the chest)..5 years
- Bounces )‫………………………………)ينطط الكره‬. 5 years
- Scoring :
C) Ask him to climb stairs: (climbing stair easier than down stair)
- Climbs and down stairs with assistance……………………. 1.6 years
- in child manner :( 2feet/step)
 Climbs stairs unaided ……………………. 2 years
 Down stairs unaided …………………… 2.6 years
- in adult manner : ( 1 foot / step)

 Climbs in adult manner …… ……………………………..…..3 years
 down stairs in adult manner………………………………… 4 years
- running stairs…………………………………………………...5 years
D)Ask him to ride a tricycle:

- sitting but can not pedal ……2years.
- Rides Tricycle……………….. 3 years.
- ride bicycle …………………..5 yrs.
E) climb furtunre (CHAIR or TABLE):

- climb chair ………………. 18 m.
- coming down from chair …….2yr.
F ) squate and stand (through toy in the floor and ask him to take , observe how baby took toy) :
- Squatting with support of hand ….15-18month.
- Squatting without support of hand……..2yr.
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iv. LESS THAN 1YEAR:
c) 180 TEST pull baby from lying flat to sit then to stand (to test for tone and power ) then
prone
6weeks
 Head in line with body.
3months:
 No head lag.
 In prone lifts upper chest up.
6months:
 Sits with support..
 In prone lifts chest on extended arms.
 Rolls from front (prone) to back (supine)
7month :
 Sit without support .
 Rolls from back to front.
9months:
 stand. Holding onto object.
12 months
 Crawling.
 Puls to stand
 Cruises around furniture.
 Walking e hand held
d) Test the primitive reflexes basic 8 (2each):

- Head and neck…….Rooting and tonic neck.
- Arms…………. grasp and moro
- Trunk ………..galant and parachute
- Legs…………..stepping and walking.
Gross motor In summary :

Task 18 month 2yrs 3yrs 4yrs 5yrs
1.1 walking Walk steadily Walk backward Walk side way Forward tandem Backward tandem
Walk tip toe
1.2 Running ………. stiffly Smoothly tip toe …….
1.3 Jumping …….. In place Forward Hope one foot Skip
1.4 stand Stand for 1sec Stand for 5 sec.
2.ball Kick standing Catch front Kick running
Throw hand Throw overhead
Catch
3. tricycle
4. stairs
5. furnture
6.squanting
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Task 4yr 5yr
1.1 walking
1.2 Running
1.3 Jumping
1.4 stand
2.ball
3. tricycle
4. stairs
5. furniture
6.squanting
Finally:
- All these findings are in keeping with developmental delay in areas of ………..to the age of
………..
 Dressing?
- Example of presentation : today I examined ali 5years old , which having distinct
features consistent with down syndrome . he :
 able to build tower of 9 cubes , bulid bridge and train but not able to make
steps .
 able to draw circle but could not draw cross., he holding the cryon in
modified tripod fashion.
 He cut paper with scissor smoothly.
 He insert /lace thread in large bead but not in small one.
 He fix 3 shape in simple board
 He turn page one by one on the book
-All these findings are in keeping with age of 3 yrs in area of fine motor .
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- community pediatrician as team leader.

- Nursery Teacher , Pre-school therapist.
- Play therapist .
- Social worker
- Health visitors
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INTRODUCTION:
- Wash your hands
child.
.‫ اليوم حاألعب مع (عىل) ابنك‬, ‫انا دكتور دمحم طبيب أطفال‬,‫السالم عليكم ياأم عىل‬
- Collect the tools :
 Objects : Dolls or car or animals .
 colored cryons.
 Pictures : Pictures book.
‫شوف (عىل) انا اسوى كده انت تقدر تسوى زى‬
(7) ASSESSMENT OF HEARING AND SPEECH

A) MORE THAN 1YEAR:
A) Ask the child about his name, age, sex, address and ask him to count from 1-10:
8. Call him by name (from behind):

 If turn to his name ……….. 1year.
 If not turn ,tell that you want to ask the mother about any concerns regarding his
hearing.
9. Ask him what is your name?
 If tell one name ……………..2year.
 If tell full name ……………..3years.
10. Ask about sex? Boy or girl.
 Know sex ……….3years.
11. Ask about age?
 Know age………3years.
12. Ask about address?
 Know ………… 4years.
13. Ask about birthday
 Say birthday…………..5years.
14. Ask him to count from 1 to 10.

 Not counting …………
 Know to count from 1 to 10 by one hand ……4years.
 Know to count by 2hands ……………………5 years.
23
b) Assess concentration and attention:
1. Body parts :
 Points / name 3 body parts ………….18 month – 2ys.
 5 body parts ………………………………..3yrs.
2. Give him a colored object and ask him to point to an object with the same color.
 If know 3 colours……………………..3years.
 If know 4 colours……………………..4years.
 5 colours ……………………5yrs.
c) assess cognitive function :

1. Assess picture /object recognition and selection:
 e.g. Ask him about the picture of the duck /horse toy: what is this?
He know things in books......3years.
 If he did not answer, tell him can you show me the picture of the duck/ horse toy ? Points
to pictures …….2years.
2. sound imitiation test :
 Show him dog and ask him what is the sound of this …………………..3yrs.
 If he did not answer , tell him which animal has haw haw sound …..2yrs.
d) commands:
a) A single task: e.g. take the horse ………………………………………18 month.
b) Double task: e.g. take the horse and give it to your mother ……..2 yrs.
c) Triple task: e.g. take the horse, put it behind your back and give it to your mother…….. 3yrs.
e) say and understanding of words:
 Understands words and say only mam - bab……….1year.

 Say mam dad and other words …………………………11/2 yr.
 Understands many words(200) ………………………….2years.
 Say 2words sentence and uses plurals (books)……2years.
e.g: Ask when you wake from sleep what you do?
Drink tea (2 words sentence)
 Says 3 words sentence ……………………………………..3years.
e.g: When I wake up I drink tea
 Says prepositions eg: up and down……………………3years.
 Says nursery rhymes (songs)……………………………..3years.
e.g can you read quran for me
 Says 4 words sentence……………………………………..4years.
B) LESS THAN 1YEAR:
24
 6weeks:
- Cries/coos
- Startles to noise
 3 months:
- Quites to parent voice
- Turns to sound.
 6months:
- Bubling
- Says vowels A E I O U
 9months:
- Say mama dada non specifically.
 12 months:
- Understand simple command
- Says few words.
Finally:
- Example of presentation : today I examined ali 5years old , which having distinct
features consistent with down syndrome . he :
- .

 Dressing?
25
Discussion of the case



- Nursery Teacher
- Play therapist .
- Social worker
- Health visitors
26
INTRODUCTION:
- Wash your hands
child.
- Collect equipments :
 Toy.( for play).
 Cup , fork , spoon , knife.(feeding)
 jacket and/or shoes.(dressing / undressing).
(8) ASSESSMENT OF SOCIAL MILESTONES
2. MORE THANE 1YEAR:
A) Feeding (by examination):

- Drinks from cup……………………….12 m.
- Uses cup and spoon……………………18 m.
- eats with spoon and fork……………..2years.
- eats with spoon and fork(+/-knife) ……. 3 years.
- Uses spoon, fork and knife……………… 5 years.
B) Play (by examination):

1. play peek-a-boo……………………9month
2. Waves bye bye, pat-a-cake………..1year.
8. Solitary play(he plays alone)………..0 -2year

 solitary and Symbolic play (‫ )اللعب الرمزى بمفرده‬e.g. feed a doll and explores
environment……………… …1.6 year
‫اللعب الرمزى عندما تصبح االلعاب رموزا الشياء اخرى‬
 Solitary and pretend play (‫ )اللعب التخيلى بمفرده‬e.g. cooking tray or mobile
talking………….. ……………..2 years
9. spectator play (observe other children play but not play
with them)………………………………..2-21/2 years.
10. Parallel Play/make believe play (along others not with them)
…….... ………………………………….. 21/2 - 3 years.
6. associate play (start to interact with other in their play and
there may be co-operation , they play in mixed sex
27
groups)……………………………………3- 4 years
7. co-operative play (play together with shared aims of play with
Others , they play in single sex group )/pretend play (mum and
dad) ……………………………….4-6 years
8. competitive play (play involve games with rules and clear
winner) …………..6+ years
C) Care (by history only):

- Indicates need (not by crying) ………..1 year
- Indicates toilet need………………… 18 m.
- Dry by day………………………….. 2 years
- Uses toilet alone……………………. 3 years
- Brushes teeth, wash and dry hands……4 years
- Mostly dry by night…………………… 5 years
D) Dressing/undress ( by examination): undress easier than dress.

-undress :
 Takes off shoes and socks…………... 18 m.
 Helps in undress …………………….. 2 years
 Able to undress , unbuttons………….. 3 years
- dressing :
 helps in dressing ………………………..3years.
 Dress with supervision…………………. 4 years
 dress without supervision, using belt , button……………….5 years
LESS THAN 1 YEAR:
 6 weeks :
- Smiles.
 3 month :
- Laughs and squeals.(‫)ينتحب‬
 6month :
- Laughs and screams.
- Enjoy mirror.
 9month :
- Stranger anxiety.
- Plays peek-a-boo.
- Understand (no ) and bye/bye.
 12 month :
- Plays pat-a-cake………….12m
- Waves bye-bye………..12m
- Finger feeds…………12m
28
Finally:
- All these findings are in keeping with developmental delay in areas of ………..to the age of
………..
 Dressing?



- Nursery Teacher
- Play therapist .
- Social worker
- Health visitors
29
Approach of developmental assessment to autistic child

Back ground knowldge:
Autism is define as neuro developmental delay mainly of language and social areas of
Autism is triad of:
1. Abnormal social interaction: need at least 2 or more of the following:
 Difficulty using non – speech behavior for social interaction like :-
- lack of eye contact ,and
- limited use of gesture or facial expression with interaction to others.
- Do not point to indicate their needs
 Failure to develop peer relation ship
 Lack of spontaneous seeking to share enjoyment , interests , or achievement
with others e.g: like if drawing something not showing picture to his mom or
bab.
 Lack of social or emotional responding e.g: if someone get hurt , pt with autism
may be not notice.
Also: May not want to be kissed or cuddled.

2. Abnormal verbal communication: need 1 or more of the following:
 Delay in ,or lack of spoken language e.g: pt not responding to Q. or using few words
sentence
 Difficulties with starting or continuing conversation.
 Echolalia is common which either immediate or delay :
- Immediate echolalia like repeat Q instead of answering.
- Delay echolalia like may repeat words from T.V show referred as video tape talk.
 Poor imagination : Lack of make believe play or social imitative play.
3. Repetitive or inflexible behavior: need 1 or more of the following:
 Rigid following of non – function routines e.g: sitting same chair
 Obsessions with inflexible and limited interests e.g: talk about one topic
 Obsessions with parts of objects e.g: focus on wheel of cars instead of car itself.
 Inflexible and repetitive body movements: in many ways:
- Body movements: jumping in place
- Visual : such as eye gazing , looking by corner of eyes
- Auditory : making sound or noises in order to hear them.
- Oral : may play with their saliva
- Tactile : may have favour material to touch.
- Smell : pick up items and smelling it before play .
31
Specific behavior may be seen:
- Head banging , rocking
- Wetting and soiling
- Impulsivity , tantrums , over or under – activity
Also he dislike of loud noises or crowded places.
Suggested scheme for examination of the child with autism

1. General measures :
- Shake the hand with examiner
- Then examiner will give a vague task like: (Moheb) is 5 years old pls assess his
development
- Introduce yourself to parents
- Collect tools : toys and ball
2. Observation : observe what child is doing: the child may be:

o Stay in corner alone , hyperactive , lack of attention or concentration ,
doing repetitive movements like flapping hands-winning (behavior)
o Lack eye to eye contact . Are he in nappies., Lack of stranger
awareness.(social)
3. Assessment of speech and social :
o Start to shake hands, make rapport with a child by asking ( speech):
‫ اسمك منو ؟ كم عمرك ؟انت ولد وال بت؟ ؟ ازيك يامحب‬...‫محب‬
 Child is not shaking hands , not responding to all these questions
 he is ignoring {delay or lack of spoken language (speech)}.
 Failure to use facial expressions/gesture to communicate (social).
o Assess concentration (speech) : what is this colour ? where is the red color.?
o Assess recognition of objects (speech) /assess play (social) : Start to play with him/ Try to
engage him
‫ده شنو يامحب؟ وين الحصان؟‬

‫ العب معاى‬-‫سوى كده‬-‫محب ده حصان ياسالم‬
 Failure to engage ,failure of getting their attention ,or share playing with
others(social).
 Failure of pretended play , and does not show any imagination.(social).
4. Then Ask the mother some questions (after take permission from examiner): to continue
assessing communication( langue –non verbal) , social , and behaviour
‫ ام محب فى اى مشكله فى سمعو وال نظرو؟‬: ‫الدكتور‬ .1
‫ بس لما اتكلم معاهو مايرد على‬, ‫ ال‬: ‫االم‬
31
Lack of or delay of speech (langue )
‫ كيف يعبر عن حوجته لالشياء زى االكل والشرب؟‬: ‫ الدكتور‬.2
‫ يسحبنى من مالبسى ويودينى على المطبخ‬: ‫االم‬
Find way of meeting their needs other than pointing(social).
‫ يعنى ماياشر باصبعه‬: ‫ الدكتور‬.3
‫ ال ماياشر ابدا‬: ‫االم‬
Not pointing (social ).
‫ ام محب محب يقدر يركب جمل ويفهم لما تامريهو بشى معين؟‬: ‫الدكتور‬ .4
‫ ال‬: ‫االم‬
Limited content of speech (langue )
‫ حاولتى تعلميهو يمشى الحمام؟‬: ‫الدكتور‬ .5
‫ حا ولت لكن فشلت‬: ‫االم‬
Failure of toilet training (social)
‫ تالحظى عليه اى سلوكيات غريبه؟‬: ‫الدكتور‬ .6
‫ زى انو يفضل يلف حولين نفسو باستمرار‬, ‫ نعم‬: ‫االم‬
Repetitive behavior (behavior)
‫يحب يروح االعراس والمناسبات واالماكن العامه زى المسجد والسوق؟‬: ‫الدكتور‬ .7
‫ واذا راح يفضل يبكى ويصرخ الين نطلع‬, ‫ ال مايحب يروح‬: ‫االم‬
Dislike crowded places (behavior)
‫ بحب تغير الروتين ؟‬: ‫الدكتور‬ .8
‫ ال مايحب تغير الروتين واذا تغير بيعصب‬: ‫االم‬
Upset by minor changes in routine (behavior)
9. Ask the mother Take from him his toy ? see his anger response.
Presentation of the case:

Moheb is 5 years old , on entering the room the most striking observation was that he did
not appear to notice that we were there . he did not establish eye contact, and I could not
engage him in any play activity . I notice that he is wearing nappies . these features suggest
marked delay in social skills.
He was vocalizing but did not have any easily recognizable words(ignoring us) and his
mother reports that he indicates what he wants by taking her hand and putting it on the
object he is interested in .he had very little facial expression. This suggests a delay in
communication skills.
In addition to this mother describes he has several rituals and repetitive behavior and he
becomes very anxious and has tantrums when there are small deviations from these rituals.
These features would be in keeping with a diagnosis of autism.
What investigation of autism?

1. Developmental team assessment.
2. Hearing assessment to exclude impaired hearing.
3. Ophthalmological assessment to rule out any visual impairement.
4. Chromosomal assessment : because associated with Ret syndrome , and fragile x-
syndrome , angleman , TS , NF-1
32
5. Metabolic screening : aminoaciduria , homocystinuria,
6. Serum amino acids for phenylketonuria.
7. Serum lead level for lead toxicity.
8. CBC , iron, thyroid function.
9. EEG if epilepsy.
What is management plan ? Multidisplenary approach: this child will get benefit if I am
refer him to :
1. Behavior therapiest
2. Occupational therapiest.
3. Speech and langue therapiest.
4. Social therapiest
5. Psychiatric therapiest
6. Education consideration.
7. Financial support
8. Trial of many new treatment , like ….
33
Common case in jeddeha centre
1. My exam in jeddah:11/2016
CNS:
- Ataxia telenectasia , examine upper limb "o/e : hypotonia , hyporeflexia , dysmetria
and nystagmus " ……. (1/2017).
- 11 yrs old female , reduce iQ , still in nappy , hypotonic , hyporeflexia , and reduce
power . ( Q: difference b/w CP and polymilytis ???) (1/2017)
- Case of shunt in frontal area…….(1/2017).
- DOWN SYNDROME …………………(1/2017-2ND day.)
- Sturge weber syndrome (1/2017 -1st day).
- spina bifida (1/2017-1st day)
- Hemiplegia. (1/2017-1st day).
- operated hydrocephalus (11/2016)
- Lt hemiparesis …. Due to trauma.
- Double hemiplegia : 12 yrs old , SCA WITH double hemiplegia right sided hemiplegic
gait , but having bilaterally spaticity and hypertonia (11/2016)
- Spastic Quadriplegia CP.: causes (11/2016).
- Diplegia.
- Choreoathetoid CP .(3/2016).
- Degenerative disease with mixed upper and lower motor neuron lesion
- Spina pifida(3/2016).
- Spina bifida = bilateral hearing aid and squent + flaccid paraplegia + hydrocephalus
with VP shunt in left side + ugly scar on the back.(course 10/2016)
- SMA type 2.(3/2016, 11/2015).
- Ataxia telengectesia.
2. CVS :
- Medsternotomy scar and latera thoractomy scar , pulmonary murmurm
- Complex congenital heart disease (1/2017)
- Operated fallot (1/2017 – 2nd day).
- 4 yrs old with multivalvular lesions.(1/2017 – 1st day).
- Case of 9 yrs old with dextrocadia and medstentomy scar with situs inversus (1/2017)
- Syndromic pt. e medstentomy scar (11/2016)
- Pulmonary stenosis post operative , TOF?
- 2yrs old with clubbing and cyanosis uncooperative (11/2016) .
- Rheumatic heart disease e mid sternotomy scar and valve replacement with residual
pulmonary stenosis.(11/2016)
- RHEUMATIC with mitral and aortic valve replacement.
- Pace maker in left apical area + 4 scars in the apical , epigastric area , with normal
heart sound
- TOF with middle scar and residual aortic stenosis.
- Metallic valve.
34
- VSD
- Marfan e sterntomy scar.
- 8 YRS old girl with median sterntomy and drainage scars with systolic murmur over
apex and pulmonary area…..
- 7yrs old boy not clubbed or cyanosis , with medium sterntomy scar
- Cyanotic congenital heart disease : 7 yrs boy down , with clubbing , cyanosis and
median sternotomy scar , pansystolic murmur , LLSB.-impression eismenger on top of
AVSD. ( 11/2016)
- Bulging percordium , pulsation , pan systolic murmur ? rheumatic heart disease not in
failure + other murmur systolic.(11/2016).
3. RS:
- Chronic supparative lung disease .
- Noonan (1/2017)
- Turner syndrome (1/2017 – 1st day)
- Treacher colins with decrease air entery on the right side (1/2017)
- Symdromic (unknown)patient with elastic skin and stiff joints (1/2017)
- Ataxia telengectasia with chronic lung disease. Dysniec (1/2017……11/2016).
- Treacher Collin syndrome e nasal obstruction (11/2016)
- Chronic supprative lung disease.10 yrs old girls : distress oxygen , clubbing , increase
AP diameter , scar in the back .(11/2016)
- Chronic supparative lung disease (10yrs old girl) : not distress , v.small for her chest ,
clubbing , chest deformity , small cautry marks , crackles all over the chest .( dr.habab
11/2016).
- Kartegner syndrome
- Cystic fibrosis.(11/2016…….3/2016)
4. ABD :
- Sickle cell disease (1/2017)
- Thathamia (1/2017)
- Case of fair hair 10 yrs old girl with distended abdomen 3 tubes : (i.e : gastrostomy
tube , RIF tube , and other long tube from RIF up to the chest) may be glycogen
storage disease (1/2017 ).
- Yamani child , with Chronic renal failure , anaemic and with peritonial dialysis tube ,
scar near umbilicus.(1/2017).
- B.Thalathamia with hepatosplenomegaly (11/2016)
- B-thalathaemia major e splenectomy and e out splenectomy.(3/2016)
- Thalathamia (11/2016) : management and complications.
5. MSS:
- Girl Pt. with alopecia (1/2017)
- ACHONDROPLASIA (1/2017).
- Oesteogensis imperfect ( 1/2017).
35
- Pt. e Multiple scars e sclosis as complication of sickle oesteomylitis ( short , L L
asymmetry , long arms )(1/ 2017 ….11/2015).
- Marfan (11/2016)
- Knee joint swelling with limbing and mild stiffness ? JIA or haemophilia (11/2016).
- 13 yrs old Obese hypotonic position , wheel chair beside the bed , and hummer :
examine the lower limb and relative system , DMD ???.( 11/2016).
- Oesteogensis imperfect = multiple fractures + multiple upper limb deformity + rt. Ll
with plaster and old fractures (course 10/2016)
- JIA ( bilateral knee deformity)….( course 10/2016).
- Hypophosphatimic ricket. (3/2016 – 11/2016).
- Rickets ( bilateral curved legs bones + chest deformity "pigon chest" + ricket rosary +
harisson groove.)…..(course 10/2016.)
6. OTHERS:
- Osteogenesis imperfect(3/2016)
- Goldenhar .
- Mucopoly sacridosis.
7. Development :
- Fine motor and langue of down syndrome. (1/2017)
- Fine motor for " radina" 7 yrs old girl hemiplegic ( did all the tasks e difficulty but no
developmental delay)….(1/2017).
- Fine motor.(3/2016…..11/2015).
- Fine motor /other gross motor– 5yrs old sanjet sakatti (11/2016).
- Fine motor 5 yrs old down syndrome.(1/2017 ….11/2016).
36
Common case in jeddeha centre
8. My exam in jeddah:11/2016
CNS:
- Ataxia telenectasia , examine upper limb "o/e : hypotonia , hyporeflexia , dysmetria
and nystagmus " ……. (1/2017).
- 11 yrs old female , reduce iQ , still in nappy , hypotonic , hyporeflexia , and reduce
power . ( Q: difference b/w CP and polymilytis ???) (1/2017)
- Case of shunt in frontal area…….(1/2017).
- DOWN SYNDROME …………………(1/2017-2ND day.)
- Sturge weber syndrome (1/2017 -1st day).
- spina bifida (1/2017-1st day)
- Hemiplegia. (1/2017-1st day).
- operated hydrocephalus (11/2016)
- Lt hemiparesis …. Due to trauma.
- Double hemiplegia : 12 yrs old , SCA WITH double hemiplegia right sided hemiplegic
gait , but having bilaterally spaticity and hypertonia (11/2016)
- Spastic Quadriplegia CP.: causes (11/2016).
- Diplegia.
- Choreoathetoid CP .(3/2016).
- Degenerative disease with mixed upper and lower motor neuron lesion
- Spina pifida(3/2016).
- Spina bifida = bilateral hearing aid and squent + flaccid paraplegia + hydrocephalus
with VP shunt in left side + ugly scar on the back.(course 10/2016)
- SMA type 2.(3/2016, 11/2015).
- Ataxia telengectesia.
9. CVS :
- Medsternotomy scar and latera thoractomy scar , pulmonary murmurm
- Complex congenital heart disease (1/2017)
- Operated fallot (1/2017 – 2nd day).
- 4 yrs old with multivalvular lesions.(1/2017 – 1st day).
- Case of 9 yrs old with dextrocadia and medstentomy scar with situs inversus (1/2017)
- Syndromic pt. e medstentomy scar (11/2016)
- Pulmonary stenosis post operative , TOF?
- 2yrs old with clubbing and cyanosis uncooperative (11/2016) .
- Rheumatic heart disease e mid sternotomy scar and valve replacement with residual
pulmonary stenosis.(11/2016)
- RHEUMATIC with mitral and aortic valve replacement.
- Pace maker in left apical area + 4 scars in the apical , epigastric area , with normal
heart sound
- TOF with middle scar and residual aortic stenosis.
- Metallic valve.
37
- VSD
- Marfan e sterntomy scar.
- 8 YRS old girl with median sterntomy and drainage scars with systolic murmur over
apex and pulmonary area…..
- 7yrs old boy not clubbed or cyanosis , with medium sterntomy scar
- Cyanotic congenital heart disease : 7 yrs boy down , with clubbing , cyanosis and
median sternotomy scar , pansystolic murmur , LLSB.-impression eismenger on top of
AVSD. ( 11/2016)
- Bulging percordium , pulsation , pan systolic murmur ? rheumatic heart disease not in
failure + other murmur systolic.(11/2016).
10. RS:
- Chronic supparative lung disease .
- Noonan (1/2017)
- Turner syndrome (1/2017 – 1st day)
- Treacher colins with decrease air entery on the right side (1/2017)
- Symdromic (unknown)patient with elastic skin and stiff joints (1/2017)
- Ataxia telengectasia with chronic lung disease. Dysniec (1/2017……11/2016).
- Treacher Collin syndrome e nasal obstruction (11/2016)
- Chronic supprative lung disease.10 yrs old girls : distress oxygen , clubbing , increase
AP diameter , scar in the back .(11/2016)
- Chronic supparative lung disease (10yrs old girl) : not distress , v.small for her chest ,
clubbing , chest deformity , small cautry marks , crackles all over the chest .( dr.habab
11/2016).
- Kartegner syndrome
- Cystic fibrosis.(11/2016…….3/2016)
11. ABD :
- Sickle cell disease (1/2017)
- Thathamia (1/2017)
- Case of fair hair 10 yrs old girl with distended abdomen 3 tubes : (i.e : gastrostomy
tube , RIF tube , and other long tube from RIF up to the chest) may be glycogen
storage disease (1/2017 ).
- Yamani child , with Chronic renal failure , anaemic and with peritonial dialysis tube ,
scar near umbilicus.(1/2017).
- B.Thalathamia with hepatosplenomegaly (11/2016)
- B-thalathaemia major e splenectomy and e out splenectomy.(3/2016)
- Thalathamia (11/2016) : management and complications.
12. MSS:
- Girl Pt. with alopecia (1/2017)
- ACHONDROPLASIA (1/2017).
- Oesteogensis imperfect ( 1/2017).
38
- Pt. e Multiple scars e sclosis as complication of sickle oesteomylitis ( short , L L
asymmetry , long arms )(1/ 2017 ….11/2015).
- Marfan (11/2016)
- Knee joint swelling with limbing and mild stiffness ? JIA or haemophilia (11/2016).
- 13 yrs old Obese hypotonic position , wheel chair beside the bed , and hummer :
examine the lower limb and relative system , DMD ???.( 11/2016).
- Oesteogensis imperfect = multiple fractures + multiple upper limb deformity + rt. Ll
with plaster and old fractures (course 10/2016)
- JIA ( bilateral knee deformity)….( course 10/2016).
- Hypophosphatimic ricket. (3/2016 – 11/2016).
- Rickets ( bilateral curved legs bones + chest deformity "pigon chest" + ricket rosary +
harisson groove.)…..(course 10/2016.)
13. OTHERS:
- Osteogenesis imperfect(3/2016)
- Goldenhar .
- Mucopoly sacridosis.
14. Development :
- Fine motor and langue of down syndrome. (1/2017)
- Fine motor for " radina" 7 yrs old girl hemiplegic ( did all the tasks e difficulty but no
developmental delay)….(1/2017).
- Fine motor.(3/2016…..11/2015).
- Fine motor /other gross motor– 5yrs old sanjet sakatti (11/2016).
- Fine motor 5 yrs old down syndrome.(1/2017 ….11/2016).
39
Common case in other centre:
Riyadh - 11-2016
1. Others : noonan syndrome please examine this pt and proceed
2. Others : Graves' disease.Cvs : cardiac TOF or metallic pulmonary artery . wel child with
median sternotomy scar and murmur in pulmonary area.
3. Development : sanget sakatti fine motor.
4. CNS : quadriplegic CP.
5. ABD : glycogen storage disease
My experience in KSA Riyadh-11/2015 clinical exam
1. Development station :
- fine motor spatic diplegia 9 yr old
child went to the bathroom for 5 min then I started my examination cooperative spastic
diplegia child on wheelchair wearing glassess didn't speak we did crayon
,cubes,scissors,book .discussed about causes prenatal perinatal post natal, gave 2.5 to 3 yr
clear pass
CVS : 5 yr old with MPS with systolic murmur in apex
described the detailed feature of MPS in my general exam
gave deferential for sysy murmur MR VSD and innoscent
with each one what go and what against
discussed fully management but the examiner didn't check involvement of family line in
discussion part of mark sheet ! pay attention to that , i was so friendly to the lovely child
he was smiling and laughing and the examiner wrote excellent in conduct of interview
clear pass
6. Resp.: immunedefeciency in 9 yr old

classic chronic suppurate lung disease with clubbing b/l wheeze and creps
have cautary marks i blanked in the exam about the cause and said trauma gave
differentials
clear pass
7. Abd: 12 yr with splenomegaly 15 cm liver 1 cm apped. scar

was so confusing examiner want running commentary said well grown he gam=ve me the
centile said pale said no she is not i found the spleen and measure it along diagonal axis he
said why you would measure it the way ( told us so in the course ) no liver to me checked
for ascites many scars in the abdomen i said lapratomy !gave differentials
surprisingly gave me clear pass
8. MSK : rickets
classic but said well grown
in differential i gave diff in rickets and then my case i told nutritional but the examiners
41
said it can be malaps.
pass
9. CNS : Rt sided facial palsy and Rt side hemiplagia in 4 yr anxious child on the bed
covered . asked to examine face the go from there child wasn't cooperative initially then
with playing and making faces ahe laughed and there was the facial pulsy raised his eye
brows upper motor went for lower limb and the child was wearing tight jenes after undress
he was a little pit upset but consolable and praised his jenes ., didin't want to walk so asked
the father but still refusing and the father said he walked with aid then skipped the gait no
scar with hypertonia and hyperreflexia ,time was up told the examiner i want to complete
my exam doing so and sothen discussed diff.
child has big scar running through his forehead and child stroller beside him . forget to
mention trauma in diff.
pass
41
Riyadh - 11-2016
clear pass
clear pass

differentials
clear pass

8. MSK : rickets
42
pass
pass
43
Egypt exam 12/2016 :
1. CVS : complex cong. Heart disease./ aortic reguire (RHD).
2. Cns : spastic diplegia…..gulian barri
3. Msk : JIA.
4. Abd. : thalathamia e splenoectomy
5. Others : short stature.
6. Development : gross motor in CP./fine motor.
Common Egypt EXAM 11/2016

1. Development : fine motor in 5 yrs old girl, gave develop age of 3.5yr
2. CVS :pulmonary stenosis. In operated fallot (pink fallot).
3. RS and others : russel silver disease.
4. MSK: vit d dependant rickets type 2 , girl with alopecia and rackatic signs.
5. ABD.: hereditary spherocytosis.
6. CNS: left sided hemiplegia with NF1.
Common case in Egypt 2016 march :

1. CNS : double hemiplegia , 17 yrs boy has squint , abnormal gait , examine his L L.
2. Abdomen : 14 yrs e thyroid swelling.
3. CVS : VSD
4. RS: short stature ….. noonan.
5. MSK : arthrogroposis .
6. Development : fine and expressive speech.
44
CASES IN FEB 2017 :

1. CNS :
- HMSN.,
- RT. Side weakness
2. CVS :
- PS,
- VSD
3. RS /other :
- 1RY CILIARY DYSKINESIA .,
- marfan
4. ABD/other :
- GSD.,
- rt. Eye prothesis
5. MSK :
- HEMIHYPERTROPHY.,
- ehalors danlos syndrome.
6. DEVELOPMENT :
- FINE MOTOR OF CHILD POST CARDIAC TRANSPLANT WITH LEFT
HEMIPLEGIA.
- 2.5 yrs vision and fine motor.
CASES EXAM UK 12/2016:
1. Abd. Ex. :
- Task : hx of neonatal bilous vomiting. Please examine pt. abdominal system
- Finding :right transverse scar at right upper abdomen and scar at the left iliac fossa.
- Ask about : dd for the scar , sign of chronic liver disease
2. CNS ex.:
- Task : hx. Of premature baby please do CNS exam.
- Finding : diplegic CP.
- Question : causes , management.
3. CVS ex.:
- Task : do cvs examination
- Finding : ejection systolic murmur at ULSE , splitting
- Dd : PS/ASD
4. MSK ex.
- Task : do general examination for this child
- Finding : marfan syndrome
- Q. : complications and management .
5. Other ex.
- Task : examine pt. neck
- Finding : thyroid swelling in euthyroid state.
45
6. Development :
- Examine fine and growth motor.
- Finding : dysmorphic not pick up.
Cases in UK centre :
1. RS:
- Cystic fibrosis e portacath
2. CVS
3. ABD
4. CNS
5. MSS
6. DEVELOPMENT :
46
1. OMAN 2017:
47
COMMON CASE IN SUDAN:
2. Abdomen :
- sickle cell disease.:
- jaundice , pale , hepatomegally , no spleen.
3. CVS :cyanotic congenital heart disease ( clubbing + cyanosis + ejection systolic murmur
"ps")
4. RS : bronchaectasis.
5. CNS :
- sturge weber – cranial nerve examination.
- Hemiplegia " upper limb examination – difficult to write".
6. MSK :
- Raumatoid arthritis : Joint pain 15 yrs old.
7. OTHERS : graves' disease
8. Development : down – fine motor .
48
Riyadh - 11-2016
clear pass
clear pass

differentials
clear pass

8. MSK : rickets
49
pass
pass
51
Egypt exam 12/2016 :
7. CVS : complex cong. Heart disease./ aortic reguire (RHD).
8. Cns : spastic diplegia…..gulian barri
9. Msk : JIA.
10. Abd. : thalathamia e splenoectomy
11. Others : short stature.
12. Development : gross motor in CP./fine motor.
Common Egypt EXAM 11/2016

7. Development : fine motor in 5 yrs old girl, gave develop age of 3.5yr
8. CVS :pulmonary stenosis. In operated fallot (pink fallot).
9. RS and others : russel silver disease.
10. MSK: vit d dependant rickets type 2 , girl with alopecia and rackatic signs.
11. ABD.: hereditary spherocytosis.
12. CNS: left sided hemiplegia with NF1.
Common case in Egypt 2016 march :

7. CNS : double hemiplegia , 17 yrs boy has squint , abnormal gait , examine his L L.
8. Abdomen : 14 yrs e thyroid swelling.
9. CVS : VSD
10. RS: short stature ….. noonan.
11. MSK : arthrogroposis .
12. Development : fine and expressive speech.
51
CASES IN FEB 2017 :

7. CNS :
- HMSN.,
- RT. Side weakness
8. CVS :
- PS,
- VSD
9. RS /other :
- 1RY CILIARY DYSKINESIA .,
- marfan
10. ABD/other :
- GSD.,
- rt. Eye prothesis
11. MSK :
- HEMIHYPERTROPHY.,
- ehalors danlos syndrome.
12. DEVELOPMENT :
- FINE MOTOR OF CHILD POST CARDIAC TRANSPLANT WITH LEFT
HEMIPLEGIA.
- 2.5 yrs vision and fine motor.
CASES EXAM UK 12/2016:
7. Abd. Ex. :
- Task : hx of neonatal bilous vomiting. Please examine pt. abdominal system
- Finding :right transverse scar at right upper abdomen and scar at the left iliac fossa.
- Ask about : dd for the scar , sign of chronic liver disease
8. CNS ex.:
- Task : hx. Of premature baby please do CNS exam.
- Finding : diplegic CP.
- Question : causes , management.
9. CVS ex.:
- Task : do cvs examination
- Finding : ejection systolic murmur at ULSE , splitting
- Dd : PS/ASD
10. MSK ex.
- Task : do general examination for this child
- Finding : marfan syndrome
- Q. : complications and management .
11. Other ex.
- Task : examine pt. neck
- Finding : thyroid swelling in euthyroid state.
52
12. Development :
- Examine fine and growth motor.
- Finding : dysmorphic not pick up.
Cases in UK centre :
7. RS:
- Cystic fibrosis e portacath
8. CVS
9. ABD
10. CNS
11. MSS
12. DEVELOPMENT :
53
COMMON CASE IN SUDAN:
9. Abdomen :
- sickle cell disease.:
- jaundice , pale , hepatomegally , no spleen.
10. CVS :cyanotic congenital heart disease ( clubbing + cyanosis + ejection systolic murmur
"ps")
11. RS : bronchaectasis.
12. CNS :
- sturge weber – cranial nerve examination.
- Hemiplegia " upper limb examination – difficult to write".
13. MSK :
- Raumatoid arthritis : Joint pain 15 yrs old.
14. OTHERS : graves' disease
15. Development : down – fine motor .
54
Common case in other centre
COMMON CASES IN UAE :
1. CVS :
- Aortic stenosis "William syndrome"
- VSD (11/2016)
2. CNS :
- Spina bifida "arachonld chairi" examine lower limb.11/2016)
- Hemiplegia
- RT. Side hemiplegia (11/2016)
3. MSK :
- Rickets with deformity and alopecia "i.e VIT d dependent".
- JIA (11/2016).
4. GIT :
- Hepatomegaly + dilated veins but no spleen no ascites.
- Hepatomegaly with epigastric longitudinal scar"palor + jaundice"
- Abdominal scar – transplanted kidney(11/2016).
5. RESPIRATORY :
- Chronic supprative lung disease. (11/2016)
- CF e scar of meconum ileus(11/2016)
6. OTHERS :
- Girl with goiter.(11/2016).
- NF1 with sclosis.
7. DEVELOPMENT :
- Down syndrome for speech and hearing.
- Gross and fine motor in syndromic pt.
55
Common Videos of previous exams
RESPIRATORY AND ENT VIDEOS
1. (RS) neonate with RD , desaturated , on O2 by nasal canula ( video show micrognathai ,

cleft palate – "pierin robin syndrome" )
- what is next intervention ?
 nasophargeal airway.
 Intubation and ventilation.
2. (RS)2 year old with 1 day history of URTI followed by stidor which is not associated with
distress and baby was crying , on his back there was capillary haemangimoa otherwise
nothing important.
- What is the most diagnosis ?
 croup
 subglottic haemangioma
3. (RS) 3 years boy with 12 hours history of cough and difficult breathing (Video show barking
cough and stridor with no RD)
- what is organism?
 Para influenza
Comment : Parainfluenza (Croup is parainfluenza virus not toxic present usually in
theearly dawn with some coryaza symptoms.)
Epiglottitis with toxic look high grade fever, there will be drooling of saliva as well
haemophlus influenza bacteria
4. (RS)Child 1 yr with runny nose and temp 37.7 c , in video barking cough
- What is the diagnosis.?
 Croup " laryngeotracheo bronchitis".
- What investigation ?
 no investigation needed
5. (RS)8 months old with noisy breathing
- What is the most likely diagnosis ?
 laryngiomalacia
 choanal atrasia...
 croup .
6. (RS) mild stridor very happy.
- what is the management?
 no need medications
7. (RS)Child with mild to moderate stridor. …..Follow up
8. (RS)poor weight gain with stridor 1 month baby,
- what is investigation ?
 flexible bronchoscopy.
Comment : indication for investigation in laryngeomylacia are : weight loss
56
9. (RS)2yr h/o of TEF repair present with cough , barking cough , stridor , prolong expiration
- what investigation ?
 do nothing.
10. (RS)asthmatic patient received 3 nebs of salbutamol and atrovent and oral steroids still
wheezy saturation is around 93
- what to do next ?
 Offer oxygen
 I.v salbutamol?
 Back to back salbutamol
 mgso4-dexamesthasone-hydrocortisone-methylpredisolone
 nothing.
11. (RS) asthmatic pt. just came to ER on neb. tachypnic conscious PR 130 – SPO2 93 on
monitor
- what to do next
 nothing
 ABG
12. (RS)preterm baby distress admitted for poor feeding brother having URTI no hepatomgaly ,
systolic murmer ?
- what is diagnosis ?
 chronic lung disease.
 Bronchiolitis.
13. (RS) Acute bronchiolitis with moderate distress , with hypoxia and hypercapnia
- What to do next ?
 Ipratropium.
 NCPAP.
14. (RS)Baby with distress, NG tube insitu, Oxygen Nasal canula and coughing.......
- What is the diagnosis ?
 Bronchiolitis
15. (RS)8 months stable child with bronchiolitis.
- What next step ?
 per nasal swab .
 none of above.
16. (RS)8 year old girl/boy with cough , fever Reduced chest expansion on left side. On
auscultation diminished air entery and Bronchial breathing and dull percussion note on left
scapula area. History of 10 days fever in spite of oral antibiotics.
- What is diagnosis ?
 Left pleural effusion.
 Left lobar pneumonia
17. (RS)Chest x ray in a child boy with cystic fibrosis and with wheezes , sudden deterionation
not respond to IV antibiotics with esinophelia ...
57
 allergic bronchopulmnor aspergollosis ..
- what is the ttt ?
 steriod
18. (RS)Whooping cough ..
- What is best investigation ?
 pre nasal swap
- What is ttt ?
 Azithromycine or erythromycin
19. (RS)Girl with cough with sputum persistently received erythromycin for 10 days , without
improvement
- What is next step?
 no treatment will her .
 clarithromycin high dose for 10 days.
20. (RS)Down with resp distress ... bronchilitis or heart failure ... according to history
21. (RS) Small child coughing at night
- what to do next ?
 CPAP .
 Anti reflux .
 nothing
22. (ENT) pus from external auditory meatus , in child with OM 3 days back now temp 37.4c
- what to do next ?
 iv antibiotic
 oral antibiotic.
 Urgent CT.
 Nothing
 ENT referral after 3 weeks.
 swab and Culture
comment : CT scan in perforated tympanic membrane in AOM only indicated if
there is major complication like cavernous sinus or facial nerve palsy.
23. (ENT)18 months old previously well,you have been called in ED,child sitting in mum's lap
with dummy in mouth, inspiratory stridor, and recessions, no indication of fever or drooling,
 Foreign body.
 Epiglottis,
 tracheolaryngitis,
 croup etc
24. (ENT) A case with sudden onset of stridor and cyanosis 2 years old and chest x Ray showing
coin shadow at the level of C4 ,
58
- what to do next?
 rigid bronchoscopy
 Flexible bronchoscpy
25. (ENT)child with retching and coin in CXR in last 10 sec of videos
- what to do next
 calling ENT
 calling general anesth.
HAEMATOLOGY VIDEOS
26. (haematology) Child with purpura and hx of URTI ………

 ITP.
27. (haematology)Little girl with purpuric rash lTP.
28. (haematology) Child with extensive rash of ITP.
- What is Management ?
 Weekly follow up.
29. (haematology) Pancytopenia with febrile neutropenia in ill child with HGB 5
- what ur first choice ?
 IV antibiotic
 IV blood transfusion
30. (haematology )Neonate with petechae rash just after delivery baby generally well
- what action to do.?
31. (haematology)Baby with low platelet and mother was normal platelet his platelet was 2000
- What is best action?
 HPA negative platelet.
32. (haemtology )a boy 5 year old known to be haemophilea A (didn't specifiy how sever) had
history of falling and minor head trauma with picture of contusions and superficial
lacerations , but no active bleeding , baby was active smiling and calm with no history of
neither vomiting ,DCL nor haemodynamic stability.
- what to do next ?
 admission for neurological observation.
 give factor 7
 give factor 8
 factor 9
 give tranexmic acid
 just bandage.
 give cryoprecpitate
 FFP .
59
Comment : tranexmic acid is only used in Gum bleeding or idopathic ipistaxis in
haemipohilic patient but any trauma to head for haemophilc A patient it's
mandiatoryto give him factor 8 please take care because there is a voice lecture
uploaded here for one of colleagues insisting on selection of doing nothing
33. (haemtology )4 yr girl drinking milk since birth , Hb 4 gm/dl , no signs of distress , with
feature of iron def anemia ,
- what treatment?
 Oral iron
34. (haematology ) 6 weeks Child presented with general fatigue and tiredness (in video recived
bottle feeding) , Hb: 4.1 , mch 58 , normal wbcs and platelets
 Feritin level.
35. (haematology)11 years girl brought to ER by her stepfather with history of multiple bruises.
normal CBC and Coagulation profile (Video show well girl with multiple bruises in arms
and legs)
- what next action?
 Skeletal survey.
 Bone marrow .
 none of the above
 platelet function .(VWF Disease)
36. (haematology)Pt. with tracheostomy , although good care but still have difficulty with
breathing. Face of pt. with infected big haemingioma like sturge weber.
- What will do to help him ?
 steroids inhaler
 antiviral
 antibiotics ?
 salbutamol
 CPAP.
Comment : Infected cavernous hemangioma needs antibiotics for infection and

plastic surgeon input .
37. (haematology)newborn preterm multiple progressive lesions increase in size " capillary
haemgioma" in scalp , upper eyelid abdomen ?
- what is treatment ?
 oral propanolol
38. (haematology)A child with ITP and low platelet count but active ...
- What is treatment ?
 wait & observe.
61
CARDIOLOGY VIDEOS
39. (CVS)CXR of dextrocardia …….

- What is the next step ?
 Echocardiography
40. (CVS) preterm neonate with stethoscope and you could hear continuous murmur
- what is the diagnosis?
 PDA.
41. (CVS) 14 years old boy. video is record of auscultation with systolic murmur radiated to the
neck .
 aortic stenosis
- what expected complications ?
 angina .
 sudden death
42. ( CVS) young boy tall fingers and elongated face ( look like marfan) with AS murmur and
thrill over neck …
- what complications may occur ?
 Sudden death
 aortic aneurythm.
43. (CVS)Pt. with TGA sp O2 84-82% , with yesterday septostomy .
- what to do next ?
 reassure parents.
44. (CVS) Down syndrome big boy clubbed cyanosed pansystolic murmur in LLSE
 Essmenger syndrome
 TOF.
 AVSD.
 Pulmonary HTN.
45. (CVS) 3 /6 months old baby on ventilator , central sternotomy scar and continuous murmur
on rt. Infra clavicular side . saturation is 86%.
- What diagnosis ?
 BT shunt.
 Fontan shunt at 3-4 yrs.
Comment : BT shunt can be through sternotomy scar , or lateral thoracotomy
scar., sat in BT shunt b/w 80-90%.
If the murmur is systolic ejection...it is not a BT shunt. Can be TOF correction
with residual murmur. But saturation should be 95% and above...Because total
correction. So the saturation is a must know.
61
ENDOCRINE VIDEOS
46. (endocrine)2 years old child sitting on a chair, trying to look around ( blind) , short
, patient came with hypoglycaemia "Case was septo optic dysplasia "
- what treatment you do ?
 increase glucocorticoid and mineralocorticoid
47. (endocrine) Obese child e striae ( cushing syndrome)
- What is Diagnostic test ?
 Dexamethazone suppression test.
48. ( ENDOCRINE) girl with chorea and thyroid eyes and very minimal bulging in the neck
- What investigations?
 TFT.
- what treatment ?
 carbimazole.
49. (endocrine) 8 years old girl with significant acidotic breathing "kaussmal breathing( DKA)"
and history of polyuria and weight loss , with abdominal pain and altered consciouseness .
- What is Initial management ?
 normal saline bolus.
- What direct cause of death ?
 cerebral oedema.
 Dehydration
 Shock.
- what to do next ?
 RBS.
 ABG
 CBC
 CXray.
Comment : blood sugar (If you did gas you will confirm acidotic breathing but still cause
is not clear ,while if u did RBS u know at least 2 out of 3 diagnostic criteria for DKA, and
by theway not all machines having glucose in it and also not availabe in lot of facilities.).
Nephrology videos
50. ( renal) Nephrotic girl anasarca ascitis effusion lower limbs edema CRT 4 high blood
pressure tahchy cardic
- what is first treatment ?
 bolus NS 10 ml/kg
62
51. (renal) Girl with URTI and took amoxil for 5 days with no effect, came with B/L periorbital
swelling and Abd distension on video (nephrotic syndrome).
- What immediate investigation ?
 Urine anylasis.
 s/albumin.
 S/cholestrerol.
 USS
52. (renal) Yong girl with buffy face and LL oedema and proteinuria , Vital signs stable ...
capillary refill < 2 sec. Video show +ve shifting dullness.
- What is the ttt ?
 60 mg / m2 prednisolone daily.
53. (renal) 6 year old boy with history of atopy and asthma, and family hx. Of hay fever
developed URTI 2 days back , receive antibiotic . present with puffiness of eyes started one
day and LL edema (pitting one)
 nephrotic syndrome
 C1 estrase inhibitor .
MSS VIDEOS
54. ( MSS)2 year old stable child pain on walking .look like irritable hip.
 Discharge without follow up.
 discharge with follow up
55. ( MSS) girl with left knee swelling for one week , she is non toxic , h/o of fever , run normal
after examination
 Reactive arthritis
56. ( MSS) Video show girl playing , hand showing proximal interpharngeal joints swelling and
redness , high ESR , WBCs count " JIA"
- what treatment?
 NSAID
57. (MSS)URTI in a child with joint pain & normal lab
 Transient Synovitis
58. (MSS)3 yrs old with antalgic gait mom concerned about limping gait for the last 2 months
only
 Perthes disease
 DDH ( appear from the start).
 Other DD of limbing gait.
63
59. (MSS)Afagani/ pakastani boy about 3 yrs in age with his father ricket manifestation " bow
leg and swelling wrist "
 nutritional .
 x-linked hypophsophataemic rickets.
- What investigation?
 Wrist x-ray.
60. (MSS)baby with loss pectoralis major.

- What is Diagnosis ?
 poland syndrome
61. (MSS)Pre teen boy in ED with swollen knee after a fall from tree, noted to have bruises and
healed paper this scaring of skin on video .
- What is the diagnosis?
 Ehlor Danlos syndrome.
62. (MSS)A child with joints hypermobility ,,, 2scenario
- What diagnosis ?
 Ehlerdanol syndrome (if without glasses)
 Marfan syndrome (if with glasses).
- What is mode of inheritance ?
 AD.
63. (MSS) a 3 years old child with unilateral neck swelling
 Lymph Node.
64. (MSS) redness and swelling behind the ear in small child ,
 CT scan.
65. (MSS)Child had URTI then after few days abnormal swelling in sub mandibular and another
one was in midline of neck with a blue tounge and abnormal voice .
 branchial cyst
 heamangioma
 caffe syndrome.
66. (MSS)neonate with neck swelling lateral aspect of the neck
 cystic hygroma
- What is complication ?
 airway obstruction
67. (MSS)Child with neck mass mainly…… torticollis.
68. (MSS)Neck swelling …. Mumps?
69. (MSS)Obese neonate with swelling in the neck ,
64
- what investigations you will do?
70. (MSS)large red swelling in rt side of neck in well child
- What is diagnosis
 Parotitis
 lymphedenitis
71. (MSS)Pt. with swelling in shaft of tibia , baby is febrile , he can stand and crawling ,not pain
full , skin is erythametous
- What is the cause of swelling?
 Fracture.
 cellulitis .
 osteosarcoma.
 ewing sarcoma.?
 oesteomylitis.
 Reassurance.
72. (MSS)a kid 2-4yrs with limping gait and swollen 1 lower limb when the swelling is pressed
the kid did not mind .
 osteomyelitis Vs cellulitis?
Dermatology videos
73. (derma)Baby received MMR vaccine before 1 month came with extensive blanching
erythema (in video) . vitally stable , feeding well
- What is next step in management?
 reassurance
74. (derma) 2 weeks old baby referred by health visitor with skin lesion ( Video show just Rt
hand with bustules (boil) and erythema ).
- What is it ?
 Epidermolysa Bulosa.
 Pustules.
 Boils .
 herpes .
 staph infection
75. (derma ) Small child with peanut allergy. Clinically stable. But hives and itching.
 oral antihistamine
76. (derma )2 year old baby who developed allergic wheels after ingestion of antibiotic with no
other signs of distress nor haemodynamic instability
- what to do ?
 dexamethasone.
 hydrocortisone.
65
 methylpredesolone.
 oral chlorophenramine-
 oral predisolone.
 send home.
77. (derma )Infected eczema …..
- What is the treatment ?
 penzile pencilline + flucoxthaline .
78. (derma)Infant with rash around mouth anus and foot "acrodermitis enteropathica"
- What treatment ?
 zinc .
79. (derma)10 y old child with a blister/vesicle skin lesion "shingle" on one side "one
dermatomal supply" hypotonia and hyporeflexia
 herpes zoster
 herpes simplex virus .
80. (derma )ataxia with rashes investigation distressed infant with O2 sat 93 %
- What is initial management ?
81. (derma )Child with shingle ,
- what is treatment?
 Oral acyclovir .
 iv acyclovir .
 antibiotics.
 steroid
82. (derma)A well looking boy with couple weeks history of multiple reddish, scared, lesions
suggestive of Bulous impetigo around lips and on rest of feet including feet, child was smiling
and picking up skin in videos.
- What choice of antibiotics ?
 IV acyclovir
 Oral Flucloxacillin.
 IV flucloxacillin.
 Co amoxiclav .
Comment : Oral Flucloxacillin as child look well to me though lesions
were extensive.
83. (derma)Infant with scalded skin but well no fever ,,,,management.

84. (derma)There was a strange video of atoddler miserable walking around the room in nappy I
think to see the gait then ten sec to the end same baby of the itchy rash in arms and back
85. (derma)Scarlet fever .
86. (derma)slapped cheek disease.
87. (derma)Steven jhonson
88. (derma)Child with rash after drug therapy……..ssss
66
89. (derma)Infant with generalized skin rash
90. (derma)skin rash after urti …….erythema multiform
91. (derma) Neonate with rash is of concern of nurse and parents , vitally stable ,well feeding.
- What is next action ?
 Reaasurance (looks like erythema toxicum)
92. (derma)10 year old girl with rash on body ? Like scratch marks .
 eczema .
 NAI .
93. (derma )Black Child presented with status epilepticus and hypopigmentation.
 Hypomelanosis of ito.
94. (derma)Generalized Rash for 2 weeks in a young infant girl with Ataxia while sitting ,finger
nose and past pointing was there plus i could see healed chicken pox rash------
 Varicella cerebellitis.
95. ( derma) Young boy post chicken pox , 3weeks later present with unsteady gait and signs of
cerebellar ataxia .
- what investigations ?
 viral serology
 CSF isolation of the organism
 no need for investigation .??
 varicella titre.
INFECTIOUS VIDEOS
96. 3 years girl with fever for 3 weeks not responding to one week course of amoxacillin ...
Hb=11.2 WBC=16 PLT=635 with high ESR and CRP
97. (infectious)Infant with lymphadenopathy , hepatosplenomegaly
 disseminated BCG
98. (infectious)baby who is doing very well with history of low grade fever and diarrhea , flue
symtoms , on video having non blanching rash and active , non-toxic
- what to do next ?
 iv acyclovir.
 antibiotic
 antihistamine
 antipyretics and discharge
 admission and work up
67
comment : petechial rash management plan, we often see children with balanchable rashes but
clinically well as GP usually feel undecisive about such rashes, in that case it all depends on clinical
presentation if child looks unwell with high grade temperature and tachycardia we usually do blood
investigations and decide about antibiotics after certain period of observation or blood results.
99. (infectious)Cervical LN ... cat scratch disease

100. (infectious)Scabies
101. (infectious) treated as meningitis and next day child very ill.
- what investigation?
 plasma osmolarity ( SIADH)
102. (infectious) HSP …..
- what important investigation ?
 urine full examination and microscopic examination
103. (infectious)6 month child e fever for 5 days , T. 39C , no spleenomegally , no LN. , in video
showing the rash .
 Measles
 kawaski
104. (infectious )a child with fissure lip , fever for 10 days non purulent conjunctivitis .peeling
of skin .
 kawsaki disease.
- what specific treatment?
 IVIG .
 aspirin
- what expected on bloods ?
 low platelets .
 high platelets.(on 3rd week).
 high ESR,
 High CRP,
 High WBC
105. (infectious) EBV infection with palatal haemorrhage
- What is management ?
 reassurance
106. infectious) Big boy with exudate in his tonsils and hard and soft palate peticial
hemorrhage…..
 glandular fever (infectious mononucleosis) .
107. (infectious )Hand foot mouth syndrome ...
- What is cause ? Coxackie virus
68
108. (infectious) pt. with chorea after 4 weeks URTI
 antistreptolysin .
 nothing
NEUROLOGY VIDEOS
109. (CNS)Infant 9 month become unable to sit unsupported (regression) , in video

 Infantile spasm .
 landu-kliffer syndrome.
110. (CNS)Infant with infantile spasm……
 EEG
- What treatment ?
 vigabatrin or prednisolone.
111. (CNS) Pt. with status epilpticus given lorazepam , and prepared for intubation/intubated –
in video abdomen distended …..
- what next step ?
 insert NGT.
112. (CNS)A child with a limb then there is MRI of Spine ...
 Tethering of the cord
113. (CNS)Boy new onset abnormal gait looked like unilateral high stepping gait for 2 month
- What is best investigation ?
 MRI spine .
 nerve conduction study .
114. (CNS)10 years old boy returned from Pakistan 2 days ago, not able to walk, on video dr
and mum were holding and he was not bearing weight, on examination ( hypotonia and
hyporeflexia and reduce power of both LL , child was conscious " GBS "
- What investigation to monitor progression ?
 Spirometry
115. (CNS)young female lying in bed and on examination showing hyporeflexia , hypotonia
(other scenario patient with foot drop gait).
 guillane baree syndrome.
116. (CNS)child with scoliosis and huff of hair at the cervical region. ex show UMNS
 MRI spine
117. (CNS) child crying and withhold breath with jerking movement ,
69
- what is the diagnosis ?
 breath holding attack
118. (CNS)Neonate present with floppieness and refuse of feeding ..management.
119. (CNS) hypocalemia with carpopedal spasm ..
 IV calcium
 Name the sign …… Govestick sign on stimulate the face
 Trousse sign ….. on inflating the BP cuff on the arm
120. (CNS)newborn birth truma… erbs palsy.
121. (CNS)4th cranial nerve infection
122. (CNS) Child couldn't follow finger outside
- What is diagnosis?
 RT. Abducent nerve palsy
- What is investigation ?
 MRI brain
123. (CNS )Facial nerve palsy e skin rash " ramsy hunt"
- What is management ?
 acyclovir
 steroid
124. (CNS)boy 9 year old with facial palsy on the right side with maculopaplular rash on the
face " erythema migrans".
- what to do ?
 CT scan.
 Lyme serology.
 start steroids.
125. (CNS )a fair boy 13 yrs old with sudden development of LMN FACIAL PALSY. i noticed a
reddish cheeks n face generally .
- what initial investigations?
 CT brain scan.
 MRI for acoustic auditory canal.
 Screening for HSV.
- What is most important to protect the eye ?
 artificial tear
OPTHALMOLOGY VIDEOS
126. (ophthalmology )Conjunctivitis not responding to fluxaciilin with vesicles around eye
 HSV .
 varicella .
127. (ophthalmology)Neonate 9 days present with eye discharge ,
71
- what is causative organism ?
 Chlamydia tracheomitis
 n.gonnorhea.
- what is treatment ?
 erythromycin
128. (ophthalmology)Eye discharge not respond to floxacillicin…….

 herpes simplex.
129. (ophthalmology)Eye swelling with low grade fever or + CRp (periorbital cellulitis )
 IV antibiotics
130. (opthalmology) Girl with swollen rt. Eye lid and fever , hx of urti
 periorbital cellulitis .
 sinusitis.
 orbital cellulitis.
131. (ophthalmology ) orbital cellulitis
- what to do next ?
 CT scan
Gastroenterology and others videos
132. (GIT)2yrs old child with FTT and wasted buttocks and distended abdomen
 celiac disease.
133. (GIT) 3 week old baby with scar in Rt subcostal area with a tinge of jaundice ( look like
kasai)
 biliary atresia.
- what complication?
 liver abscess .
 ascending cholangitis.
 Peritonitis.
 wound infection
134. (OTHERS)Increased nuchal thickness in a sonar ;

- What is diagnosis ? Down syndrome
135. (OTHERS)Neonate with features of down ,…
- What investigation ? Karyotyping
136. (OTHERS)syndromic baby…….
71
- What is the diagnosis ? mostly turner or pradder willi?
137. (OTHERS)shocked child
- What to do ? ABC(airway+iv line fluid)
138. (OTHERS) 2 year old baby, mother came to OPD complaining that today morning he was
not active is the morning and lazy when she wake him up then video showing developmental
motor and neurological examination of the baby , the question is
- what do do ?
 admit the baby.
 discharge and give him follow up visit.
 discharge without follow up.
 start work up .
139. (OTHERS)Neonate in NICU with dehydration…….
72

Khidir Development

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1

Prepared by Dr.Mohammed Abdalla Khidir

(1) GROSS MOTOR DEVELOPMENTAL ASSESSMENT

i. MORE THANE 1YEAR:

A)movements( Ask him to walk/run/jump/stand):

B) Give him a Ball:

C) Ask him to climb stairs:

N/B: child manner…….2feet/step.

D)Ask him to ride a tricycle:

E) climb furtunre (CHAIR or TABLE):

 stand. Holding onto object.

b) Test the primitive reflexes basic 8 (2each):

(2) FINE MOTOR DEVELOPMENTAL AND VISION

1. MORE THAN 1YEAR:

2) Building of bridge/ train and steps:

 Draws 3 parts in draw a man test…..3years.

 Draws 4parts(+head) in draw a man test…..4years.

 Draws 8parts(+head) in draw a man test….5years.

C)Scissors and paper:

D) Beads and threads:

 Fix 2 simple shapes :circle and square……2years.

2. LESS THAN 1YEAR:

(3) ASSESSMENT OF SOCIAL MILESTONES

1. MORE THANE 1YEAR:

3. Solitary play(he plays alone)………..0 -2year

C) Care (by history only):

(4) ASSESSMENT OF HEARING AND SPEECH

1. Call him by name (from behind):

7. Ask him to count from 1 to 10.

 Points to 3parts of body " name 3 body parts "…..18 month.

B) say and understanding of words:

 Understands words and say only mam - bab……….1year.

C) Assess concentration and attention:

D) Assess picture recognition and selection:

b) LESS THAN 1YEAR:

 Discussion of the case

- Carefull listening to the examiner questions.

What investigation of the child?

What is management plan?

Common cases in development station

(5) FINE MOTOR DEVELOPMENTAL AND VISION ASSESSMENT

6. MORE THAN 1YEAR:

4) Building of bridge/ train and steps:

J) Scissors and paper:

K) Beads and threads:

7. LESS THAN 1YEAR:

N) Pincer grip (Hundreds and thousands , or make a small paper):

Discussion of the case

- Carefull listening to the examiner questions.

What investigation of the child?

What is management plan?

- community pediatrician…….is the key person and team leader.

HOW TO ASSESS DEVELOPMENT IN THE CLINICAL EXAM

(6) GROSS MOTOR DEVELOPMENTAL ASSESSMENT

iii. MORE THANE 1YEAR:

A)movements( Ask him to walk/run/jump/stand):

- in adult manner : ( 1 foot / step)

D)Ask him to ride a tricycle:

E) climb furtunre (CHAIR or TABLE):