Académique Documents
Professionnel Documents
Culture Documents
Contents:
Renal
GIT
12
CVS
18
Respiratory System
24
CNS
28
Neonatology
40
Vaccines
50
Growth
59
Nutrition
78
Blood
88
Infections
91
Malignancies
101
Miscellaneous
103
Milestones
110
RENAL
Acute Post Streptococcal Glomerulonephritis:
Definition:
-
Clinical Features:
-
Rapid onset puffiness around eye (more in the morning) and pedal edema.
Oliguria
Hypertension
In atypical cases:
-
Convulsion
Diagnosis/Investigation:
a. Blood Leukocytosis (infection)
b. Hb anemia (NCNC due to hemodilution)
c. ESR -
d. BUN:
elevated
e. Blood creatinine:
elevated
f.
Urine
a. Oliguria
b. Hematuria RBC Cast
c. Proteinuria:
1+/2+
Throat swab
II.
ASO Titer
III.
Anti DNAse B
b.
c.
d.
Important Complications:
a.
ARF
b.
c.
Hypertensive encephalopathy
d.
Hyperkalemia / Hyponatremia
Treatment:
1.
General:
-
Bed rest
BP
2.
Diet:
-
Intake of protein, sodium and potassium should be restricted till the blood urea value reduces
and urine output increases.
3.
Weight:
-
In severe oliguria, patient loses about 0.5% body weight per day.
4.
Antibiotics:
-
5.
Hypertension:
-
Other Atenolol
6.
Edema/CCF
-
Nasal O2
Nephrotic Syndrome:
Definition:
-
Values:
a. Proteinuria:
>40mg/m2/hour
>1g/m2/day
>50mg/kg/hour
3+/4+ by dipstick
b. Hypoalbuminemia
Serum albumin <2.5g%
c. Hyperlipidemia
Cholesterol >250mg%
Investigation:
< 2.5g%
e. Serum Cholesterol:
> 250mg%
f.
Australia Ag Hepatitis B
g. VDRL Syphilis
ASO titer - in GN
Throat swab - + in GN
b. SLE/RA/etc. suspected
ANA
Ds DNA
RA factor
D. Other:
a. USG Abdomen
b. Renal Doppler
c. Ascitic tap
COMPLICATIONS:
1. Thromboembolism:
Causes:
Increased level of fibrinogen, factor V, VIII, platelets Enhanced coagulation
Decreased level of Antithrombin III, Factor IX and XI Low ability to limit coagulation
2. Infection: (IgG due to low protein, steroid)
SBP, TB, Viral infections - chicken pox/measles
3. Growth retardation:
Due to: Protein deficiency
Anorexia
Steroid
4. Cardiovascular disease
5. Anemia
6. Hyponatremia
7. Hypertension
8. ARF
9. Hypocalcaemia
10. Complications of steroid therapy.
TREATMENT:
A. General:
a. Diet:
Salt restriction
Fluid restriction
Maintenance of protein
b. Complication:
I.
Thromboembolic episode
Prevent immobilization
Antiplatelet agent
Anticoagulants
II.
Infection : Antibiotics
III.
IV.
Anemia Fe
V.
Hypocalcaemia/Hyponatremia
c. Edema:
Diuretics Furosemide 1.4 mg/kg/day
Human Albumin Infusion when human albumin falls below 1.5 g%
B. Specific:
SKDC Regime:
Prednisolone 2 mg/kg/day 3 divided doses X 4 weeks
1.5 mg/kg/day single morning X 4 weeks.
Initial episode:
Prednisolone 2 mg/kg/day X 6 weeks
1.5 mg/kg/day on alternate day X 6 weeks
First 2-3 relapses:
Prednisolone 2 mg/kg/day X 2weeks
1.5 mg/kg/day on alternate days X 4 weeks
Frequent relapse/dependence:
a. Alternate day prednisolone 0.3- 0.7 mg/kg X 9-12 months
b. Cyclophosphamide X 2 mg/kg/day
+
Prednisolone 1.5 mg/kg/alternate day
duration 12 weeks
Definition:
It is a congenital anomaly of the urinary tract and is an important cause of distal urinary tract
obstruction.
Dribbling
Abnormal stream
Palpable bladder
Recurrent UTI
Investigation:
MCU:
Dilated posterior urethra and valves at the junction with anterior urethra
Enlarged bladder with diverticuli and trabeculations
Vesico ureteric reflux
Treatment:
Endoscopic fulguration of valves
UTI
Definition:
-
It is infection of any part of urinary tract with urine microscopy showing pus cells > 510/mm3 and > 105 organism/ml on urine culture (preferably single type of organism)
Predisposing factors:
a. Vesico ureteric reflux.
b. Obstructive uropathy.
c. Neurogenic bladder (associated with meningomyelocele, tumor, trauma at lumbosacral
region)
d. Malnutrition
e. Immunosuppressive therapy.
f.
Sample Collection:
a. Supra pubic aspiration
b. Urethral catheterization
2 years
Investigation:
a. ESR, CRP -
b. USG Renal abnormalities
c. Urine microscopy and culture:
> 10 WBC / mm3
> 105 bacteria/ml on culture
Second UTI:
Investigations:
a. USG
b. IUP
c. MCU
d. DMSA scan for pyelonephritic scans
e. DTPA scan for renal function
AGN
-
NEPHROTIC SYNDROME
Hematuria:
Gross >5 RBC/HPF
+/-
RBC Cast: +
Oliguria
Rare
Proteinuria 1+/2+
Massive proteinuria,
> 2 g/day
>40 mg/m2/day
>1 g/m2/day
>50 mg/kg/hour
3+/4+ dipstick
Pre renal:
o
Acute gastroenteritis
Hemorrhage, shock
CCF
Renal:
a. Acute tubular necrosis
b. Glomerulonephritis
c. Hemolytic uremic syndrome
d. Interstitial nephritis
Post renal:
a. Calculus
b. Posterior urethral valves
TREATMENT OF UTI:
a. First attack:
Neonates: Parenteral ampicillin + Gentamicin x 7-10 days
Infants:
10
Urine culture after 1 week, 1 month and then 3 consecutive months to ensure complete
clearing
b. Recurrent attack:
Co-trimoxazole, 2 mg/kg/day long term night dose
-
Duration of treatment depend on the interval between 2nd and 3rd episode.
If interval
< 3 weeks:
treatment 1 yr.
3 weeks 3months:
3 months
> 3 month:
no prophylactic treatment
Anemia
Failure to thrive
Growth retardation
Hypertension
Bony deformities
Malnutrition
Peripheral neuropathy
11
GIT
Dehydration/Oral Rehydration Therapy
Assessment of dehydration:
Condition
Well/Alert
Restless / irritable
Lethargic /
Unconscious / Floppy
Eyes
Normal
Sunken
Tears
Present
Absent
Absent
Moist
Dry
Very dry
Thirst
thirsty
to drink
Skin pinch
Slowly
Very slowly
Decide
No
Some
Severe
Treat
Plan A
Plan B
Plan C
12
Weight loss
2-5%
5-10%
10%
Achars
Mild
Moderate
Severe
ORS Composition:
New
Old
NaCl
3.5
3.5
KCl
1.5
1.5
Citrate
2.6
2.9
Glucose
13.5
20
Water
1 liter
1 liter
Advantage of citrate:
a. More stable product
b. Longer shelf life
c. Less stool output
d. Increases intestinal absorption of sodium and water.
IV Rehydration solution:
1. Ringer lactate/ Hartmanns solution
2. Diarrhea treatment solution
3. Normal saline
Plan A:
a. Educate mother to use increased amount of home available food.
b. ORS should be given.
c. Return to health worker if
Not corrected in 3 days
1. Danger signs:
i.
ii.
Repeated vomiting.
iii.
Marked thirst
iv.
Eating/drinking poorly
13
v.
Fever
vi.
Blood in stool
Plan B:
It has 3 components:
a. Rehydration therapy.
b. Maintenance therapy
c. Provision of normal daily requirement.
a. Rehydration therapy:
Give 75 ml/kg of ORS in first 4 hours.
b. Maintenance:
Begins when signs of dehydration disappear - normally within 4 hours
ORS should be equal to diarrhea losses approximately 10-20 ml/kg body
weight/liquid stool
c. Provision for normal daily requirement.
Breast feed even during rehydration.
Semisolid food soon after deficit replacement
Plan C:
a. Start IV fluids immediately.
While the drip is being setup, give ORS if the child can drink.
Solution used:
1. RL + Dextrose 5%
2. RL
3. NS
<12 months
1 hour
5 hours
1yr - 5yr
30 min
2 hours
14
Monitoring:
If improvement but still showing some signs of dehydration, start Plan B and
discontinue IV fluids.
Observe child for at least 6 hours before discharge, to confirm that mother is able to
maintain the childs hydration with ORS.
Portal Hypertension:
Definition:
It is defined as elevation of portal venous pressure in valves above 10-12 mm Hg.
Causes:
a. Cirrhosis Post viral, autoimmune hepatitis, Wilsons disease.
b. Budd-Chiari syndrome
c. Veno-occlusive disease
15
d. Palmar erythema
e. Clubbing, White nails
f.
Dupuytrens contracture
g. Flapping tremor
h. Ascites
i.
Gynaecomastia
j.
Testicular atrophy
Adults only
k. Menstrual irregularities
Lactose Intolerance:
Definition:
Lactose intolerance is the development of clinical symptoms resulting from lactase
deficiency following ingestion of lactose in water in a standard dose.
Cause:
-
Secondary
Acute gastroenteritis
PEM
Worm infestations
Malabsorption syndrome
Consequences:
-
Osmotic diarrhea
Metabolic acidosis
Bacterial proliferation
Caloric loss
Clinical Features:
-
Perianal excoriation
16
Failure to thrive
Abdominal distension
Borborygmi, flatulence
Investigations:
-
Stool pH <5.5
Reducing substance >0.5%
Treatment:
-
Secondary
17
CVS
Cyanotic Spell:
- An effect of TOF
Cyanosis
Increasing cyanosis
Gasping respiration
Valsalva maneuver
Increased O2 demand
P CO2, pH, P O2
18
Hyperpnoea
Venous return
CO
Cyanosis, clubbing
Management:
1. Knee chest position/ squatting position
2. Humidified O2
3. Morphine 0.1mg/kg sc for sedation
4. Correct acidosis. Obtain pH give sodium bicarbonate iv.
5. Propranolol 0.1 mg/kg iv during spell.
Long term 1 mg/kg 4-6 hourly orally.
6. Vasopressor methoxamine(vasoxyl) im/iv
7. Correct anemia
8. Consider operation.
-Long term
19
CCF:
Definition:
-
Inability of the heart to maintain an output at rest or during stress, necessary for metabolic
needs of the body and inability to receive blood into the ventricular cavities at low pressure
during diastole
Clinical Features:
A. Symptoms:
a. Poor weight gain
b. Difficulty in feeding
c. Breathes too fast
d. Breathes better when held against the shoulder
e. Persistent cough and wheezing
f.
g. Puffiness of face
h. Pedal edema
B. Signs:
Left
Both Side
Right
Tachypnea
Cardiac enlargement
Hepatomegaly
Tachycardia
Facial edema
Cough
Peripheral cyanosis
Wheezing
Edema affect
Rales in chest
Treatment of CCF:
Management consists of four pronged attack for the correcting of inadequate output.
a. Reducing cardiac work
b. Augmenting myocardial activity
c. Improving cardiac performance by reducing heart size
d. Correcting underlying cause.
20
Stepwise management:
1. Frusemide 1mg/kg/dose + Amiloride/Triamterene
2. Add Digoxin
3. Add ACE inhibitor and stop K+ sparing diuretics
4. Add Isosorbide nitrate
5. Intermittent dopamine + dobutamine (in separate iv) or dobutamine.
6. Myocardial biopsy & add immunosuppression with steroids in case of active myocarditis
and -Blocker in cases without active myocarditis
7. Cardiac transplantation
21
TOF Components:
1. VSD
2. Pulmonic stenosis
3. Overriding dextroposed aorta
4. Right ventricular hypertrophy
Complications of VSD:
1. Recurrent dust infections
2. CCF
3. Infective endocarditis
4. Conduction disturbances
5. Eisenmengers phenomenon and pulmonary hypertension
6. Aortic / Tricuspid regurgitation
7. Growth retardation
PDA:
Clinical Features:
Symptoms:
Small: Asymptomatic. Poor exercise tolerance
Large: Effort intolerance
Palpitation
22
23
RESPIRATORY SYSTEM
Management of Status Asthmaticus:
Improvement:
1. 2 agonist every 30 min interval gradually increased to 4-6 hourly
2. Stop O2 if child is able to maintain O2 saturation > 95 %
3. Prednisolone once daily for 5-7 days then stop without tapering.
No improvement:
1. Continue salbutamol and add ipratropium 250g every 20 min.
2. Inj. Hydrocortisone 10 mg/kg
improvement
Treat as early
responder
Reassess at 2 hr.
No response
1. Start injectable theophylline bolus followed by
continuous infusion
Magnesium 50mg/kg in dextrose over 30 min
No improvement
Mechanical ventilation
24
Advantage:
a. Delivery to the target tissue
b. Less dose, less side effects
c. Rapid response
d. Self-administration possible
e. Decreases incidence of severe attack and hospitalization.
Limitations:
a. Technique needs to be learnt
b. Cost is high.
Devices:
MDI, Rotahalers, Spacers, Nebulizer
MDI: Puff is synchronized. (Inspiration and breath is held for 10s)
Rotahalers: Patient has to inhale after the capsule is broken by a fin inside one of the
halves.
Spacers: MDI attached to one side and mouth piece on the other side.
Nebulizer: Given for 5-20 minutes.
Complications Of Pneumonia:
1. Pneumatocele
2. Empyema
3. Pyopneumothorax
4. Metastatic abscess
25
Acute Bronchiolitis:
It is defined as the first episode of expiratory wheeze of acute onset usually in a child less than 2
years of age who has features of viral respiratory illness like coryza, otitis media or fever, with or
without indications of respiratory distress, pneumonia or atopy.
Incidence:
Age: 1-6 months (peak age)
Season: October to march
Sex: more common in males
Etiology:
Viral: Respiratory syncytial virus
Adenovirus, influenza virus
Parainfluenza virus 1, 2, 3
Bacterial: Mycoplasma pneumonia
Clinical Features:
Symptoms:
-
Rhinorrhea
Difficulty in feeding.
Signs:
-
Tachypnea
Tachycardia
Chest retraction
26
Investigations:
-
ABG
Serum electrolytes
Treatment:
-
Nursing care: humid atmosphere preferably sitting position at 30o-40o angle with
head and neck elevated
IV fluids
Antibiotics
Ribavirin: shortens the course if given in the early stages delivered by an nebulizer
16 hours a day for 3-5 days.
27
CNS
Treatment of Status Epilepticus:
Acute Seizures
Phenobarbital IV
Loading dose 10-15 mg/kg @ 1-2 mg/kg/min
Maintenance 5 mg/kg/day
Im/rectal paraldehyde
Midazolam infusion
Phenobarbital coma
28
Specific therapy:
a. Glucose for hypoglycemia
b. Pyridoxine 50 100mg if deficiency
c. IV calcium if hypocalcaemia
d. Im Magnesium
Neonatal Seizures:
Causes:
The five major causes are hypoxic ischemic encephalopathy, hypocalcaemia,
hypoglycemia, meningitis, and polycythemia
a. Perinatal complications:
i. Hypoxic ischemia encephalopathy
ii. Birth injuries
iii. Intraventricular hemorrhage
iv. Subarachnoid hemorrhage
b. Perinatal infection:
i. Meningitis
ii. Tetania neonatorum
iii. Intrauterine infection TORCH
c. Metabolic cause
i. Hypoglycemia, hypocalcaemia, hypomagnesaemia
ii. Kernicterus
iii. Pyridoxine deficiency
iv. Unknown error of metabolism PKU, homocystinuria
29
ii. Hydrocephalus
iii. Porencephaly
iv. Agenesis of corpus callosum
Febrile Convulsions:
Definition:
Seizure during fever occurring between 6 months to 8 years age in the absence of
neuro-infections
Investigations:
LP to rule out meningitis
Treatment:
A. Acute:
a. When child is convulsing.
i. Diazepam iv 0.2 0.3 mg/kg/dose (max 5 mg)
ii. Maintain airway, give oxygen
iii. Semi prone position
30
Pyogenic Meningitis:
Causes:
Neonates:
S.pneumoniae, H.meningitidis
>3yrs:
31
CSF Analysis:
-
Appearance : turbid
Culture: Positive
CSF in TB Meningitis:
Pressure:
Elevated
Appearance:
Cells:
Protein:
Sugar:
AFB:
Positive
Culture:
Positive
Definition:
-
Etiology:
A. Prenatal
a. Anoxia
b. Toxemia of pregnancy
32
c. Intrauterine infections
d. Congenital malformation of brain
B. Natal:
a. Anoxia
b. Asphyxia
c. Difficult labor
d. Precipitate delivery
e. Birth trauma
C. Post natal
a. Kernicterus
b. Trauma
c. Infection meningitis and encephalitis
d. Metabolic disturbance hyperglycemia
e. Vascular hemorrhage and thromboembolism
Classification:
A. According to motor deficit
a. Spastic quadriplegia, hemiplegia, paraplegia, diplegia, monoplegia
b. Athetoid
c. Atonic
d. Mixed
B. According to patients functional status
Class I No practical limitation of activity
Class II Slight to moderate limitation
Class III Moderate to gross limitation
Class IV Inability to carry out any useful activity
C. According to patient therapeutic requirement:
Class I no active treatment required
Class II require minimal bracing and treatment
Class III Require bracing and service of CP team
Class IV Long term hospitalization and management
33
Clinical Features:
1. Spastic:
-
Quadriplegia, hemiplegia
Hyperirritable, ophisthotonus
2. Atonic:
-
3. Chorioathetoid:
-
Chorioathetosis
Deafness dystonia
Associated features:
Eye: Strabismus, cataract, refractiveness
Ear: Deafness partial/complete
Speech: Dysarthria, Aphasia, dyslalia
Sensory defects: Astereognosis, spatial disorientation
Seizures: Generalized/focal tonic
Intelligence: Borderline/moderately/severely mental retardation
GIT: Constipation, feeding difficulties
Teeth: Malocclusion, caries
Miscellaneous: Critchelys sign - thumb is persistently flexed across palm after 1st month
of life
Differential Diagnosis:
a.
Neurodegenerative disorders
b.
c.
d.
Muscle disorders
e.
Ataxia telangiectasia
34
Management:
Depending on severity and type of neurological deficit and associated problem.
1. Symptomatic treatment:
-
2. Physiotherapy:
-
Massage/exercise
Special therapy
3. Occupational therapy
4. Educational management: vision, speech and learning problems.
5. Orthopedic support: splints and surgeries
6. Social Support
CP Team:
-
35
GB Syndrome:
Definition:
It is acute inflammatory polyneuropathy
Etiology:
Viral: EBV, mumps, measles
Post vaccination
Bacteria: Campylobacter
Clinical Features:
-
Hypotonia
Miller Fisher syndrome areflexia, ataxia and ophthalmoplegia without significant limb
weakness
Ryes Syndrome:
Definition:
-
Etiology:
a. Salicylates
36
b. Varicella
c. Influenza B
d. Aflatoxin
Stages:
Stage I Mild confusion, listlessness, apathy, anorexia, vomiting
Stage II Delusion, restlessness, lack of orientation, frightened stage
Stage III Coma, decorticate posture later become decerebrate, Death
Stage IV Flaccidity, areflexia, apnea,
Dilated pupil not reacting to light
Sever hypotension
Treatment:
-
Low protein
Mannitol
Glucose
Correct electrolyte
a. Prenatal:
1. Metabolic PKU, homocystinuria
2. Chromosomal disorders: Down, Klinefelters
3. Environment and nutrition gap: iodine deficiency
4. Developmental defect: Microcephaly
5. Maternal factor:
a. Teratogenic drug use
b. TORCH infection
c. Radiation during pregnancy
37
b. Natal:
a. Birth trauma
b. Hypoxic ischemic encephalopathy
c. Intracerebral hemorrhage
c. Postnatal:
a. Meningoencephalitis
b. Kernicterus
c. Hypoglycemia
d. Malnutrition
e. Child abuse
f.
Autism
AFP
Definition:
Acute onset of flaccid paralysis in any child aged <15 years for which no obvious cause is
found or paralytic illness in a person of any age in which polio is suspected.
Differential diagnosis:
Polio, GBS, transverse myelitis, traumatic neuritis
AFP Surveillance:
Aim:
a. Identify all remaining area
b. Monitor progress toward eradication
c. Target supplementary immunization
WHO recommends immediate reporting and investigation of every case of AFP in a child < 15
years and collection of 2 stool samples for analysis in a WHO approved lab
38
Immunization of all child <5 years by 1 dose OPV, residing within 5 km radius
Search for cases < 15 years age for history of AFP in last 60 days.
Adequate specimen:
-
Completion of survey
o
Sodium Valproate:
Indication:
-
Side Effects:
-
Fulminant hepatitis
39
NEONATOLOGY
Problems of SGA baby:
1. Birth asphyxia
2. Meconium aspiration syndrome
3. Hypothermia
4. Hypoglycemia
5. Infections
6. Polycythemia
Pathological
Physiological
Less increase
Always <15
Not required
Direct >2g
Indirect increased
40
Problems of prematurity:
Birth asphyxia
Feeding difficulties
Hypothermia
Infection
Hyperbilirubinemia
Intraventricular hemorrhage
Necrotizing endocarditis
Apneic spells
Metabolic acidosis
Cephalhaematoma:
Definition:
Sub periosteal hemorrhage usually involving parietal and temporal bones
Etiology:
-
Forceps delivery
Vacuum extraction
Prolonged labor
Clinical Features:
-
Clinical significance:
Can cause exaggeration of physiological jaundice
41
Treatment:
No treatment resolves by itself.
BFHI
Requirements:
Baby friendly hospitals are required to adopt a breast feeding policy and confirm to its
10 steps for successful breast feeding.
1. Have a written breast feeding policy that is routinely communicated to all health care staff.
2. Train all health care staff in skills necessary to implement the policy
3. Inform all pregnant women about benefit and management of breast feeding
4. Help mother initiate breast feeding within hour.
5. Show mothers how to breast feed and maintain lactation even if they should be separated
from their baby.
6. Give newborn no food or drink other than milk unless indicated
7. Rooming in practice
8. Encourage breast feeding on demand
9. Give no pacifiers/soother to breast feeding infant
10. Foster the establishment of breast feeding support groups and refer mothers to them on
discharge.
42
A. Anatomical features:
-
No lanugo
B. Functional features:
a. Respiratory system: good cry
Good cough reflex
b. GIT: sucking/swallowing reflex good.
c. Neurological: Moros reflex present
Good suckling, swallowing reflex
Pupillary light reflex positive
Good muscle tone
43
APGAR Score:
It is a quantitative method for assessing the infantile respiratory, circulatory and neurological
status
Appearance
Blue
Pink completely
blue
Pulse/min
Absent
<100
>100
Grimace (reflex
No response
Grimace
Flaccid
Some activity
Respiration
None
Slow irregular
Good crying
stimulation)
Score:
>8 normal
4-8 moderately asphyxiated
<4 severe distress
Importance:
1.
2.
3.
4.
44
c. Intrauterine infection/septicemia
Drawbacks:
1. Subjective scoring except HR
2. Ignores time of first cry
3. 1 minute score is not useful in deciding the intervention necessary for resuscitation
as action must be initiated before that
4. Cannot be used in
a. Preterm baby
b. Infant Erbs palsy
c. Severely sedated baby
5. It does not give any idea of duration and severity of asphyxia.
Kernicterus:
Definition:
-
Clinically 3 phases:
-
Sequelae:
-
Sparse/athetoid type of CP
Mental retardation
45
Epilepsy
Treatment:
-
Exchange transfusion
Phototherapy
Drugs
Phototherapy:
This converts bilirubin into photoisomers that can bypass the conjugating system of liver and be
excreted in the bile or urine without further metabolism.
Mechanism of action:
-
Photo oxidation
Indication:
-
Prophylactically
o
Contraindication:
-
Obstructive jaundice
Technique:
-
46
Protection of infant: eye patch to protect retinal damage and diaper to protect
external gonads.
Side Effect:
-
Dehydration
Diarrhea
Skin burns
Tanning
Retinal damage
Hyperthermia
Neonatal Sepsis:
It is the systemic bacterial infection of the new born which incorporates septicemia, pneumonia
and meningitis.
Etiology:
-
Late
Time
<72 hours
>72 hours
Complicated pregnancy
+/-
Source
Post-natal environment
Clinical Features:
Fulminant, multisystem
47
General:
Respiratory System:
Lethargy
Cyanosis
Refusal to suck
Tachypnea
Poor cry
Chest retractions
Grunt
weight loss
Apnea/gasping
CNS:
Hypotension:
-
Poor profusion
Seizures
Shock
Excessive crying/irritability
Abdominal distension
Neck retraction
Diarrhea
Bulging fontanelle
Vomiting
GIT:
Temperature problem:
Others:
Hypothermia
Sclerema
Fever
Excessive jaundice
Bleeding
Renal Failure
Investigation:
-
Blood counts
Cultures
X Ray chest
Gram stain
Management:
1. Antibiotics
2. Supportive therapy;
a. Maintenance of nutrition
48
Prevention of infections:
-
Hand washing by care givers before and after handling the baby.
1. Hemolytic disorder
2. Cephalhaematoma
3. Rotor/Dubin-Johnson disease
4. Maternal diabetes
49
VACCINES
Hib Vaccine:
Types:
-
Dose:
0.5ml im, anterolateral aspect of the thigh.
Vaccination:
2 months: 3 dose at two month interval, booster at 12 months after the third dose.
6 12 months: 2 dose at 2 month interval; booster at 12 months after the second dose
12 months 5 years: single dose
Indication:
-
Splenectomy
HIV
DPT:
Contents:
-
Diphtheria toxoid
25 Lf
Tetanus toxoid
5 Lf
B. pertussis
50
Al. phosphate
1.5 mg
Thiomersal BP
0.01 %
Route: Deep im
Site:
Dose: 0.5 ml
Side effects:
Contraindications:
a. Progressive neurological disease
b. Uncontrolled convulsions
c. Contraindication to second and successive dose:
o
Convulsions
Encephalopathy
Anaphylaxis
Hyperpnoea
DT Vaccine:
Contains 2 Lf diphtheria toxoid per dose.
For immunizing children over 12 years.
Dose: 2 dose at interval of 4-6 weeks followed by 6-12 months after second dose.
51
Combination Vaccine:
Definition:
-
These are the vaccines which merge several antigen into a single vaccine that
prevent against different disease or protect against multiple strains of infectious
agent causing the same disease.
BCG:
6-12 weeks
Healing with permanent, tiny, round scars, typically (4-6 mm in diameter)
Complications:
Local
Focal
General
Abscess
Enlargement of draining LN
Fever
Indolent ulcer
Suppurative lymphadenitis
Keloid
Otitis media
Lupus vulgaris
Osteomyelitis
52
Contraindication:
-
Generalized eczema
Infective dermatosis
Deficient immunity
BCG Adenitis:
-
Treatment:
When axillary LN are unusually large INH will retard the progression and speed up
healing.
BCG Test:
Can be done directly with prior MT or if MT is negative.
Read on 3rd day.
Type of reaction:
a. Classical reaction: Develops after 3 - 6 weeks with erythema papule formation and
occasionally ulceration. Subsides within 2-3 months leaving a small scar.
b. Accelerated BCG reaction: Whole process is fast. Child shows the papule in few
hours, a pustule on third day and scab by 5 or 6 days.
c. Delayed reaction: Papule takes 72 hours to appear and subsequent course takes
place similar to the classical reaction.
Significance:
Negative test helpful in excluding TB
Optional Vaccine:
a. Hepatitis B
b. Typhoid
c. Hib
d. Pneumococcal
53
Hepatitis B Vaccine:
Content:
Contain small envelope proteins, which contain the principle envelope antigen, Hepatits
B surface antigen (HBsAg) (A recombinant vaccine)
Dose:
0.5 ml for children < 11 years
1 ml > 11 years
Site: im
Normal: 0, 1, 6 months, booster at 5 years
High risk: 0, 1, 2 months, booster at 12 months given to infant born to Hepatitis B positive
mother.
Pneumococcal Vaccine:
Type:
Purified polysaccharide vaccine
14 valent and 23 valent. 23 valent is more commonly used.
Dose and site:
Subcutaneous/im
1 dose booster not before 5 years,
Indication:
-
Nephrotic syndrome
HIV infection
Side effects:
Hypersensitivity reaction
54
Typhoid Vaccine:
im:
-
Oral:
Polio Eradication:
4 point strategy:
a. High routine immunization coverage with OPV
b. Supplementary immunization in the form of national immunization day or pulse
immunization program.
c. Effective surveillance system
d. Final stage consisting of mopping up by door to door immunization campaigns.
Content:
Inactivated pertussis toxin combined with filamentous hemoglutinin. Sometimes
additional component such as fimbrial antigen and pretactin is also present
Administration:
Given with diphtheria and tetanus toxoid as DPT, also with Hepatitis B
55
Mantoux test:
This is used to rule out tuberculosis.
Technique:
1 mg in 1 ml of purified protein derivative of mycobacterium is taken and injected
intradermally on the volar aspect of the forearm.
Syringe used Omega microstat syringe fitted with 1 cm steel 26 gauge intradermal needle.
Reading: After 48 hours, the size of induration felt (not the erythema).
Interpretation:
Size:
Inference
0-5 mm
Negligible chance
5-10 mm
Doubtful
10-20 mm
Significant
20-30 mm
Moderate infection
> 30 mm
Severe infection
Clinical Significance:
If the size of induration is > 10 mm, it indicates significant either the person is
infected/immunized.
Condition of false negative:
a. Post measles
b. Immunocompromised
c. Chemotherapy treatment
d. Malnourished child
56
UIP
At birth
6 weeks
10 weeks
14 weeks
9 months
Measles
DT
57
OPV
History
Developed by Salk
Developed by Sabin
Type
Contents
Type 1 40D
Type 2 8D
Type 3 32D
Schedule
Route
Im
Oral
Mechanism of
action
No intestinal immunity
infection.
(immunity)
Use
Cost
manufacture
Contraindication
None
58
Acute infections
Febrile illness
Malignancy
Corticosteroid therapy
GROWTH
Define Growth:
-
It denotes a net increase in the size or mass of tissue which is due to multiplication
of cells and increase in the intracellular substance. Hypertrophy contributes to a
lesser extent to the process of growth.
Principles of growth:
59
1. Genetic factors:
a. Phenotype: head, chest, fatty tissue
b. Parental characteristic
c. Race
d. Sex Pubertal growth spurt occurs 2-3 years earlier in female than males
but mean height and weight attained at maturity is less than males
e. Biorhythm and maturity
f.
Genetic disorder:
1. Chromosomal abnormalities: Down, turner
2. Gene mutation: Galactosemia
2. Environmental factors:
a. Prenatal:
1. Maternal malnutrition
2. Multiple pregnancies
3. Medical illness in mother CRF, CCF, Eclampsia
4. Maternal infection TORCH
5. Drugs: thalidomide
6. Hormonal: thyroxine, insulin, IGF
b. Postnatal period:
1. Neonatal hypoxia
2. Neonatal convulsions
3. LBW babies
4. Social factors:
1. Socioeconomic level
2. Natural resources
3. Climate
5. Infection and infestation
6. Nutrition
60
7. Trauma
8. Emotional factors
9. Cultural factors
It can be done by
-
Assesses child development in terms of gross motor, fine motor and adaptive,
personal, social and language
At birth
50 cm
1 year
75 cm
2 year
85 cm
4 year
100 cm
Birth length
doubles at 4 yr
Triples at 13 yr
2-12 yr = [Age(yr)x6] + 77 in cm
61
Head circumference:
Birth
35 cm
6 months
43.5 cm
1 year
46.5 cm
2 year
49 cm
HC growth:
1. 2 cm/month for 3 months
2. 1 cm/month for next 3 months
3. 0.5 cm/month for next 6 months
4. 0.5 cm/yr for 2-7 years
5. 0.33 cm/yr for 7-12 years
Weight changes:
First year of life:
For expected weight, add to birth weight as follows:
First 4 months age in month x 0.8 kg
Second 4 months age in month x 0.7 kg
Third 4 months age in months x 0.6 kg
Expected weight:
between 3-12 months =
62
U/L ratio
At birth
1.7
6 months
1.6
12 months
1.5
2 years
1.4
3 years
1.3
5 years
1.2
7 years
1.1
10 years
1.0
13 years
0.9
Chest circumference:
Visible graphical display of a childs physical growth development primarily for long
term follow up of child, so that changes over time can be interpreted and progress
of growth monitored.
63
Weighing of child:
-
MAC
It remains constant between 1 5 years of age in healthy children. The reason for it to remain
constant is the replacement of body fat of infancy with muscle.
Technique:
Measured with help of non-stretchable, plastic measuring tape midway between
olecranon and the acromion.
Grade
Circumference
Shakirs tape
Normal
>16.5cm
green
Mild PEM
13.5 16.5cm
Moderate PEM
12.5 13.5
Yellow
Severe PEM
<12.5
Red
64
Microcephaly:
HC < 2nd SD deviation, below average head circumference
Causes:
1. Craniosyostosis: brachycephaly, dolichocephaly
2. Trisomy 13
3. Downs syndrome
4. Trisomy 18 (Edwards syndrome)
Anterior fontanelle:
Anatomy:
-
Closure: 18 months
Method of examination:
-
Significance:
-
Depressed in dehydration
Delayed closure:
65
Rickets
Hypothyroidism
Prematurity
Raised ICP
Short Stature:
If the length or height of the child is below the 3rd percentile or less than 25D from the mean, he
or she is considered to be short in stature.
Causes:
1. Proportionate short stature:
a. Normal variants:
1. Familial
2. Constitutional delay in growth
b. Prenatal causes:
1. Intrauterine growth retardation
2. Intrauterine infection
3. Genetic disorders
c. Postnatal:
1. Nutritional dwarfism
2. Chronic visceral disease
3. Endocrine disorder
4. Psychological
66
Failure to thrive:
It is a term given to infants whose rate of weight gain is sluggish. The length of the child may or
may not be affected.
Causes:
1. Extrinsic:
a. Inadequate nutritional intake
b. Social and environmental deprivation or a combination of both
2. Intrinsic:
a. Defect in absorption coeliac disease, lactose intolerance
b. Persistent vomiting pyloric stenosis
c. Metabolic disorder diabetes mellitus
d. Chronic disease of heart, lung, kidney and liver
Clinical Features:
1. Looks small for age
2. Weight below 3rd percentile
3. Wide eyed expression/expressionless face and avoids direct gaze
4. Vocalization delayed and motor activity curtailed
5. Inadequate response to social stimuli
6. Marked preoccupation with thumb sucking
7. Shows lack of cuddling and assumes infantile posture.
67
Diagnosis:
-
Treatment:
-
Immediate and long term should be directed at both infant and the mother.
Etiology:
-
I2 deficiency
Thyroid dysgenesis
Thyroid dyshormonogenesis
Physical examination:
1.
68
Treatment:
Lifelong level thyroxine 10-15 g/kg/day
To bring T4 to 12-16 g/dl a.s.a.p.
Monitoring:
-
Hormonal assessment
69
Enuresis:
Definition:
It is defined as normal nearly complete evacuation of the bladder at a wrong place and
time at least twice a month after fifth year of life.
Types:
1. On basis of achievement of control:
a. Primary: Repeated (at least twice a week for at least 3 consecutive months)
passage of urine into clothes/bed during night in a child 5 years who has
never been dry in night.
b. Secondary: Child has been dry for several months and again starts bed
wetting.
Causes:
1. Primary:
a. Organic:
1. Bladder neck obstruction
2. Ectopic urethral opening
3. Sacral agenesis
b. Non organic:
1. Developmental delay
2. Psychosocial factor anxiety
3. Sleep disorder
2. Secondary:
a. Urinary tract obstruction
70
Evaluation of child:
1. History:
a. Type of enuresis
b. Time of enuresis
c. Frequency
d. History related to organic pathology
2. Psychosocial history
3. Examination to rule out organic cause
4. Lab evaluation:
a. Urine analysis and culture
b. Blood examination
c. IVP
Management:
It depends on:
a. Age of child
b. Type of enuresis
Treatment:
1. Counseling
2. Bladder training/bladder stretching
3. Conditioning therapy (aversive conditioning)
4. Pharmacotherapy
a. Imipramine
b. Oxybutine decreases bladder reflex contractility
c. Desmopressin - urine output
5. Other:
a. Behavior modification
71
b. Psychotherapy
c. Restriction of fluid after dinner
6. Treat the organic cause.
Clinical Features:
Children suffering from Down syndrome have dysmorphic features, also structural and
functional abnormality.
1. Dysmorphic features:
a. Facial features:
1. Flat face**
2. Short, upslanting palpebral fissure**
3. Epicanthal folds
4. Short ear with abnormal ear lobes**
5. Protruding tongue
6. High arched palate
b. Other dysmorphic features:
1. Skin excess posterior neck skin **
2. Simian crease **
3. Clinodactyly - short hand and finger marked by incurved 5th finger
**
72
Complications:
-
Chronic rhinitis
Conjunctivitis
Periodontal disease
Autism:
Definition:
Autism is characterized by profound deficit in interpersonal and communication skills
Impaired communication
Impaired imagination
Etiology:
-
Intrauterine rubella
Fragile X syndrome
Phenylketonuria
Specific symptoms:
-
Mental retardation
73
Management
-
Special education
Medical management:
Only for associated problems like severe hyperactivity, aggression, self abusive
behavior.
It is a conduct disorder due to some cause (being hurt or thwarted) where child holds his/her
breathing, expiration which may lead to cyanosis (with or without hypoxia, limpness and
convulsion)
Types:
-
Clinical Features:
-
Age: 6 18 months
Cry
Venous return
Cardiac output
74
If hyperemia 10 15 sec
Convulsions
-
Investigations:
Rule out other pathology like seizure, cardiac arrhythmia, brain stem tumor
Management:
-
The child should never drive any benefit from a breath holding episode
9 months:
-
Fine motor:
1 year:
Scribbles spontaneously
Personal, social:
o
75
Fine motor:
2 years:
Language:
o
Uses pronouns
3 years:
-
Gross motor:
o
Riding tricycle
Climbs stairs in coordinated manner keeping only one foot on each step
Fine motor:
o
Language:
o
Telling a story.
76
NUTRITION
Complications of PEM:
Primary Signs:
cornea)
Secondary signs:
XN Night blindness
cornea)
XF Fundal changes
XS Corneal scarring
Amount
<6 months
50,000 IU
6 12 months
100,000 IU
> 1 year
200,000 IU
Schedule: on day 0, 1, 30
77
Local Treatment:
-
Padding in corneal ulcer to promote healing, prevent dehydration, reduce pain and
photophobia
Mydriatics
2. Chronic:
a. Anorexia
b. Dry itchy skin
c. Weight loss
d. Sparse hair
e. Hepatosplenomegaly, hypoplastic anaemia
Definition:
-
Solid food to replace breast feeding to be started at 4 6 months and completed by 1 yr.
Culturally acceptable
78
Principle:
-
No generalized rule
Problem of weaning:
-
Rickets:
Clinical Features:
79
Radiological Features:
-
Changes:
o
Fraying of metaphysis
Splaying of metaphysis
Cupping of metaphysis
80
Treatment of rickets:
Yes
no
Yes------------------------------------- Responded
No
2. Surgical:
a. Correction of deformities
b. Should be done after correction of rickets
81
Dugdales index
2. Raos index:
Constant between 1-5 years irrespective of gender
Name
Methods
Raos
Kanawatis
Dugdales
N/Severe PEM
0.15-0.16/ <0.14
MAC
82
Classification of PEM:
1. Wellcome classification:
Weight
Edema
Inference
60-80% of expected
Underweight
60-80% of expected
Kwashiorkor
< 60%
Marasmus
< 60%
Marasmic kwashiorkor
3. IAP Classification:
-
4. WHO Classification:
Moderate
Severe undernutrition
undernutrition
Symmetrical edema
No
Yes (edematous
malnutrition)
70-79% of expected
(measure of wasting)
wasting
85 89 % of expected
(measure of
stunting
stunting)
83
Label
80%
90%
Normal
80%
<90%
Stunted
<80%
90%
Wasted
<80%
<90%
Malnutrition definition:
-
PEM is the term applied to a class of clinical conditions consisting of classifiable and
non-classifiable manifestation of protein lack and energy inadequacy.
General features:
Skin:
o
Psychological:
o
Voracious appetite
Growth:
o
84
General features:
o
Skin:
Hair changes:
Mental changes:
Takes little interest in the environment and does not play with his toys
GIT:
o
Impaired appetite
Hepatomegaly
Feature
Breast milk
Cow milk
Calories
67 kcal
65 kcal
Lactose
7g
48 g
Fat
3.5 g
3.5 g
Proteins
1.1 g
3.3 g
Fe
Ca
34
Vitamin K
Deficient
Vitamin D
Water soluble
0.5 g
117
85
Easily digestible
Complete nutrition
More whey protein which form fine curd and easily digested
Other benefit:
-
Higher IQ
PKU
Galactosemia
86
Definition:
Only breast milk is given to baby. No other food or drink, not even water is given.
Medicine, mineral drops, vitamins are permitted if indicated.
Essential features
Marasmus
Kwashiorkor
Edema
Loss of fat
Present
Less obvious
Muscle wasting
Severe
Less
Growth retardation
More in weight
Appetite
Good
Poor
Skin
Dry, scaly
Hair damage
Hypopigmented
Flag sign
Moon face
Hepatomegaly
Clinical features:
87
BLOOD
IDA: C/F, Lab diagnosis, Response to iron therapy, PS findings:
Clinical Features:
Symptoms:
-
Failure to thrive
Pica
Anorexia
Signs:
-
Pallor
Koilonychia
Lab Diagnosis:
1. RBC Changes:
a. Hb, PCV, MCH, MCV, MCHC All decreased
b. PS
1. Microcytic, hypochromic red cells
2. Anisocytosis
3. Poikilocytosis
4. Reticulocyte count decreased
2. Marrow changes:
88
3. Iron studies:
a. Serum iron low <30 g/dl
b. TIBC increased >350g/dl
c. Transferrin saturation less than 15%
d. Serum ferritin less <10 ng/ml
Elevation of Hb level
Treatment of IDA:
-
Wearing of shoes
Iron therapy
Thalassemia:
Peripheral smear:
-
Poikilocytosis
Fragmented RBC
Clinical Features:
89
Progressive pallor
Mongoloid facies: bossing of skull, prominent frontal and parietal eminence with
flattened vault. Prominent malar eminences, depressed nasal bridges and puffy
eyes.
Poor feeding
Recurrent infections
Hepatomegaly
Growth failure
Hypogonadism
Diabetes
90
INFECTIONS
Measles complications:
Measles eradication:
MMR Vaccine:
Content:
-
Dose:
0.5 ml subcutaneous
Schedule:
9 10 months with vaccination at 15-18 months of age
Contraindications:
-
Leukemia
Lymphopenia
91
Mumps complication:
Orchitis
Epididymitis
Pancreatitis
Oophoritis
Nephritis
Tetanus neonatorum
Agent: C. tetani (gram positive, mobile, non-capsulated, anaerobic spore bearing bacillus)
Clinical Features:
1. Age: 5 10 days after delivery
2. Excessive unexplained crying, refusal to feed, apathy
3. Spasm of neck muscles mouth kept open
92
Management:
1. General supportive measures
2. Immunization (passive by toxoid)
3. Nutrition, fluid and electrolyte balance
4. Antibiotics
5. Tracheostomy and assisted ventilation
6. Central of spasm by diazepam
Complication of Ascariasis:
1. Malnutrition
2. Intussusception
3. Intestinal obstruction by round worm bolus
4. Jaundice and pancreatitis
5. Gall bladder disease
6. Peritonitis
Complications:
-
Myocarditis
Clinical Features:
1. Constitutional symptoms:
93
2. Local Manifestations:
a. Nasal diphtheria nasal discharge and excoriation of upper lip
b. Faucial diphtheria redness and swelling over fauces.
Pseudomembrane formed by exudate over tonsils. The membrane
bleeds on being displaced.
c. Laryngotracheal diphtheria
Membrane over the larynx results in brassy cough, hoarse voice.
Malaria:
Complication:
-
Algid malaria
Acidosis
Anemia
Cerebral malaria
DIC
Pulmonary edema
Hypoglycemia
Treatment:
-
Chloroquine resistant:
o
94
Or
o
o
-
Complicated malaria:
o
Artemether 3.2 mg/kg im (loading dose) followed by 1.6 mg/kg im daily for
6 days.
Chemoprophylaxis:
Begins 1 week before entering the area (doxycycline is started 1-2 days before
departure) and continued for 4 weeks after leaving transmission area.
Pertussis complication:
-
Respiratory system:
o
CNS:
o
Severe malnutrition
Subconjunctival hemorrhage
Gastrointestinal manifestation
95
1. Hematogenous spread:
a. Miliary TB
b. TB meningitis
c. Skeletal TB
2. Local spread:
a. Adenitis
b. Bronchopneumonia
c. Bronchiectasis
d. Collapse/consolidation
Polyarteritis nodosa
It is defined as illness of more than 6 week duration documented fever above 101 oF
(38.3 oC) on multiple occasions; lack of specific diagnosis after 1 week of admission
and investigation in a hospital setting.
Causes:
1. Infection:
a. Bacterial:
1. Local: abscess brain, lung, intraabdominal; osteomyelitis
96
MDR TB definition:
WHO defines a MDR strain as one that is at least resistant to INH and rifampicin
XDR TB: Resistance to INH, Rifampicin, Floroquinolone and any of the following three injectable
drugs Amikacin, Kanamycin, Capriomycin.
In asymptomatic no findings
Hilar opacities
Apical consolidation
Cavitary lesion
97
ESR -
Antibody against TB
Clinical Features:
-
Constipation
Spleen palpable
In severe toxemia, child may have typhoid state in which child has muttering
delirium and may pick at bed clothes.
Complications:
-
Oral: parotitis
98
Heart myocarditis
Diagnosis:
Clinical signs pathognomic of typhoid:
-
In endemic area, typhoid should be a diagnostic possibility in all fevers > 7 days
duration, especially those without localizing signs
Bradycardia
Lab diagnosis:
-
Hematology:
o
Thrombocytopenia
Blood culture:
o
Treatment:
-
Specific:
o
Supportive treatment:
o
99
Nutritious diet
Antipyretics:
Treatment of complications:
Treatment of carriers:
o
Giardiasis: C/F
Symptoms:
-
Abdominal distension
Flatulence
Nausea, anorexia
Epigastric cramps
100
MALIGNANCIES
Neuroblastoma Staging:
Stage 1: Localized tumor confined to area of origin. Complete gross excision, with or without
microscopic residual disease; identifiable ipsilateral and contralateral lymph nodes
negative microscopically.
Stage 2A: Unilateral with incomplete gross excision; identifiable ipsilateral and contralateral
lymph nodes negative microscopically
Stage 2B: Unilateral tumor with complete or incomplete gross excision; both positive LN;
identifiable contralateral lymph nodes negative microscopically.
Stage 3: Tumor infiltrating across the midline with or without regional LN involvement or U/L
tumor with contralateral regional LN involvement; or midline tumor with bilateral
regional LN involvement
Stage 4: Dissemination of tumor to distant LN, bones, bone marrow, liver and/or other organ
(except as defined in stage 4s)
Stage 4S: Localized primary tumor as defined for stage 1 or 2 with dissemination limited to liver,
skin and/or bone marrow.
101
Examination:
-
HL
NHL
45-70 years
Symptoms common
Less common
diagnosis
diagnosis
Early involvement
late
Waldeyers ring involvement is uncommon
Common
BM involvement late
Early
Late
Alcohol present
Absent
102
MISCELLANEOUS
Stridor:
Noisy respiration produced by turbulent air flow through the narrowed air passages.
Etiology:
1. Congenital: laryngomalacia, laryngeal web, stenosis, hemangioma, tongue and jaw
abnormalities
2. Mechanical: Foreign body, enlarged tonsils
3. Infection: Laryngitis, epiglottitis, diphtheria, retropharyngeal abscess
4. Trauma: Intubation, inhalation burns
5. Paralysis: Bilateral vocal cord paralysis, central paralysis due to CP.
6. Nutritional: Tetany
7. Allergic: Laryngeal edema
Investigations:
1. X-Ray:
a. Soft tissue neck AP and lateral
b. Angiography of aberrant vessel suspected
c. CT scan
2. Direct laryngoscopy without anesthesia
3. General anesthesia followed by bronchoscopy, laryngoscopy and esophagoscopy
103
Rapid respiration
Sign/symptom
Classification
Therapy
Where to treat
-Cough/cold
No pneumonia
Home remedies
Home
Pneumonia
Cotrimoxazole 5 days
Home
Severe
In/im penicillin
Hospital
Iv chloramphenicol
Hospital
pneumonia
-Cyanosis
Very severe
-Severe chest
indrawing
-Inability to feed
104
Age/wt
Tablet
Sulfamethoxazole
SMX 200mg
100mg
Tri 40mg
Trimethoprim 20mg
<2 months
One tab BD
spoon BD
Two tab BD
1 spoon BD
3 tab BD
1 spoon BD
3-5 kg
2-12 months
6-9 kg
12-60 months
10-19 kg
Convulsion
Tachypnea
Chest indrawing
Cyanosis
Altered sensorium
Cold Chain:
Definition:
-
105
Deep freezer are for making ice packs and to store OPV and measles
vaccine
PHC Level:
Deep freezer
140l
ILR
140l
Peripheral center:
Cold box vaccine carriers (these can carry 16-20 vials for outreach
seasons)
Ice packs
Underfive clinics:
It combines the concept of prevention, treatment, health supervision, nutritional surveillance
and education into a system of comprehensive health care within the resources available in
country.
Aim and objective:
Care in
illness
Growth
monitoring
Preventive
care
106
1. Care in illness:
a. Diagnosis and treatment of illness, disorders of growth and development
b. X-Ray and laboratory services
c. Referral services
2. Preventive care:
a. Immunization
b. Nutritional surveillance
c. Health checkups
d. Oral rehydration
e. Family planning
f.
Health education
3. Growth monitoring:
By use of growth chart
Child Labour:
In 1973 ILO passed a convention establishing 15 years as minimum work age for most sectors
while permitting light work from age 13, provided that such work was unlikely to harm childs
health, morals or safety or prejudice his school attendance.
Problem statement:
-
Maximum number of child labour are in J&K mainly engaged in carpet weaving
industry
Causes:
-
Poverty
107
Unemployment
Lack of education
This act was implemented to protect children against child labour, protect child
labour against abuse, exploitation and health hazards.
It is a serious emergency as the resultant cardiac toxicity may cause sudden death.
Treatment:
-
Iv glucose 0.5 g/kg along with soluble insulin 0.1U/kg over 90 min
Exchange resins
Dialysis this is more beneficial in ARF as the above measures give transient benefit
108
CASES
1. 2 month old child 3.8 kg H/O intermittent sucking, 2 weeks duration. Birth weight 3kg.
Diagnosis? Management?
4. 2 year old child 12 kg, fever + 8 large stools + vomiting 1 day duration.
Examination: irritable, cold peripheries, HR 130, BP 80/40, Diagnosis? Management?
6. 8 year old child. 110cm, 24 kg. Likely cause and basis of this
8. 6 year old child with fever 10 days is found to be pale, has ecchymotic patches.
Investigation?
9. 10 year male 20kg, 110cm assess nutritional status and order investigations.
10. 10 year old child cola colored urine. Examination, findings and work up?
11. 5 year old child puffiness of eyelids 2 days duration. Generalized convulsions on morning
of admission. Diagnosis, urinary findings, 4 complications, management.
12. Treatment of 10 kg child with severe dehydration due to acute diarrhea of 1 day duration
109
IMPORTANT MILESTONES
Gross motor:
-
3 month
Neck holding
5 month
8 month
9 month
10 month -
11 month -
Crawling (creeping)
12 month -
13 month -
18 month -
Running
24 month -
36 month -
Riding bicycle
4 month
5 month
Bidextrous grasp
7 month
Palmar grasp
9 month
Pincer grasp
12 month -
15 month -
18 month -
12-24 month-
Scribbles
2 year
3 year
4 year
5 year
1 month
Fine Motor:
Language:
-
110
3 month
Cooing
6 month
Monosyllables
9 month
Bisyllables
12 month -
18 month -
24 month -
Simple sentence
36 month -
telling a story
Binocular vision
3-6 months
Depth perception
Vision:
Personal, social:
-
2 month
Social smile
3 month
Recognize mother
6 month
9 month
waves bye
12 month -
36 month -
knows gender
111