1. 2. 3.

Swelling and redness of ankles Insect bite Allergic reaction Injury (sprain/broken ankle) Right heart failure/kidney failure Gout Mouth ulcer and gum bleeding Gingivostomatitis Canker sores Oral thrush Dengue fever Bloody stool Food poisoning AGE Inflammatory bowel disease (Crohns Disease) 4. Bloody stool and rashes - Allergy reactions - AGE - Measles - 5th disease 5. Fit and fever - Febrile fit

6. 7. 8. -

Meningitis Encephalitis Metabolic syndrome Brain hemorrhage Kidney problems Shortness of breath Bronchiolitis Asthma Pneumonia Viral bronchitis Choking Fever Dengue fever Viral infection URTI Otitis media Sore throat Pneumonia Headache Vision problems Sinusitis Meningitis Intracranial hemorrhage Migraine

Seminar - bleeding and clotting disorder

Paediatric 2010 Y3

1) Normal physiology hemostasis Prostaglandin and NO maintain vasodilatation of blood vessels Coagulation pathways (endothelial injury vasoconstriction platelet plug [need minimum 20 000 platelets to form] fibrin - thrombosis ) Fibrinolysis by tPA and plasmin 2) Bleeding disorder Thrombocytopenia - Divide into primary and secondary causes. Primary part further divides into congenital and acquired causes. Primary congenital is Fanconi anemia, which is inherited aplastic anemia. Primary acquired is ITP. Secondary including decrease production and increase destruction (radiation, aplastic anemia, hypersplenism, dengue infection, SLE, tumor including neuroblastoma leukemia causing marrow infiltration lymphoma). Clotting factor disorder - Hemophilia A, B and von Willebrand factor deficiency using plasma derived factor via IV 3) Clotting disorder DIVC

Radiology abdomen and genitourinary

1. Abdomen Disease Necrotizing Enterocolitis Description Pre term - hypoxic Imaging X ray (AP) Finding Pneumatocele intestinalis air trap in bowel wall Pneumoperitoneum Portal gas Microcolon and soap bubbles sign Double bubble sign DJ flexure at right side Jejunum at right side Hypertrophic muscle of pyloric Shoulder sign Transverse - swirl sign Longitudinal pseudokidney sign

Meconium Ileus Duodenal atresia Malrotation Pyloric stenosis

Bowel content of fetal Closed ended of duodenum

Narrowing of pylorus, projectile vomiting,

Contrasted x ray (rectal) X ray Contrasted x ray (mouth) Ultrasound Contrasted x ray (mouth) Ultrasound

Intussuseption

Hirschsprungs

Telescoping of intestine, intussuscepian and intussusseptum Red currant jelly stool Aganglionic megacolon

Contrasted x ray (rectal)

Narrow rectum and dilated sigmoid colon

2. Genitourinary
Paediatric 2010 Y3

Vesicoureteric reflux MCU reflux of contrast and dilated ureters DMSA scarring of kidney Ultrasound hydronephrosis Posterior Urethral Valve MCU stricture and dilation of urethra 3. Tumor neuroblastoma (along sympathetic nephroblastoma/Wilms tumor and hepatoblastoma US, CT and MRI

chain

from

brachial

plexus

to

buttock),

Fingers clubbing
*formation of new blood vessels at fingers, start at thumbs Causes: a) GIT Crohns disease, cirrhosis and GI lymphoma b) Heart cyanotic congenital heart diseases (ToF, tricuspid atresia and transposition of great arteries), endocarditis and aneurysm c) Respiratory chronic lung suppuration (abscess, bronchiectasis and cystic fibrosis), fibrosing alveolitis and TB d) Unilateral clubbing upper limb artery aneurysm and brachial arteriovenous malformation

Fluid maintenance
0 6 months: 150ml/kg/day 7 12 months: 120ml/kg/day

Weight to age
Birth 6 months 1st year Next - Double - Triple - (age + 4) X 2

Head circumference to age

Birth 1st year of life 2 to 5th year - 1cm/month - 0.5cm/year

Dengue infection
Dengue fever Dengue hemorrhagic fever
Paediatric 2010 Y3

Fever Thrombocytopenia Hess test Plasma leakage Ascites Hematocrit increase Pleural effusion

+ + + NO

+ + + YES

Diabetes
Fasting glucose level (mmol/l) Normal Impaired fasting glucose Impaired glucose tolerance Diabetes
VITAMIN V I T A M I N C E - vascular/hypoxia - idiopathic - trauma/toxin - autoimmune - metabolism - infection - neoplasm - congenital - endocrine

2h plasma glucose level (mmol/l) venous blood < 7.8 7.8 - < 11.1 11.1

< 6.1 6.1 6.9 < 7.0 and 7.0 or

Pneumonia Viral infection caused wheezing plus crackles. The viral caused alveolar type II cells to lose its structural integrity and secrete less surfactant. Hyaline membrane form and cause less effective gases exchange. Edema occurred and cause obstruction. Bacterial infection cause secreting proteinaceous fluid in alveolus. Then cause influx of RBCs and inflammatory cells in alveolus red hepatization. While gray hepatization occurred when fibrin formation and degradation of ic. Then resolution when the bacteria and inflammatory cells are digested by alveolar macrophages. All these result in consolidation of lungs. Crackles appeared when it infected small respiratory airways (inflammation). Lastly inflammation and pulmonary edema cause stiffness and less dispensable lungs.

Reflexes Supinator C56 Biceps C56

Knee quadriceps L23 Ankle calf muscles L45 S1

Paediatric 2010 Y3

Triceps C67

Persistent/prolonged fever weeks and months - Autoimmune: SLE and rheumatoid arthritis - Infections: HIV, TB, malaria and endocarditis - Neoplasm: leukemia and lymphoma - Endocrine: hyperthyroidism

Paediatric 2010 Y3