Pediatric
177
PEDIATRIC Dr Masooma Alsharkhat
-
Upload
masooma-alsharakhat -
Category
Health & Medicine
-
view
16 -
download
0
Transcript of Pediatric
PEDIATRICDr Masooma Alsharkhat
Intro
at the nape of neck
STORK'S BEAK MARK
at the eyelids
glabella
MONGOLIAN BLUE SPOT.
Due to melanocytesarrested in the dermis
This is a condition in which a child, usually under 1 year old, has a chronic, persistent or intermittent wheeze, heard without a stethoscope, but is happy and smiling, not at all distressed.
HAPPY WHEEZING
MURMER
على حتىالثياب
لما الماي خريرالمسه
Normal Onset in the second to third day of life. mostly in term babies of lesions. They are benign. Aetiology is unknown.
ERYTHEMA TOXICUM
MILIA
MILIA • These commonly occur on the face and scalp,
and consist of tiny white papules which are usually discrete. .
• They usually resolve within a few months without treatment. Milia are inclusion cysts which contain trapped keratinised stratum corneum.
• They may rarely be associated with other abnormalities in syndromes including epidermolysis bullosa and the oro-facial-digital syndrome (type 1).
• . When on the hard palate, they are referred to as Epstein's pearls; when on the alveolar ridges(contain the socket of teesth), they are called alveolar cysts or Bohn's nodules.
EPSTEIN'S PEARLS
caused by the pressure of the presenting part of the scalp against the dilating cervix.
disappears in first few days
CAPUT SECUNDUM
CEPHALHEMATOMA doesn’t cross the suture line . hemorrhage of blood between the skull and
the periosteum the swelling is subperiosteal causes of a cephalhematoma are a
prolonged second stage of labor or instrumental delivery, particularly ventouse.
may develop jaundice, anemia or hypotension
VENTOUSE
SEPSIS Syphilis and Listeria monocytogenes
are acquired by transplacental infection.
RADIANT WARMERS Evaporative skin water losses can be
higher in neonates, especially premature infants who are under radiant warmers or undergoing phototherapy
HYPONATREMIA Hyponatremia causes a fall in the osmolality
of the extracellular space. Because the intracellular space then has a higher osmolality, water moves from the extracellular space to the intracellular space to maintain osmotic equilibrium.
The increase in intracellular water may cause cells to swell.
Brain cell swelling is responsible for most of the symptoms of hyponatremia.
CENTRAL PONTINE MYELINOLYSIS Central pontine myelinolysis is brain cell dysfunction
caused by the destruction of the layer (myelin sheath) covering nerve cells in the middle of the brainstem (pons).
The most common cause of central pontine myelinolysis is a quick change in the body's sodium levels. This most often occurs when someone is being treated for low blood levels of sodium (hyponatremia) and the sodium is replaced too fast. It also can occasionally occur when high levels of sodium in the body (hypernatremia) are corrected too quickly.
INFANT GROWTH AND DEVELOPMENT When there is baby born a premature
by 2 month period , at 4 month he will be developmentally like a 2 month old !!
We don’t say the development of the child is 10 month old , we say for example the gross motor development of the child is 10 month old , fine motor is 10 month , speak &language is 6 month جرا .وهلم
INFANT GROWTH AND DEVELOPMENT Delays in one domain may impair
development in another domain •A deficit in one domain may
compromise assessment of skills in another domain
•Understanding normal development and acceptable variations is essential
Development proceeds from cephalic to caudal and proximal to distal
if the Galant reflex is asymmetrical, We can use this reflex to assist hemiplegia .
The more severe the retardation, the more likely an underlying cause is identified
CONGENITAL HYPOTHYROIDISM Most common treatable cause of Mental
retardation. Asymptomatic at birth, sporadic. Most common cause is thyroid dysgenesis
(doesn’t exist or very small). Lethargy, slow movement, hoarse cry, feeding
problems, constipation, macroglossia(large tongue), umbilical hernia, large fontanel, delay in the closure of the ant. fontanels, hypotonia, dry skin, hypothermia, and prolonged physiological jaundice.
CONGENITAL HYPOTHYROIDISM Oral T4 is drug of choice, as soon
as diagnosis is confirmed.
RISK FACTORS FOR MENINGITES hemoglobinopathies such as sickle cell
disease. functional or anatomic asplenia, and
crowding such as occurs in some households, day care centers, or college and military dormitories.
CSF leak (fistula), resulting from congenital anomaly or following a basilar skull fracture, increases the risk of meningitis, especially that caused by S. pneumoniae.
Poor prognosis is associated : with young age, long duration of illness
before effective antibiotic therapy, seizures, coma at presentation, shock, low or absent CSF white blood cell count in the presence of visible bacteria on CSF Gram stain, and immunocompromised status.
Even with appropriate antibiotic therapy, the mortality rate for bacterial meningitis in children is significant: 25% for S. pneumoniae, 15% for N. meningitidis, and 8% for H. influenzae.
Recurrence may indicate an underlying immunologic or anatomic defect that predisposes the patient to meningitis.
3)Tripod sign: when the patient is in supine position and you ask him to
let his trunk flexed 90 degrees with his hip he can’t do it and he will put both hands on the bed towards the back to relive the pain, in other words: tripod position is a position assumed by the patient with abdominal weakness or meningeal irritation while sitting in bed, supporting the body with the hands in a plane posterior to the pelvis.
4)knee-chin sign:
here the patient can not touch his knee with his chin due to pain.
What is this?
Meningococcemia is a life-threatening infection that occurs when the bacteria, Neisseria meningitidis, invades the blood stream. Bleeding into the skin (petechiae and purpura) usually occurs and the tissue may die (become necrotic or gangrenous). If the patient survives, the areas heal with scarring.
HYPOPLASTIC LEFT HEART SYNDROME the most common cause of death from
cardiac defects in the first month of life.
There is usually no heart murmur. low cardiac output gives a grayish
color to the cool, mottled مرقش skin. A small left ventricle that is unable to
support normal systemic circulation
HYPOPLASTIC LEFT HEART SYNDROME
ASD
the most common ASD.
The least commonAssociated with anomalous pulmonary venous return.
near the endocardial cushions
The membranousseptum is below the aortic valve and is relatively small.
ENDOCARDIAL CUSHION TISSUE The inlet or posterior septum comprises
endocardial cushion tissue.
VSD Large VSDs are not symptomatic at birth because the pulmonary vascular resistance is
normally elevated at this time. As the pulmonary vascular resistance decreases over the first 6 to 8 weeks of life, the amount of shunt increases, and symptoms may develop.
Pulmonary hypertension due to either increased flow or increased pulmonary vascular resistance may lead to right ventricular enlargement and hypertrophy.
RIB NOTCHING
TOF ON CXR
TRANSPOSITION OF GREAT ARTERIES an egg on a string created by the
narrow superior mediastinum.
INTRAVENTRICULAR HEMORRHAGE
INTRAVENTRICULAR HEMORRHAGE
Anasarca, or extreme generalized edema, is a medical condition characterized by widespread swelling of the skin due to effusion of fluid into the extracellular space.
[
PNEUMOPERICARDIUM
recognized in preterm neonates
عليش ما للفهم بساألرقام من
1
SHORT STATURE Mostly short stature patients present to
clinic at age of 7 years old
chronic renal disease, celiac disease ,cystic fibrosis, congenital heart disease, chronic malabsorption
Any signs of puberty and at which time they commenced? As if they had early puberty: this mean they used to be tall in early life but due to early epiphyseal closure they’ll be short later on.
Medication history (long term steroid) Steroids = antigrowth hormones Dietary history School performance : As worsened school performance may be indicative
of Hypothyroidism;
Family history: Parents’ Height Parents’ ages of Puberty Family History of Short Stature Family History of delayed growth or Puberty Family History of endocrinopathis or systemic illness that may affect growth
: Is the range above or below the mid-parenteral height by 8.5 cm
Target height
in any endocrine related short stature the bone age is lower than chronological age except in 3 cases:
1. Precocious puberty : early puberty due to excess sex hormone level
2. Congenital hyperplasia 3. Hyperthyroidism In these cases the bone age is higher than or equal the
chronological age because these conditions cause acceleration of bone ossification early in life. In this period the child seems to get tall stature but because the epiphyseal plate become ossified earlier >> the child height stop increasing in the early age and become shorter than still up-growing child.
TRIDENT HAND DEFORMITY
the hands are short with stubby fingers with separation between middle and ring finger
In Achondropl..
IGF-1 is evaluated as a marker for growth hormone deficiency rather than GH itself because GH secretion is pulsatile Indication of GH therapy
GH deficiency/ insufficiency Chronic renal insufficiency : for short
stature pt. Turner syndrome
IUGRIdiopathic short stature Prader- willi syndrome.
Response after GH therapy
1/3 poor responders,1/3 respond as expected
(gain 5-10 cm)1/3 excellent responders
Good Predictors: Good growth velocity-
1st year Tall parents
Adverse effects of GH therapy
Intracranial Hypertension Oedema
Worsening of scoliosis Gynaecomatia
Slipped capital femoral epiphysis : the rapid growth of femur causes separation of epiphysis results in
severe pain and limbing
MENKE’S DISEASE
KLINEFELTER SYNDROME
BRONCHIECTASIS
: DOUDENAL ATRESIA
double bubble sign
cases
RACEMIC EPINEPHRINE Racemic epinephrine is a racemic
mixture of epinephrine and is a sympathomimetic bronchodilator that is delivered by aerosol.[1] Commonly used in croup (laryngotracheobronchitis) and when stridor is present after removal of an endotracheal tube (extubation).
BANDEMIA Bandemia refers to an excess of band
cells (immature white blood cells) released by the bone marrow into the blood.
STEEPLE SIGN found on a frontal neck radiograph
where subglottic tracheal narrowing produces the shape of a church steeple.
NONINFECTIOUS CAUSES OF STRIDOR include mechanical and anatomic
causes (foreign body aspiration, laryngomalacia, subglottic stenosis, hemangioma, vascular ring, vocal cord paralysis).
BACTERIAL PNEUMONIA CAN BE THE CAUSE
Lobar conslidation
DKA
rounds
TURNER SYNDROME
ALLERGIC RHINITIS طول على مرشح Allergic rhinitis is a diagnosis associated with a
group of symptoms affecting the nose. These symptoms occur when you breathe in something you are allergic to, such as dust, animal dander, or pollen.
Symptoms: Itchy nose, mouth, eyes, throat, skin, or any area Problems with smell Runny nose Sneezing Watery eyes
upslanting
downslanting
PYLORIC STENOSIS Pyloric stenosis can lead to forceful vomiting, dehydration and weight loss. Babies with pyloric stenosis may seem to be hungry all the time. Signs of pyloric stenosis usually appear
within three to five weeks after birth
PYLORIC STENOSIS Signs and symptoms include: Vomiting after feeding (projectile vomiting). Stomach contractions. You may notice
wave-like contractions (peristalsis) that ripple across your baby's upper abdomen soon after feeding, but before vomiting.
Changes in bowel movements. Since pyloric stenosis prevents food from reaching the intestines, babies with this condition might be constipated.
PYLORIC STENOSIS Risk factors Sex. more often in boys — especially firstborn children. Race. more common in Caucasians of northern European
ancestry, Premature birth. Family history. Smoking during pregnancy. Early antibiotic use. Babies given certain antibiotics in the
first weeks of life — erythromycin to treat whooping cough, for example — have an increased risk of pyloric stenosis. In addition, babies born to mothers who took certain antibiotics in late pregnancy also may have an increased risk.
Focused history
CYSTIC FIBROSIS
CYSTIC FIBROSIS
CYSTIC FIBROSIS
non cancerous growths within the nose or sinuses.
CYSTIC FIBROSIS Post nasal drip refers to that sensation
of having excess secretions (either thick or thin) drip down the back of your throat.
Mini osci picture
ROSARY BREADS
MILIARIA
MILIARIA
Miliaria is due to obstruction of sweat and rupture of the exxrine sweat duct. It is commonly seen secondary to thermal stress,
Non pruritic
RHEUMATIC FEVER It is due to an immunologic reaction that is a delayed
sequela of group A beta-hemolytic streptococcal infections of the pharynx.
*Minor criteria include fever (temperatures of [38.2°–38.9°C]), arthralgias, previous rheumatic fever, leukocytosis, elevated erythrocyte sedimentation rate/C-reactive protein, and prolonged PR interval.
†One major and two minor, or two major, criteria with evidence of recent group A streptococcal disease (e.g., scarlet fever, positive throat culture, or elevated antistreptolysin O or other antistreptococcal antibodies) strongly suggest the diagnosis of acute rheumatic fever.
SCARLET FEVER
Other signs and symptoms associated with scarlet fever include: Difficulty swallowing, enlarged glands in the neck, Nausea or vomiting, Headache.
Flushed face: The face appears flushed with a pale ring around the mouth.
Red rash: The rash looks like a sunburn and feels like
sandpaper.
HENOCH-SCHÖNLEIN PURPURA The immune complexes associated with HSP
are predominantly composed of IgA. the most common systemic vasculitis of
childhood and cause of nonthrombocytopenic purpura.
It occurs primarily in children 3 to 15 years of age, although it has been described in adults.
slightly more common in boys than girls and occurs more
frequently in the winter than in the summer months.
HENOCH-SCHÖNLEIN PURPURA The hallmark of HSP is palpable purpura. The rash is classically found : below the waist,
on the buttocks, and lower extremities. Arthritis occurs in 80% of patients with HSP and
is most common in the lower extremities, particularly the ankles and knees.
The platelet count is the most important test, because HSP is characterized by nonthrombocytopenic purpura with a normal, or even high, platelet count.
KOPLIKS SPOTS
BECKWITH–WIEDEMANN SYNDROME
an overgrowth disorder usually present at birth, characterized by an increased risk of childhood cancer and certain congenital features.
Most children (>80%) with BWS do not develop cancer; however, children with BWS are much more likely (~600 times more) than other children to develop certain childhood cancers, particularly Wilms' tumor (nephroblastoma), pancreatoblastoma and hepatoblastoma.
Children with BWS are most at risk during early childhood and should receive cancer screening during this time.
In general, children with BWS do very well and grow up to become adults of normal size and intelligence, usually without the syndromic features of their childhood.
BECKWITH–WIEDEMANN SYNDROME
Children conceived through In vitro fertilization have a three to fourfold increased chance of developing Beckwith–Wiedemann syndrome. It is thought that this is due to genes being turned on or off by the IVF procedures.
HSV1 Herps labialis=Cold sore = fever blisters.
PERTUSSIS Classic pertussis (whooping cough) is caused by
B. pertussis,a gram-negative pleomorphic bacillus with fastidious growth requirements.
The peak incidence of pertussis in the United States is among those less than 4 months of age—infants.
Infants may not display the classic findings, and the first sign in the neonate may be apnea.
radiographic signs of segmental lung atelectasis may develop during pertussis, especially during the paroxysmal stage. Atelectasis may develop secondary to mucous plugs.
PERTUSSISThe
progression of the
disease
catarrhal stage
nonspecific signs (increased nasal secretions and
low-grade fever) lasting 1 to 2
weeks
paroxysmal stage
the most distinctive
stage of pertussis and lasts 2 to 4
weeks.Coughing occurs
convalescent stage
marked by gradual
resolution of symptoms
over 1 to 2 weeks.
ROCKY MOUNTAIN SPOTTED FEVER rickettsial disease transmitted by ticks. The rash starts at the soles and palms.
ABNORMAL BIRTH WEIGHT
BRUCELLOSIS, Brucellosis is a highly contagious zoonosis caused by ingestion of unpasteurized milk or undercooked meat from infected animals, or close contact with their secretion. Osteomyelitis is the most common complication.
Mini osci analysis
SUBCONJUNCTIVAL HEMORRHAGE usually a harmless condition that disappears
within 10 to 14 days. You may not realize you have a
subconjunctival hemorrhage until you look in the mirror and find the white part of your eye is bright red.
Subconjunctival hemorrhage often occurs without any injury to your eye, or it may be the result of a strong sneeze or cough that caused a broken blood vessel.
SEBORRHOEIC DERMATITIS
SEBORRHOEIC DERMATITIS
Seborrhoeic dermatitis primarily affects the scalp and intertriginous areas. It is most common in the first 6 weeks of life. Involvement of the scalp is frequently termed "cradle cap", and manifests as greasy, yellow plaques on the scalp.. The aetiology is unknown. Treatment includes the use of a mild tar shampoo, and avoidance of soaps. Occasionally, a mild topical steroid may be indicated.
NEONATAL ACNE
Neonatal acne may be present at birth, or develop over the first 2-4 weeks of life
SUCKING BLISTERS
These lesions are present at birth, most often over the dorsal and lateral aspect of the wrist.. They can be either bilateral or unilateral. The infant is noted to exhibit excessive sucking activity.
Cause :Unknown
Description :Characterized by 3 stages of lesions:1) 2-4 mm nonerythematous pustules with milky fluid2) Ruptured vesiculopustules with collarettes of scale3) Hyperpigmented macules
Treatment :Reassure parents this is a benign, self-limited condition with no known sequelae that requires no treatment. Vesiculopustular lesions disappear in 24 48 hours and hyperpigmented macules generally regress by 3 months of age.
Extra :”, more in black
Also known as (port-wine stain)
commonly seen on the face and should cause the examiner to consider (Sturge-Weber Syndrome)
Extra :Sturge-Weber Syndrome ( proliferation of brain arteries that causes angiomas)Symptoms : trigeminal angiomatosis, convulsion, and ipsilateral intracranial “Tram-line” calcifications
Pigmented lesions of varying size noted in 1% of neonate.
Uncommon, but have malignant potential.
EPIPHYSIAL DISPLACEMENT Separation of humeral or femoral
epiphysis. The diagnosis is clinically based on
swelling around the shoulder, crepitus, and pain when the shoulder is moved.
Management consists of immobilizing the arm for 8-10 days.
CONTINUE…
CONTINUE…
Mini osci Qs
Q3: A) What is the criteria for the diagnosis of this
disease?B) What are the 2 most important drugs for the
treatment of this patient?
Answers:A) Fever > 5 days & 4 out of 5: 1.Polymorphous rash, 2.
Cervical lymphadenitis, 3. Changes in the lips and mucus membranes, 4. Extremity skin changes (redness, swelling, peeling of the skin), 5. Non-purulent bulbar conjunctivitis.
B) Aspirin & IVIG
Q5: This is a peripheral blood smear, What is the deficient nutrient?
Answer: Vitamin B12
Q6: What is your diagnosis?
Answer: Esophageal Atresia
*This is exactly the same picture we had in the exam
