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-past medical hx
-marfan syndrome
-klinefelter syndrome
-karyotyping (confirmatory)
- TFT:T4,TSH
-urine:homocystine
2) short stature
-hypothyroidism
-panhypopituitarism
-cushing syndrome
b) Ix
-karyotyping
-TFT
-pituitary fx test
-ovarian hormone?
c) Tx
- hypothyroid( thyroxine)
-cushing:cortisol
d) physical features
-turner: Lymphoedema of hands and feets in neonates, which may persist, Neck webbing or thick
neck, hypoplastic nails, broad chest, widely spaced nipple ,amenorrhea,ptosis,cataract, otitis media,
pigmented nevi, increased carrying angle
e) complications of turner:
-coarctation of aorta
f) pathophysiology turner
g) Tx
PBQ
2) pts come with diarrhea 3 days, lethargy, sunken fontanelle,, sunken eyes, no tears,CRT > 2
seconds,
b) causative agent:
d) pathophysiology:
-secretory: The responsible organism attached to the wall of small intestine Produces
enterotoxin that bind to specific receptors Activate production of second messenger
(cAMP,cGMP) Activate intermediate s(protein kinase) which act on apical membrane by
phosphorylating CFTR channel Cl secretion, and inhibit Na,Cl absorption across mucosa
epithelium (net secretion>net absorption) Secretory diarrhoea/watery diarrhoea
-invasive: Colonization of pathogen at the wall of intestine Pathogen invade and generate
cytotoxinin mucosal layer Inflammation of the bowel Mucosal ulceration and cell death
(erosion of the GIT wall) sloughing of dead cells Passing of liquid or semi-formed stool with
mucus and blood Invasive diarrhoea/dysentery
E)IX
- fluid resuscitation ( 20ml/kg NS 0.9 % as bolus , freely as fast as possible, calculate deficit fluid), % of
dehydration x weight x 1000ml & correct dehydration: 12-24 hours (iso and hyponatremic), 48-72
hours (hypernatremic)
-infusion maintenance fluid: according to calculation (1st 10kg:100ml/kg, 2nd 10kg: 5oml/kg), HSD5%
g) complications
- dehydration & shock
h) prevention:
Prevent the spread of infection by maintenance of personal hygiene - good hand washing
practices
Promote exclusively breastfeeding for the first 6 months of life to promote passive immunity
and guard against exposure to contaminated food and water.
Giving health education for prevention of diarrhea, home management of diarrheal diseases
and importance of ORS.
c) IX
-serology: IgM/IgG
d) complications
-dengue shock
MCQ ( ithink laa)
1. hypothyroidism clinical features: coarse facies, open mouth, protruding & thick tongue,coarse
extremities, thick skin, umbilical hernia, sleep more, sluggish, chronic constipation
2. vasculitis
SLE
Symtopms / clinical features :DOPAMIN RASH (discoid rash, oral ulcer, photosensitivity, ANA, malar
rash, immunological phenomenon (ds DNA,) Neurological (seizures, psychosis), renal
(nephro,nephritic), arthritis, serositis, hematological (leukopenia, thrombocytopenia, anemia)
1. Malar rash
2. Bilateral joint swelling
3. Generalized lymphadenopathy , discoid rash.pleural effusion
Investigation ?- C3,C4
- anti ds DNA (T)
-ANA (T)
- blood culture (F)
- lymph node biopsy (F)
HSP
-IX: FBC,ANA,Rh factor, x-ray (decrease jt space, joint erosion, deformity,soft tissue swelling
-tx: corticosteroids
DEVELOPMENTAL MILESTONE
Renal system
AGN:
UTI
Diagnosis of UTI
- culture and urinalysis
- most sensitive (comfirmatory ) : urine culture and sensitivity
- ultrasound , DMSA scan and MSUG
Treatment UTI
- Trimetrhoprim
-Cefotaxime
Infectious Dz
-mumps
-Ix: Clinical: examine parotid duct may show redness & swelling
-measles
complication measles :
- respi : pneumonia , 2 bacteria infection , otitis media , trachitis
-neuro : febrile convulsion , EEG abnormality , meningoencephalitis , subacute subsclerosing pan
encephelatis (SSPE )
-others : diarrhea , hepatitis , appendicitis , corneal ulceration , myocarditis
Clinical features fever , cough , runny nose , conjunctivitis, marked malaise ,koplic spot , macular
papular rash
I.P: 12 days
Stages/phases: Four phases:
I. Incubation:8-12 days from exposure to the onset of symptoms and 14 days from exposure to
the onset of rash
High fever 40C to 45C; classic triad: cough, coryza, conjunctivitis( Stimson Line)
Macular rash begins on the head(above hairline) and spread over most of body in 24 hr.-
cephalad to caudal pattern. Discrete maculopapular rash may be blotchy & confluent. It will
desquamate in the second week
IV. Recovery
s/s: sore throat, fever, swollen glands and weakness. The hallmark sign is a sheet of thick, gray-
colored membrane composed of dead cells, bacteria and other substances. This membrane can
obstruct breathing causing difficulty and rapid breathing.
-pertussis (bordetella pertusis): A highly contagious respiratory tract infection which cause classic
spasm (paroxysm) of uncontrollable coughing that is violent and persistent followed by a sharp, high
pitch intake of air which create characteristic WHOOP sound. Patient try to take deep breath
between cough
Uncontrollable coughing that may end with a high-pitched "whoop" sound during the next breath of
air, cyanosis, facial congestion
Adults: side effects of the strenuous coughing, ie; bruised or cracked ribs, abdominal hernias, broken
blood vessels in the skin or the whites of your eyes
CVS
Cyanosis : bluish discoloration of the skin and mucosal membrane due to more deoxygenated blood
Hb < 5g/dL
Causes of cyanosis :, ,
Respi : severe pneumonia , severe bronchiolitis ,
CVS : Eisenmenger syndrome , congenital heart failure
If patient present with cyanosis since birth other history yg kena tanya ( congernital heart dz n TOF )
- any feeding problem
-cyanosis of other part
- SOB ?
-Fever ?
-History of breath holding attack ?
Tettralogy of fallot
-overriding of aorta
- pulmonary artery stenosis
- Right ventricular hypertrophy
-large VSD
Haemodynamic of TOF * :
-when there is pulmonary stenosis , only little blood go to pulmonary circulation
- a lot will be left in the Right ventricle Right ventricular hypertrophy
-together with VSD and overriding of aorta , blood in the right ventricle will be shunt to the left
ventricle
- mixing of blood aorta body cyanosis
Presentation
-poor feeding
-cyanosis during feeding
- fussyness
- Tachypnea
- agitation
Complication
-hypercyanotic spell ( rapid increase in cyanosis , irritability , inconsolable crying due to severe
hypoxia and SOB and pallor )
-MI
- CVA
-IE
Clinical features :
-clubbing
-systolic murmur upper left sterna edge
-single heart sound
Investigation :
-ECG- tall R wave ( Right ventrical hyperthrophy )
- Chest X ray : boot shape heart , pulmonary artery bay , reduce pulmonary vascular marking
Tx: treatment
- shunt (Blalock-taussig shunt) between subclavian artery and pulm artery in very cyanosed
- in hypercyanotic spells: sedation and pain relief( morphine), bicarbonate to correct acidosis, IV fluid
to reduce hyperviscosity, o2 adminikstration
VSD
Haemodynamic changes :
VSD pressure in LV higher than RV Blood from the left ventricle right ventricle more
blood in pulmonary artery congestion HF ( no cyanosis )
Complication of vsd HF , RTI , IE , FTT, chest infection, coarctation of aorta
Immunization
2,3,5,18 months:
3) DTaP
Pertussis: bordatella pertussis-family hx of febrile fits is not contraindication, can give vaccine
Complications in vaccination
contraindication : Contraindication
- immune compromised patient -severe local or generalized reaction towards the
- severe anaphylaxis reaction towards the previous dose
vaccine
-leukemia pt Example
-HIV -Pertussis in DTaP , IM polio , influenza
-chemotherapy pt
-on high dose of steroid
-within 2 weeks of elective
Example :
BCG (Intradermal ) ,MMR ( IM ) , Per oral Polio ,
Varicella ( subcutaneous ) , Rotavirus ( oral )
Hepatitis vaccine
-all infant including yg born to HBsAG positive mothers ( 0 1 6 )
-health care personnel
-given IM ( give with immune globulin for infants of HBsAG positive mothers )
Measles Vaccine
- side effects : transient rash , fever day 5 12 post vaccination , URTI symtopms , febrile convulsion
, encephalopathy
Pertusis :
-side effect : anaphylaxis , encephalopathy , high fever , fits within 72 hour , persistent inconsolable
crying
Optional Mandatory
-pneumococcal ( 2 months ) -BCG ( 0 )
-Influenza ( 6 bulan ) -Hep B ( 016 )
-rotavirus ( 6 weeks 6 months ) - DTap , IPV , HiB ( 2 3 5,18 )
Rotarex , Rotarix , RotaTeq - MMR ( 9,12) n boster 7 tahun )
-hep A ( 10 month ) -HPV ( 13 tahun - 3 doses )
- chicken pox ( 12 months )
Immunization : is a process whereby a person is made to be resistant to a infectious disease
H&L
1.IDA
-s/s: pica
2. thalassemia
Breastfeeding:
Skin
Cases?
Pts contact with mumps, what to do?: take vaccine at usual time
Pts 8-9 y/0,abd pain, kussmaul breathing,polyuria,thirsty: DKA
Pleural effusion
exudate transudate
Infection,inflammation,malignancy:pneumonia,tb,RA.SLE, Inc venous pressure: cardiac
lymphoma failure,pericarditis
Hypoproteinemia:
cirrhosis,NS,malabsorption
IV IG: GBS,ITP,kawasaki dz
Malnutrition:
kwashiorkor marasmus
Edma, skin changes
Cx: infection
Tx: GOBF
ITP
Leukemia
-bacteria: HiB,C.diphtheria
-viral: parainfluenza
Meningitis
pneumonia