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Pediatrics X-rays
Prepared by
Maysa Marwan
Mohamed El Far
Typed by
Medical
Sources
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Notes of Medad Team 10
X ray chest
Any pathology in lung either
1- radio opaque
2- Radio lucent opacity
1- Radio opaque
1- consolidation = pneumonia
2- collapse
3- effusion
How to differentiate?
1-
A- If the lesion is all heterogeneous
Consolidation
B- If the lesion is all homogenous
1-collapse
OR
2- effusion
How to differentiate?
1- pneumatocele
2- pneumothorax
3- emphysema
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How to differentiate?
1- pneumatocele :
cystic
Scattered in lung
Surrounded by radio opaque shadow of pneumonia
Usually caused by klebsiella & staph.
2- pneumothorax :
3- emphysema :
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Pediatrics CT Scans
Prepared by
Ibn El Waleed
Mohamed El Far
Typed by
Omaregy
Sources
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CT scans
Background:
outside view:
Sagittal section:
0 (zero) unite:
completely black
0 unite is fluid or water- like (CSF)
80 unites:
60 unites:
white
60 unite is early/ acute intracranial hemorrhage
N.B.: 80 unit & 60 unit density can NOT be diffrerentiated by naked eye,
it can be differentiated by computer
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40 unit:
grey matter of brain tissue
in contrast- enhanced CT
20 unit:
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Types of CT scan:
more while
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How to know it? NOT lateral ventricle, NOT 3rd, NOT 4th ventricle
Hyper dense:
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Hypo dense:
Ventricles:
Dilatation:
1- Hydrocephalus
a- Obstructive hydrocephalus
- Not all ventricles are dilated
- It's due to obstruction in between ventricles
=between both lateral ventricles & 3rd ventricledilataion of 2 lateral
ventricles
=between 3rd & 4th ventriclesdilatation of 2 lateral ventricles % 3rd
ventricle
b- Communicating hydrocephalus:
- All ventricles are dilated
- It's due to obstruction after 4th ventricle i.e.: in subarachnoid space
2- Passive dilatation:
- It occurs in brain atrophy as there is shrinkage of brain substance leading to
passive dilatation
Compression:
2- Level of cut:
Supraventricular level
ventricular level, level of bodies of lateral ventricle
ventricular level, level of horns of lateral ventricle & 3rd ventricle
infra ventricular level, 4th ventricle
3- showing: comment on :
brain: hyper dense or hypo dense lesion
ventricles: compression , dilatation or normal
4- anatomical site of lesion: e.g.: left frontal
5- diagnosis
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Hints on Examination
Prepared by
Heba Saif
Ahmed Mohsen
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Clinical Pediatrics
How to examine
4th IC space just
outside MCL if
< 4 years old
I- Cardiology cases:
A.
1. inspect around the 4th/5th intercostal spaces, look for pulsations of apex [normally
5th IC space
2. Inspect other 4 areas for pulsations.
if >4 years old
3. put your Rt hand at the site of apex (where u can see pulsations if possible),
confirm place detected by inspection, (dont forget to count IC spaces with your Lt hand)
try to localize it with one finger (or if less than 2 cm, if more than 2 cm, it is diffuse)
comment on character and thrill felt: normal character with no detected thrill
Hyper dynamic character
Slapping character: in Mitral stenosis (very rare in children)
4. put your Rt hand on the left Parasternal area to detect thrill (use roots of fingers)
and pulsations ( use your hand just below the wrist joint)
5. put your hand on pulmonary and aortic areas to detect thrill (roots of fingers)
and pulsations (with your finger tips)
6. Put your hand at epigastric area; try to detect origin of pulsations
From RT side: enlarged Lt Ventricle.
From left side: liver due to RT sided Heart Failure.
Centered: aortic origin, normal.
B.
Auscultation:
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Parasternal area:
d. Pulmonary area:
e.
Epigastric area:
Percussion:
Auscultation:
a. S2 (pulmonary area)
b. Murmurs:
Rule: use cone and
diaphragm in
examination of all areas.
Rule: if you hear
murmur at apex, move
towards axilla, if its
propagating towards
axilla, it is mitral
regurge.
Rheumatic
VSD
Fallot
Present (only if
u can see it)
S: shifted down
& out
Area: localized
Character: hyper dynamic
Thrill: no
Pulsations: present
Thrill: No
Pulsations: yes
Thrill: no
Palpable S2: yes
Pulsations: yes
Thrill: -- Dullness on pulmonary
area (pul. Artery dilatation)
Dullness to the RT of the
sternum.
Accentuated S2
Accentuated S2
No
Mitral regurge:
Site: apex + muffled S1
Area of propagation: axilla
Character: soft
Timing: pan systolic
VSD:
S: 3rd, 4th Left
Parasternal spaces
A: all precordium
C: harsh
T: pan systolic
Tetralogy of Fallot:
S: 2nd left IC space
A:
C:
T: ejection systolic
A: localized
C:
T: No
P: present
T: yes
P: yes
T: no
P: yes
P: no
T: ---
A: localized
C:
T: No
P: +/- present
T: No
P: no
T: yes in 50%
P: no
P: no
T: ---
---
---
Mitral stenosis:
S: apex + accentuated S1
A: apex
C: rumbling
T: mid diastolic
Aortic regurge:
S: 3rd left
A: apex
C: soft
T: early diastolic (decrescendo)
Pulmonary hypertension:
S: 2nd left
A:
C: soft
T: ejection systole
So, you may hear murmurs at
apex/pulmonary/aortic area.
Parasternal and epigastric are
free
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Apex:
free
Parasternal:
Thrill + pulsations
Pulmonary
Pulsations
Aortic
Free
Free
epigastric
free
Free
free
Free
Accentuated S2+Soft ejection systolic murmur
Free, OR,
Soft early diastolic murmur propagating to
apex.
Free
4)
Tone:
Shaking
method in 4
limbs (wrists
&ankles)
Passive flexion
&extension of
all joints
5) Reflexes:
a) Superficial reflexes:
i.
Plantar/Babinski reflex:
y Scratching the outer aspect of the sole of the foot.
y +ve response dorsiflexion + fanning (it normally disappears at 1 year).
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Abdominal reflex:
y Move a blunt object( ) \on the patient's abdomen starting at flanks towards the
umbilicus.
y+ve response shift of umbilicus outwards, then it returns.
Response
Where to
hit
Position of
the patient
Knee
Quadriceps
contraction
(front of thigh)
Tendon Below
knee joint
(between tibial
tuberosity patella,
detect with your
finger)
Knee angle: 90
degrees
ankle
Calf muscles
contraction
+dorsiflexion ankle
biceps
Biceps contraction
(flexion elbow)
Triceps
Triceps
contraction
(extension elbow)
Tendon Achilles
Put your hand below
the knee or at the thigh
raising the patient's leg
above the table
Hit on triceps
aponeurosis above
the back of the
elbow joint.
Elbow angle: 90
degrees
Raise the hammer to the same height in both Rt and Lt sides to avoid a stronger hit on one side
than the other, as this may cause inaccurate results.
Move your wrist when you are using the hammer ()
How to detect clonus:
i.
ii.
iii.
iv.
Hold the thigh, raising thigh and legs off the table
Let the foot be in plantar flexion (its position in passive
state)
Do sudden maintained dorsiflexion
Response: Regular rhythmic movement of the foot.
7) Cranial nerves:
a) Pseudo-bulbar palsy; (9, 10) is the commonest:
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Exaggerated reflexes of
palate & pharynx
Dysphagia
Nasal regurge (as palate shuts
nose during drinking)
Gag reflex: with a tongue depressor
b) Others:
1st: olfactory nerve: use coffee, every opening separately
2nd: optic nerve: see if the patient can follow the torch/ ask if the patient
3rd, 4th & 6th: occulomotor, trochlear and abducent nerves:
Move torch/pen at 6 cardinal directions and check the patient's eye direction. If affected squint
12th: hypoglossal: ask patient to protrude his tongue tongue will deviate towards paralyzed side.
3)
4)
5)
6)
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NMT10
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Shifting dullness:
Start from epigastric region till you reach dullness that represents the upper border of the bladder. (Mark it
to percuss above it)
Start from epigastric region till umbilicus.
Then to the RT of the umbilicus.
Then to the LT of the umbilicus.
When you find dullness, fix your hand there and ask the patient to turn his body to the other side, percuss
again, if you find resonance, this is called shifting dullness. (It happens because while the patient is on his
back, moderate amount of fluid is present in flanks, so when you ask the patient to move to the other side, the
fluid is displaced and resonance is heard in a previously dull flank.)
Transmitted thrill:
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NMT10
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b. Measurements
Head circumference is
How to measure head circumference: make sure you place the meter correctly, on the supraorbital
ridge (2cm above eye brows) & on the occipital protuberance.
Height is
How to measure height:
If < 4 years old: supine
If > 4 years old: standing:
y make the patient take off the shoes.
y Patients heals are adjacent to the wall
y Feet close to each other
y Body adjacent to the wall
y Head neither flexed nor extended
y Put a book above patients head.
y Measure
Weight is
c. Head
Skull: box shaped, wide anterior fontanelle/mongoloid features/cephalhematoma/ forceps marks.
Hair: Hair is light in color, sparse/silky.
Eye: subconjunctival hge/ jaundice/ puffy eyelid/sunken/lateral upward slope.
Cheek: loss of subcutaneous fat/moon face/butterfly rash of SLE.
Mouth: pallor in lips/cyanosis in tongue/teeth extraction/ tonsillitis/angular
stomatitis/moniliasis/delayed dentition/small/protruded tongue.
Ear lobules: underdeveloped, over folded helix, small external ear.
Anxious look.
d. Neck:
Carotid arteries show no exaggerated pulsations, they are equally felt on both sides with no special
characters or thrill/there is exaggerated carotid pulsations with/with out associated thrill.
Neck veins are not congested shows systolic collapse/ neck veins are congested reaching cm with
patient seated at 45 degrees position.
Trachea is centralized, thyroid is normal, LNS are not felt.
Short and broad/Buffalo hump
e. Upper limbs:
There is/ is no clubbing, pallor, splinter hge, oslar nodules.
Broadening, convexity
Short, Simian crease, clinodactyly.
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NMT10
Notes of Medad Team 10
Dorsalis pedis arteries are equally felt in both sides. There is/is no lower limb edema, clubbing.
Wrinkled/ulcerated/fissured skin, wasted muscles, prominent bones.
Broadening, Knock knees, bow leg, Marfan sign.
Short, broad, wide gap between 1st and 2nd toes.
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IMCI
Prepared by
Mohamed El Far
Typed by
Medical
Sources
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Notes of Medad Team 10
:
:
:
) (
:
: 100
: axillary
in mother's own words :
: , :
Initial visit
follow visit
initial visit
Assessment
if one of these DANGER sign is present , this indicates VERY SEVERE DISEASE
which requires rapid admission to hospital
2- Vomits everything:
:
NMT10
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21
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3- History of convulsions:
/ :
:
proceed to next step ,,,,,,, : DANGER SIGN
NB:
A- You should confirm that it is generalized Clonic , convulsions , not just
B- Do not ask leading question
4- Lethargic or unconscious:
- Lethargic:
infinity - Disinterested
- Conscious but lethargic
- - -
5- Convulsions now
Classification:
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NMT10
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. :
put on NO and bypass this box assessment & classification box -
Assessment:
: -1
3. Chest indrawing
8
chest
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Classification
- If checking & assessment of the box is NO , so write NOTHING in classify
- Red box indicates dangerous condition which necessitates urgent
referral to hospital.
- Yellow box indicates that specific ttt and follow up are needed.
- Green box is safe to pass
- Classify from above downwards, for example, if you found sign for both
red and yellow boxes, so classification will be the red box (take the
more dangerous classification)
, box -Write the classification EXACTLY as it is
Assessment:
:
Def .of diarrhea: is increased fluidity of the stool
regardless of number of stools
:
proceed to the next box :
. :
-1
: persistent diarrhea 14
Duration of gastroenteritis is 7-10 days
Persistent diarrhea may lead to dehydration
-2
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: : -
Classification:
Lethargic
Restless / irritant /
2- Sunken eyes:
Groove all around the eyes.
If you are in doubt, ask the mother
...
Classification
- In diarrhea: at least 2 signs are required for diagnosis and
classification of red box. One sign is not enough.
- one sign , classify as yellow box
- One sign classify as: no dehydration, means NO clinically
detectable signs of dehydration, but if left he will develop some
dehydration.
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Classification:
diarrhea
If no dehydration, classify as persistent diarrhea
Assessment:
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General comments:
- if you find any sign ,CIRCLE it
24 sign -
Assessment:
:
tick on NO & proceed to next box : proceed to further assessment : .1
Agonizing pain in last 24 hrs
:
NB
This agonizing pain is due to collection of pus under tension, if drum is perforated,
pain will decrease
- patient with agonizing pain is unable to sleep , he may sleep from exhaustion
.2
NB
If mother said there is pus, write it discharge not pus.
If less than 14 day acute
If more than 14 day chronic
3. Look at pus:
- if mother said there is discharge , look at that discharge & examine it ,if this
has criteria of pus , so it is PUS
* Criteria of PUS:
- Yellowish to greenish
- Offensive
- Sticky
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Classification:
- If no ear problem, tick on NO & proceed to next box.
* Red box:
- If bone behind the ear is tender, so classify mastoiditis
- If pus is seen coming from the ear & < 14 days so classify as " acute ear infection "
OR
- if there is agonizing pain ONLY , so classify as "acute ear infection"
- If you find pus for 14 days or more, so classify as chronic ear infection
* Green box:
- If mother said that there is ear problem ( if you entered box of ear problems ) , but
you found no signs , so classify as " NO ear infection "
- this may be foreign body in the ear but NOT infection
NB
If you ask the mother & she told you that there is NO ear problems , tick on " NO" &
DO NOT " write ANY classification , do NOT write EVEN " no ear infection ( LEAVE
the classification box EMPTY ) .
NB
If mother said there was fever (fever by history) but by thermometer there is no fever,
this may be effect on antibiotics, so tick on YES
Assessment:
1- for how long ? :
2- if fever lasts for more than 5 days,
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- Results:
Stiff neck .
* most probably due to meningitis
Classification:
- Always look at the previous boxes.
if you find stiff neck ( from this box)
OR danger sign (from box of danger signs)
So classify as VERY severe febrile disease
if you find apparent causes of fever as :
- pneumonia
- dysentery
- streptococcus pharyngitis
- acute ear infection
- abscess / carbuncle
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Assessment of measles:
AND
1. Look at eyes:
a- Look for clouding of cornea.
NB: clouding may cause permanent loss of vision
2. Mouth ulcers:
Classification of measles:
If find:
Assessment of malnutrition
1- look for visible severe wasting
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-1
-2
growth curve -3
*Results:
Classification of malnutrition:
- If you find:
Assessment of anemia:
overstretch -1
comparison -2
- Interpretation:
If they are all red, so no palmer pallor
So classify as NO anemia
If they are mixed (white and red), so some pallor
So classify as anemia
If they are all white, so severe palmer pallor,
So classify as severe anemia.
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Photos
Prepared by
Mohamed El Far
Sources
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Mongolian spot
Bluish discoloration of an area of skin in lumbosacral region.
Definition
Significance It is of no significance, may be mistaken for bruising.
Fades gradually as the infant grows older.
Fate
Milia
Description & site
Fate
Treatment
Neonatal gynecomastia
Incidence It occurs in both sexes during the first weeks of life.
Precaution It should not be squeezed.
Moro reflex
Incidence
Duration
How to elicit
Significance
Cephalhematoma
Definition It is a subperiosteal hemorrhage.
Treatment Is conservative, and aspiration is contraindicated.
Neonatal conjunctivitis
Causes
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Facial palsy
Include compression of facial nerve by pressure from forceps blades
But may occur after normal delivery.
Presentation As unilateral weakness of facial muscles and drooping of mouth.
Most cases resolve within a few weeks after birth.
Fate
Causes
Erb's palsy
It results from injury of 5 and 6 cervical nerves.
Cause
Character Moro reflex is absent on the affected side, but grasp reflex is intact.
Treatment is by physiotherapy from second week.
Umbilical granuloma
Presentation Persistent serosangunious discharge and a fleshy protuberance from the
Treatment
base.
It can be treated by local application of silver nitrate or rarely by surgical
excision.
Tongue tie
It is a short lingual frenulum, which may be worrisome to parents.
Definition
Complications It only rarely interferes with eating or speech,
generally requiring no treatment
Treatment
Hypoglycemia
Respiratory distress syndrome
Polycythemia and
High incidence of congenital malformations.
Phototherapy
Procedure Exposure of infants to blue, white, or green lights of wave length 450-460
nm
Decreases unconjugated bilirubin levels.
Action
Indication It is mainly indicated for levels above 15 mg/dl in full term infants.
Include hyperthermia, dehydration, loose stools, and skin rash.
Side
effects
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Congenital hypothyroidism
Clinical features Includes coarse facies, large protruding tongue and umbilical hernia.
Of all newborns within a few days of birth ensures early diagnosis
Routine
and early treatment, to prevent mental retardation.
screening
Hydropes fetalis
Uncommon since the prevention of rhesus disease with anti-D
immunoglobulin.
Include pallor, gross generalized oedema, ascites, and heart
failure.
Includes exchange transfusion and ventilatory support.
Incidence
Features
Mainstay of
treatment
Necrotizing Enterocolitis
It is a serious illness mainly affecting preterm infants in the first weeks
of life.
It is caused by ischemia of the bowel wall and infecting organisms, and
Causes
may be accelerated by milk feeding.
Manifestations The abdomen becomes distended, milk is aspirated from stomach, and
the baby may rapidly deteriorate.
Is to stop oral feeding and give broad spectrum antibiotics.
Treatment
Definition
Inguinal hernia
It is the commonest condition requiring surgery during infancy.
Incidence
Presentation An intermittent swelling in the inguinal region or scrotum, noticed
Surgical
repair
Hypospadias
Definition The uretheral orifice is situated on the ventral aspect of the penis at a site
proximal to the normal opening.
Treatment Circumcision should be delayed until corrective surgery is done, as the
prepuce may be needed for urethroplasty.
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Imperforate anus
Diagnosis
Other
anomalies
Treatment Most cases need colostomy performed in the neonatal period.
Positional talipes
Definition The feet often remain in their in utero position.
Differential unlike true talipes equinovarus, the foot can be fully dorsiflexed to touch
the front of the lower leg.
diagnosis
Simian crease
Definition It is a transverse palmar crease seen in many chromosomal aberrations,
e,g, Trisomy 21
Meningomyelocele
Definition
Antenatal
diagnosis
Association
First aid
Hydrocephalus
Definition It is dilatation of the ventricular system.
In infants,
Clinical
The head is enlarged with a large bulging anterior fontanelle,
picture
Scalp veins are prominent, and
The eyes are deviated downward (sun-set sign).
Treatment Is by shunt operation.
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Microcephaly
rd
Definition Head circumference is below the 3 centile for age and gestation.
Include congenital infections.
Known
causes
Impetigo
Caused by gram positive cocci e.g. staphylococcus aureus.
Organism
Presentation It is a superficial infection resulting in small pustules anywhere on the
Treatment
skin.
Extensive lesions should be treated with systemic flucloxacillin.
Oral moniliasis
Definition & It is a fungal infection caused by candida albicans.
etiology
Presentation It appears as white adherent plaques on the buccal mucosa and tongue.
Is by topical nystatin or miconazole.
Treatment
Perineal moniliasis
It gives a bright red confluent rash in the napkin area or around the
anus.
Presentation Typically, there are discrete satellite lesions lying peripheral to the rash.
By topical nystatin cream.
Treatment
Definition
Roseola infantum
Definition Acute viral illness caused by human herpes virus-6,
& etiology
Incidence Infants between 6 months-2 years.
Treatment Is mainly symptomatic i.e.antipyretics for the high fever.
Measles
It is characterized by typical maculopapular rash which starts behind
the ears and on the face. Then, it spread downwards to the trunk and
feet.
Kopliks spots Are pathognomonic. They appear as grayish white lesions on buccal
mucosa.
is symptomatic
Treatment
Complications Are mainly respiratory and neurological.
Rash
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Scarlet fever
Etiology
Diagnostic
features
Desquamation Occurs as the rash fades. It can involve hands and feet.
and peeling
Can follow other febrile illnesses eg Kawasaki disease.
Other causes
of Peeling
Chickenpox
-The rash appears in successive crops,
-is centripetal in distribution and
-pleomorphic.
-The rash is mainly papulovesicular.
Include
secondary infected lesions, pneumonia, and neurological
Complications
problems e.g.acute cerebellar ataxia
Characters of
rash
Henoch-Schonlein purpura
Is a purpuric rash involving the lower limbs and buttocks.
The
characteristic
skin lesion
It is a vasculitis with a normal platelet count.
Include arthritis, abdominal pain and nephritis.
Other
features
Fate
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Purpura fulminans
This is large ecchymoses with irregular shapes evolving into
hemorrhagic bullae and then into black necrotic lesions.
Include sepsis (e.g. meningococcal), malignancy and massive trauma.
Causes
Management It carries a high mortality rate and intensive care management is
urgently needed.
Pathology
Hemophilia A
Definition It is an X-linked recessive disorder characterized by bleeding, easy bruising,
large hematomas, and hemarthrosis.
Urticaria
It is a common allergic manifestation.
There is itching, erythematous rash with wheals, and edema around the
eyes and mouth. -One serious complication: is laryngeal edema and airway
obstruction.
Treatment Is by s.c. adrenaline and systemic steroids.
Incidence
Clinical
features
Atopic eczema
-: Itching is the main symptom resulting in scratching and exacerbation of
Main
the rash.
symptom
Distribution Is age related:
Treatment
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Scabies
It is caused by infestation with a mite
Etiology
By severe itching which is worse at night.
Clinical
feature
Distribution In infants and young children the distribution of the lesions often includes
Treatment
Kwashiorkor
Etiology
Constant features
Other important
features
Complications
Rickets
Include large head, rosary beads (enlarged costochondral junction), Marfan
Clinical
sign, fractures, and limb deformities (bow leg and knock knee).
features
Treatment Is by vitamin D therapy for deficiency rickets.
Osteogenesis imperfecta
Incidence An uncommon genetic disorder,
Osteoporosis, bone deformities, fractures, blue sclera and defective
Clinical
dentition.
feature
Clinical severity depends on the subclass. Some variants are lethal. The diagnosis is
considered in suspected child abuse.
Dehydration
Dehydration and its complications are the usual cause of death from gastroenteritis.
Clinical features of Include depressed fontanelle, sunken eyes , dry tongue , loss of
skin turgor, and acute weight loss.
dehydration in
infants
-Infants are at
particular risk of
dehydration
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NMT10
Notes of Medad Team 10
Pediatrics Sheets
Prepared by
Mohamed El Far
Soma El 3ageeb
Ibn El Waleed
Typed by
Omaregy
Medical
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Notes of Medad Team 10
Personal history
Sex and name:
Age:
Residence:
Consanguinity
Complaint
Present history
Analysis of complaint:
Onset: Course:
Duration:
Chest: Cardiac:
GIT: UTI: NEURO:
- FEVER:
: Natal history:
..... Neonatal history:
:
....... . -
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Developmental history
Motor:
Mental:
Nutritional history:
Breast feeding:
Artificial
-
Weaning :
) ( minerals:
-
& Vitamins:
Vaccination history
40 -
Past history
See history of other system affection
-
Family history:
- .
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12-complaint:
-
Antenatal history :
Natal history:
Neonatal history:
:
....... . -
Nutritional history
Breast feeding:
- artificial
Vaccination history
Family history
?Is he her first baby? If not how many siblings? Normal or not
-
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44
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Neonatal hyperbilirubinemia
welcome the patient :
introduce your self to the patient :
.....
Personal history
Sex and name:
Age:
Residence:
Consanguinity
Complaint
Present history
Analysis of complaint :
Onset:
Course:
Duration:
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Notes of Medad Team 10
45
Chest:
Cardiac:
GIT:
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: Natal history:
..... Neonatal history:
:
....... . -
Developmental history
Motor:
Mental:
Nutritional history
Breast feeding:
) ( -
- artificial
weaning :
Vaccination history
40 -
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Notes of Medad Team 10
46
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Past history
See history of other system affection
-
-
Family history
? Is the mother diabetic or did she suffer from diabetes with pregnancy
- .
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Notes of Medad Team 10
47
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Marasmus
.....
Personal history
Sex and name:
Age:
Residence:
Consanguinity
Complaint
Present history
* Ask for symptoms suggestive hunger: continuous cry and anxiety and
scanty stools
-
* History of diarrhea:
* History of any preceding illness
Analysis of complaint:
Onset: Course:
Duration:
Chest: Cardiac:
- GIT:
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UTI: NEURO: -
- FEVER:
Developmental history
Motor:
Mental:
Nutritional history
Breast feeding:
- artificial
Weaning :
) ( - minerals:
& Vitamins:
Vaccination history
40 -
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Notes of Medad Team 10
49
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Past history
See history of other system affection
-
Family history
- .
Kwashiorkor
.....
Personal history
Sex and name:
Age:
Residence:
Consanguinity
Complaint
Present history
History of diarrhea
History of any preceding illness , measles
Analysis of complaint :
Onset: Course:
Duration:
- Chest:
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GIT: UTI: NEURO: -
- FEVER:
Developmental history
Motor:
Mental:
Nutritional history
Breast feeding:
- artificial
Weaning :
) ( - minerals:
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Notes of Medad Team 10
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& Vitamins:
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Vaccination history
40 -
Past history
See history of other system affection
-
Family history
- .
Rickets
.....
Personal history
Sex and name:
Age:
Residence:
Consanguinity
Complaint
present history
* Anorexia:
* Constipation:
* Housing condition:
-
* Deformity:
* Excessive sweating
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Analysis of complaint :
Onset: Course:
Duration:
Chest: Cardiac:
GIT: UTI: NEURO: -
- FEVER:
Developmental history
Motor:
Mental:
Nutritional history
Breast feeding:
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- artificial
Weaning :
) ( - minerals:
& Vitamins:
Vaccination history
40 -
Past history
See history of other system affection
-
Family history
- .
Down syndrome
Welcome the patient:
Introduce your self to the patient:
.....
Personal history
Sex and name:
Age:
Residence:
Consanguinity
Complaint
Present history
Analysis of complaint:
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Onset: Course:
Duration:
Stress on:
Cough
Chest: Cardiac:
GIT: UTI: NEURO:
- FEVER:
: Natal history:
..... Neonatal history:
:
....... . -
Developmental history
Motor:
Mental:
Nutritional history:
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Notes of Medad Team 10
55
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Breast feeding:
Artificial
-
Weaning :
) ( minerals:
-
& Vitamins:
Vaccination history
40 -
Past history
See history of other system affection
-
Family history:
- .
Nephrotic syndrome
Personal history
Sex and name:
Age:
Residence:
Consanguinity
Complaint
Present history
edema
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Notes of Medad Team 10
56
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urinary symptoms:
abdominal symptoms:
Complaint
, , -
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Notes of Medad Team 10
57
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Palpitation
Chest pain
Fever & joint manifestation
Past history
Recurrent tonsillitis
Arthalgia, arthritis
Family history
Similar condition
Complaint
": , , ,
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58
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Past history
Antenatal history:
Maternal fever+ rash
Medications, diseases
Developmental history
Weight gain:
) ( - minerals:
- artificial
Weaning :
& Vitamins:
Mental:
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Notes of Medad Team 10
59
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Vaccination history
40 -
Family history:
Consanguinity:
hereditary diseases, congenital heart diseases
Complaint
Present history
abdominal symptoms:
1- Hepatobiliary symptoms
Jaundice:
? Urine stool discoloration
Itching:
? Abdominal distension or enlargement
Lower limb edema:
Bleeding tendency:
Hematemesis:
If positive
* Frequency
* Amount & color:
* contain food particles
* Severity & received blood transfusion
* bleeding per rectum or melena
* Coma:
60
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Diarrhea
If positive
- Frequency:
) ( - Consistency, volume, color
- Presence of blood or tenesmus or pus
constipation :
If positive
- Onset, course:
- Degree:
- Dietary history
Chest: Cardiac:
GIT: UTI: NEURO:
- FEVER:
Past history
Bilharziasis
Hepatitis, jaundice
Fever, typhoid
)( TB
Blood transfusion
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61
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Drugs, operations
Perinatal history
Prenatal history:
: -
..... -
Neonatal history: :
....... . -
Mental:
Dietary history
- Breast feeding:
-
- artificial
Weaning :
Vaccination history
40 NMT10
Notes of Medad Team 10
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Family history
Consanguinity:
hereditary diseases, congenital heart diseases
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63
NMT10
Notes of Medad Team 10
Blood Report
Prepared by
Soma El 3ageeb
Typed by
Mohamed El Far
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64
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Notes of Medad Team 10
6 Reports
2 RBCs
2 Platelets
2 WBCs
Hemolytic anemia
Fe deficiency anemia (Microcytic hypochromic anemia most probably Fe
deficiency anemia)
Pancytopenia
Not aplastic anemia
Thrombocytopenia
Not ITP
Bacterial
Viral
1. Hemolytic anemia:
2. Fe deficiency anemia
3. Pancytopenia
Anemia
Thrombocytopenia
Leucopenia
4. Thrombocytopenia
Thrombocytopenia
+/- Anemia
5. Bacterial infection
6. Viral infection
Polymorph
Lymphocytosis
Comment
Diagnosis
Investigations to prove the diagnosis
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NMT10
Notes of Medad Team 10
Comment:
Diagnosis:
Hemolytic anemia with thrombocytosis due to overall activity of bone marrow or
due to splenectomy
Hemolytic anemia with thrombocytopenia due to hypersplenism
Interpretation:
Comment:
Microcytic hypochromic anemia with normal leucocytic count
Diagnosis:
Microcytic hypochromic anemia most probably Iron deficiency anemia
Interpretation:
Thrombocytopenia
+ mild in Hb due to bleeding
Comment:
Severe thrombocytopenia with mild anemia
Diagnosis:
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(NOT biopsy)
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NMT10
Notes of Medad Team 10
Interpretation:
All are
Anemia ( Hb + MCV OR MCV + MCH) + Thrombocytpenia ( Platelet) +
Leucopenia ( WBCs) + Reticulocytopenia ( reticulocytes)
Comment:
Diagnosis:
Pancytopenia
Interpretation:
Comment:
Diagnosis:
Bacterial infection with anemia
Interpretation:
Comment:
Leucocytosis with predominant lymphocytosis (No shift to left), NO bandemia
Diagnosis:
Viral infection
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67
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Notes of Medad Team 10