Drug Induced Dystonia

P-1. 6-year-old patient had spasmodic conjugate

deviation of the eye upwards accompanied by
synergistic movement of head and neck
(Occulogyric crisis). This abnormal posture was
caused by receptors.drug metachlorpramide, a
nonphenothiazine antiemetic that blocks post
synaptic dopamine

P-2. Two-year-old boy presented with abrupt onset

of dystonia of neck with up rolling of eye ball, he
has received injection metachlorpramide for
vomiting

PHENYTOININDUCED GINGIVAL
OVERGROWTH

Transillumination test

Note the transillumination over the skull

LARGE HEAD (MACROCEPHALY)

P-1. A neonate with hydrocephalus at birth.

P-2. A neonate with Hydranencephaly

JOUBERT SYNDROME

P-1. A one-year-old child presented with

prolonged pyrexia. He was first issue of
nonconsanguinous marriage. He had history of
periodic tachypnea and apnea. Note the hypotonia
and postaxial polydactyly of fifth toes, occulomotor
apraxia and abnormal eye movements

P-2. Fundus examination revealed coloboma of disc

and choroids.

P-3.CT Scan head revealed vermian agenesis and

Molar tooth sign

P-4.

LISSENCEPHALY

There is smooth thickened cortex with diminished

white, there was absent sulci and gyri of the
brain.

AGENESIS OF CORPUS CALLOSUM

P-1. CECT head depicting selective dilatation

of trigones and occipital horns of lateral
ventricles. There was a high riding third
ventricle with radial spoke like arrangement
of gyri.

P-2. MRI head-hypoplasia of corpus

callosum.This11-month-old patient was put
onto long-term anticonvulsants

MICROCEPHALY

P-1. Small sloping forehead with head

circumference below 2 SD. Clinically patient
was exhibiting features of spastic cerebral
palsy

P-2.A patient with gross microcephaly and

mental retardation

INIENCEPHALY

the extreme retroflexion of neck and

rechischisis of cervico thoracic spine

ANENCEPHALY

P-1. Anencephalic baby with occipital

encephalocele and attached placenta.

P-2.Anencephalic still born note the loss of

cranial vault and peeping brain matter

SINCIPITAL MENINGOENCEPHALOCELE

P-1. Sincipital meningoencephalocele.

P-2. Sincipital encephalocele in one month old

SPINA BIFIDA

P-1. lumbosacral Meningomyelocele

P-2.Cervical meningomyelocele

P-3.Thoracolumbar meningomyelocele

NEURAL TUBE DEFECT

P-1. Pilonidal sinus.

P-2.Lipomeningocele.

P-3. Precoccegeal cleft.

P-4. Hypertrichosis over spina bifida occulta

DUCHENNE MUSCULAR DYSTROPHY

P-1. Note ths patient aged 6 yr exhibiting

classical GOWERS SIGN. The child needs to
turn prone to rise, then uses his hands to
climb up on his knees before standing,
because of poor hip girdle fixation and or
proximal muscle weakness. Any child
continuing to do this after 3 yrs is likely to
have a neuromuscular condition

P-2.

ANGELMAN SYNDROME

Note happy disposition, wide mouth, wide

spaced teeths

RETT SYNDROME

P-1. Hand wringing and mouthing movements

in a girl aged 2 years

P-2.Note the stereotype hand washing

movement and mouthing in a 1-year-old
patient

MYASTHENIA GRAVIS

P-1. Bilateral ptosis and facial weakness.

P-3. 8-year-old patient presented with ptosis

which aggravates during the end of the day

P-4.Watch the response to inj neostigmine

over the ptosed eyes and facial alertness, this
test is also one of the diagnostic for
myasthenia gravis

MARCUS-GUNN PHENOMENON

P-1. Demonstration of Marcus-Gunn

phenomenon. On an attempt to move the
lower jaw, as in the act of sucking the
bottle, the left eyelid is retracting
upwards.

P-2.Note the retraction of left upper eyelid

making the eyeball quite prominent

WAARDENBURG SYNDROME

P-1. Unilateral hetrochromia iridae.

P-2.Note hetrochromia iridae in a child and his

grandmother, there was hearing loss in both

KLIPPEL-TRNAUNAY-WEBER SYNDROME

P-1. New born with the vascular nevi and

asymmetrical right limb hypertrophy.

P-3.New born with hypertrophy nevus over

left lower limb

ATAXIA TELANGIECTASIA

Note right temporal bulbar telangiectasi

STURGE-WEBER SYNDROME

Sturge-Weber syndrome facial nevus

(portwine stain)

TUBEROUS SCLEROSIS

P-1. Adenoma Sebaceum

P-3. Hypomelanotic Macule.

P-4.Shagreen Patch.

TUBEROUS SCLEROSIS

P-1. Subependymal Calcified Nodules

NEUROFIBROMATOSIS TYPE II

P-1. MRI image, bilateral acoustic neuroma.

P-2.CT scan. bilateral acoustic neuroma

NEUROFIBROMATOSIS TYPE I

P-1. Plexiform Neurofibromatosis involving

trigeminal nerve

P-2.Cafe au lait patches on back.

P-3. Plexiform neurofibroma of left upper limb.

NEUROFIBROMATOSIS TYPE I

P-1. Skeletal deformity in Neurofibromatosis

(Angular scoliosis)

P-2.Subcutaneous nodules

bells palsy

P-1. Left facial palsy.

P-2.Left facial palsy in a boy note it becomes

obvious while closing the eyes, left half of the
face droops

CONGENITAL
SCOLIOSIS

P-1. Note the gibbous in-3-year-old boy,

note the convexity of the lower thoracic
spine to the right side along with
hemivertebrae.

P-3.Note the spinal deformity clinically and its

radiological correlate

GREENSTICK FRACTURE

P-1. Note the deformity of upper limb.

P-2. X-ray forearm depicting greenstick

fracture of ulna

MULTIPLE CARTILAGINOUS EXOSTOSIS

P-1. Note cartilaginous outgrowth at lower

and upper end of tibia.

P-2.Cartilaginous growth at lower end of

radius.

P-3. X-ray of knee joint AP and Lateral

view. Note the outgrowth from the lower
end of femur and upper end of tibia

ECTRODACTYLY
(LOBSTER-CLAW DEFECT)

P-1. Autosomal dominant family with split

hand and feet, note mother and two kindred
are the sufferer.

P-2.Sporadic split hand and feet, no family

history of such defect in family

BRACHYDACTYLY

P-1. Brachysyndactyly present over both feet.

P-2. Brachydactyly of both third toe

POLYDACTYLY

P-1. Preaxial polydactyl there is duplication of

both great toes along with postaxial
polysyndactyly of both hands

P-2. Preaxial polydactyly of great toes

P-3. Syndactyly of third and fourth fingers

CONGENITAL CLUB FOOT

P-1. Bilateral club foot

P-2.Unilateral club foot

P-3.Unilateral mild

P-4.Club hand left

P-5.Unilateral severe.

OSTEOGENESIS
IMPERFECTA
P-1. Note the fracture segments obvious in both

lower limbs.

P-2.X-ray whole body of newborn depicting multiple

fractures of both upper and lower limb.

P-3.X-ray of left upper arm at the age of one month

depicting fracture of humerus with callus formation

P-4.A patient aged 12-year with blue sclera since

birth

P-5.X-ray of the same patient at the age of one year

depicting healed fracture with callus formation

Scurvy

P-1. A five-year-old boy, a case of spastic cerebral palsy

presented with frank manifestation of scurvy. With swollen
knee joints and spongy gums. The examination revealed
classical scorbutic beading over costochondral junction.

P-2.The X-ray elbow, leg and knee joint revealed classical

radiological changes. Patient responded well will oral
ascorbic acid.

P-5.A 1-year-old, male child came to Pediatric clinic with

complaints of anorexia and crying on being handled. The
childs bones were tender and he was reluctant to move his
limbs.He used to keep the limbs in frog like posture. The child
also had evidence of gum bleeds. The X-ray of Knee joint
showed characteristic features of Scurvy. The child was
treated with Ascorbic acid 300 mg per day and the child
responded in 6-7 days

RICKETS

P-1. X-ray wrist joint showing cupping and

fraying of distal radius and ulna. The
prominent wrist is due to excessive
accumulation of osteoid

P-2. X-ray wrist joint after a week of vitamin

D dose. Preparatory zone of calcification is
seen, an indirect evidence of healing
nutritional rickets

RICKETS

P-1. Ricketic beading (enlargement of

costochondral junction).

P-2. An infant 6-month old having physiological

bowing, it has to be differentiated from NR which
exhibit Marfans sign over ankle. This patient has
normal serum alkaline phosphatase level

P-3. child at age of four year. Note bowing

disappeared

MEASLES

P-1. A 6-year-old patient presented with

cough, coryza, fever, photo-phobia and
classical rash

P-2. Morbilliform rashes

P-3. Conjunctivitis with peculiar rash

MUMPS

P-1.Enlarge parotid gland

P-2. Two brothers suffering from mumps

CHICKENPOX

P-1. Neonate with chickenpox

P-2. Chickenpox rashes

Necrotizing fasciitis

P-1. Necrotizing fasciitis

P-2.Spread of secondary bacterial infection

leading to extensive necrotizing fasciitis

Molluscum
contagiosum

Warts

P-1. Condylomata in 7 months old child

P-2.Venereal wart in an adolescent boy

TUBERCULAR LYMPHADENOPATHY

P-1. Large solitary cervical lymph node proved

to be tubercular on histopathological
examination.

P-2. Scrufuloderma over cervical region

P-3.X-ray chest of the same patient depicting

hilar adenopathy.

LUPUS VULGARIS

P-1. Lupus vulgaris in a nine-year-old boy.

P-2. Lupus vulgaris in different parts of the

body.

TETANUS

P-1. Tetanus in grown-up child, note the facial

expression during the spasm

P-2. Spasm in neonate

KAWASAKI DISEASE

Kawasaki disease, note the exfoliation of

palms and soles

HYDATID DISEASE

ASCARIS LUMBRICOIDES

HERPES ZOSTER

ATOPIC DERMATITIS

P-1.The lesions in childhood form are flexural

in distribution as contrast to infantile form
where there is axillary involvement.

P-2. antecubital areas involvement

ALOPECIA

P-1. Alopecia areata in a 2-year-old boy.

P-2. Tinea capitis. Circumscribed area of hair

loss without scalp change and hair broken off
at the follicular orifice

TELOGEN EFFLUVIUM

Note acquired diffuse non scarring alopecia

STEVENS-JOHNSON SYNDROME

SJS-Erythematous, dark macules along with

mucosal lesions in a two-year-old child who
was kept on carbamazepine for seizure.
See the evolution of the rash from
extreme left to extreme right, the
recovery.

STEVENS-JOHNSON SYNDROME

StevensJohnson syndromeIn three-yearold child, rashes appeared after starting

cotrimoxazole for diarrhea, note the
progress of the lesion. The beginning of
the eruptions (extreme left),subsequent
evolution of the rashes in the middle and the
recovery (extreme right).

TOXIC EPIDERMAL NECROLYSIS

Dark skin peels off in sheets measurung > 3

cm,bullae and erosion involves more than 30
percent area

HENOCH-SCHNLEIN PURPURA

P-1. A10-year-old boy presented with severe sore

throat. Examination of throat revealed white patch
over the tonsils, throat swab culture identifies the
streptococcal beta hemolyticus. The white
patches have to be differentiated from white
patch of Infectious mononucleosis, where other
features of IMN are also present. This patient was
kept on adequate penicillin coverage. A review,
after a week, the patch disappeared but parents
noticed purpuric rashed over lower limb, hand
and buttocks which was palpable over lower
limbs. The platelet count was normal patient was
clinically diagnosed as a case

SEBORRHEIC DERMATITIS

Greasy scales involving scalp, face and

eyebrows.

HEMANGIOMA AND VASCULAR MALFORMATION

P-1. Hemangioma of lower lip

P-2. Portwine stain over right half of face

P-3. Hemangioma right cheek in an infant

with cavernous component

CUTIS MARMORATA TELANGIECTATICA CONGENITA

EPIDERMOLYSIS BULLOSA

Junctional epidermolysis bullosa in new

born.There are multiple moist erosions
involving fingers and perioral skin, and
pressure points. Few bullae are large in
size.Nails could also be affected. Hands
and feet are relatively spared.

Epidermolysis bullosa simplex lesions over

soles of 4 year old child

ACRODERMATITIS ENTEROPATHICA

HYPOMELANOSIS OF ITO

P-1.A five-year-old patient with linear

depigmented areas and hyperpigmentation
along side, distributed along Blaschkos lines

P-2.Note streaky distribution of

hypopigmentation

ECTODERMAL DYSPLASIA

Hypohidrotic ectodermal dysplasia is

characterized by pointed ears, wispy hairs,
periorbital hyperpigmentation, pegged teeth.

JUVENILE XANTHOGRANULOMA

P-1. Xanthogranuloma over face associated

with a cafe au lait patches.
P-2. Xanthogranuloma in a neonate. Note the
dome shaped nodular lesion over body in a
other wise normal neonate.

CONGENITAL MELANOCYTIC NEVUS

Note the large bathing trunk

nevi and small lesion elsewhere especially

head and scalp. Note the Giant hairy nevus
over back and chest

Dermatofibroma

DERMATOGRAPHISM

URTICARIA

Tinea corporis.

Presence of circinate patch with prominent

papulo-vesicular margins

SCLERODERMA

Hardening of skin with pigmentation, loss

of nasolabial folds and expression less
face.

Comparison of skin laxity with her

mothers. Hardened skin is difficult to lift

Cutis laxa

Child with loose skin folds, joint and

ligamentary laxity

ICHTHYOSIS
VULGARIS

HARLEQUIN FETUS

P-1. Severe ectropion and O-shaped mouth.

P-2. Horny cracks of the skin
P-3. Disfigured baby, tight constricting
integument, digital loss.

COLLODION BABY

P-1. First child at birth.

P-2. Both child, elder is 4 years old with

extensive lamellar ichthyosis.

P-3. Second one in nenatal period

PSORIASIS

P-1. Scalp involvement results in

accumulation of thick scales throughout the
scalp

P-2. Guttate psoriasis in an old child. Drop like

white silvery plaques seen over extremities
and trunk

HEAD LICE
(PEDICULOSIS
CAPITIS)

Scabies

P-1.An infant with involvement of hands palm,

soles and face

P-2. Involvement of dorsa of hand and interdigital

areas

P-3. Eczematous eruptions in an infant

P-4. Involvement of male genitalia

P-4. Involvement of natal folds and buttocks

P-4. Involvement of dorsum of hands and finger

webs in older age

OMPHALOCELE

P-1. Exomphalos-minor

P-2. Exomphalos-major

Gastroschisis

Intraoperative photograph showing

intestines hung with a urine collecting bag.

Achalasia cardia

P-1. barium swallow AP view.

P-2. Lateral view, X-Ray depicting narrowing
of the distal esophagus

Infantile Hypertrophic
pyloric stenosis

P-1.Note classical visible peristalsis.

P-2. The pyloric tumor

P-3. Ramstedts pyloromyotomy

DUODENAL ATRESIA (DA) AND STENOSIS (DS)

Plain X-ray and barium contrast study. Note

the smooth end of the duodenum,
differentiating it from malrotation

DISORDERS OF ROTATION AND FIXATION

OF INTESTINE (DRF)

P-1. Malrotation: Note right sided jejunal loops

and coiling at the end of dilated duodenum.
This baby also had a paraduodenal hernia

Pneumoperitoneum

P-1. 3 days preterm neonate presented with

refusal to feed and abdominal distension.

P-2. X-ray Chest and abdomen in erect

position reveals gas under diaphragm
depicting hollow viscous perforation

INTUSSUSCEPTION

P-1. Red currant jelly stool

P-3. Barium enema showing spring coil

appearance

Hirschsprungs disease

P-1. Barium enema showing transition zone

(a funnel shaped area between the normal
distended colon and aganglionic segment)

P-2.Operative photograph of a case of

Hirschsprungs disease showing the narrow
and the dilated colon and transitional zone.

ARM in males

Low ARM-note the meconium track

Female ARM

P-1. Anovestibular fistula

P-2. Cloaca

RECTAL PROLAPSE

Congenital diaphragmatic
hernia

P-1. Newborn presented with respiratory

distress and scaphoid scaphoid abdomen

P-2. X-ray showed a left CDH

Congenital
Diaphragmatic Hernia

P-1. Two days old infant was admitted for

respiratory distress and kept of oxygen.

P-2. X-ray revealed Right sided diaphragmatic

hernia.

EVENTRATION OF DIAPHRAGM

PHIMOSIS

P-1. phimosis in a newborn

P-2. Balanitis xerotica obliterans

Paraphimosis

P-1. Paraphimosis in a 3-year-old child. Note

the tight constricting ring formed by the
trapped foreskin proximal to glans.

P-2. After manual reduction, oedema takes a

few hours to subsid

Labial adhesion

P-1. A thin vertical raphe is seen in the

midline

P-2. After separation

HAIR-TOURNIQUET SYNDROME

P-1. Hair tourniquet

P-2.Urethral fistula

P-3. The culprit hair.

VESICOURETERAL REFLUX

Voiding cystourethrogram depicting Vesicoureteric reflux. In a male baby with urethral

valve

Posterior urethral valve

cystourethrogram shows dilatation of

posterior urethra, small capacity irregular
bladder and vesicourethral reflux

Bladder extrophy and epispadias

Bladder extrophy and epispadias in male

Cloacal exstrophy

P-1. Cloacal exstrophy with limb anomalies

P-2.Meningocele in the same patient

Rhabdomyosarcoma
Rhabdomyosarcoma of the tongue

Conjoint twins

P-1. Mono cephalus tetrapus dibrachius.

Conjoint twins

P-1. Conjoint twins Ischiopagus tetrapus

P-2.Conjoint twins parasitic

Empyema thoracic

P-1. Five-year-old boy presented with

pyrexia, breathlessness, cough.Examination
revealed bulging of left hem thorax,
reduced breath sound and stoney dull
note on percussion over left hemithorax.

P-2. X-ray chest revealed opaque left

hemithorax with shifting of trachea to right
side

P-3. intercostal chest drainage ICD with wide

bore chest tube