Appearance of normal Tonsils and Inflamed Pharyngeal Tonsilitis

Normal tonsils can be small and not visible or quite prominent when checked in a mirror.

When the tonsils are small (as in young babies and in most adults) they are barely visible. Between the age of two and five,the tonsils peak in size and may be large enough to touch each other. It is normal for a young child to have large tonsils, and if they appear normal and are not causing any problem (such as sleep apnea), the size of the tonsils alone is generally not a concern.

If the tonsils are infected with a bacteria, they will usually get large, turn somewhat red, and may have some yellowish-white debris on the surface. This would be called bacterial tonsillitis, which is one kind of sore throat. Appearances can be misleading, since there are some viruses which can make the tonsils look like this or worse. Teenagers with infectious mononucleosis (a condition usually caused by infection with the Epstein-Barr virus) have particularly severe symptoms, with very swollen tonsils covered with debris, yet antibiotics are not needed for this disease. On the other hand, the "strep" bacteria can be present in a normal looking throat. The only way to be sure is to do a throat culture, although there are other tests which may suggest a bacterial infection.

Appearance of Epstein pearls in the mouth of newborn infants

Epstein's pearls are very common and benign small white or yellow cystic vesicles (1 to 3 mm in size) often seen in the median palatal raphe of the mouth of newborn infants (occur in 65-85% of newborns).

It represents epithelial tissue that becomes trapped during the palatal fusion. On palpation, these are firm papules that can be appreciated when the infant is sucking on the examiner's finger. They do not require treatment as they resolve spontaneously over the first few weeks of life.

Epstein Pearl in 5 week old infant

Appearance of Sunset sign in infant eyes

 The sclera are visible between the upper eyelid and the iris,Sunsetting sign is seen usually in hydrocephalus due to loss of upward conjugate gaze caused by raised intracranial pressure (ICP)

The setting-sun phenomenon is an ophthalmologic sign in young children resulting from upward-gaze paresis.......................

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Characteristic appearance of the rash of Henoch-Schonlein purpura (HSP)

Henoch–Schonlein purpura

Henoch–Schonlein purpura (HSP or anaphylactoid purpura) is the commonest childhood vasculitis, with an incidence between 13.5 and 24 per 100000 children under 14 years old, falling with
increasing age. "Vasculitis is a general term that refers to the inflammation of arteries, or blood vessels".
It is a multisystem disorder affecting the skin, joints (in 60–84 %) particularly ankles and knees, gastrointestinal tract with pain and gastrointestinal bleeding, and kidneys. The aetiology is unclear although preceding infection, particularly upper respiratory tract infection; there is a seasonal variation in incidence supporting an infectious aetiology. No single organism has been found to be associated with HSP.

For most children, Henoch–Schonlein purpura HSP is diagnosed by the appearance of the rash......purple, bruised rash on legs, buttocks or elsewhere. This is caused by red blood cells that leak out of the damaged blood vessels.

 The palpable purpuric rash of Henoch–Schonlein purpura in the classic distribution around the lateral malleoli,the ventral aspects of the feet,the buttocks and the extensor aspects of the legs.The rash may start with urticaria.

Joints: painful, brief swelling. The joints most frequently affected with pain and swelling are the ankles and the knees. Usually this only lasts from 1-3 days in the individual joints. Sometimes whole limbs will swell. The inflammation does not cause crippling arthritis.

Intestines: mostly abdominal pain, but can also include loss of appetite, diarrhea, vomiting and occasional blood in stools. Rarely, patients develop an abnormal bowel folding called intussusception.

Kidney: a significant number develop nephritis with an estimated 1 per cent developing endstage renal failure. 5 to 15 % of children requiring dialysis have Henoch–Schonlein purpura.

How to Remember The Fallot's tetrology, triad and pentad - A different Medical mnemonic

Medical Video mnemonic, showing a different way to remember the components of fallot's tetrology, fallot's tetrad and pentad.

Diagram shows Assessment of the seriously ill child

Photos of Salmon Patches in neonates

Salmon patches are commonly seen in the newborn period ,Salmon patches are more common in Caucasian populations. Alternative terms are naevus simplex, "angel kisses" (when on the forehead or eyelids), and "stork bites" (over the nape of the neck). They are midline malformations consisting of ectatic capillaries in the upper dermis with normal overlying skin.

Most will resolve over the first couple of years of life, but some - especially the nuchal lesions - may persist into adulthood.

It is important to differentiate salmon patches from port-wine stains (PWS). PWS are more lateral, do not resolve, and may darken and thicken with age. Some haemangiomas over the eyelid may also start as a faint erythematous patch before developing into a more typical haemangioma.

Spinal Vascular Malformations

Manual of Neonatal Care (Spiral Manual Series)

This Spiral(R) Manual provides a practical approach to the diagnosis and medical management of newborns. Chapters cover maternal, fetal, and neonatal problems and common neonatal procedures. An outline format provides quick access to a large amount of information, and the outline headings are standardized in this edition. The updated coverage includes new information on fetal assessment, survival of premature infants, and perinatal asphyxia and new guidelines on neonatal jaundice. The popular appendices include effects of maternal drugs on the fetus, maternal medications during lactation, and NICU medication guidelines. A neonatal dosing chart and intubation/sedation guidelines appear on the inside covers

Vascular ring and Double aortic arch

What is vascular ring ?

vascular ring is a malformation of the aortic arch that results in vascular branches or major blood vessels encircling the trachea and esophagus. In the double aortic arch (one of the most common vascular ring malformation patterns)It is most often due to persistence of the double aortic arch "right-sided aortic arch is present" after the second month of fetal life.

The two arches surround the esophagus and trachea which, if sufficiently constrictive, may cause breathing or swallowing difficulties.

In other vascular ring malformations, vascular remnants such as the ligamentum arteriosum (formerly the ductus arteriosus) may be part of the ring encircling the trachea and esophagus.

The esophagus and trachea are both compressed by the vascular ring made by malformation of the brachial arch vessels.

Caring For a Newly Circumcised Baby

Assessment of Head injuries in children

Perform a primary survey and ensure that the child’s airway, cervical spine, breathing and circulation are secure.

Rapidly assess the child’s mental state using the AVPU scale. Use firm supraorbital pressure as the painful stimulus.

* A Alert
* V Responds to voice
* P Responds to pain
----> Purposefully
----> Non-purposefully :

•  Withdrawal/flexor response
•  Extensor response

* U Unresponsive
Assess pupil size, equality and reactivity and look for other focal neurological signs.

Perform a secondary survey looking specifically at:

* Neck and cervical spine – deformity, tenderness, muscle spasm
* Head – scalp bruising, lacerations, swelling, tenderness, bruising behind the ear (Battles sign)
* Eyes – pupil size, equality and reactivity, fundoscopy
* Ears – blood behind the ear drum, CSF leak
* Nose – deformity, swelling, bleeding, CSF leak
* Mouth –dental trauma, soft tissue injuries
* Facial fractures
* Motor function – examine limbs for presence of reflexes and any lateralising weakness
* Perform a formal Glasgow Coma Score
* Consider the possibility of non-accidental injury during secondary survey especially in infants with head injury.
* Other injuries

Duchenne muscular dystrophy and Gower sign

Duchenne Muscular Dystrophy is a common sex-linked recessive trait appearing in 20 to 30 per 100,000 boys. The disease results from absence of a large protein called dystrophin that is associated with the muscle fiber plasma membrane.  
Becker muscular dystrophy arises from an abnormality in the same gene locus that results in the presence of dystrophin that is abnormal in either amount or molecular structure. It has the same clinical symptoms as Duchenne dystrophy, but onset is later, and progression is slower.

Clinically Manifested at about 2 to 3 years of age, boys develop an awkward gait and an inability to run properly. Some have an antecedent history of mild slowness in attaining motor milestones, such as walking and climbing stairs.
By Examination .......> firm calf hypertrophy and mild to moderate proximal leg weakness exhibited by a hyperlordotic, waddling gait and inability to arise from the ground easily. The child typically arises from a lying position on the floor by using his arms to "climb up" his legs and body (Gower sign). Arm weakness is evident by 6 years of age, and most boys are confined to a wheelchair by 12 years of age. By age 16, little mobility of arms remains, and respiratory difficulties increase.
Cause of death :Pneumonia or congestive heart failure resulting from myocardial involvement.

Gower's Sign:

Practical Paediatric Problems: A Textbook for MRCPCH

The problem based approach of the book presents the reader with a slightly different perspective from that found in the traditional system based textbook. Junior doctors deal with and learn from dealing with children with problems – so this textbook with its alternative approach will be a useful additional source of advice and help to many starting off their careers in paediatrics.

This innovative text, modelled on the current RCPCH syllabus for paediatric training, provides all the information that the senior house officer and specialist registrar in paediatrics will need during training and when preparing for the MRCPCH examination. A series of chapters discussing general principles in paediatric medicine is followed by a section covering the problems associated with the major body systems. Each chapter within this latter section is divided into three elements. Element A covers the background basic science to the particular problems being discussed in the chapter, including basic embryology and anatomy, biology and physiology. A description of the techniques involved in investigation where these will be critical to the diagnoses that follow is also included here; Element B presents the core system problems for the chapter. Tables are provided to summarise the different causes, classifications and differential diagnoses, clinical features, key investigations, therapeutic options and outcomes. Concise supporting text provides more detailed information where appropriate. Selected short case histories are also included to highlight the key issues covered in the chapter. Element C is a concise bibliography, incorporating a short series of key primary papers and review articles and suggestions for further reading. Subjects covered under general principles include developmental paediatrics, behavioural issues and learning difficulties, community paediatrics and clinical pharmacology. Clinical chapters include the respiratory, cardiovascular, endocrine and all other body systems. Haematology, oncology, psychiatry, surgical problems and tropical paediatric medicine are also covered here. All chapters contain up-to-date and appropriate information written by practising paediatricians who are each acknowledged specialists in their own field. This textbook will fast become an indispensable guide to the specialty for all trainee paediatricians in preparation for the MRCPCHexamination and beyond .

APGAR Scoring for Newborns

Click on diagrams for enlargment

A score is given for each sign at one minute and five minutes after the birth. If there are problems with the baby an additional score is given at 10 minutes. A score of 7-10 is considered normal, while 4-7 might require some resuscitative measures, and a baby with apgars of 3 and below requires immediate resuscitation.

Illustrated Cephalohematoma Vs Caput succedaneum

Cephalohematoma is a collection of blood under the periosteum of a skull bone "very tough tissue covering that encapsulates bones"
Because of its location,.................

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Pediatric Vital Signs; Normal values

Respiratory rate at rest

Age (years)........................Respiratory rate (breaths/min)
<1 .........................................30–40
1–2 .....................................25–35
2–5 .....................................25–30
5–12 ...................................20–25
>12 .....................................15–20

Heart rate

Age (years) ........................Heart rate (beats/min)
<1 .......................................110–160
1–2 .....................................100–150
2–5 ......................................95–140
5–12 ....................................80–120
>12 ......................................60–100

Systolic blood pressure

Age (years) ........................Systolic blood pressure (mmHg)
<1 ........................................70–90
1–2 ......................................80–95
2–5 ......................................80–100
5–12 ....................................90–110
>12 ......................................100–120

Pediatric orthopedic examination

Intended to detect congenital anomalies of the musculoskeletal system and reassure parents their baby is healthy. This is a demonstration of a real-time physical examination in the nursery setting.