INDEX Teri pate Tittle rae | Teacher 1 NEPHROTIC SYNDROME On ‘| 2 CEREBRAL. PALSY 10 3 BRONCHIAL ASTHMA 17 4 ACUTE GASTROENTERITIS WITH ss) | on , DEHYDRATION | 26 6 THYPHOID.. FEVER. BL 7 RHEUMATIC HEART DIStAse 36 8 DOWN SYNDROME 40 9 SHORT STRATURE. 43 10 ACUTE GLOMERULAR NEFHRITIS..°| 22. i PRE-TERM 46 12 ASSIGINMENT 13. NATJONAL IMMUNISATION SHEDULE | OL lus] | rap Recommendation. of vaccaves | 02 as] 15 GROWTH AND. DEVELOPMENT | 03 16 INSTRUMENTS. am 7 LARYNGOSCOPE o1 18 AmBu BAG oF 19 NASOGASTRIC TUBE 10. 20 OMBLLICAL ARTERY CATHETERTSATION|. 12 —!INDEX Topic pte Tittle Page | Teacher 21 LUMBAR PUNCTURE 12 2 BONE MARROW ASPIRATION 13 23 LIV CANNULA 17 24 PARENTERAL NUTRITLON 2s SUBCUTANEOUS INJECTION 11 26 INTRAMUSCULAR INJECTION 18 27. INTRADERMAL - INTECTION | 17 = DRUGS ‘| a ADRENALINE 20 £ DIAZEPAM: on 4 MIDAZOLAM on PARACETAMOL 22 3 CETRIZINE ODD 5 AMOXICILLIN.“ 23. : ORAL REYYDRATION 60LUTION| 24 [ s HYDROCORTISONE 26 TP] CLerum GiLvton@re + | 26 NUTRITION bear COMPO6ITION OF BREAST MILK [| tuman marek ve Com mckCLINICAL DISCUSSIONSCAGE 1: 4 3 year 10 month old male cult most han Kum, finst bonw to mon- tonsanguincous parents hailing from Thonuleanwn Tinfonmner ws Wit potter, whose neltabtlily x good - Brougnt Witte histony of Wuffiness of ayes and fates * to days Gwin of tower and upper tive x © hays Avaowinal Aistengion x 2 Amys Histony OF qrusenting ines (itd was apprrentty- nonmal to days yaclc, thaw We developed putin around the Lye oun Love fon post 0 Anus iwsidtous tn onset ond atadua ly progressive from ttlally- iwolvivg port — onhital veqtow to The whole fae mone dung mornunge hours and tL Aevvensic aS doy Puoyreses -Then moter «noticed Swill Pletal. J atl days insidcous tw onset, progressed from feet to mee then from hands upto eow more and decreases 2% tower — tlw qadually in upper timhs unin monninge hous Anu prog eesses Atlin 3 ays Aldomtvl — Atetevsion. and 0 moter kd general ced + nssountid with abdominal paw Mother tod notited seduction, iw pot. trequeny and the amount of urine passed fon tne pst & doy intially “ged Ww pees | oe times pur day and presently pas siney 3-4 im nedued amounts 0 concentrated wnine 4 | Himes | No H/o wlw colownerl urine No tifo headache No Hfo breathlessness Ohm ecercton No +o test pain and Sy tope__ — alo #0 Jaundiie , reduced appet te and fatlime to thre: No HO crying Adutiiig micturttor Past History Alo Ho similar illwess iw the past No Ho $oHe thraroat No to skeen twfecttion, No Hfo tulenono 515 Treatment tistony— The (Wild was nor ow any Aequlan mudt cation - Antenatal Higtony- Booked » immumsed , taker inon and ‘folie aud Alo Ufo ercanthematous fever) em%y intake, ndindions "deine 21.8 sripuestee No H/o Pit, GDM tw ond tyimestor No Hlo Bleeding PY Ww ard samestor No 4H{0 Bleeding iN}Birth Metony- q Full teow — nontinal vaginal delivery at TWMER ; (red tmmedtately af to pint At latte. — 3-29 Bueast feeding ston of the tila Postnatal Wistdhy- No Ho convulsiow - thild nas No HO Developmental Hiotovy— Ege Atl clevelopmental clowains “pcuoued tit” zd 30 menutts pereattaleso ness | pausadcl fever wot yet joed ginool- rs NicU admis 5} ow Ante Immunization etiotony— Tmmunixation Aone Up Tmwuunixatwou 50 +p date oeeonduny + Nocttonal he dute -per Hietony- Chith was exclusively breastfed till 6 went of age complementowy feed wos stand at 6 month ap age « Brenst fuding- stopped by Lymm of Age CALORIES PROTEINS Expected 100 tal [any al gm [day Taken ano tal ldny- Qi qm [day Detielt aso cal [Any nil “Family Aotony- Type - ruclenn family rmemloons — 4 Cporents and zialds)) sthling — & monte vd henttay gial child No abortion On oti bleth No Ho hand of renmiing, 0” weual distuvbountes | Meinl Stones PHTN 1 DM LTB? Aastha tw the family |Goulo - eonomile — thistony- Modified — Kuppusouny- gcale- owen middle General examtnotow and ontenled No pallon 1 teens Lyons! 4 clubbivg and hayrmpr acter PG Chita’ te » concious Anasarca © BIL pitting pedal’ edema upto knee present” Vttals Temp — 4 F PR — gx bp RR lia BP — ge [mo mmtlg- Head to Tor Examination _ Normal ite and shape periorbital puffiness , fractal pusfiness No catanact Head face | Eyesh omal re moult! avity nO lanes Kin _— No Hash » pyoderma scans leek trunk — norwal Apdo — aisttpded External genitalia — normal spine — Alormal dadieropomet ory Normal anthro pe meterxie measurement Systomle Examinatlow ait — Examined i fiipine position + Trspection, Ahdomen distended uniformly. 7 flanks full | Att quadrants ot eodomen moves equally with wespl nation . vmbliag in midline slide shaped , Alaltd ying , "0 vig thle | No Stans peristalsis om pulsations -Huwvial pvifies ane nor al oviftees ane novmal Exton ee hy inal genitalia. _nonmal qnol no eduy, ¥ Palpation Sof F prot wart / pn tend no srigrait dn deep palpation ive jet palpable Liv span — gum spleen not palpable No other mass felt - other systems . wvs- 452 head , 70 mux eg — Novena yeacutan STE sounds head ble equal an iy n adda gourds lg — ~NO focal roarolo gicrt defile Povesston ~ gpifting dullness present . normal powel unas hewta - fuseullation —piagnosls pivst episodes Of Anasarcn with most probably of venral ¢t10l0gy, pligurtia / probably HIN, hematuria ; most without ang wrthout idiopathte nephrotte syndrome ! omplitations , without PEM. STANT ETCASE R: 4 an wl old boy mother of no pied Kujepu swrarnys sagan of frst bth i - cons ouder bow to & marriage i belonging. amit status —# +0 mod! Souio —eu yitltanwe + | ereltnbiltty- re good , development t milestones Birth tHistorg tenatal history birth Ordl7 — was 27 yt an mother She was pregnant wt pot Trimester Mother tpneetved spontaneously a booed sl were taken she was Folic acid tabletsce ep tate 0 | ! g _antake lor) radtation exposure 27 trimester Quickenteg yet at gtr month gestation Reg ulate anteinatal Tnow and caletum SupP 2 doses Of TT taken No [0 pre- cctampsla 14 no #0 bleeding PM - check ap were attended lamentation taken DM » Ania ela 3th trimester tal check “ps attended - wll fp rela pre} Regulan anttna Fetul movemmemen Hom . busin te ere No (0 a micturitior 1 pleading pv-Developrnental thistory- DOMAINS OF | | pate OF Lae aa MILESTONES — MENT (OF 4 DEVELOPMENT j ATTN [ | | 4 - - nthe Syr0ss motor. neck contol) ja? me bund contvol, | | five maotor — immature | a yeas 4 montis pincer, Jamo? | | personal and nerognixes | Wy monting 3 months sotial | motu + aii les | speech rnonosgtiables 1-5 yes (tno Pack Higtony- Hilo mecwrrent anespinatony- tnact twnfection in the past. no Hf0 asthma , 1B| Immunixation tNstony- Child 13 immunised upto date Beh star 13 Stew on IE pp anim last inmaunixation was ot age oF heya Diet Motony- The tony te taltisngy about s7olceal Erpectzd colonies fon shis ane m0 tccal Deficit — weolccal Fowntly Wwstony— (wid ts bom out of a now — won saung ined: mannlane o «nfo Slmtlas complaint ta the family: Oo. oO O oh Dtyeans BRYON aT YsGeneral Examination Pallon @ , No tctems s No ryanosis, No tubbimy ) No pearl adem 1 NO tymph. adenopathy \italo Pulot = ei ap- wl 70 TU RR — 20 wyles Antivopomerony Leng, — 8% Ow ( cope tad 7 uw) asp of height fom Ie Walght = — 10 lem (wepecliad lb ky) = asp of wurabt for ye He — hau Lenpertad = $1 tm) “-2 nateaveephaly-Head to toe examination necic— normal, no igidt ty thest-— ho deformity Atdomen — Vo ai'stenstonw lead — vrommal fate - nosmel ayes — nonmal no cataract ann and n0se — noumal stun — woumal mote. £ onal caylty— normal Spine — nowmnal oystemic oramination Migher junction — wonselous 1 moderately ostenléd Emotional Status — wonmal, dy anthria. preset (Hanial veave examination Nonmol Motor examination Bulle — wastuay ow A gy Limbs Jone — Hypertovin ow All gy limbs ted on all ¢ limb: Deep tendon Meflex — cag eral Dwe —- Oo m all uwbsBlL Anite onus preset | BlL planta extensor OU Senoony- oomination, ramnot —-bL detected Neonatal neflexes Mono's x wef le Mine Rootiny 1 Sucletmey Palm 1 plautar tl abetlan tap — present Diagnosis Enow the = alvove nil 1s alagnosed 40 owe developmerrn| Avloy~ of. milestones, ve prota mre matwention - oominatiow the Spact tevaplesla ‘with global wittrout eredenu| CAGE 3: A Ayeo, olet boy Mahe ond bow to a mother of no | mAMnlage belonging to modified Kuppu swam y- | ges— 1 Watling from villian 1 informant ig moti » Whose veluasal ity ig good came with complaints of tough x 4 kays and epenthle’s nus * 3 days. sh of avd bigth "- Won sanguine yuSs | HOPL the clild was apparently nonmal 4 4445 efone the child developed coun ‘yobs was tnsidtous tr Onset and progressively increasing the wugh Was won= pHogresave.. in nature also Aeveloped preattlessness TH Tne nt tnolatous in onsel ane past 3 days which was and gradually png tessive - No Hfo {eter No Ho nematuntaNo fo. pain duwiing cough ~~ No fo vomitwroy No Blo | watouy stools No Hl neadache Past Hiotony He was oopttall at the AEF a yoo He way ° patie theotment ged fon whuxe onte w homeo - Antenatal Histone Antandal hutony 0 uunevenful Derlelopmental Higtony- Nonmal Tmmunixation Histoay- thild ig immunised arto done Bl HAr stern Ww left upper asinDiet thotoay the aby. expect — 400 kel efratt ~— 30cal tg taking 370 Keal Family ttiotony Hig mother and grand wothrer wit ts General Tacamtwrtionw ane cid was Congtiows Aa pallow » pedal edema asthmate A AUKLOUS No wyanen's cubbinay jaundice ; dywaph-adeno pats -Aint. mdpometaic examination | Nommal Head +0 Tbe excamination Noxmal Systemic Damination — Ain ontray, gual ow both ut pune mo viney a expinaition RS Twapectiow IL wheezing, phere on ™ | sides ® | sunt, tthe wmapinati — rrteretal | supera stonnal / Palpabiow ouirronstal metnactions We presente ponrugsion — Auypur yesonant duoualtetion — wheexanry present NG — 41 192 head » No manny | ants — No focal marotooyical defi ple — No 4b _wonmallties Actec teDiagnosle Second episode sub coastal mebnact espinatony- Arsondlent pith ea th — 4 of severe asthe of wheeze with intercostal, supea sternal pus, most panobably ot A cough 1 guggestv lesshess connplication and PEM. without m4CASE |: A eon oho hoy Mitish of +9 vite onaen| howe to oa mothin of non —vow-gaunguiir Lous marring 6-3 nally bulonging to modified Kuppuswand se {nom kudapateeam informant us motley wohrO5e metiavitity as good. came nyt the compl ainlt of puptiness of fare fom pase 3 anys and igure fon, past 3 days - HOPL the posrtent was bale » latew he develope whic was insidtous “ons tata, enowsred fom ue pase 1 40H fow smell wr USUAL no Aston Of No H/o bunny, yaictuntthvow No lo Jaundlhe No ato | fey No Ale omitting No 4 Jo water stoolanot Hakone one month «baclc he has Ho 408@ throat wiv fever but the child did not take amy treat - _ ment No le TE 1 asthma “ptenat Hrstouy Antenatal Wistony 6 _ouclgrn History Nosmal Tmmunixation Uietony- | tule immunised upto Aose | BO Sea ab seen, ow eft upper Ame wnewunful Dir tistony- tre (nild is talcunny 70 Iceal expecta = 400 oat deficit = — 0 Keo | Fawlty Wretony : (hitd % Worm out of non- raanuineoie | MUNLAQENo 4le stmttary complacnts UA fanny Anions General Erxcomination, thitd te tontlou, Am oviented Puffins of we ++ Mid sun edema + No patton ; LYyamoels 1 Clubbing \ LA) Ieterus Vttals HR —- <0 byw : RR 1% cycles [mun Bp — \e0 jroo mmta- Head to Tou uaminatron yee — puffiness anvund te Os AHL OUliv okays are MMmal Antanopont mle exomunotlow Normal !systemic Axcominattow Aodomen Tnapection - Att quadnants ae mone equally witty Aespiration No abdominal Al otenalow no dilated veins) no wetble tump | puleative San: Talpation - No omganomegaliy » wow— tender , soft 1 wot wow ohiftingy dullness porrussion — No lucyensed bowel movements — fusuintion — No B\o0 heand » wo mun Wo — woumal visitor breath aounds RS - (NS — wo focal nuunogical effet Diagnosis From the Above Ye dtl fu, HID one dnnoat anol fetor ome monte. Wack awd presented with puttiness of faut Hank cola loured unine Suggestive of ooute plomerelo vephaitig withouk any complticctt Ong ang wothout any vem. ecamiuatven and pustony-CASE FD ° . old male child shankar of A > yer 1% onder bint hor +o a mother of now Coneny quinenus manniage _betowgting, to moditied euppy gwamy cass % Walling from Wiupuran, (veto (6 her mother whose Aelialai tity (o good and Lon, wet clo fever, fequent watery. stool alrd Vomiting for 2daws —HOPL The pation’ was Appasrenty Wonwmal 2 days boefome , Later the Unit cevetoped fev wibuth was Insidious tia onget and gradually progressive. The child also Aevetoped wotury stools whith iS Moe thaw (0 eptoodes per Aaiy- and yellow tw voloun No stony, OF pain dunt parsing stvols. Te Wid also had vomiting, whit {9 Semi Solte im womnigtonuy ard mow projectile. iw natune - Tae dita Way wot volded wune Soy, tte past g hows -No HI0 Abduminal pawn No Hip oWtllung MW abdomen No Hilo jaundite » no Hfo burning wuctunitlonw No Hlo hemoctwria No Ho Aysentey- Tost Hiotony- No Hlo simular Complacnts tin the past No fo TH 1 Asthma | epllepey- Andunotal tHhiotony- Antenatal Wastony was — wnriverfil Developmental tHletony- Normal “ Tmmunixadion Hiatony- (hitd 1% immunized upto dott Blo Sun B ollu OW Left upped asimDiet ‘oto thild is dal Anpected ~ 300 Meal cinq 210 Kal Defielt — 0 jecal Family Histon Ula % bon out of mon- Low No Ho ot la wom plaints To Byeors La Jat Gun quincous mam iw family: General Examinahow tite to Anow 5 Deena No Hfo tyasr051 97 clublouny tleno un , ictyius Rnd pallor: Raters) Vitale PR — 10 bem pp - sof bo mmtey- RR — fo wytles [wun Temp — 106°Fmuasunements Noxnmal Aunth0 om et tc Head to be examinations Skin— shaunleow Atclomen — distended othens §=—normal Systunic Examination, Abdomen Ingpection — AN quadrants moves cy ully wht. nvopinudvow abdomtual olstenston present - Ailatsd vuins ,no viable lwp | pulsatile AUN No Torpation — No omapnomenply- ;non-tendr , Soft , YON -WaAnWL dullnus present rewaseton — No ghifting pow movernts dread A usuiltatvon — inerrersedDiagnosis From the above examination ; fingt of Arananer augqustive of dehy aration and fiver « vomiting gugyestive of aude petro cuetenitio wrt. Aeltydeation. without minty complica and witrout rem. episode(ASE 6: A & vem old ginl Reema of 1% orden birth oonw ty % motbwr of nMon- Loncanguineous monntayye belongivy to modified Kkuppuswamly eins 3 hailing {nom Kudapak kam informant 16 mer mother whose melatitty 1% 2004 and came wit Clo fever fon wo days 1 abdominal pan ond Loone atrolo x a days HoPL The pationt was apparentty normal to days befone yloten the pode developed Forrr which was Insidious va onset ond \eyradually prog wssive Faye, ond heodarhe Melieved Ow talcury Pastocetamet The intensity of fever Was increased over the day and wih wore ra the cuuuings The pationt tbo Auveloper| abdominal pour and wose stools . Abtonuinal pain was VAgie si wot progresaue lovee, t00ls aud wns senticolid iw comsigtenvy Aud wot rscoutatad witr bloodaud mus. Sve would occasionally ua, whit 16 mow~ productive th nature . Hlo ete No. tO womiting- NO HO mashes , seixunes | Past Histony- No fo simile Lomplatuts, Iw the past “Antenatal History Autanntal “wistonye was umetenful Developwienta| thetpay- | Normal Twmunization tHietony- thild ie immunised upto ate Ble, ge 15) Seem om “Left Mppere retin: Dick Histony- (Wild 5 taletng 4°10 leeal Expected bo0kcal Defirit 130 KeaFamily tistony No Helevant -farmily history Genwnal examination, cnsttous dicle tooling and ovtienlécf No uanosis , clubbing LA jeden ; teteaus, will pallon Anthnopometnic meagunements Nosimal Head to Toe examination, Head and eyes — normal Toque — toate tongue see Skin — WO naghes Seer eos ond nose — monmal eacennnl — genitation — vouwal Uitals HR — 82 bpm Tewnp — WSF RR — 26 cytles |min, BP — 100 |2 wa tHeSystemic Examinertoww Abdomen Tnspection — AL quadnawts move equally wit espiaatiow - nO abdomiual tatenolow = Setw No attarad Vans Palpation — Soft non tender; livey size Ineentes by aw Pentuslon— dullness Awsuuttation — twoneaged bowel movements head NS — S52 @ imo munmun CNS — No focal meuoiotogical deticit RS - wonwal vestludan boneath sounds Daagnosis Tutumuttent fore with vague abdominal pain and associated witty (nose Stools wht aening, House Af tomporatune most prollyfewer wht epatomeaty Suggestive of +4phold» fev witout aaty tOwmpli cations and PEM.CASE 7: A i2yeo 4Howr viitlamust of 1 of mon con sang vinous wmoritiag| arconding to wmiodifiect cuppuswaunys Stale came clo singin side Knee pain fox eos followtog wee pain subsided and ther child Aureloped left knee and ante jotwt pawn old fimale child Sindluja hit onde, vind bon to A mothe, 2 belongs to SES-3 with, HOPL The pationt was appanentty- vorimal dow, bacic then she developer ® side Ynee pon fo wdays whit was insidioug iv neue amd guadualhy- progie ave -fottowing- whic pour gules aind whic Aoteloped lef Knee and ante folnt pain whic was Also ingidtons in, onset and gradually puogeessive The pain ts Wore nadtating- ihe thild algo had histonay of falor with wougit aweeks back wir modoate grade tyste] fon 4 aes and subsided afte taleing panacetamotNo 410 palpitations No Ho fatigue No H/0 pedal edema No Hlo swelltag in fotots No lo Mash No Hlo involuntary movenents Tost Histoay lo fever 2 weeks back Diet History child Is taking 360 kcal Expected — 50 tecal | Deflatt — aookeal | Antenatal History unewenful pinth tise ye full fume wrth Nonmal vaginal geliry | | | | | wt. alg:Developm ental tHistony- developmentally vonmal child Immunisation stay Jmmunvxed till dalt Family Histony- sears it ne perl” No alo Similar complan’ TG 12yeons Systemic Examination evs Inspection — No wnacheal olewtation chest shape and mouernents nonmal teft wth 10s na Apleal impulse Sev at No pre candical bulge adjlatad vrs | 6ans % Siases ee Palpadtion. - Apica Was nyperdynarnic {impulse ab left wih TS whitchPP usuttetion — Loud bandon [rem] ig Neand in ant ea Tawnmwr axilla and back. a nadiating to left nica spla ayor- yyade 2 P Auortic and pulmonanu, wntn - ng 7 NO focal newnolog!cal aeficlt an. breathe sounds an systolic munmWt $,$2 @ RS Nonmal vesicul p/4 7 NAD piagnosts Gnade pansystolic maura tn mityal be Aue +0 mitnal peg ucegi tation mnt guteuspla neqarg! ~ heont pan systolic mur tuieasp(t due mild gation and tts uggs of RheumatTc AtseaseCase 1: — SHORT CASE A Ne yous male child; phon share of WA butt, onder followed by quneatened abortion at a months bow ty mother of won- (pnsanrgertiy morning bbetonguay * modifted Kcuppursnounty: Ww eat turiienp pan Rassrfication uy nating no Mfonmawt ts hee mother W ig good and tame witty romplainrs of deta milestones Of parsing pimsele to Sting position Examinatiow No pallor uy nels ) Unbbluy iLA edema Vitals : ep —no}a0 Mm tla RR- 0 tyeles| mi PR- Sy lbp Temp — Afebrtle Anatropometnic examinatlow we fon age (eA) A gight fn age (HFA) 18cm| BMI = 4 | — = 244 16-36 to2 $D of eight fom height examination clinical Head — nonmal | nose — flat and nnidge eyes = mongolian slant of eyes aang — low set eons hands- stmtan Ceose on pote hands fingurc — baachydauty - appeans monmal | tonal genitalia y Systumic evominatiow oS. © wo munmure evs - Pla — Liver ust pal parle , softs non-tender Eng — thor funtion? alent and plugfal tal neve vy aU ates Cnantal nee palstesoo” Moton Syston Tow, - grade & oA UppYL and Lower limbe tone — dervtage iw upp and low Lumb deep ttndon nef lex —bnisie | Diagnosis | From the above cunmtnaction flat nasal | fomlge monogoloid slant ot the ayes low | oe 2045 epi canthal folds | | prachyaactiy wit decreas and tower Umbs with bat i Down's syndnome Ctra'somy 21) Sewmtor (Hearse ) od tone im upper ge DIR ugg’— CASE Ri - SHORT CASE WW yeaus ath mote enild Kishone of ahd bint onder bonw to a mother of and degree consan— — guilneous manslage belongs to 6ES-2 atcondlng +n modified Kuppuswamy scale halting from Wilanuse tame wit Clo shout stnatune with Lonset of Qrowthy fittoring cine age of 3-4 Yams: AS per his ponents , till 5, pane of ang his hwight Was at pan to bs Age 1 but since he Sooted appeoriiua shont 45 compesunay tO other boys at wis age. At paesent he wae the shonlat boy an pris clase at Stool - He wos bomw at full fonm lem) . Binthe | wurgink was 2-B ka Tt was a beech aelivny Neowatel pertyd wag unevortut. ig elder male | altoling was Alo short He had vot developed beond on -fariat hair No ctw foumuly mumbyr was Very shot bh Wad any Jnstony of delayed puberty om Infoslty’.General examination No patton ; wyaurocis itlubbing 1 Lk and: edvma. “Head to Toe examination | till tee facies, small mands and feet [Anionnpometni exawinactton, webgint for age (Wea) bey | Megat dom age (eA) foam | BMI — 1b.1€ T Sune ~-ltoo SD Mid posental Hetaiat ad Ino tmt [67 UM +13 2 = tot ow (expec ut)| Systemic Ecaminaton (NS- Grouniol none examination, were wonmal No focal MuwWlogteal Aefteit ptr Sysiems ane normal Daqnosls | Frow the examination and findings , the | with ts thewtitied ag n shot. gtratune! due to san degree of wnsanquineous marriage with no tompltati@wne and wo PEM |CASE 3: — SHORT CASE 4 | 4 wale ody Ardvoned AE 32 Wieke SF gestation to Primignautda Cemown (ase of DM) Wuryvang bw leg by Spontawwons Uneven, Vasyinal Aetivory, wit. APGAR YT at Lmum ang |@ at 5 min Glewral Examination Trfant 18 — cyanotic No clubbing ) pallosr 1 LA jedema 1 Jaundice \Wtals Temp — 16. 2F HR - Y16 bpm RR — “To cycles [mnin BP- not mensuricd Systemic ercamunatiow RS — subcostal setnaction » gnunting : nasal | floxing » meduced ay onlay, ag — S$2 Q ro mus P/A — No &Abvormabrries fetected CNS — No focal newnological deficitDiagnosis From, the above examination ) the new boon wars Hla and Adlivered at 32 weeles of _ qeketion Guggestive of preterm assouad vith gubvoastal metnacton « grunting « nasal Flaning: | “yeduced curt ontauy, Sugg active of pre tem with PRB -ASSIGNMENTSIMMUNIZATION! — National — Immanixation Schedule t re AGE | VACLING at blath | BL, boPY -0 , HBV -° | b weeks | bopV=t) Pentavalent -1 «Rotel | ogpyen, eve! “10 weeks | p opv-2) petavalent -21 Rota~ 2 \y waks worv-3, Pentavalent -37 Rotm-3, ppv-2 1PCV-2 | 4 months MMR a1-¥T6 ~ hey POV. S | ‘ | | e-2y months pre-B, 7 b OPV-B, Je-2,MR-2 | | | | wo yes DIR -B2 = yens | Hpv-L 7 HPV 2— Tap Recommendation | |_4te 0 CAE Birth) T VACCINE SCHEDULE. BlG1, OPV- 01 Hep By DTP-1 Hep Ba, HIB Rota—(, Pry, ) 6 weeks 10 weeks peed rpv-2,MiB2) Rota-2 \pry | | le weeks / orp -3: ,TPV-3, MBs Rotm=3 Puy. 6 months opv 4 /HBV-3 4 montis opv2 , measles } 12 months Hep Aq um months = MMR 1, Vootteella 21 POV By | |\o-24 months | pTP—B,) TPV-Bi1 Hi By 2 Yyooss Typhoid 1 5 yoons — | DTP-Bz. 10PV-3 MMR 2 jvanteella 2, typhoid 2 | to yeang | Tay HPN Cold chain Tne wld chan 13 Syston of Stoning aud tmansponting vacttnes at newommended funporturt from the point of monutastur, and point %f USL -y GRON TH AND DEVELOPMENT i motor development milestones oro" _ HE ih MILESTONE monte | Neck holding 5 months HOS oven 4» morths “sits in tnipod position (sitting vatthe | own support) ¢ months | ottting without support: a months | stninds hotdurge onl with suppoat) ts movie Cops well) Walles buk falls stared wottirouk Guppont “ur monte sak alone, neops up seodns ig months rund, explores Anawens 2 yeons >was Up aud down stoins (2-fectl ste, Jumps B yeans Hides arieycle paltonate feet gotngy, wporauns 4 Yuns — Hops ow me foot att anate feet aa Aownstouns - |= Fine motor \ developmen tel mies | Age | MILESTONE h months BidextVous seach, Crenclatng with both hands) 6 moutirs uniderctus seach Uteadning Out fo, objects with one Wound) tran stey Chey for Obey, 4 mowts Immature piven 4¥aSp 1 probes wit, THC fines 12 months moilune pincer AIASp i months imitates Seribblunq , tower, of 2 block, ie monty | scribbles, tower of 3 blocks Tower of 6 blocks, vertteal and usculay 2 Yyeons f an 3 yoans Town of 4 blocks « topies uscle Yes — | Lopes (10S% bale witir blocks 5 ylang optes Monge , aate wrttr lolocks.iz a r A P goal an Adaptive. mitle stones Abt p months 3 months 6 months 4 months iz months “ur months le months Lyons 3 yore a yeons | —] yang MILESTONES | sour mite (smile af tH bi -telled ) | ruognixes mother , anticipate feeds tuogniees strangers shranser adeby wales “bye bye" _ tomes vohun called , plays Simple tall awe | Tongow Copies pariuils task Qe oweepnys Age fon food anintc taller, pulls people. to show toys ores oy Yous full Neune Ayendon ee o-operaniVely- jn a gooup 900s din, toilet atone - pouserotd tasks: Av eSSeS Helps 4A and undresses .— Language ‘Milestones * > — Abe MILESTONES \ months | Alerts to sound } 3 monte | wos (musteal vowel so | unde) h months | downsyin’ oud, 6 months ‘Monoa4l\ ables (laa, Aa PA) 1 A-a 00 | 50nd « (2 months —Bigyllables (mama, baba dada) | [2 months | Leo words with meanunay | We months geo words vocabulary ayes = 2-3 wondsentuntes uses pronouns | ‘tT! ‘Me! You’ 3 yeons — Ags npastions , Knows full owe, gender oy toes gq yeons Says 0M4 OM HP rtulls S | 7 qeoMs es mavine- pf wordsy INSTRUMENTS oypgortere * _ tr to used fox critically Ul pestints _ se Seeums — pationts adda gydticatiovv _ In neonate asply 1A Bag and mask resuscitation, o Appoonontly- gtill nn, aby aft ado suctlonuoy and upper a ra . o Tnfaunls With anda dinporrynatic haria — Cando musiretohy: art due to ay COUSE - —— Contranl —vartvows 24sliin deposttion ancase of bend injured comatose pationt - — Dieense of peripheral vexvous sysin — poliomy' Ges, tetanus LGAs elitis y _ Aduninistetton with errminpat blede ‘fon neonalt - Ton . ~ Ptient placed an euupene position ~ Te operaton otonde behind “the patients hed aud ved -is alieg ht ettided with, fea - Potiunts neck in, mid le , — ton te ong me with gentle cuctign. toma, hold the wandie of long rau — empl with Loft had aoum and fist TQM / Stebilixe tie wand wir ot fingen om patient oeeks, — tne blade should be pointing away fom, url. pabule mouth and push the tongere = Open the yf left with vacle of fone -finget ond Steady thy ead with nest of loft round. = While ovale ingent the blades midline witil ip betwuw base of tongue and epigfotts wittin He Vallala Complications = Hypoxia, - Bradyorrdin. - Apnen - Proumotiohan ~ "ifn and Ueeeperirihas ae cee Qy puss_ Infection EEO) _ post extubntion stridon can be manage’ by: ppulixee egivnephnt on stridor « pniae PO” a using self inflating ba tion "6 Given- 4 and mask nos” postive pressure sentila qnditations 7 Infant IS apnoetc on gasping _ Heant vale 2 100 bpro unt central cyaunos!s = Infant has persis wn - despine administration of 100 ‘/ free flo ~ Resgusitntion bag chould be Self type with & —Lapacdly of 270ml 0 150 ml - ber should be attached wit oxygur couse and ov meservoin 90 8 to delim 0-l00%/ 0, to Re ology - lontorvindication S = Dap ainaic Ania —T cuses aldol distareton, oxypen vot Puy onting the ung Luk also ascapes into stomach tr _L50pnaryet - In lating— Measure the dlsteance of testing from baiidge of nose ty earilole tm —Tncort thvough ose OF tel the pationt +, swallow - . — Hop imnmedinddely and wittr Aman the tbe , if Lug Lt becomes —altetended ound wyanoeed . — Although de tubes ane simple to. insert thoy ane oasity- displaced - RS — Knay continms *he portion - ; | - an 10 mphisternuy, st Uses q ( \ — Tn newborn , nasogastric tube for Feeding of sick bbaloy OM pHe-tomn ltanbles 2 32. weeks » LBW < 1¢004, — Somocly wade it these was meron ume shaun im openative Aduivory- on pot soning Complicartows —Nasogastne Aus comfort —Nasal erosions — Epigtnms a ESophagen| ulceration oN, - Spruncteys — Pacenal re | onintnation of external feed qnuse serious — infection, abdominal HYeedingy gw see wpnounished children, Nagoqastic tube ote gir for waalnovot dned syndbione may occur In petously- fed up with previous woase In Oxyyer overload daw nefecdtvoy ainourvsied dnitdver who ae saat nourished diu due inc cons » nugplneddonty- and candial whidw May precpiinte quate heostt fal une . , Unilical Anton Cathet _ tt & wea fo" pento fon constant Mm gatiow * tic, mnonitrting® °F anturial blood gases and pnitorting of hood praesoue- wo umblital anus - — Thre ne Techvuque - Tanti the ost and fe caudal Ainection, pully the wumblical stump - ince the | oetoncin aptly— Position of tip of cothetiy OW Man aN low position. , — Keep obceniing the wotoun of Mmbus during procedune bod : _ Fin the catheton using shang sulin at that place; — Everytime — befone sampling — MenioVe the hooptabixed salune and close the end with Ube, Stopper alonay the sume blood ,vollect the same blood and weinfuse the proyiously- wollecZ into thy thild- Complications = Vernal perfonation — Trombo embolism — Ain embolicw — Nev tletwey enterovolttis ~ Hypurtansion — (SF estimation In Guspuctal infection. — Installation and intrathecal Chuo thevopy/ WAL= Mensarten eee of opening pressure « tee . Position of child in laliral peuumbent position vie ymee rib ond veel flexed - P “port lampronuse the infants coring respinetony sols dununry posi Honing: dicted intervertebral space by — totale the Anaminy a Une from, fips of iting crak! vrespond- Any to Ly: ‘done todtne — Propane the sian with, —applytigy POV! witty weal anasthesia - Puncture — the stun ky the vastious pr0lese towonds the umblieus - = Advavee Tne needle grodualiy til tooo of wsistane ig seen at midline - culture aud gira staining, acter. aggjustivaticn in matdlune , just uapholit ; slighty alony the cephalic om optval fwd = $und tne tule for biochemustry fom tell wound avd tut - — Monin SE pnesount with monometvr Kept perpendiuby to he worixontal —onturty the\ 2 err ee eee ee ere TS ae py tes patient with free fluid. tomptreattorr, anne . , *, complicoctions ~ Locl pur - Infection - Bleedtng- = tHevnatton due to nosed ICP. Eibone, Marron fepinatien” te ig a Wal procedure in hematoma fo AS60565 the ove mastnow -function . Tdi cation, - Explouned annum, - Suspetted — marrow y aplastic hyperplasia. - Strong dsOnden op Gamer's digense - Infections a brucellasis » malania - Microbiological culture, Onteric fever -Agplnation, Of marrow Is spytad on Side and —The Wiopy Io used fon agoessinunt- of cellulfity avduttect — of marrow.ve gedooe toe CTA wth, anya; t wrtte mudacolow, IV 1 moyfi _ ean dhe site of aSpiMactbla . ¢ Position io thine 4on old children, and ih nspect of tibia fon infants. _ Position the child aiigat | left position, okin with povidone todive coluttn .») tandnoatles and inrfilterartun and pentosteum, with, — Parpane — Taentfy the bone gubuutancous tak anosstieatov- Position the bone rmae7i0vw aspinadion © Aopinatish \o done at avofat ange +0 hone vith Kem prensune , ayckicloclewice punchy te made throug uate torte wont 40 ful the Aucunsed resiotante- complication / = Dleeding: ~ Louvl Infection sein local; TIV cannul: ; ) | administration - Tt atlows meditime , ftutd vodvient 1 —Intw cathetr and xAlp | commonly used fom thus purpose ° gamplinge 1 ood blood and blood product yun needle ane ote Vein ow dovgum of hod - — Saperftetal podial yuu on wadial aspect of “vam. - Saperfictal yen ove Adour aspect of forearm, —Basilar win and medion wbltal ven ow, atenlts over — ubltal oso: Veins ow wnedioul aspect of lea, above anne. ene VOAM + Tecnwique A tourniquet ts pled over the Limb 3-t a qioximal to the site eluted fon Venous pressull The pssune should he, aA a way 90 tht ‘it oecludes Venous flow by continuous arterial blood flow -y gt punctured Bye ineeetia level upto aH pavastel to the ven, .callected i¢ ! of. vo . Acad _ wee IV sets attached ‘for flushlieg- la gan ; — nomal saline should be astd «PARENTERAL NUTRITION | 1 Subbeutian cous injection : : ¥ Indication = Tnmunixahon — Medication (Inulin) $ Procedme ~ Late — injection site upper oul ax, oul aspect of “pen tn — Cheam kin with aluohd| —Tnomt 0-07 tw 26 needle tntd the subuitancous fous at the angle oF AS” ty the Slun - — Aopinate fon Wood thar inject the + Complication ~ Allergic Heartions - formation of Subuutanuus nodules iti repeae tyjecion .a yy Indication ~ Immuixation su Madicaitadin ¢ PHocedune — Locite injection alte, 1 aster lator upper pig ev genall “alanen ; oulan asp of upp © ww ow Olde children vortral glutoal meqtow is wad by Tom ee by paving an inde finger anton guperion [bac negion and wmosival finger ow dial crest - Tujecion. ww be gt crt we tatangle formed ye & fingers and flac — clean te seun with spintt - od wy 22.6 needle in masete at — Inset an angle of ap” xo Skin, tlt Te Is flushed with Stun - 3 ; ; | — Aspinate font ood 1 ject medteactow Homplications im Mlorgic aeaction — Plecdingy hematyma