indexiContents ri Growth and Development Chapt rath 1 co Weight. © Height © Head circumference. o Dentition... «Development... o Summary Gross motor development median ages © Vision and fine motor development median ages .. © Hearing, speech and language development median ages. © Social, emotional and behavioural development median ages .. 7 © Developmental milestones by median age 8 Chapter 2 Immunization and Centile Charts.. eee cee es Definitions Diphtheria Vaccine Typhoid Vaccine Cholera Vaccine Tetanus... Pneumococcal Vaccine... Scanned with CamScannerChapter 4 Psychiatric Disorders * Plea. * Nocturnal Enuresis * Encoporesi: Chapter § Nutrition and Nutritional disorders. * — Malnutrition (includes Kwashiorkor and marasmus Chapter 6 Acutely ill Child. * — Anaphylaxis. © Foreign body inhalation and choking Chapter 7 Neonatology... © Care of the newborn Temperature regulation(Hypothermia and Hyperthermia) » Nutritional management of newborn... « Total parenteral nutritio! © Birth asphyxia « APGAR score « Prematurity Respiratory distress syndrome/Hyaline Membrane disease . . . . . * . . . . . * . . Scanned with CamScannerChapter 4 Psychiatric Disorders, 2 Pica... e — Nocturnal Enuresis. « — Encoporesis.... Chapter 5 Nutrition and Nutritional disorders. ® Malnutrition (includes Kwashiorkor and marasmus) Chapter 6 Acutely ill Child. * Anaphylaxis.. * _ Foreign body inhalation and choking. Chapter 7 Neonatology.. Definitions... Neonatal Resuscitation. Care of the newborn Temperature regulation(Hypothermia and Hyperthermia) Nutritional management of newborn Total parenteral nutrition... Birth asphyxia APGAR score Prematurity Respiratory distress syndrome/Hyaline Membrane disease .. Necrotizing Enterocolitis.... Intraventricular hemorrhage.. Neonatal sepsis... TORCH infection: Jaundice Neonatorum .. Post-term infant Small for gestational "RPO n se es 0 . Neonatal seizures Hemorrhagic disease of se ee ‘hapter 8 Infectious diseases « — Acute diarrhea & Dehydr Scanned with CamScannerCOCR RHE HES Scanned with CamScannereee eee eee ee eee Chapter 9 Respiratory Disorders snissnnnnmnninnns Poliomyelitis Diphtheria Typhoid Past paper scenarios... Acute respiratory infections Acute epiglottitis Croup Bronchioliti Pneumonia. Bacterial Pneumonia .. sinvecnuswsosenseenbonee Scanned with CamScannersoe eeee Chapter 12 Neurologic disorders... 60 000 6 a6 9.0 Acyanotic heart diseases Ventricular septal defect Patent ductus arteriosus Atrial septal defect ..... Some basic things a final yet Congestive cardiac failure infective endocarditis. student should know Scenarios ...... Pyogenic Meningitis Tuberculous Meningiti Epilepsy. Status Epilepticus Breath holding spells a Scanned with CamScannerChapter 15 Endocrine disorders Diabetes Mellitus. Diabetic Ketoacidosis Hypothyroidism Short stature. Diabetes Insipidus Rickets .... oe ee eee Chapter 16 Rheumatic diseases ..... Juvenile Rheumatoid arthritis .. Chapter 17 Genetics. e Down syndrome 183 « Edward syndrome. 184 e Patau syndrome 185 e Klinefilter syndrome. 185 e Turner Syndrome... 187 Fragile X syndrome . 188 Chapter 18 Nephrology 89 — Scenarios ... » 189 fo —_ Hermaturriatssssssssssrsssnersescnsenesenen 189 _ Henoch-Schnolein Purpura... 190 © Acute Post Streptococcal Glomerulonephritis ce Wilrm’s turmi0 sssesssecesseserersnneeneene ° . ° Scanned with CamScanner‘Scanned with CamScannerGrowth & Development Growth and development are s0 closely related that they are usually assessed simultaneously. * Discases tend to have more impairment when they occur during period of rapid growth Growth ‘Change in size due to increase in number and size of cells © Quantitatively measured (in centimeters and kilograms) Development ‘© Functional maturation of organ systems ‘Acquisition of skills and ability to adapt to new situations as the nervous system matures Growth ‘Rate of growth is more important than actual size Influenced by nutritional status, climate, season, illness and activity «Serial measurements of growth are best indicators of health © Measurements are plotted on centile charts and compared with normal standards ht Best index of nutrition and growth ‘Average weight at birth = 3.2kg (7 pounds) i Initially Newborn loses 10% weight (due to meconium,urine,less intake,edema) Regains weight by 10" day of Iife é Increase-in weight in first 3 months = 30g/day or 200g/week 3 months > 1 year= 150g/week Doubled at 6 months .Trippled at 1 year,4 times at 2 years and then 5 pounds/year During puberty > rapid growth and weight gain ‘Weight(pounds) Weight(kg) Scanned with CamScanner‘Scanned with CamScanneremt trent eno hat — pa Pane ns ge Pred = Se ea 2 etiam See eponty| Sante Swe, indepen | Atm 1 ieee ino pn tensed mater Unitapes a Serene | ements rece now teurng teechand wngueg vont ee "Sound mcogtion eciiaton wee 2 tes Peeractate | Toone 1 Siler ended se Saat | i 2 Ent sens nee sane 1 end comeloe Sones ayn Somerton ‘ Frecienmen | 23yen Scanned with CamScannernewborn‘Scanned with CamScanner‘Scanned with CamScanner‘Social, emotional and behavioural development (median ages) Scanned with CamScanner‘Scanned with CamScannerImmunization and Centile Charts ~ Long ternv/Slow in onset ‘Administration of all or part of microorganism oF 4 modified product of the organi immunological response \ism to evoke an vid in onset ive b i ‘Short tem/Rap! ‘of preformed antibody to a recipient Administration Herd Immunity TF Number of people in a community have active immunity against an infection exceeds a critical level ted from getting the disease 4. tkthis level is achieved then even non-vaceinated people are Protee by individual’s immune system an be recognized inst the antigen in the vaccine Vaccine ‘® Protein similar to part of virulent organism that cé vanich then produces antibodies or cell mediated immunity against jive ° (We vi ism producing antigenic response by causing a MILD infection. «Produces active immunity + Example : BCG,OPV,MMR, Yellow fever de but their Scanned with CamScannerBacille Calmetie Guerin Most widely used vaccination in the world Live Attenuated vaccine of mycobacterium bovis Effective in reducing the likelihood and severity of TB in infants and yoigg children Ideal age is < 1 week of age : Tolder child reports - Do Mantoux test > if negative > vaccinate 0.05 ml for newborn and 0.1 ml for other children Intradermal ‘Wheal disappears in 30 minutes Nodule forms in 2-3 weeks ‘Nodule indurates and forms superficial abcess Abcess heals in 4-6 weeks Scar left in a total period of 2 months ‘Koch’s Phenomenon ~> accelerated reaction that completes in 10 days Erethyma nodosum Deep abcess and ulceration Lymphadenopathy of supra-clavicular or axillary nodes Generalized Tuberculosis see eee eele ree eleven Rabies ‘Active(Human Diploid cell vaccine-HDCV) Pre Exposure * ImlSCoriM 2 doses at 4 week interval | Booster after 1 year | Then booster 3-4 yearly _ i 1 ml S/C or IM | 0,3,7,14,28 days, s | Post exposure ele « «: + Live Attenuated polio virus LI an Sabin in the mouth) « _ Injectable Polio Vaccine (IPV)—§. + Remember IPV is not capab poliomyelitis « Evenif child has suffered from poli other two types of polio viruses «It leads to lifelong immunity if b Scanned with CamScannerEasy 10 administer Superior antibody response a ee baie | Week Any household contact with HIV Known Immunodeficiency Immuno-deficient household contact Breast feeding Current antimicrobial therapy Mild diarthea developing countr es Interference from other enteroviruses Cold Chain ‘A gystem of storing and transporting the vaccine, at a low temperature from the place of ‘manufacture to the actual vaccination site is called cold chain Diphtheria vaccine Formaldehyde inactivation of diphtheria toxin adsorbed into alluminium. salts to increase antigenicity Eyen immunized persons can be infected by toxin producing strains of bacteria but systemic manifestations donot occur Almost always administered as a part of DPT. 0.5 ml Intramuscular No significant adverse effect Diphtheria toxoid > used alone only when pertussis and tetanus toxoid are contraindicated DT (Diphtheria-tetanus) > When pertussis vaccine is contraindicated ‘(Only used in children) _ Td(Tetanus-diphtheria) > Used in persons 7 years of age or older | DPT (Diphtheria-Pertussis-tetanus) > Standard immunizing agent © Horse serum for passive immunization used when Anti- diphtherie Antibody is not available Test dose is necessary - Prophylactic dose 10,000 1U by UM. Tirapautio dase : si hag by IM Scanned with CamScannereee perenne Study Mate Serles by Dr. Ahmad Hassan, Typhoid Vaccine (Typhium Vi) * Purified Vi antigen * One dose injectable vaceine * Single UM dose of 0.Smi with boosters every 2 years Choler + — Killed whole cell vaccine * Not too much practical value * Doesnt confer immunity against serotype 0139 vaccine ive Immunization (Tetanus Toxoid * Toxoid > inactivated toxin with formaldehyde : Stable and can withstand exposure to room temperature months without significant loss to potency (can withstand 37C for few weeks) Even if a person is previously diseased still he should be vaccinated since previous disease doesnot confer immunity © Booster every 5-10 years Toxoid > induces formation of anti-toxin > neutralizes the toxin Newboms can be protected if mother during pregnancy is given 2 injections of toxoid at 6 week interval (2™ injection atleast 4-6 weeks before delivery to provide adequate time for antibody production) = Dose 0.5ml /M ‘Side effects /—* Raresince it is really safe . Piiviser piotectonior 713 days * Test dose is a must before administration _ Prophylactic dose 1500-3000 TU 1/M | Therapeutic dose ‘Neonates : 10,000 IU S/C around umbilicus, 10,000 IU Sst 10-000 TV: Scanned with CamScanner@ Killed/inactivated vaccine ‘Used as a.component of DPT vaceine 0,5 ml Intradesmal against differerit components: ‘Tempe Collapse/Shock like state Seizures Crying » 3 hours Encephalopathy Neurological Sequelae ‘Neurological Sequelac Family history of convulsions ‘Family history of Sudden infant death syndrome Family history of an adverse event following DPT administration jours of DPT injection further is case receive Pertussis vaccine ussis se ele ele eee eee administration of pertussis vaccine If Convulsions occur within 72 h is contraindicated Give DT alone in thi 12 years of age children should not Children with brain damage or previous history of convulsions should not receive pert e After vaccine ns to containing Immunizations Scanned with CamScannerSide effects © ~~ Live attenuated vaccine | * — Produces neutralizing antibody | © Immunity is life-long if boosted by wild virus |e ctmunity is shorter when no wild virus is cfreulating | |__» Mostly as.a component of MMR (Measles-Mumps-Rubellay | © _0.5ml Subeutaneously ee . Anaphylax! * Anay + Pregnaney + Immunodefici ee Simultangous TB skin testing Breast feeding Pregnancy of MOTHER Mild febrile illness Morbiliform rash Febrile convuslions Post-exposure prophylaxis Soa \e 60 |e oe Encephalitis, Tewithin 72 hours of exposure > give vaccine immediately Ifmore than 3 days but less than 6 days of exposure > Immunoglobulin given /M Given to all infantsychildren and adolescenis ‘Not contraindicated in immunosuppressed or in pregnant women 31M doses Increasing the interval between 1" and 2 doses has little effect on ‘immunogenicity Longer the interval b/w 2" and 3" dose higher the titers of anti-HBs | 0.5 ml if <19 years | | | 1d Hepatitis B vaccine at Scanned with CamScannermmunization ‘Scanned with CamScanner; 3 Scanned with CamScannerPsychiatric Disorders PICA Definition Clinical findings Persistent eating of non-nutritive substances for a period of atleast 1 ‘month at an age in which this behavior is developmentally ‘inappropriate (eg: more than 1 ¥4 year) Depends on the type of thing ingested Lead : Neurologic issues (irritability lethargy ataxia headache, cranial nerve palsies,encephalopathy,coma,death) and GI issues (Constipation,abdominal pain.colic. vomiting.anorexia diarrhea) ‘Clay/Dirt/Soil : Parasitic infections like Toxocariasis and ascariasis | Burnt match heads : Hyperkalemia ‘Mechanical bowel problems secondary to something that is indigestible : Constipation,ulceration obstruction and even perforation | ada SaaS Deficiency of Iron,Calcium,Zn Maternal deprivation Parental Separation Child abuse Lows -Multidisciplinary approach ‘Removal of toxic substances from environment “Address maitionaldefiieney and correct it Scanned with CamScanner‘Scanned with CamScanner‘Scanned with CamScannerPediatrics Made Simple — The Stui ‘Mate onal Disorder Malnutrition * Pathological State Resulting from relative or absolute deficiency of one or more essential my * common in children of ages 3 mont * if it occurs in infants and pre schoo! children- development + mental development ths- 3 years permanent effect on physical growth and y When there is deficiency of food availability 1 Failure of lactation (ill mother or pregnant again) 2. Ignorance of weaning 3, Poverty 4. Cultural patterns 5 Lack of immunization and repeated illnesses Feet or family planning(malnourished mother-malnourished baby) “ecreased assimilation of food though food is available (ICMMP) 1. Infections(measles.tb,uti) 2. Congenital diseases(VSD.ASD,Lung diseases) 3. Malabsorption(Celiac, Lactose intollerance) 4. Metabolic disorders(DM,DD 5. Psychosocial deprivation Classification 1) Grade 8 Grade 2; Weight is 61-70% Scanned with CamScanner5) General a) ‘Midarm Circumference «cut off point is 75% of expected mid arm point is <14cm d) 9) Clrcumferrence (normal is 12.5-16.Sem), cut off » — Yellow=Borderline 14-120m + Red=Malnourished <12 cm ‘Skin Fold thickness + Herpenden calipers © measures at the region of triceps or back of shoulders © Normal: 9-11cm Malnourished chil 1) History (Age,Diet breast feeding, weaning sinking of eyes,irritability,vomiting or diarrhea associated,last urine passed?,birth weight.milestones,immunization) 2) Physical examination Weight Height Edema Liver tendemess or jaundice Abdominal distension , Abdominal splash Pallor Signs of ciculatory collapse Thirst Te omen eh i Eyes:Corneal lesions showing vitamin A deficiency ‘Skin-infections or purpura i 5 Respiratory rate and type of respiration :pneumonia or heart failure signs ai Scanned with CamScanner. a Dietary deficiency or © Over diluted milk (ignorance or poverty) * Infections rds) Clinical findings (will start from head and move downwa * Normal Skin and Hair : ood apetite ° in proportion to the body MOnkey face) (Little old man, Skin hangs (shriveled) Protuberant abdomen Muscle wasting and loss of Subcutaneous fat in thighs and buttocks + Tendon reflexes diminished © Plantar reflex absent Growth retardation (<60% expected weight) No Edema TB and Measles may complicate the picture Prevention Detect and treat early malnutrition > promote breast feeding upto the age of 2 years > avoid artificial feed till 4-6 months 4 immunization and primary care ‘Kwashiorkar ‘Marasmus UnderWeight Extremely underweight (below 60%) _ ‘Edema is always present "No Edema_ ‘Thin Jean muscles,fat is present “Muscle wasting and loss of subcutaneous fat Puffy, Moon face, "MONKEY face “Hair changes are present “Miserable looking and apathetic : | Poor apetite and anorexic e is better 4 Flaky Paint dermatitits ‘normal Scanned with CamScanner‘age is deposed from broast feeding which is the only source of reife apathy and irritability) changest oer ‘fine,straight,sparse, discolored jane may be deficient but proteins are always deficient All ma ays present but doesnt involve serous cavities 2 Growth failure (anasked by edema) weak: and wasted child but there is subcutaneous fat iow iron stores Low folic acid,low protein ssupply,hookworm,mnalaria) Fray Paint dermatitis, Uleers/Open sores, Vitamin deficiency signs tiver due to fatty i n Ene jools (secondary lactase deficiency) Complications Hypothermia Hypoglycemia Cardiac failure Infections Vitamin A deficiency © Severe Anemia + Dermatosis ‘Biochemical Changes 1 ia and reversal of albumin:globulin 2 Kefonuria due to starvation 5 Glucose tollerance curve is like diabetics 4. Aminoaciduriz ee ‘medical and social problems must be recognized and corrected as ‘chances of relapse are higher and there is a chance other children at home may ‘of death in first 2 days) - fed every 2-3 h day and TY, if cannot be given quickly ee —5. Treat/Prevent Hypothermia(specially in marasmus, treated if underarm temp is fess than 35 ae well ov cr ith Wann blanket , Kangaroo technique,lamp(measure temp every 30 minutes) hypothermic children must be treated for hypoglycemia and infections 4. Treat/Prevent Dehydration and restore lenrotyee balance (give 1Smi/kg 1V Darrow/Ringg tate/Half NS with 5% dextrose-reassess after | hr-still dehydraterepeat -Switch t0 ORS-ot impr, consider it as a septic shock and treat accordingly) « 5. Treav/Prevent Septic Shock : 6.7 avPrerent Infections- antibiotics (no signs:cotrimoxazole , signs:Ampicillin+Amoxycillin+Gentamycin) oa 7. Start Feeding the chil (ott form 2 provide calories and protcin ,small feeds since hile, to anorexia and vomiting) * first 3-4 days :90-150mi/kg skimmed milk * 3-4 days later = one solid feed per day * 3-4 days later~add aridther solid feed * 20th day=add three solid feeds/day 2)Rehabilitation et Starts when child's appetite has returned (a child on. NG cant enter this p Indications to start rehabilitation * Eating well Mental state improves (smiling, socialising) Sits.crawls stands or walks * Normal temperature + no diarrhea or vomiting = no edema * gaining weight >5 kg body weight per day for 3 consecutive days What to do? © <24 months =Liquids/semisolids >24 months=solid food - supplementary folic acid and iron to combat anemia (Iron =3mg/kg/day in 2 divided doses for 3 months) (Folic Acid =5mg on day 1 and then Img/day thereafter) Weight Measured daily and checked for adequate weight gain (>5 kg body weight per day for} consecutive days) «Discharged (if treated well,vaccination programme started,mother is willing and knows the sz & preliminary treatment of infections an u Bi ) Follow Up I week 2weeks Scanned with CamScannerAcutely [iI Child ‘Anaphylaxis Etiology Keute life threatening systemic reaction due to IgE mediated hypersensitivity characterized by Urticaria-Angioedema 2-Acute Airway obstruction 3-Circulatory collapse ‘Occurs within.a few minutes to hours after antigen exposure Drugs (Antibiotics) Bee Stings Foods (Peanuts,Shellfish) Latex(Gloves) Findings Unrticaria,angioedema flushing and itching ‘Nasal congestion ,thinorrhea,SOB, bronchospasm and hypoxia ‘Nausea, Vomiting, Diarrhea Dysphagia,abdominal cramps Headache Treatment | Removal of the trigger ‘Adrenaline aa 02 inhalation Fluid therapy and Vasopressors . . . . . e Syncope,hypotension . ° . . . . . © Bronchodilator drugs * Corticosteroids ‘Death due to Mechanical Airway obstruction is most common b/w 1-4 years of age Food and Coins are the most common cause of choking he most common site in children younger than 1 year of age Scanned with CamScannerins > May be tolerated for a longer period Wheezing a Asymmetric or absent breath sounds i Mechanisms of Airway Obstruction COMPLETE FIRST-DEGRI SECOND-DEGREE oBsTRUCT! cuneren OBSTRUCTION 7 s ii L. Management * No intervention if child can cough,speak or breathe * Fingers should not be put blindly into the mouth, > Lyear of age = Heimlich’s Manuever * <1 year of age = Back blows and chest thrusts * Ifnot removed > rigid bronchoscopy under general anesthesia * — Sometimes thoracotomy or bronchotomy maybe required Prevention ‘ * — Not given toys that can be easily Food should be cut, broken or m Food should not be eaten while ‘Nuts.hard beans,raw vegetables Chewable tablets are not re Scanned with CamScannerTt Neonatology First 28 days of Life | First 7 days = Early Neonatal Period 8-28" day of Life = late Neonatal Period From 28" Week of Gestation to 7 days after Birth From 28" Week of Gestation to the Birth of the baby After Birth: 1* Year of Life (first 365 days) ¢ Expulsion of dead fetus prior to 28 weeks pregnancy (Pakistan) and 24 2 Wee peste (doveloped counctios) + _ Expulsion of dead fetus after 28 weeks of Pregnancy '* ‘Number of Stillbirths and early neonatal deaths (upto 7 days) per 1000 elelelele ee Scanned with CamScanner‘Scanned with CamScanner[ge BY wosks in PCB To Wash ant Mesure i feeding carly (2-4 hours of life) pani liections(prevents HD) “ppositioning of the baby to avoid “spiration(supine/right side) Baby's Glucose regulation(Thermoneutral eny ‘tronment) Wash hands to handle baby , Wash Baby's y's umblical stump wi J Measure: Weight, Length Head circumferrence With antibiotic cream or g)Bathing Infections Dehydration i Over-wrapping Preterm infants it Increa : Little Subcutancons fat creased environmental igh rati temperature -High ratio of Surface area: Body weight ih -Reduced glycogen and brown fat stores a fever during Immature shivering and vasoconstriction © Increased Metabolic rate * Increased 02 consumption) ‘© Tachycardia(increased HR) ‘Tachypnea(Increased RR) Irritability Dehydration Acidosis Brain damage Death Scanned with CamScanner* DIC * Intraventricular hemorrhage * Pulmonary hemorrhage _ : * Remove the ] : ae oT . + Treat infection ify * Dy + Run sepsis seresning # Place in radiant warmer + Tum off any het i, Make him wear a hat © Remove excessive © Ensure 23-24C temperature of room clothing «© 26-28C temperature of room if high © Tepid water sponge risk infant © Paracetamol + Slow rewarming © Fullterm— radiant warmer + Preterm-incubator * Manage for sepsis It is the environmental ‘temperature at | which Scanned with CamScannermn (aniimg/day) | Pretenw/SGA (ilfmg/day io 60 80. 100 100 120 120. 150. 200-220, parenteral Nutrition tal Pa £ : i Tou val parenteral nutrition Intravenous administration of all nutrients (Fats, protein, carbohydrates: Tol vitamins and minerals) Parenteral nutrition 1S supplemental intravenous administration of nutrients Enteral nutrition is oral or gavage feeding cations ada XPO x 2 weeks Periods of poor intake for 2-3 days to 2 weeks Newborn ‘Older children ~©LBW<1000g ‘ Intestinal failure ‘Severe respiratory problem Malabsorption Short gut syndrome “Allother indications are related to GIT © Intestinal obstruction 's Intestinal failure (sepsis. NEC) ¢ Paralytic ileus * Diaphragmatic hernia ¢ Diarthea/Vomiting + TEF ¢ Hypermetabolic states © Gastroschisis ‘* Congenital GIT malformations *Meconeum ileus Complications TPN (THIS-MAT) © Trace elements deficiency (Cu,Zn) Hepatic issues (Cirrhosis, Hepatomegaly) Hydropneumothorax Infections Skin Sloughing Metabolic Hyperglycemia Hypoglycemia ‘Hypomagnesemia Hypocalcemia Hyperlipidemia ree eee ere ae ee ee Scanned with CamScannerz g = fe 3 z &+ Treat Cardiac failure > digoxin and inotropic support * Simple, painless and effective check used by midwives and doctors to assess your newborn's health * Atone minute after birth, and again at five minutes after birth. all help to decide if your baby needs any immediate treatment during the first le below is given a score between zero and two, which are then added up to give check ® Minutes are more strongly correlated with asphyxia Keep scores artificially lowTrauma Some Neuromuscular disorders | ‘Metabolic or Infectious insults to CNS ! ‘Candiae or pulmonary malformations | Score 10 is rare ; --9 > mostly, require no further intervention : Sere x pulse oximetry monitoring and positive Score <7 > require further evaluation and resuscitation, If beart rate <60 > chest compression may be given i d : APGAR score at 5 min is useful in assessing response to preliminary intervention ‘Most concerning factors are heart rate and respiration. r mises concern very young maternal age H/o DM H/o HIN H/o Substance abuse Scanned with CamScannerive born infunt delivered before 37 weeks from the first day of Last menetea iI d a iil period pile ee Polyhydramniog PROM ‘Trauma Tatrogenic Problems/Complications of prematurity ‘Short term (Immediate/Acutc) «Hypothermia + Hypoglycemia > lack of glycogen stores * Hypocalcemia > immaturity of hormonal control system + Intraventricular hemorrhage immature vasculature vitamin K) Retinopathy of prematurity Retrolental fibroplasia Feeding issues> uncoordinated sucking and swallowing, GERD Necrotising enterocolitis >immature gut and enzyme deficiencies PDA and clotting factor deficiency (treatment Respiratory issues > IRDS and Apneic spells Liver immaturity> leads to prolonged physiological jaundice Anemia of prematurity > decreased iron stores , Vitamin E deficiency , physiological anemia Metabolic bone disease -> Rickets (due to calcium and vitamin D deficiency) Bronchopulmonary dysplasia due to vitamin and iron deficiency ction > CP. learining issues deafness,mental subnormality ,hydrocephalus Scanned with CamScanner3)Defective Coagulation 4)impaited excretion into Bile Hemolytic disease of the Newborn * Incompatibility of Maternal and fetal Rhesus srouPs + Rhy ° Fe * — IgG requires amplified response on pr ases with inet + IgG crosses placenta and forms comples with fe Hemotysis occurs in spleen leading to anet * Earlier the IgG crosses the placenta , seve «Aft crosses at erm the anemia will be moderate «If itcrosses during 2™ trimester there will be | faihure-hypoproteinemia,ascites(hydrops) edema > Major Blood group (ABO) incompatibility protects iis antibodies are destroying fetal cells in Maternal circulation system to produce antibodies € ABO incompatibility ~ Canbe seen in 1" pregnancy ‘When Mothers Blood group is O, bal Severe hemolysis is rare Naturally occurring antibodies are IgM that DONOT CROSS PLACENTA Fetal A/B antigens produce a WEAK maternal Immunoglobulin response “Antibodies produced by mother are NEUTRALISED by A/B antigens ‘Coombs test may be -ve (Since it is positive due to IgG) es/Evaluation ‘previous sibling with jaundice to Rh -ve Mother Joells entet maternal cireularion thus mother forms Ami-D IgM and fg ‘exposure the sed Parity (conceptions) I RBCS jaundice in the baby refore 8 nancy, The risk ine is the disease natospleenomegaly liver disease ca nd ultimately Death ~ sinst Rh-incompatibility since Anti. before they sensitize the mothe ; +s my? by’s Blood group is A/B Scanned with CamScannererrr a NID nee eT TS TEN Fenim Dilinibin (Total.direct and indiwo) Urine exam for reducing substances Liver Biopsy main methods Fechange Transfusion Noms therapy 1)Phototherapy Indications ‘When Bilirubin is Smg below transfusion level ‘When seam Bilirubin is unconjugated In Hemolytic disease of Newborn, waiting for exchange transfusion Following exchange transfusion Prophylactic gh to eliminate kernicterus risk Scanned with CamScannerComplications Overheating and dehydration Hypothermia and Chilling in winter months Skin rashes Loose stools (Increased salts and Unconjugated bilirubin in stool) Eye injury (Retinal damage,Comeal abrasion,Conjuctivitis) Bronze baby syndrome > When infants with conjugated bilirubinemiia (mixed jaundice) diy dark brown discolouration that persists for months 2) Exchange tran: ‘Done through umbilical vein Aims Remove sensitized RBCs 3 Cheeulatien fitteihh Improve anemia Indications At Birth ° Hb < 12p/4L Bilirubin >5 mg/dl, Coombs test positive Reticulocytes > 10%jourubin 20mg/dL ee > Img/dL/hour or 10 mg/day Pay of sume disease and treatment in sibling Harare LBW mreatment fils to prevent bilirubin rise progression of anemia poo Wet Umbilical stump.catheter passed in umbilical vein but should not reach liver ‘Blood required = 2 x Infant's blood volume (160 ml/kg) Blood agitated periodically to maintain constant Hematocrit Blood warmed to 37C ; ‘Blood withdrawn 10-20ml , discarded using 3-way catheter,10-20 ml drawn from blood bag and infused 2 : 1-2 ml calcium gluconate may be infused during or after exchange transfusion E Umbilical vein © Umbilical artery Large Peripheral vein (Jugular/saphenous) | * Use fresh blood stored in citrated phosphate dextrose + Hemolytic disease > Blood group O -ve that is cross matched Drape the baby.empty stomach by NG aspiration ‘Maintain temperature,Respiratory rate and Heart rate Cut umbilical cord near the stump Identify Umbilical vein, insert catheter under strict asepsis Flush catheters and Syringes with heparin Scanned with CamScanneracologic Tinatmer Give antibiotics if septicemia is present Adequate feeding. Rhogam to mother within 72 hours of delivery Phenobarbitone Metalloporphyrins (Hemeoxygenase inhibitors) IVIG Albumin transfusions if albumin < 3p/dl- Kernicterus * Neurological sy’ deposition in brain cells drome due to Unconjugated bilirubin oe * wae Scanned with CamScanner‘Scanned with CamScannerDepends on cause Antibiotics * TPN induced > stop TPN atic > Phenobarbitone + Cholest > Kasai procedure within first 6-8 we available/successful go for liver transplant = The Study Mate Series by oy Pediatrics Made Simple - nine ks ier 42 weeks of gestation calculated from LMP. Idiopathic (most common) ae | Anencephaly Trisomies 16 and 18. Seckel’s syndrome Clinical findings Absent lanugo (body hair) coating the skin of newborn) Long nails Abundant scalp hair White scaly loose wrinkled skin Increased alertness If placental insufficiency > retarded growth ‘Complications Meconeum aspiration Hypoglycemia ‘Hypocalcemia Asphyxia Polycythemia Careful Obstetric monitoring to avoid post-term infants Early feeding for proper nutritional support ° . . . . . Significant risk of mortality if delivery is delayed 3 weeks ormor beyond the term nd Large for Ges Scanned with CamScanner© Poor sociocconarnie satis 3, Malnutrition 8 Smoking 9. Short stature: 10, Anemia 11. Fundal Lag (<4 em for gestational age) 2, Drugs(Phenytoin, Valproate) 1. Chromosomal disorders (Trisomies 15, 18,21, Turner) 2. ‘TORCH infections 3. Congenital malformations(Potter) 4. Congenital Heart disease 1 1. Decreased placental weight 2. Decreased Placental Surface area, 3. Placental separation 4. Tumor $__Twin-Twin transfusion syndrome First 6 Deals with decrease of things since it is small for Gestational age) 1)Glucose(Hypoglycemia) 2)Temperature (Hypothermia) 3)Neutrophils(Neutropenia) 4)Platelets(Thrombocytopenia) 5)Calcium (Hypocalcemia) 6)Oxygen(Perinatal asphyxia) Birth Asphyxia Birth Trauma(Fractured clavicle/Erb’s Palsy) Hypoglycemia Polycythemia Evaluate for the complications Feed Early since they are prone to hypoglycemia (due to hyperinsulinism) Scanned with CamScannerPRETERM (decreased response to PTH) IDM(increased Calcium demand) Asphyxia Poor enteral intake Stressed during perinatal life Infants receiving blood transfusions Infants receiving diuretics Meconeum aspiration idism (congenital ,Digeorge) ‘Vitamin D deficiency Jncreased extensor tone,clonus{itteriness,lethargy & hyperreflexia Early onset > usually asymptomatic er in whom adequate control of blood sugar has not been accomplished during, Fetal Hyperglycemia Fetal insulin production > during bisth there infusion to the fetus but insulin production remains high Scanned with CamScannerpirge and Plump baby (Macrosomi a) due to increased body fat Pufly plethorc facies eee S ceedae Viscera {Signs ofimitabitiy , nyperexcitabilty and later hypotonia,letharey and poor sue Signs of respiratory distress (immature lungs and decreased surfactant) Congenital anomalies Cardiac issues Hypoglycemia Hypocalcemia Hypomagnesemia Birth asphyxia Birth trauma (Klumpke’s or Erb’s palsy, Clavicle fracture, Cephalhematoma) RDS Hypertrophic cardiomyopathy Hyperbilirubinemia Polycythemia and hyperviscocity Renal Venous thrombosis Renal > Agenesis GIT > Situs inversus,Small left colon syndrome Neuro > Anencephaly Meningocele Skeletal > Hemivertebrea Scanned with CamScanner‘Scanned with CamScanner‘Scanned with CamScannergs Infectious Diseases pee more stools in a day of consistency softer than usual OR Passage of 1 Watery Stool po a “Food borne or water borne ~ ‘Also causes Traveller's diarrhea ‘Types of Diarrhea caused Invasive Enterotoxic Entero-pathogenic ‘Hemorhagic(O157:H7) Pathogenesis By Action of toxins released by bacteria Heat Labile toxin(LT) Adenyly! cyclase > Accumulation of ‘cAMP that causes Sodium and Chloride secretion in gut lumen Heat Stable toxin(ST)> Guanalyl Cyclase Increases secretory activity of Gut * Recovery by replacement of effected cells by regeneration in 2-5 days wee e ee weees fru Remember its LOTA vinus (That forces a child to use the restroom D) Invades intestinal cells and alters their function and reproduction ‘Causes shedding of mucosal cells with loss of disaccharides Leads to osmotic diarrhea Scanned with CamScanner2 8 5 8 £ z 8abou hepsi ‘complaint vating factors, Alleviating BART oeee ar” Ps Hise te of loos ol + ‘Colour of stool) Se er ciaiComrat _Amount,Blood present or ‘stool, dour + Projectile/non projectile) + ‘Fever (OFDPAAA + Pattern and If it is Examination | Strt From General tings then move wo Mouth Eyes >head-> Abdomen includis turgor Other systems = 1. General Look 2. General behavior 3. General Physical Examination (Pulse, Temperature, RR,BP,Skin perfusion) Weight and Height . Mucous Membranes (Normal,dry parched) 6. Byes(Normal shiny with tears,not sunken,sunken,hazy cornea) Anterior fontanelle(Open,closed, depressed, full, bul ging) 8. Abdomen(Nonmal,distended,mass,Bowel sounds) 9. Skin turgor(Normal,Lost,goes back slowly,Goes back very slowly) 10. CNS and respiratory system oe Scanned with CamScannereee Normal Formed Stools | Gade It Soft Stools aS rade UT Cis 3" letter (Liquid stool thai Takes shape of Conta Watery Stool with flakes, Appears Opaque Watery stool with flakes, Appears translucent fication of Dehydrati | Mita Weight Loss is Less than 5% © Irritable Marked thirst Feeds taken cagerly but often vomites ‘Markedly irritable Se Eyes and Fontanelle sunken and skin 7 Extremities cool and cyanosed Deep, rapid, sighing respiration 7 Marked Thirst Moderate | Weight Loss is b/w 5-10% Cold Ashen grey extremities Deeply cyanosed DESIRE TO SUCK IS LOST Glazed comea Eyeballs rolled up Fontanelle sunken Oligemia and peripheral circulator fame Severe Weight loss is More than 10% Scanned with CamScanneri 3FS= Fluid Feed and Follow-up Fluid © Breast feed urgently and for a longer ti | ORS in adltion to breast mike SM ood > Teach mother how to Mix > aa by smal sips and ifthe child vomits wait for 10 minutes —» Continue this until di oo passed | ht sal masts ea anda TO minutes an then ge the ORS apn bt dors © Tell the mother that Freq child vomits wait for + Breast Feeding is continued (fon cow's mill/formula milk half due) | ‘© Ifeating food > food 4-6 times/day | ‘+ Fruit juice/Mashed banana given to replenish Potassium Follow-up | «= After 5 days Return immediately it | Notable to drink | Becomes sicker | Fever | Blood in Stool Drinking Poorly jan fo use NOW Scanned with CamScannerTreatment Plan C or Severe deindration a hether IV fluids can be given or not I First thing that needs to be decided is w If IV-Fluids can be given 0% 70% calculated HE1V-Fluids can be given g—__ 709% ealealaied TOOmI/kg R/L or NS 30% calculated aoml/K; __(7om ST Year 1-5 Years Within 30 Minutes 2% Hours | iafier every 1-2 hours wae ‘e _ Reassess the patie ; Give ORS Sml/kg/hour if the child cam drink Then again reassess the patient after 3 hours (for an infant and hous, child) and choose treatment plan | If TV Fluids can not be Given ifthe care is nearby refer the patient sone care isnot available nearby and there is facility for NG then pas yg ‘give ORS and reassess the patient and if he is not improving rece Hospital management lable nearby and there is no facility to pass NG ree «Ifthe care is not avai patient for hospital management HOSPITAL MANAGEMENT Fluid Use the following Formula( So First day = 250ml/Kg) eS Deficit Therapy Maintainance Tine ‘Total Fluid (%D/W-V/SNIS) + S%DK Given = (RiLorN/S)+ 5 Se | 30% calculated 70% calculated 100mI/kg R/L or N/S (70m! “sYern—————Witlin30Minues_2/Hiows_ Oral rehydrati ion Salt (C Scanned with CamScannerratory infection with Group ABeta Heng Rheumatic Fever 105) . Delayed. 0% pu CLL ~| ed Ce isa i ving joints) heart,blood vessel (Nba streptococe iV » Diffuse ‘aflamatory disease of connor! subcutaneous tissue Epidemiology, + Mostly children b/w 515 years) Ncalt Poverty Overcrowding Poor housing Inadequate health. Tropics Chigh tempo ‘Winters and. ae Streptococcal phary? in 4 yeas) . services . perature nd precipitating ith other proteins fema and cel] infiltration amicry > antiodies cross react with eneration pf connective tissue intl xual and(fibrinous exudaie>? & infiltration, ae eS cling degeneration surrounded by a ofa gzntr of fibrinoid d Scanned with CamScannerDiagnosis PIS lta eatin food by sess iX10 yeas © Adil pani welingottaeajaag——— + Houndawollen end ying a + Migratory in are i fein | SS iis improving white another | recovery no residual Sova imolenin in Inversely propotional to severity of me of br : lie murmur radiating to axilla '* _Nodules on Mitral vah a com Wve" soft mid-iasoic murmur Cares-Coomi | “Cardiac faire * Onextensor surfaces i ad es © Raised red macules: © Ontrunk and, of limbs, ‘* _Jerky,involuntary purposcless n-repititive Main in posimalJimb muscles orn.” | © Iegular gait ¢ _ Deterioration of speech and writing ‘Main thing to diagnose ] 2-Major criteria + evidence of preceding strep throat 1 +1 Minor criteria + evidence of preceding strep throat Scanned with CamScannerScanned with CamScannerFever(HIGH TEMPERATURE WITH See LOW PULSE RATE) Abdominal tenderness Rash Diarrhea/constipation Rose spots(Upper abdomen and lower chest) Spleenomegaly and Hepatomegaly Toxic look~ LONG DRAWN FACE WITH FURRED TONGUE ede bleeding and perforation Melena Tleus Rigid abdomen : Bp Coma a < : Relapse p Weight loss ‘Reappearance of cachexia woelm rev esleocccclece P [solation of causative organism ‘Blood culture > during first 2 weeks of illness yy culture > Most sensitive Urine and stool culture > Late - Widal test “Measure antibody to somatic and flagellar antigens of salmonella - antibody titers > 1:160 > infection iy titers > 1:160 > previous infecrion/immnization e specific and sensitive than blood culture despite high fever narmochromic normocytic anemia Scanned with CamScanner‘Scanned with CamScannerRespiratory Disorder. past paper Scenarios 1 ior han? year OK : Some Difficulty Cough, Tachy) : Poe Che ndings Ctrl ne ona : oe ; Seat £ No Fgver present Bilateral ee Sere "onch and fy ce peeartast on ‘repitations Sinaiar posumonia : / + Cough breathing Inability 0 et oi fod Taye atsjomen/Chest Pain/Convulsions/Vomiting,Chestindrawinge (nae es eve ih pin rections) ings (Inerostal and subcostal «+Other Scenarios of Pneumonia : Fever and Cough for Gost on onesie (Can be pleural etusion) 2 | We%- CXR showing Honngeoas ‘Bronchiolitis, + Less than? years of age + Low Grade fever.co rat a i ugh, Respiratory difficulty and tachypnea,Chest indrawings Ronchi AND + CXR : Overinflated hangs Cooup (Acute Laryngotracheo 1 Crow + Low grade fever,Stridor,Flu Respiratory distress Xray shows Sub-gotic namowing ‘+ Barking cough Chest recessions common inPakistan in Developed countries Scanned with CamScannerPediatrics Made Simple ~ The Study Mate Serles by Dr, nfections Jaemophilus phylococ 4-Group A Streptococci 3-Tachypnea (Fast Breath rate/minute for the di cutoffs for respiratos i If the child is: Then he has fast breathing if you count: Less than 2 months 60 breaths/minute or more. 2 months upto 11 months | 50 breaths/minute or more 12 months upto year 40 breaths/minute or more Treatment © Most don’t need antibiotics ‘© Use non-sedative cough Mixtures ° Home remedy (Green tea with honey, Qahwa,Joshanda) Acute Epiglottitis (Bacterial Croup Pathogenesis and Epidemiology * — Mostly in winters and b/y 2-5 years of age + Rare in below 2 years of age * tis due to infection of epiglottis.aryepiglottic folds and arytenoid soft tissues by Haemophilus Influenzae (Remember it is a bacteria not a virus , influenza is a virus too) © There is direct invasion by bacteria leading to inflammation and edema and deposition of POLYMORPHS and FIBRIN * There is Supraglottic involvement ana . Dec in incidence Clinical fin Scanned with CamScanner-40C) ~ Toxic look ee in Gesativa since cant swallow normally) poner jon and child sits leaning forward Sens ang with iitablity and restlessness pif ~peukocytosis BC girect visualisation) of the swollen epiglotis * y! i 105 ly Lannanseek Xray Shows Thumbprint Sign Quick PI i ieey (Nasotracheal intubation) Ventilatory support unt edema subsides (Several days usually) send bacterial swabs for culture Fluid and. Flectrolyte support Jntravenous antibiotics (since orally Ceftriaxone/Chloramphenicol ~ or (Acute Laryngotracheobronchitis)(Viral Croup) ppidemiology and Pathogenss*s | svinters and in children less than 4 years of age ‘Mostly in ‘More common in boys Due to Parainfluenza/Influenza VIRUS Infection spreads from nasopharynx > Laryns and trachea There is sub-glottic involvement primarily toms last 3-7 «Slow in onset with milder symptoms like cough.cory7a ‘and low grade fever Cough with inspiratory stridor (Barking cough) starts in 12-48 hours ‘+ Respiratory distress and cyanosis . : : ag se PY, jrisanemeree en i? amination since there maybe complete obstruction of airway if the treatment is | Vy it is virally impossible for the child to eat) ~ i since it is not a bacterial infection vy shows Steeple Sign (Sub glottic tracheal the trachea itself) narrowing producing the shape of a Scanned with CamScanner* Patient should be calmed down and must be kept as peaceful as possible * Oxygen = Cold and humidified ! {Mist Therapy: Hot Steam using Vaporizer or Cold steam using Nebulizer until ough subi * Pulse oximetry and ABGs to assess the prognosis and adequacy of air exchange { Fhinephrine Nebutization (Nebulized racemic epinephrine) — * Antibiotics (if there is suspicion of secondary bacterial infection) * Dexamethasone (to reduce edema) Indications for Hospitalisation * Cyanosis * Decreased Conciousness * Progressive stridor * Toxic Appearance Differentials Scanned with CamScannerei being somite gation posse ype lated lungs and increased AP ‘au ines «Poe: Usa nonmal sacs tisa vat inten ¢ Percate anvil antibody ter tom sharp sac ons mer, Increased broncbovascular markings and srpicaions ee esc orele ith rupeiadded bacterial infection Pneumothorax. Dehydration Respiratory acidosis. Respiratory failure. Heart failure Prolonged apneic spells and death may occur (Less than 1%) Scanned with CamScannerRibavirin * Avoid sedatives * No role of bronchodilators or steroids tnflammation of lung parenchyma Antibiotics if superadded bacterial infection Anatomical Classification [ Etiologien! Clas T 1)Bronchopneumonia 2. Viral -Patchy involvement of the Lung 3. Aspiration | 2)Lobar Pneumonia - Foal | ~One or more lobes involved 6. Protozoal (due to | : Mycoplasma,Pneumocystis carinii) | 3)Pneumonit ffler's pncumonia (associated | “Patchy inflammation ofthe lung that may oF Desist) | maynot be associated with consolidation lobar pneumonia Pleural effusion , Empyema and poeumatacete is Predis sposing factors Repeated aspiration (esophageal reflux) or immunosuppression ‘Congenital abnormalities (intrapulmonary sequestration, trachea-esophageal fistula,Cleft palate) Abnormalities in clearing mucus (Cystic fibrosis,Ciliary dyskinesia-kartegner’s mnchiectasis) «Congestive heart failure (VSD,AV canal defects) Pathogenesis ‘Nomul Mechanisms that prevent lung infection ‘Macous covering the mucosal epithelium Secretory IgA antibody in mucosal secretions ‘Lymphatics directly draining lung parenchyma ‘Macrophages ‘Systemic humoral and Cell mediated immunity : eo tocae mechanisms is disrupted duc to viral infections or aspiration of pathogenic bacteria gs hematogenously from a distant source (meninges,bones joints) d High grade fever utt rate : Respiratory rate) becomes 2:1 or 3:1 instead of normal 4:1 due j ith coughing flaring of alae nasi,use of accessory muscles of respiration ' and intercostal retractions i Scanned with CamScanner. oie : Vomiting, Meningismus and Convulsions may occur ea hilen Complain of abdominal and ches pain Her non productive cough that may change to productive and blood tinged lay oy Classic Physical findings * Decreased chest movement on effected side (Inspection) * Increased vocal fremitus (palpation) * Dullness to percussion (Percussion) * Bronchial breathing and increased yocal resonance ,Pleural Rub (Auscultation) Associations * Measles * Otitis Media © Congenital heart disease * Malnutrition Septicemia CBC and DLC : Leukocytosis (WBC > 12K) with predominant neutrophils but if WBC Empyema Effision > Small effusions treated ifthe cause i tees 1° is treated , Drainage with chest tube and 1V + Tung Abcess > Postural drainage and physiotherapy 5 meses 2 Peete ieeteay apy lococcal Pac and 1" gener Cy nt Exytronycin PMP *phalopsporins and i I Cloxacitin in) Asthma "Chronic inflammatory disorder of the airways {Chronically inflamed airways are hyperesponsve they become obstructed when the airways are exposed o various stimulants and/or igen ht mite factors Respiratory infections (Viral- mainly RSV and parainfTuenza/Mycoplasa) Initants (Air pollution, cold air.cigarete smoke) Buerise Inhalants (House dust animal dander, feather pollen. mould spores,vegetable seeds) Foodls (Fish,egg.milk, Nuts) Strong Family history of asthma.eczema and hay fever Changes in Weather Strong emotional expression Medications (Aspirin,Beta blockers,Penicillin) GERD Sinusitis Endocrine factors: (Symptoms improve in some children at puberty and it is usually said that Joufgrow asthma’. But asthma may exacerbate in relation to menses or withthe onset of Scanned with CamScannerLange family size ( 6 members) Intense allergenic exposure in infancy Frequent respiratory infections in childhood Types of Asthma Extrinsic (allergic) . . Inte . . Due to exposure to environmental factors Increased concentration of total IgE and specific IgE ma No evidence of IgE Often seen in first 2 years of life ‘olvement Pathophysiology . . . Inflammatory condition of lungs Bronchospasm (broncloconstriction or smooth muscle contraction) Mucus production Edema and inflammation of airway mucosa Infiltration of inflammatory cells Obstruction mainly during expiration (remember asthma is an obstructive disease) Pulsus paridoxus : increased intrathoracic pressure de {0 hyperinflation of lungs and air trapp decreased venous return thus decreases cardiac output ™ Respiratory acidosis : Hypercapnia since the child is unable 10 expel the CO2 leading to respiratory acidosis Metabolic acidosis : Hypercapnea leads (0 decreased conversion of lactic acid to carbondloxide and water thus causing metabolic acidosis Bronchial hyperreactivity Early immune response : due to Histamine,L'TB4,LTE4.LTD4-Platclet activating factor-Causes bronchoconstriction that is treated by Beta 2 agonists and can be prevented by mast cell stabilisers (Cromolyn.Nedochromil) Late phase reaction : 6-8 hours later, treated and prevented by steroids and mast cell stabilises Scanned with CamScanner‘ABGs: Hypoxemia Primary funtion texs Pee Oxyse ination (By masWasal peng Salbutamol (Beta 2 agonist) - Side Simulation Hyperactivity, Hypotan Ipmatopium Steroids (To prevent ate phase reaction) ‘dealin Epineprine (Not usd oticly bt some ‘Terbutaline (alternate to adrenaline) “Himes used) Aminophsline (For those unable tolerate maxi Antibiotics (If bacterial infection is suspected MEM With inhaled 82 agoniss) Mechanical ventlation Adega dation (o prevent dy dation oe pun uetypy tinue oral teamen fr seven wecks depending onthe cacy ey Danton Whe pet conti to lave significant respmtory distess despite amination of dng to which stom tanly esse (gmpathoninetic ds with ora haan we ech sh ‘samen: ‘Oxygen inhalation (By mask/nasal prongs) Steroids (given initially if patient is already on steroids) Salbutamol (Beta 2 agonist) - Side effecs include tachycardia Arrhythmias, CNS stimulation, Hyperactivity, Hypokalemia and itability Ipratropium ‘Aminophyline (For those unable (o tolerate maximal treatment with inhaled B2 agonists) Antibiotis (If bacterial infection is suspected) ‘Mechanical ventilation (ifall other measures fail) Scanned with CamScanner60-80% predicted Se at Conta Frequent | <60% predicted” | cane ma iploms such that physical activity is limited Frequent exacerbations MDI (pressurized) MDI(Breath activated/monitored) Nebulizers Dry powder inhalers Spacer (or holding chamber) Less than 2 yeas of Age 2.5 years of age ‘Pressurized MDI with spacer/mask Nebulizer Rule of 3 5 allacks/week ~Awakens at night due to night symptoms 3 times/month -Neods refill of inhaler atleast 3 timesiyear Admitted to hospital 3 times/year sthma (Important viva question) — Hints towards severe persistant asthna, il Treatment © Patient Education + Due © Improving patient skills in using Metered dose inhalers (MDI) Psi © Useof peak flow monitoring + ° omnes ee ein of triggers * Doe © Information about When and how to me han gesin in symptoms iE ESF Scanned with CamScanner4 sox acting (Sata 01) fr gui oy {Galmemetr))~ Only used for : rl copy ine hie ating Ipetpium (anticholinergic) — ney I frromasonists Zattukasy tized With Beta agonis ation > identify and avoid triggers ‘Breast feeding Features ae as bronchiolitis, rotopean Mak ia Tas ck hopeumonia, pertussis and | Foren body fala young he | onsot. X-ray mn may cause localized se | Snset Xray may hep but bouche ee of ian — scesay for iagostic Asthma like SIS mr | Vascular ing or eioaalscamas————____| Lafflr’ssymrome due to mi a eal] Gistic Fibrosis | Pathogenesis * Autosomal Recessive inherited multisystem disorder * Duelo adefect in gene on long arm of Chromosome 7 duc to deletion of Phenylalanine reside at _ Position 508 (A F508) ‘CFTR (Cystic fibrosis transmembrane regulator) ial ces are unable to secrete chloride ions in response 'o cAMP se due to mucus plugeing dry later purulent) Scanned with CamScannersna airays 8 te ete shromaliy jareisPetbnoms AM Bacay vento ingore issn ae bop ec plemes 2 3 5 8 5 8 &2 5 g 5 8 € ? &‘Scanned with CamScanner‘Scanned with CamScanner; EBs Palre develops 3 Digoxin durtic increased calcd ‘Suis mimmmen (RAND ‘ re Ee NE wknd 0% on means no ten %in " + Congstve tate > Tiicupidatreds a Rensrstoth ASD an VSD ea -——-Exthoptrsilogy Scanned with CamScanner‘Scanned with CamScanner‘Scanned with CamScanner‘Scanned with CamScanner‘Scanned with CamScannerScanned with CamScanner2 8 5 8 £ z 8Scanned with CamScanner3 5 8 g 3 8Scanned with CamScanner Rembeial alee nai pa ose3 3 © 8 = z 3B "Mich 8 ambaLDits Sete fom of alm oo apn resin Coma, Comubions nr oe: &‘Scanned with CamScannerScanned with CamScanner e mt sae Mosel Eales J's Ss adome) * Eelbyesof ae + Noma New exam 4 ues moclns jes on svakening aod my ocloms ds arin te ming Responds Valproate (Given for Life)3 5 8 £ 3 8Scanned with CamScanner‘Scanned with CamScannersnes ati frend ed HF)3 5 8 = 3 8 Palen willbe se “Beating tine wil be neice platelet pli some)‘Scanned with CamScanner‘Scanned with CamScanner‘Scanned with CamScannerScanned with CamScanner7) iasnosis identify Reed-Storaberg cellsScanned with CamScanner Catia ere Conant Hot sate lae menarche sb neck. § include Iympheasn of taba Diabetes Mellitus 5-7 yeas ending to sbeormal boty pron nd tblScanned with CamScannerScanned with CamScannerined with CamScanner Scar‘mesic “+ Hypocalemia > stints PTH seeresion incised Ca ‘ecbsonpion fom bone and decreased renal bso of phosphonss ‘+ Calcium and phosphonsis low ,ALP i high + Type2 > end-organ resistane 2 high biochemical, feature Scanned with CamScannerRenal ches > Treat CRF and soplement Caleta and vitain D Cassification Tsisemic Ont sar oa n children < years ears > equal in bath bo gears > female pred Fever + Ras ++ Hepato Antragiaand My Female predominance sociated with soft years of age and af Splenomocaly, Soros (pveaditis) ries more prominent han Anis Soins imolved -rstsankles, PIP, DIP) CANEERECT ANY JOINT (nee (CP are Spare Tiitaon of neck and TMS Liat an involvement > Aantal sblnaion Mild LAD and Hepatosplecromesaly Tow grade fer ‘Low Pid by RF factor presence not Rr postive > sheuras ‘oslsae, Arai M 2 ssa Gipsar effected more than boys 2 3 — 5 8 = z 8Genetics ‘oss Wace and Pls 2 poligoasclar> sormal CBC and plas mostly negative (positive in polar ses Polaticlar day Scanned with CamScanner + Serger (eplacement a © Opthaimologea assessment every 3-6 months to prevent iridoeycltis,Ato alin Hypodyriisa _Acate Imphocrtcleakemia (but cute myoblasts ‘Mental retardation. varable kena fin fs. ye oti Pau syadrome isa eft of midi, ean forebrain dclopment ~ sgl fect init + Pat ievlopment of pechrdal mesoderm It voles oer neal a2 Scanned with CamScanner Genetics + older mama p=; ondsjuntion wings Growth efiieny ‘Mental retardation 2 Loresct, malformed ears; microcephaly, micrognatia prominent oc ¢ Glenched band—index over thirds th over fourth nm oeat + Short sternum + VSD, ASD, PDA, cyanotic lesions, + Rocker-bottom feet, hammer toe + Omphalocete 1+ VSD, PDA, ASD, cyano sons + Singleunbilcl anery KLINEFELTER SYNDROME (XXY) Genesis “Most common dings manifest st pabes Findings Decreased 1Q average 1085-90) hati problems reas upperlower seme 8) pos ogeitalis inca) asm (estan east stage WIZE) personae an ereund FSH and LH, and sereasd testo) poms (is oy s “e Jafertity i lmst al Gynecomastia ruexeDolder maternal age seen Scanned with CamScanner Feminine fet dfstibution Smal testes (testiculer atrophy) \ 90 structures) No menstruation 1+ Morsesboe Kidney, and other renal defects“+ Cada: Bid ari va (number I cardiac anomaly seepale < ) Coartaton Ae, 1 Iypessmeconmon even nitout cant or renal discase Mi + pay npstynigen mostyasoinmane, an other atinian sass Natural bitore ie diay Doses! hh velo with dstned bone age + Espepereumen insted ‘+My sases ipt y3-4cm with growth homone (GH) FRAGILE X SYNDROMI Scanned with CamScanner Genes Fapiest os bag amo Xin Fi tats aed males and some caer females FRAGILE X SYNDROME i rT Sng nae mete mee lot aon pantry ow ‘le feel pls with ypc’ olga grcrazed edna (sl postive ASS) Hematuria 1 + or an S10 RBCS per high ponerse aio TSA | cen, rdsrcam ue snpleScanned with CamScanner - ine) 2 Aearbetoss Limbs Able duet Moringa Oxy pF)3 3 © 8 = z 3BCounseling of parts nd emotional support ising restons (Sl restriction (water estction not necessary) levatesorctum with pillow Defiakive (SDA) [ici (presisolone) for $ wecks and emf rot cued then move to oter treatments Diuretics (ESH) > Forosenside, Spironolactone, Hydrochlorothiaide Alkylating asess > Cy cloptosphamide, Chloranbucl, Cyclosporin 3 & & 8 é é z 3+ Unie Cuts an Sey WESC aap +) hecedformearene afer evay 12 Mowe ave emined ifeaon fs br year? "SU Vesicoureteral reflux ‘+ Retrograde passage of urine fom the bladder it the tet det exodus PET way tet duet isongec yy eat eg a ic, CL ee ore na oem ty Fore ot deevey seek ae ae cs Soe UN a attorma te pe ttn nt Seelam a 2 omer ah eeaeenaes eS Seren Grading of VUR (Grade i: VUR into non dled ute, (Grade 1: VUR ino te upper callectng syste wiht ston, (Grade Il: VUR into ded wee andor batng of clye foes Grade 1V: VUR ito a os ited wet Grade V; Massive VUR, with igaifcnt ureteral ton and toms andes of he papillary impression. Bo saa Severe Grp a a Ihe bison ects Scanned with CamScanner| Sie Masel Dyson Se an a ee ——_ oo feo + Cangenive Heat Fan: Scanned with CamScanner23 General MCQs Guideline for Final Year Pediatrics + Grow arnsrton wag wale chap bles hin wo ay fin Head cimuntemeocoheght maga e {Sige development moots abn me in Hoo isp * Passi alisha mane pla AC dyn way ya ATT, + Acimaimtsion sets ar dank a Wo me in pray jo imei tabies hain wo meq Puch saktay k Aur sath sath chyna plas join tal in {Neots resusison min jo vais hin wo puch aay bain * Hypocaleemiaypercalomia wags jo vale ain ks 0 uper iss 82 wo puch sakte megs main . a + Apgar score calition Jal + Aurye yan rane wo Iau min pe ches katay * FRU doves wah bi sr oo vecine ka pe pty (a any ala mg ne ‘hai kiun k wo epi ka seq hi sajata hai) is = ene ‘Ala meq mening k path hota ings otis i Akane ot fin bana ta ons ‘+ Congulaion studies wali chain inpetant hain agnosis ni chabye on basi peli at important nn dagosis ant chabye on ati fb * Aik-mog tb drugs kay side effect ka kaif imp hai + Aurmetseski complications ka may is omen to especialy ye Bus min it A dey {+ _Iskay daa nomaa ales of espinton pata on chayein age group kets say ‘+ Aikmea lez syndromes ata ai musthnow how to ditrentte beeen down pasa and edward syndrome + Aidchypothyroiom ka b alos donc hams in wnblcal hema ya prolonged Jjaundies isthe buzz word you must know - ‘+ Haan CVS t pura hi nporant i for Megs “+ Pertusis ka b important meq bai js main diagnose kara hota hai aur sath DTap vaccine b yaad rakhni us aur e usmai neurologic sur myecards hots al + Difcentil diagnosis of rash wala jo potion al skins ak tah (Yond aka measles mia kop sptsbkotay bai) IMCs Guclnefr Fil Yea Peas Tey emt py nbc le book ine aa et a wo bh * ea hut 3 ‘Rk Meg DKa ka pala ta ooo agnosie aris a estes ° rApetasnm adsnsinadetmeme) 4 cts ka jt nba min itd denen pot ain: 2 DOWN EDWAR AU UATABAL, \UIN TEENON SYNDROME SEB A . I ROTA HAIN AUR KERTAY HAIN KIA HATISAY [FEATURES A JATAY | x "YA dowas ki condition puch ey in joes asi ot ai . [MVP hota hai marfan's main ye ba jaata bai Scanned with CamScannercts bi Ps rn Past Paeds MCQs Buzz Points + WWD= Incas BTnseased APTT.Nonl PT 2 GaFmVSD sw Scanned with CamScanner consis - emesis Ves No hpstomegaly but hs lenny = Pol «Simi Tnisenia=Keep Hoenn bons Non pgs sre dor ‘Screening for Duchene’s Muscular Dystrophy ~ Creatinine phosphokinase assay Fe nlarged + Polio ~ Veutral(Anter Spinal Cord oe Bn ee shox on Pot cova phadcoply = Mess is B patient ~ Anti HBsAg esas rin sound Pe opal cou > RTE abo dstubed ~ SLE Fu a lasts Do boremarow Bop "dy » 60-80 UK fday ‘+ Healthy 3-day od inant devcops jaundice Motes blood group is O + Pysological und3 Momhs epee day = 30 grams 00 granshvech ing alam = Chick soot oy nam NESS Lee eerie Us or Scanned with CamScanner api 4s This book il a et yu oof l {Marke pce tbe on writen ncn: hem whe dig at ca sy cor ers ny a st standen sofort stot jon? ~ Hagin etoptais neon inch 2 and22 foo ely weld lids dking goat Mik = ot ercaeig * fd cy wer bok ey paar) er com llr esposur to animal = Gucse 6 ing, Tachycardia and wperboninl 5 Biaer pestis din + ee —— it nephrot syndrome = Hypercokestrolemia ory distress fcr feeding = Trachoesophgea sult ur yndrome= Low IQ with Low platelets and low leukocytes with eadace,fver an vomiting ~ Dengue eM| Respiratory Diseases (ARI) | Gestrontestinal Tract - cz 3" frenroas (eases (AWD) 6. | Vactinology ~ EPI Schedule 38 POISONING POISONING xp DEVELOPMENTIONLY IF UHAVE TINE) | SEUArRNG NUTRITION and terns 3 5 8 = 3 8