Pedia

Thursday, 23 November 2023 8:11 AM

Disease Etiology Risk factors C/F Lab diagnosis Diagnosis Treatment Complications D/d
NRDS • Premature (preterm • Very early- cin 6hr after X-ray • Risk factors • O2 therapy/ assisted Complication Rx- PDA • Transient tachypnea of
infant) birth • Ground-glass—diffuse • C/F ventilation — the newborn TTN
• Lack of pulmonary • Tachypnea; b/l atelectasis—early • Assistant PaO2(50-70mmHg); • Meconium Aspiration
surfactant Grunting & mild examination SaO2(90-95%) syndrome MAS
• Poor lung compliance • Intercostal & • Air bronchog— major • CPAP • Congenital heart
• Atelectasis subcostal airways highlighted by • IPPV+PEEP disease CHD
retractions atelectasis air sacs • Surfactant replacement • GBS pneumonia
• 26w (90%); 28w (80%); • Nasal flaring; progressive • <27w of gest
• 30w (70%); 32w (55%) progressive cyanosis • White lung — later & • Cin 30m after birth
• Poor chest mov C severe— severe RDS • Intubation surfactant
flat thorax extubation (INSURE)
• Breath sounds- N/d; • Symptomatic & supportive
fine rales in deep • Vital signs monitoring
inspiration • Fluid & nutri
• Low • 60-80ml/kg.d—
BP+fatigue/cyanosis/pallo 120-150ml/kg.d
r+ apnea/irregular resp—> • Prevention — maternal
cyanaosis+dyspnea—> steroid prophylactic Rx; PS
resp failure+mixed resp- prophylactic Rx
metabolic acidosis+ • Preterm delivery
edema/ileus/oliguria —> • Maternal disease
MODS • Perinatal asphyxia
Neonatal • Failure to initiate & • Fetal asphyxia • Pre-delivery APGAR SCORE NRP Asphyxia—> hypoxia-
asphyxia maintain effective resp • Early- HR>=160bpm; • Fetal monitoring • Colour- • Evaluate- term gest? ischemic injury—>
after birth —> hypoxemia, fetal movement inc • Amnioticscope — blue/pale0; Good tone? MODS—>NICU
hypercapnia & metabolic • Late- HR<100bpm; meconium stained body Breathing/crying?
acidosis meconium stained amniotic fluid pink/extremitie • Warm & maintain
• Breathing change (primary amniotic fluid • Fetal scalp blood s blue 1; normal temp, position
tachypnea & apnea; • Neonatal asphyxia sample — ABG completely pink airway, clear
secondary tachypnea & • Resp distress • Post-delivery 2 secretions, dry,
apnea) • Hypotonic; HypoTN • ABG • HR- no response stimulate
• Circulation change— inc • Brady; cyanosis • Glucose 0; <100 1; >100 • Apnea/grasping?
blood in heart, lung & • Electrolyte 2 HR<100/m
adrenal gland; • BUN, Cr • Response to ○ Yes—> PV, SpO2
tachycardia; HTN catheter in monitor,
nostril - NR 0; consider ECG
grimace 1; monitor
cough/sneeze 2 ○ No—>position &
• Muscle tone- clear airway,
limp 0; some SpO2 monitor ,
flexion of extr 1; supplement O2
active motion 2 as needed,
• Resp effort- ab consider CPAP
0; slow, • HR<100/m
irregular 1; ○ Yes—> check
good cry 2 chest mov, vent
corrective steps,
ETT/ laryngeal
mask
○ No—>
postresusc care,
team brief
• HR<60/m—> intubate,
chest compression,
coordinate C PPV,
100% O2, ECG
monitor, consider
emergency UVC
• HR<60/m—>IV epi
(repeat every 3-5m if
HR<60/m)
• HR persistently
<60/m—> consider
hypovolemia/
pneumothorax
• Postresusc nursing
○ Body temp, RR,
HR, BP, SpO2
○ MODS
If meconium-stained
amniotic fluid, evaluate
breath, HR, ms tone
• Vigourous-initial steps
• Nonvigourous
○ Inadequate
breathing
efforts;
HR100bpm; poor
ms tone
Intubate & suction through
laryngoscope cin 20s

Neonatal • Cin 24h—> ABO/Rh Past history Accompanying symptoms PE: Etiological exam • Phototherapy
jaundice incompatibility • Perinatal hypoxia • Anemia, dark yellow • Blanching the skin C • Blood • Light: blue —425~
• 24-48h —> ABO • Acidosis urine finger: face (5-6 incompatibility: 475nm; green—510~
incompatibility, G6PD def • Infection • Fever/ low temp, dec mg/dl); chest(8), blood type, 530nm
• 2-3d (mild jaundice) —> • Drugs- Vit K3, in activity (mov, abdomen (10), thigh modified • Mechanism:
physiological jaundice, sulfanilamide, eating, crying), pale (12), shank (14), palm Coombs test, Ab photochemical react;
early onset breast milk indomethacin skin, apnea & sole (>15) release test, str isomerization
jaundice • Contact history of • Vomit, diarrhoea, light • Anemia & infection: free Ab • Tech: single/double
• 3-7d (mod/sev) —> infectious diseases yellow/ white clay-like pale skin & mucosa, • G6PD def: sides phototherapy
septicemia such as hepatitis stools edema, ecchymosis, enzyme activity • Drugs
• 2-3w or recurrence—> • Drowsiness, irritation, infection foci of skin & • Neonatal sepsis: • Dec free bilirubin: alb,
septicaemia, neonatal Personal history sucking weakness, umbilical cord, WBC, NEU, CRP, plasma
hepatitis, congenital • Premature birth screaming, dyspnea, pulmonary blood culture, • Inc bilirubin
biliary atresia, • Low birth wt convulsions rales, HF, culture of conjugation:
spherocytosis, breast milk • Fetal distress hepatosplenomegaly umbilical phenobarbital
jaundice • Prolonged labor • Liver & spleen size & secretion • Inhibiting hemolysis:
• Rapid progress—> • PROM texture • Intrauterine inf: high dose IVIG
hemolysis • Feeding history: • Neurological signs: hepv, TORCH • Exchange transfusion
• Slow progress—> hepatitis breast-feeding, head mass; tense ant • Congenital • Severe hemolysis,
• Insidious onset —> biliary inadequate intake Fontanel; biliary bilirubin>4.5mg/dl,
atresia • Delayed discharge weakened/inc ms obstruction: B Hb<110g/L of umbilical
of meconium or tension; primitive usg of liver, cord blood after birth C
constipation reflexes weakened gallbladder, CT, edema,
Mother’s pregnancy Aux ECT hepatosplenomegaly,
history • TCB : noninvasive HF
• Gravidity & parity • Sr bilirubin: venous • Nuclear jaundice sym
history: abortion? blood collection • Mech: remove Ab, Ab-
Stillbirth? • Exam for hemolysis: coated RBCs &
• Perinatal infection blood routine (RBC, bilirubin, correct
• Blood type Hb); Ret; urine routine anemia
• Transfusion history (urinary bilirubin, • Choice of blood
urobilinogen); LFT, components: ABO
Family history blood smear hemolytic disease: type
• Siblings-neonatal O C AB plasma
hemolysis? • Blood vol: double vol of
• Family hist— G6PD infant’s blood,
def 150-180ml/kg
• Hist of infectious d/s • Tech: peripheral
• Long-term jaundice arteriovenous
pt synchronous exchange
transfusion
• Other
• Hypocalcemia
• Hypoglycaemic
• Acid-base balance
• Hyperkalemia
• Infections
Neonatal Route of infection • Immature immune EOS • Hemogram: • High risk factors• Antibiotics • NEC
sepsis • Prenatal infection: system in newborns • Day 1 - <12hrs • Low WBC • C/F • Initial: ampicillin & • Meningitis
maternal bacteremia • Skin and • Resp distress d/t • Absolute • Lab findings aminoglycoside • Abdominal distension
& septicemia mucus pneumonia neutropenia (gentamicin/amikacin)
( transplacental membrane • Unexplained low <1000/ml Definitive • Nosocomial in NICU:
infection) thin & APGAR score cout • Low PLT diagnosis: blood nafcillin to drug • Shock
• Intrauterine infection tender/easy Fetal distress, poor • Prolonged PT & PTT CSF & urine sensitivity test • Metabolic acidosis
○ Vertical to be perfusion, hypoTN • ESR inc • 3rd gen cephalosporin: • Meningitis
transmission damaged LOS • CRP/PCT inc cefotaxime • Hypoxemia
(bacteria—> • Umbilical cord • Body temp changes: • Pathogen cultures: • Duration: -ve blood • DIC
placental—> unhealed/ low/high • Blood, CSF, urine, BLOOD ROUTINE, culture (5-7d after
fetal infection) portal of (hypo/hyperthermia) skin/secretion CRP, BLOOD effective Rx); +ve blood
• Intrapartrum infection bacterial • Breathing problems: • Detect antigen: CULTURE culture (10-14d); C
ascending infection: invasion & apnea countercurrent immune- complication (>3w)
○ bacteria transmit into • Lethargy electrophor enzyme- • IV or infusion
colonization in blood stream • Hypotonia linked immunosorbent
the birth canal • Low • Red mov assay, ELISA latex • EOS: Ampicillin+
before delivery complement, • Poor sucking- poor agglutination aminoglycoside/
( risk factor— poor feeding • Biochemical profile: Ampicillin+3rd gen
PROM & phagocytosis, • Seizures • Hypoglycaemia/hyp cephalosporin
prolonged chemotaxis & • Brady erglycaemia C no
stages of labor) cytokine • Vomiting change in glucose • LOS: + nafcillin
○ Acquired just production • Yellow skin (jaundice) administration
before delivery • Inc O2 req • Metabolic acidosis • Continuing therapy base on :
(high risk • Hypoglycaemia (unexplained) culture & sensitivity results;
factors: rupture • Elevated CRP/PCT clinical course; CRP
of membranes Special • Hyperbilirubinemia
• Postnatal infection: • Liver & spleen • DNA identification • Preterm infants:
○ After birth direct enlargement • Plamid analyses • Blood cultures
contact C • Bleeding tendency • REA, PCR • Broad spectrum
pathogen or • Shock • Nucleus acid antibiotics (48-72h)
medical • GI dys hybridisation • Preterm C in dwelling line
procedure • Resp dist • CONS
○ Environment: • Vancomycin-10mg/kg
skin, umbilical every 8-12hrs
cord, digestive
tract, • Immunotherapy: IVIG;
respiratory exchange transfusion
tract, medical • Reg-GSF
devices,
○ Direct infection • Other
from various • IV glucose
human sources - • Nutritional support
mother, family, • Vol expansion
hospital person • Pressors as need
○ Contaminated • Oxygen/vent support
equipment • Temp management
(nosocomial inf)
Acute
glomerul
onephriti
s
VSD • Inc pulmonary blood flow • PE • Vigorous Rx C anticongestive • Pneumonia
• Repeating resp tract • 4th LSB; measures • HF
infection • Grade II~IV/VI • Transcathetar closure of • Pulmonary HTN
• Feeding difficulties • Harsh pansytolic muscular or perimembranous (Eisenmenger’s
• Exercise intolerance murmur (caused by VSDs C Amplatzer syndrome)
• Diaphoresis L-R shunt across • Pt C cardiomegaly, poor
• Congestive HF defect) growth, shunt(>2:1), Cout
• Thrill pulmonary HTN —> 3-6m
• ECG • Pt. C pulmonary artery
• Small: normal pressure = systemic pressure
• Large; LV Inc (pulmonary HTN) —> before
• PH: Lv Inc, RV Inc 2 yrs
• Eisenmenger
syndrome: RV inc
• Chest X-ray
• Large shunt:
Enlargement of LA,
LV, RV
• Cardiomegaly
• ECHO
• ECHO-DOPPLER
• Catheterisation &
angiocardiography
ASD 3 major types: • Dec systemic blood flow • PE • Surgical/catheterization • Pneumonia
• Osmium secondum • Low body wt • 2nd LSB; laboratory closure— ostium • HF
(mc) —> middle of • Poor growth • Grade II~III/VI secundum (pulmonic to • Pulmonary HTN
septum in foremen • ejection-type systemic blood flow>2:1) (occasionally)
ovale systolic murmur • Age 1-3yrs
• Sinus venosus —> high (caused by inc flow • Mini sternotomy or post
in atrial septum (lc) across the pulmonic thoracotomy approach
• Ostium primum—> valve)
low in position, form • Short, rumbling mid-
of AV septal defect diastolic murmur at
lower LSB
• No thrill generally
• Loud 1st HS,
pulmonic ejection
click
• Widely split P2
• ECG: RA inc, RV inc
• Chest X-ray
• Large: Dilation of RA
& RV
• Echo: dilated RV
• Oximetry: inc in O2
saturation at atrial level
PDA • PE • Surgical when large PDA • Pneumonia
• 2nd LSB; • Symptomatic PDA+ N • HF
• Grade II~IV/VI pulmonary artery • Pulmonary HTN
• Rough machinery pressure—> coil-occluded (Eisenmenger’s
continuous murmur during cardiac catheterisation syndrome)
(caused by L-R shunt ( 5kg wt) • Infective endarteritis
across defect) • Indomethacin, inhibitor of
• Decresendo murmur prostaglandin synthesis—>
• Thrill preterm infants C PDA
• ECG: LA inc, LV inc, LVH (bw >1200g)
• Chest X-ray • Fluid restriction C/cout
• Large: Enlargement diuretics (renal func
of LA, LV rapidly dec)
• PA bulge • Surgical ligation
• Aortic knob is • Transcatheter closure of PDA
N/prominent possible in cardiac
• ECHO- L: LA LV incr catheterisation lab
• Small PDA—Intravascular
coils
• Mod-to large PDA—>
cathetar-induced sac- several
coils released C umbrella like
device/ Amplatzer device
TOF Dec pulmonary blood flow • PE • Palliative Rx • Secondary polycythemia
• Cyanosis • 2-4th LSB • Medical: chronic oral b • Cerebral thromboses
• Squatting • Grade II~III/IV blocking agents • Brain abscess
• Loss of consciousness • Rough ejection type • Surgical: creation of • Bacterial endocarditis
• Dizziness systolic murmur systemic arterial to • HF— pink TOF
• Syncope ( caused by VSD & pulmonary arterial
obstruction to RV anastomosis
outflow) • Balloon angioplasty
• P2dec, S2inc • GoreTex shunt from
• No thrill generally subclavian artery to
• ECG: cardiac axis to the ipsilateral pulmonary
right, RV inc artery (modified
• Chest X-ray: lung fields Blalock-Taussig shunt)
clear • IV prostaglandin E1- ductal
• Boot shaped heart smooth ms relaxant
• Hb, hematocrit, RBC • Oral propranolol
elevated • Primary repair: 6-12m
• 2D ECHO- thickening of • Surgical closure
aorta & large subaortic
VSD
Measles • Genus Morbillivirus family • Unvaccinated • Prodromal phase - fever • Measles-specific IgM & • Epidemiology No specific Rx of measles • Pneumonia (mc measles • Infectious d/s
paramyxoviridae • After infection, eruption of skin rash, lasts IgG serology (ELISA) • Measles • Supportive care related death) • Measles
• RNA virus immunity is 3-4d endemic area • High dose of vit A • Caused by measles • Rubella:1st day of
• Mode of transmission: generally lifelong • Fever OTHER • Potential supplementation virus alone fever; red rash
resp droplets; direct • Age: 6m to 5yrs • 3 Cs- cough, coryza, • Measles RNA detection exposure to • Management of • 2 viral infection C without itching
contact C secretions • Season: late conjunctivitis by PCR measles complications adenovirus or HSV • Rosella infantum
• Reservoir: ptns — winter/spring • Koplik spots: greyish • Antigen detection by • Unimmunised • Laryngitis (<3yrs) 3rd d of fever
conjunctiva, nasal, white Dotson ant fluorescent Ab or vaccine Prevention • Voice hoarseness, • Chicken pox: rash
pharynx, tracheal buffalo mucosa; 1-2 • Isolation of virus in failure • Early diagnosis, early arising-like cough, centripetal
secretions d before rash to 1-2 tissue culture system • C/F report, early isolation, dyspnea, hypoxia distribution, itchy
• Period of d after rash • Prodromal: early Rx • Obstruction rash C small fluid
communicability: 5 d • Eruptive stage- 3-4d after fever, 3C, • Isolation: 5d after rash • Encephalitis-very rare filled blisters
before- 5d after rash prodrome, lasts 3-5d koplik spots onset; C pneumonia, 10d • 2-6d after measles • Hand foot &
onset • High grade fever • Eruptive: after rash onset infection mouth d/s
• Exacerbated cough, maculopapula • 21 days quarantine • High mortality rate, • Scarlet fever: 2nd
Severe measles dry or moist rales r rash • Cut off route of high risk of D of fever; rash
• In • Hepatosplenomegal • Convalescenc transmission sequelae diffuse redness of
Modified measles immunocompromis y e: brown • Protect susceptible • SSPE skin C small
• Received IG & infants who ed person —> 2 to • Lymphadenopathy staining, fine populations • Long- term papules;strawber
have residual maternal Ab severe infection • Erythematous branny ○ Active complication ry tongue,
• Mild prodrome • Prolonged course, maculopapular desqamation immunisation: live • 2-17 yrs after pharyngitis,
• Atypical or no koplik spots high mortality rash( no itch) • Diagnostic tests attenuated measles Measles circumoral pallor
• Sparse, discrete rash of • Hemorrhagic; shock; • Rash accompanied • Measles- vaccine - 1st Progressive • Non-infectious d/s
short duration toxic; hermetic by high grade fever specific IgM dose(8m of life), neurological • Drug eruption-
measles • Hairline & behind ears—> serology +ve 2nd dose(18m-2yrs) deterioration, itchy rash
face—>neck—>trubk & • Isolation of ○ Passive characterised by • Acute rheumatic
extremities—> palms of virus immunisation IG behaviour change, fever
Atypical measles hand & soles of feet intellectual • Kawasaki d/s
• Received killed inactive • Convalescence stage- lasts problems,
measles vaccine (KMV) — 3-5d myoclonic seizures,
exposed to wild-type • Fever subsides, rash blindness, ataxia,
measles virus fades death
• Prodrome of short • Brown staining, fine • Characteristic
duration branny periodic EEG
• No koplik; pneumonia desquamation discharges
common • Course 7-10 • Anti-measles IgG
• Atypical rash: high level
polymorphic, begins on
extremities, spreads to
involve trunk
• Rare, difficult to diagnose
Acute • GRP A beta hemolytic • Age: 5-15yrs • Prodrome • Recent grp A strep Jones criteria • Primary prevention
rheumati streptococci • Season: winter & • Precursor infection infection Major criteria (eradication of strep)
c fever • Pathogenic strains: M type spring • Fever + Fatigue, • +ve throat culture • J-joint • Penicillin G 2-4w
1,3,5,6,18,24 • Cold, wet; poor appetite, • ASO, AH, ASK inc involvement • Allergy— macrolides
overcrowding , low anemia, sweating, • Anti-Dnase B inc • O- carditis • Anti inflammatory (aspirin,
socioeconomic nosebleed, • Heart involved: ECG; • N- nodules, steroids)
status, poor medical abdominal pain Doppler subcutaneous • Arthritis alone-
care • Arthritis mc & most echocardiography; X-ray • E- erythema salicylate (aspirin)
• Recurrence: rate earliest (75%) (water bottle sign) marginatum 80-200mg/kg/d 4-6wks
30-75% • Large joint • Active RF • S- Sydenham • Carditis- steroids: oral
involvement • CBC: WBC inc, chorea prednisolon 2mg/kg/d
• Migratory anemia Minor criteria 8-12wks
polyarthritis • ESR, CRP inc • C - CRP • Supportive management &
• Involved joints-hot, • R - Raised PR management of
red, swollen, interval complications
painful, tender • E - ESR • Bed rest
• Dramatic response • A - arthralgia • Rx of CCF- steroids,
to small doses of • T - temp diuretics, vasodilators
salicylates • E - evidence of • Rx of chorea- self
• Carditis 50% previous limiting, diazepam or
• Most severe rheumatic fever haloperidol
• Carditis/pancarditis
=myocarditis+endoc Evidence of • Secondary prevention
arditis+pericarditis antecedent strep (prevention of recurrent
• 80% of ptns develop infection attacks)
within 1st 2 weeks ○ Throat swab • Preventing initial acute
of RF culture or RAT rheumatic fever attack
• Acute rheumatic ○ Elevated/increa (primary prophylaxis)-
carditis: sing anti-strep Rx strep sore throat C
cardiomegaly; Ab tiger in sr antibiotics
murmur; • Preventing recurrences
pericarditis; ARF: 2 major or (secondary
congestive HF 1major+2minor prophylaxis)-
• Sydenham Chorea 3% - >F benzathine penicillin
• Late onset 91-6m)/ once 3-4wks IM
sole manifestation • Prevention of bacterial
• Extrapyramidal sys endocarditis
• Self limiting,
resolves cin 12 wks
• Rapid, irregular,
aimless involuntary
mov
• Hypotonia
• Muscular weakness
• Psychological
features
• Erythema marginatum
6-25%
• Erythematous ring
like macular lesions,
margins visible C
pale centres
• No pain, no pus
• Mc on trunk or
proximal
extremities, NEVER
on FACE
• Characteristic rash
of RF
• Subcutaneous nodules
2-16%
• Small 0.1-1cm
• Firm, mobile,
painless
• Self limiting-2wto
4w
• Sign of rheumatic
fever activity
Kawasaki • Infection • Age-<5yrs old • Fever: >39-40, >5d, • CBC Fever for >5d+atleast • Decrease systemic
disease • Genetic susceptibility • Peak 18-24m, rare unresponsive to • Leukocytosis C 4 principal features inflammation
• Activation of immune sys beyond childhood antibiotics, lasts for 1-2w neutrophilia & • Changes in • Prevent coronary aneurysms
• Coronary vasculitis • Boys>girls (1.5:1) • Conjunctivitis : b/l immature forms extremities • Minimize peak dimensions of
nonexudative • Anemia ○ Acute: coronary aneurysms
• Rash: maculopapular, • Thrombocytosis erythema • Prevent coronary thrombosis
erythema multifilament, • Elevated ESR, CRP of palms,
scarlatiniform; NOT • Liver func: elevated ALT, soles; • IVIG- high dose 2g/kg cin 1st
VESICULAR Hypoalbuminemia edema of 10d of illness
• Oral changes - red, • Sterile pyuria hands & • Aspirin: moderate
cracked lips, strawberry • Cardiac involvement feet (30-50mg/kg/d to high dose
tongue • Pericardium, myocardium, ○ Subacute: (80-100 mg/kg/d) until ptn is
• Cervical endocardium including periyngua afebrile, decreased from anti
lymphadenopathy- valves and coronary l peeling inflammatory to anti
nonsuppurative, u/l, arteries inflamed of fingers, thrombotic diodes
size >1.5cm • Coronary artery toes in w (3-5mg/kg/d as a single dose)
• Extremity changes- abnormalities 2&3 • Steroids: IVIG resistance
erythema palms/soles, • Polymorphous • TNF alpha antagonist
edema, induration; exanthem • Cyclosporine
desquamation of fingers & • B/l conjuntival
toes begins 2-3w after infection cout
onset of illness exudate • Follow up
• Changes in lip & • No coronary
oral cavity: insolvent-30d, 60d, 6m,
erythema, lip 1ye, 5yr
cracking, • Small or medium
strawberry aneurysm- 30d, 60d,
tongue 6m, 1yr, every 6m
• Cervical • Items: echo ECG
lymphadenopat
hy (1.5cm in
dia)
Infantile • Transmission from person • Bacterial enteritis- • Viral enteritis—>osmotic • History • EIEC • Fluid therapy (ORT) • Disturbance of water, Rotavirus
diarrhoea to person through feco- summer diarrhoea • Stool character • Blood, mucus, • Prevent dehydration electrolyte, & acid base • Wheel like virus
oral route or by ingestion • Viral enteritis- • ETEC—> secretory ○ Frequency, leukocytes in • Enteral feeding & diet balance • Most severe in
of contaminated food or autumn &winter (traveler’s d) Amt, colour, the stools selection • Dehydration 6-24m of age
water • Immature digestive • Invasive pathogens—> consistency • Abdominal • Breast-feeding ○ Isotonic- • >3m infants
• Viruses: rotavirus(wheel), func; low gastric exudative ○ Blood/mucus cramps; continued acute GI fluid protected by
Norwalk virus, astrovirus, acidity, low activity vs watery tenesmus & • Bottle fed infant: no loss(Na+ transplacental Ab &
echovirus, enteric of digestive • GI sym • Diet urgency dilution 130-150) breast-feeding
adenovirus enzymes • Diarrhoea • Water source • Fever, • Viral enteritis: lactose- ○ Hypotonic- • 1st infection more
• Bacteria • Rapid growth • Vomiting • Travel/ill contacts systemic sym free feeds chronic GI severe
• Parasities • IgM level & • Abdominal pain • PE • Campylobacter • Rice, wheat, potatoes, fluid lose • Latent
• Fungus secretory IgA from • Wt changes • Diarrhoea+- bread, cereals, lean (<130) period:24-48hrs
• Systemic infection: otitis GI mucosa very low Severe • Abnormal growth blood, meats, yogurt, fruits & ○ Hypertonic- • Vomiting 1st
media, URTI, meningitis, • Enteric bacteria • >10/day watery stool • Resting tachycardia abdominal veg high grade sym—> cin
pneumonia, urinary flora disturbed • Yellow/greenish yellow + • Signs of dehydration cramps, • Fatty food & high in fever, 24hrs—> mild-mod
infection, cutaneous • Formula feeding mucus, pus & blood ○ Mucus memb malaise, fever simple sugars avoid infection fever+ voluminous
inflection • Blood in vomit ○ Mental status • Self limited • Zinc supplementation (>150) watery stools
• Non-infectious factors: • Anorexia, nausea & ○ Tears • Salmonella <4yrs • Reduction in duration • Metabolic acidosis • Self limited, 4-8d
Antibiotic associated abdominal distension ○ Skin turgor old mc of acute episodes (cherry lips) • High infectivity;
diarrhoea AAD • Lethargy, coma ○ HR, BP • Fever, • Red in stool output, • Hyponatremia cout gross blood or
○ Fontanel, eyes diarrhoea frequency, incidence • Hypokalemia white cells in stools
• Shigella ○ Urine output (watery/ • 20mg/d >6m; 10mg/d (K+<3.5) • Temporary lactose
• Fever, abdominal • Abdominorectal blood+mucus <6m 14d • Hypocalcemia intolerance
cramps, tenesmus ○ bowel sounds, • Crampy • Antibiotic therapy (total <2.2)
• Mucoid stools mass abdominal • Watery diarrhoea—> • Hypomagnesemia Norovirus
C/cout blood tenderness, pain not recommended (<0.6) • Nov-feb, 12-72hrs
• Serious distention, (unless travel his of duration
complications peripheral cholera) • Latent period:
wasting • Shigella 12-36hrs
• Lab studies gastroenteritis—> • Vomiting +
• Stool culture- diarrhoea in older
○ Occult Boole proven/susupected— children & adults
○ WBC Azithromycin 5d
○ Culture/gram • Salmonella
stain gastroenteritis-NO
○ Rotazyme test ○ High risk-
○ Ova & neonates &
parasites young
○ C. difficile infants(<3m),
toxin underlying
○ pH, fats, immune def,
reducing functional/anato
substances mical asplenia,
• CBC/d, electrolytes, corticosteroid/im
UA, ESR, CRP munosuppresive
therapy, IBD/
Chronic diarrhoea achlorhydria
• Stool culture, ova, • ETEC: azithro
parasites (10mg/kg.d 3d);
• Stool collection 48-72 hrs cefixime (8mg/kg.d 5d)
for wt, fat, content, • Additional therapies
electrolytes & osmolality • Loperamide -slow
• Colonoscopy for intestine motility
visualisation of mucosa & • Probiotics:
biopsy lactobacillus,
bifidobacterium,
saccharomyces
• Smectite powder-
intestinal mucosa
protector
Anemia • Pale appearance in skin & • HIST:Premature twins, • Is there anemia • Remove underlying d/s
mucosa nutrition, bleeding, drugs, • Severity • Rx for anemia
• Hepatosplenomegaly , family hist, underlying d/s • Kind • Transfusion: Hb<=60g/L
lymphadenopathy • Cause • Supplement: IDA-iron;
• Headaches dizziness, • PE: skin, mucosa, lip, MA- B12/folate acid
decreased food appetite heart, abdomen, LN, • Stem cell transplantation:
• Nausea & tachycardia nervous sys Thalassemia & AA

• CBC: Hb, MCV, MCH,

MCHC
IDA • Stored iron def at birth • Babies • Blood • BM Prevention
• Inadequate diet • Preterm • Pallor, fatigue, • Hemosiderin • Improve dietary intake of
• Rapid growth • Term: iron weakness, shortness disappear iron
• Malabsorption replete for of breath • Most reliable • Breat feed to atleast 1yr
• Excessive loss of Fe 5-6m, then • Extramedullary indicator • No solid food before 6m
• Preterm infants need fortified hematopoeisis: • CBC • No yea before 1yr
• Low birth wt infants foods hepatosplenomegal • Hb, RBC dec
• Twins • Toddlers: too much y • RDW Inc Therapy
cow’s milk (ferrous • Digestive : anorexia, Pica, • Retic -/inc • Good nursing: inc iron-
+Ca/P strophic glossitis • Blood smear: MCHC rich foods
salts=insoluble • CNS: fatigue, irritability, • Fe: SF dec, Fe, TS Dec, • Remove Etiological
compounds) short-attention spans, lack TIBC Inc factors
• Teenagers of interest in surroundings • Rx C iron preparation
• Inc growth & • Cardiovascular: • Transfusion (rarely
dev tachycardia, cardiac necessary)
• Menstrual loss hypertrophy
• Koilonychia (spoon-
shaped nails)
Nutrition • Vit B12 def • General manifestation of • CBC: macrocytic anemia, • General therapy
al • Folate def anemia • RBC Hb Dec, • Removing cause
megalobl • Manifestation of • WBC,PLT-/dec • Folic acid def:
astic extramedullary • Ret N/dec • Oral folate: 5mg tic for
anemia hematopoeisis • Smear: inequality of size , several wks
• GI: smooth & beefy major large cell • Vit B12 def
tongue • Sr: vit B12 def and/or • Vit B12: 0.5-1mg,
• Neurological sym in B12 folate def IM,once; 100mug, IM,
def—> regression of dev • BM: megakoblastic 2-3/w for several wk
changes • Neurological
involvement:1mg, IM,
qd, atleast 2w
• B12 malabsorption:
1mg/m IM for life
Thalasse • B0 Thalassemia- • B Thalassemia major • CBC Major • General Rx Major • IDA & A Thalassemia:
mia B mutuation causing no B- major- B0/B0, • Anemia • Hb, MCV, • Anemia: • Prevent inf • Indequately elevated HbA2 level
globin chains B+/B+, B0/B+ • Frontal bossing MCH,MCHC: Hb50-60g/L, • Appropriate transfused ptn diagnostic 0
• B+ Thalassemia- • B Thalassemia • Hepatosplenomegaly hypochromic, low MCV, MCH, supplementation of ○ Poor growth, • Iron therapy
mutuation causing B- intermedia- B+/B+, • Hemosiderosis microcytic anemia MCHC colic acid and vitE recurrent inf • DNA analysis
globin chain reduced B0/B+ • Peripheral blood • Blood smear: • No need for Fe ○ Thinning of
• B Thalassemia intermedia smear abnormalRBC, supplementation cortical bone
minor- B+/BN, • 2-4yrs, mild-mod • Hb analysis target cells • Regular blood transfusion ○ Pathological
B0/BN anemia • Cellulose acetate • Hb • Iron chelation fractures
• Hepatosplenomegaly film electrophoresis electrophoresis; • deferoxamine, ○ Enlarged spleen
• Growth retardation • Agarose gel HbA2: 3.5-7%, deferiprone, &
• Bone problems electrophoresis HbF: 40-95% deferasirox hypersplenism
• Capillary • Sr bilirubin • SF>1000mug/L ○ Die cin 1st
minor electrophoresis elevated • No. Of blood decade of life
• No signs/sym • High performance • Sr Fe high transfusions>=10-20 • Transfused ptns
• Normal PE liquid • BM: • Splenectomy ○ Iron overload
• HbA2:3.5-6% chromatography erythrocytes • HbH ○ Hemosiderosis
• Blood test: Hb (HPLC) hyperplasia • Medical & surgical ○ Enlarged spleen
90-100g/L, MCV dec • DNA analysis • Genetic • Allogenic hematopoeitic stem ○ —> need iron
• Gap-PCR diagnosis: cell transplantation chelation
• PCR-ASO confirmed • Only curable method therapy
• RDB, SSCP, DGGE, • Source of stem cell:
• Real time PCR Intermedia BM, cord blood,
• DNA sequencing • CBC, BM : peripheral blood
similar to major • Gene therapy
• Hb electro: HbF • Increase Y gene
Inc (0.40-0.80) expression
• Genetic analysis • Expression of
Minor exogenous B globin
• Mild anemia:
Hb 90-110g/L
• Low MCV
(60-70fl), MCH
(18022pg)
• After 6-12m Hb
electrophoresis
is diagnostic
○ HbA2:
3.5-7%
○ HbF:2-6%
Thalasse • Silent carrier: -A/AA & Major/ hydrops fetalis HbH HbH • HbH —> anemia, • Ida
mia A AA/Aacs—> no sym • Hepatosplenomegaly • MCV,MCH,MCHC dec • Supplement colic acid Splenomegaly need • B Thalassemia minor
• Minor/trait: - -/AA & -A/-A • Large fragile placenta • Proliferation of • Avoid the oxidant drugs occasional blood • HbH having jaundice &
is—> minor anemia • Cord blood: HbBart’s marrow • Occasional blood transfusion or splenomegaly
• Intermedia/ Hb H d/s: - -/- (Y4) C minor HbH (B4) • Blood smear: transfusion splenectomy differentiated from
A & - -/AAcs—> mil-mod • Non HbA, A2, F abnormal RBCs, target • Genetic counselling • Women pregnant C hemolytic anemia
anemia cells hydronic A Thalassemia
• Major/hydrop HbH • Hb electro: HbH foetus —> complications
Fetalis: - -/- - —> death • Chromic hemolytic 0.024-0.44, HbA dec, Prevention of pregnancy: toxaemia,
inutero/at birth anemia Hb Barts (<6m) • Education postpartum hemorrhage
• Growth retardation • Inclusion bodies +, • Carrier screening
• Hepatomegaly denatured globin • Genetic counselling
• Gallstones bodies • Prenatal diagnosis
○ Anemia • Genetic diagnosis:
○ Frontal bossing confirmed
○ Hepatosplenom
egaly
○ Hemosiderosis

Minor
• Asym/mild anemia in
family invest
• Hb Bart’s 3.4-14% at
birth, disappear cin
6m
• RBC mildly
anisotropic
• Normal Hb electro
• Genetic diagnosis

Silent
• Asymptomatic/mild
anemia
• RBC morphology N
• Coed blood Hb Bart’s
1-2%, disappeared
after 3m
• N Hb electro
• Required genetic
diagnosis
Acute • Rhinovirus-Strep Pharyngo-conjunctival • Systemic: fever, headache, PE: limited to upper resp Non pharmacological • Otitis media
URTI • Resp syncytial v -Staph fever myalgia, malaise tract, congestion , swollen • Elevating head (older • Fever
• Corona - S. pneumonia • Adenovirus 3.7 • Local: nasal irritation, glands children) • Ear pain/tug at the
aureus • Fever nasal discharge, sneezing, • Parents ceasing smoking ear or be fussy and
• Influenza - hemophillus • Laryngitis: sore sore throat, mild cough Lab • Plenty of rest cry more than usual
influenza throat, runny • WBC/CRP • Frequent intake of fluid • Fluid draining from
• Parainfluenza nose, swollen Herpangina • Viral pathogens: the ear, ruptured
• Adenovirus glands • Coxsackievirus culture, antigen 1. Sym Rx- antipyretic eardrums (dizzy
• Enterovirus • Conjunctivitis: • Fever 1w detection , serologic (ibuprofen); nauseated, having
red eyes, • laryngitis test antihistamines ringing or buzzing
discharge, • Discrete ulcerative lesion • Grp A strep, pertussis, (rhinorrhea, in ear)
tearing, foreign in the mouth: red-ringed nasal dipth: bacterial decongestants, cough • Sinusitis
body sensation blisters & ulcers on tonsils cultures, or antigen suppressants) • Stuffy or runny
& soft palate detection 2. Antiviral Rx: specific nose
Influenza • Interferon a spray Routine lab—> not antiviral therapy not • Continuous thick
• Epidemiological helpful—> not indicated available for rhinovirus; green mucus
his oseltavmir—> influenza discharge from
• Systemic sym: 3. Antibiotics-> if bacterial nose; post nasal
predominant, infection drip
high fever, 4. Interferon a- Rx virus inf, • Lasting dull pain
headache, spray or nebulization around eyes
muscle aches • tenderness pain in
• Local; mild, Prevention or around
upper resp tract • Handwashing cheekbones
catarrhal sym • Vaccines • Headache, fever
• Enlarged cervical nodes
• Nasopharyngitis
•
Acute • Virus • Hoarseness d/t PE • Airway Mx- keep child calm,
infectious • Bacteria inflammation of vocal • Stridor- inspiratiry vs crying can make croup worse
laryngitis cords expiratory • Corticosteroid- IV or inhaling
• Barking cough • Resp rate Inc budesonide
• Variable degree of • Chest retractions • Antibiotics- bacterial inf
dyspnea • Air entry into chest by suspected
• Sym worse at night & ausc • Tracheotomy- severe airway
when child is upset or • Anxiety or restlessness obstruction anticipated
crying • Cyanosis
• Subside cin d—wks • O2 desaturation by
pulse oximetry
• Strobovideolaryngosc
opy: vocal fold msss,
erythema & edema
(not indicated)
Acute • URTI • Sys: fever, myalgia, Chest X-ray Rx
Bronchiti • Exposure to malaise • Normal • Non pharmacological
s environmental irritants • Local: cough, sputum • Mild increase in ○ Drink lots of liquid
including smoking & toxic (lasts 2wk) bronchovascular ○ Get plenty of rest
gases • Physical signs: breath markings ○ Antibiotics;
sounds become coarse, bacterial inf
rhonchi &/or moist rales, ○ Supportive therapy
changeful § Cough
suppressants
Asthmatic bronchitis § Bronchodilat
• Atopic ors : albuterol
• Wheezing, rhochi to be
high-pitched, prolonging
expiration
• Recurrent episodes
• <3yrs old
Bronchiol • RSV • Highest during • <2yrs old, 6m mc PE Exclusively in history • Resp support • Acidosis • Asthma: repeated
itis • Parainfluenza winter & early • Diffuse wheezing • Prolonged expiratory and physical • Warm humidifies O2- • Resp failure episodes of wheezing,
• Adenovirus spring • Fever: low grade phase examination findings O2 saturation 90% or ab of viral prodrome, pr
• Mycoplasma pneumoniae • Sporadically & • Severe cases: cyanosis, • Diffuse wheezing less of family his of atopy or
• Human metal pneumoniae epidemical failure of lung func, • Coarse crackles (rales) Does not requires • Noninvasive support C asthma
virus HMPV lethargy, poor feeding scattered throughout radiography or lab nasal continuous • Foreign body in trachea
• Rhinovirus the lung fields studies positive airway • Tracheo- or
Lab pressure or bronchomalacia
• Sample: nasal or endotracheal • Vascular rings
pulmonary secretions intubation • HF
• Methods: fluorescent • IV hydration/placement of a • Cystic fibrosis
Ab staining nasogastric or orogastric • Pertussis
• ELISA, PCR, rapid feeding tube
detection of virus • Dec nutritional intake
antigen d/t resp distress &
• Chest X-ray tachypnea C inc
○ Diffuse insensible losses need
hyperinflation & fluid & nutritional
peribronchial support
thickening • Antivirus therapy
○ Atelectasis & • Ribavirn by nebulizer
patchy 12-18hrs everyday 3-5d
infiltrates • Bronchodilator therapy
• Nebulised salbutamol:
0.1mg/kg every 2-6h as
needed
• Nebulised budesonide: 1mg
bid-tid
• Rx of complications
• Prophylaxis: palivizumab
Bronchop • RSV, adeno, influenza Severe pneumonia • Fever>38.5 & chills PE • Definite diagnosis of • Anti microbial therapy • Empyema • Staphylococcus aureus
neumoni • Parainfluenza, entero • Resp • Cough • Dyspnea: nasal flaring, pneumonia • Staph pneumonia : • Pyopneumothorax • Cond changes
a • Mycoplasma, chlamydia ○ Fast • Very fast breathing tachypnea, tracheal • History & PE oxacillin IV 6wks • Pneumatocele abruptly, onset of
CAP & • S.Pneumoniae, strep. breathing • Trouble breathing tug, intercostal & • X-ray exam • Pneumococcal: • Pneumothorax high fever, rapid
HAP Staphylococcus aureus ○ Lower • Wheezing subcostal • Pathogen penicillin G+cefotaxine • Abscess progression of
• Hemophilus influenza chest wall • Chest or abdominal pain recession/retraction • Degree • Mycoplasma: sym
indrawing • Loss of appetite • Cyanosis • Characteristic azithromycin 2-4wk • Rash- scarlatina-
○ Stridor in • Exhaustion • Decreases breath s, comorbid • Chlamydia like
calm child • Vomiting & dehydration sounds illness, PE, pneumoniae: Clamydia pneumonia, • Mc compli
• Cardio • Widespread rales, basic lab azithromycin chlamydia trachomatis abscess,
○ Dysphoria fixed, diffuse, fine findings • Supportive therapy • <6m old empyema,
extremely moist rales - bottom • Pathogen • Influenza: oseltamivir • Onset slowly cout fever pyopneumothora
serious of lung no vertebral (antivirus) • Preceded by nasal/eye x
cyanosis column • Symptomatic Rx discharge • Adenovirus
○ HR>180/m Diagnostic std for • O2 therapy: nasal tube, • Pulmonary inf dev first • Hugh fever
, heart Lab severe pneumonia flux 0.5-1L/m wks of life • Signs of lung
sound • Peripheral blood WBC • Resp: O2 sat<93%, • Airway Mx: drain • Nonproductive cough & appear later, rales
low, count & classification severe tachypnea, sputum, tachypnea 3-9wks old • Other sys easy
gallop • Organism: virus, diffuiculty bronchodilator, shift • Incubation period maybe involves
rhythm bacteria others breathing, position 2-3m • Wheezing’severe
○ RR.60/M • X-ray: consolidation in retraction • HF Rx • X-ray: hyperinflated lung necrotizing
○ Liver one side middle & • Cardiology ○ Sedation & diffuse interstitial pneumonia—>
enlarge lower lobe • Neurology ○ O2 infiltrates pneumatoceles
quickly • GI administration • Hemophuilud influenza
○ Oliguria, ○ Cedilanid • Lobar
anuria, Definitive pathogen test ○ Lascivious Chlamydia pneumonia distribution,
edema • Sputum: >25 WBC & ○ Regitine chlamydia pneumoniae onset insidious]
• Neurology <10 epithelial cells • Abdominal distension: • >5yrs mimic acute
○ Lethargy • Nasotracheal hypokalemia, toxically • Onset slowly cout fever bronchiolitis in
○ Coma suctioning enteroparalysis • Cough lasts 1-2m early stage,
○ Convulsio • BALF • Indication of • Bronchospasm common increasing
ns • Blood culture or corticosteroid • X-ray:infiltrates interstitial
○ Bulging of pleural effusion ○ Wheezing edema—> shaggy
fontanelle culture ○ Empyema • Bronchitis: tachypnea appearance on
• GI • Serologic testing ○ Toxin radiograph
○ GI (immunological encephalopathy • Foreign body • Mycoplasma
bleeding testing) ○ Shock inspiration:recurrent pneumoniae
○ Asphaltic • Molecular techniques persistent pneumonia, • Elder child, cough
stool coughing, choking, airway prominent
○ Abdomina obstruction maybe • Infant: wheezing
l • Cold
distension • Tb: contact history, low hemoglutinin
grade fever, sweat, no tiger elevated
obvious physical sign, acute
PPD test/spot test + presentation,
1;64–>
pneumonia +ve
• Chest X-ray:
inetrstil7/bronch
opneumonic
infiltrate, middle
or lobes
Rickets • Poor sun exposure • Early active stage • Radio • Hist cout vit D • General Rx • Renal tubular acidosis
• Urban living • Irritability—night • Widening feeding or poor sun • Sun exposure • Franconia syndromes
• Winter cry metaphysis —> loss exposure’sum • Avoid long time walking (type I & II)
• Northern latitudes • Restlessness of zone of skeletal deformities & standing
• Baby C dark skin • Night sweat provisional • Lab & radio • Asymptomatic cases
• Lack of vit D in diet • Occipital baldness— calcification changes: helpful for • Daily req of vit D is 400
• Breast milk hair loss • Lab mild cases, not for IU
• Poor nourished • Active stage • Ca N or dec, P dec classic cases • Symptomatic
infants • Softening of bones • AKP inc, PTH inc • Mild: Vit D 1000-2000
• Increased need for vit D • Expansion of • 25-hydroxy vit D dec IU daily 203m, then
• Fast growth metaphysis • 1,25-dihydroxy vit D 400IU;
• Below 3yrs • Developmental dec supplementation of Ca
• Unable to make enough delay • Severe: severe skeletal
vit D • Delayed closure of • Recovery stage deformities—> surgery;
• Intestinal d/s fontanelle • Sym disappear after IV calcium gluconate
• Liver d/s • Delayed dentition Rx
• Kidney d/s (10m-2yr) • Child becomes more Prevention
• Drugs • Poor growth active, N ms tone • 2nd m of baby, vit D 400 IU/d
• Glucocorticoids • Dec ms strength & • Ca & P normal, AKP until 2yrs old
impair vit D func tone : frog abdomen recover slowly in • Premature baby: 800 IU/d vit
• Antiepileptic drugs: • Inc risk of infections: 1-1.5m D in the 3m, then 400IU/d
phenytoin sodium, URTI, bronchitis, • X-ray improves in • No necessity for >3yrs
luminal pneumonia 1-2wks
• Antiretroviral drugs • Curved humerus, • Sequelae
radius, femur, fibula • Clinical sym
• Kyphosis disappear
• Ca, P & AKP N
• X-ray N
• Different degrees of
skeletal deformities
Tetany of Hypocalcemia • Convulsions • Chvostek’s sign: facial • Convulsions cout Emergency Rx • Febrile convulsions
vit D def • Lose nerve stimulate- fever, C sym & signs • Keep airway open & clear • Infants & young
consciousness—> contraction of ms of eye, of rickets • O2 therapy children
goes stiff—> rolls mouth or nose • General cond N • Stop convulsion • Symptoms
back eyes • Trousseau’s sign- when child wakes • Prescription: 10% glucose sol • EEG, lumbar
• Jerks —> stop compression of up 10ml or 10% calcium puncture
breathing forearm—> thumb • No sym & signs of gluconate 1-2ml/kg —> IV • CNS infection,
• Sleepy—>N general adducted, fingers nervous d/s slowly meningitis, encephalitis
cond bunched, wrist flexed • Blood Ca : • Fever, coma,
• Tetany <1.76-1.88 (N • Seizures, CSF
• Midwife hand 2.24-2.75) change
• Ballet feet • IV 10% gluconate
• Laryngospasm sol—> quickly stop
• Dyspnea suddenly tetany
occur
Trisomy • Virus infection • Characteristic facial Karyotype analysis • Clinical diagnosis • No specific therapy • Congenital
21 • Radioactive rays features • Characteristic • Surgery for heart hypothyroidism
syndrom • Isotope • Physical dev delay faces problem • TSH, T4 test &
e • Toxic substances • Small stature • Dermatoglyph • Antibiotic for infections karyotype
Down • Medicine • Bone age • Mental • Special education for analysis
syndrom • Maternal age retardation retardation their learning • 20% DS
e • Teething, Fontanel • Multiple difficulties accompany c
closing delay malformation Goal of Rx help affected hypothyroidism
• Mental def • Final Dx children dev to their full or
• Low IQ • Karyotyoe potential hyperthyroidism
• Severe learning analysis
difficulties
• Alzheimer’s d/s at Prenatal Dx
30 yrs • Maternal sr testing: triple
• Joint: flexible, suppleness screen
• Hands & feet: short & • AFP; low
broad • FE3: low
• Sandal gap • HCG: high
• Single crease in palm • Fetal chromosome analysis is
• Dermatoglyphics features a reliable way to detect fetal
• Multiple malformations DS (amniotic fluid or fetal
blood)
Phenylke • PAH enzyme is deficient • Newborn screening • Neurological features • Blood test • Newborn screening Goal: Reduce phenylalanine
tonuria • Hyperphenylalaninemias • breast • Impairment of brain • Analysis of uronterin: +C/F+phenylalanine levels in plasma & brain
d/t BH4 cofactor feeding for dev & func neopterin & biopterin conc+ exclude BH4
deficiency 72h • Behavioural & level in urine def+ lab findings+ Dietary restriction should be
• Heel blood intellectual • DHPR enzyme activity : B4 genetic analysis started ASAP until adolescence
sampling disabilities def • Diet v low in natural
• Dried blood • Info processing • DNA analysis: genetic protein + metabolic
PAH normal range in sampling impair diagnosis & prenatal Dx formula (cout
plasma: ca. • BIA, CFEIA • Irreversible phenylalanine)
60-120mumol/L (1.0-2.0 • Tandem mass intellectual disability
mg/dl) spectrometry • Seizures 1st 4-6m of life—> breast milk/
• Postnatal testing for • Microcephaly infant formula+ Phe-free infant
common inherited • Fair skin & blue eyes formula
disorder • Skin rashes, like eczema
• Musty odour in urine, Baby weaned & solids
breath introduced—> foods+ special
low-protein products+ PKU
formula

Monitoring diet- blood Phe

level, clinical status & growth,
checked frequently

Rx of BH4 def—> combination

of low phe diet + oral
supplementation of BH4, L-
dopa & 5-hydroxytryptophan
Congenit
al
hypothyr
oidism
Bacterial • 3m-12y—> neisseris • Immunocompromis • Sudden onset/acute onset • CSF Analysis of clinical & • Antibiotic therapy • Subdural effusion • Viral encephalitis
meningiti meningitidis, strep ed individuals (1-24hrs; less common) or • Appearance: turbid CSf: microorganisms • Empirical:resistance of • <2yr • Slight CSF
s pneumoniae, hemophilia • T cell def subacute onset (preceded or purulent on gram stain & s.pneuminae to B • Cerebral Vasculitis changes
influenza • Genetic risk factors; by several days fever+ • High ICP culture, neutrophilic lactam—> vancomycin C Inc capillary • Specific test: viral
• 0-2m—> gram-ve bacteria, def I’m complement URT , GI sym+ nonspecific • Panda test: +ve pleocytosis, elevated (60mg/kg/24h, every permeability serology
staph aureus, grp B strep components & signs of CNS inf like • Elevated leukocyte protein, reduced 6hr) + cefotaxime causing leakage • Tb meningitis
asplenia lethargy &irritability) count: >1000/m3, glucose conc (200mg/kg/24hr, every • Bulging Fontanel, • Onset insidious C
• Cranial defect • Neonates: poor feeding; polymorphonuclear 6hr) or ceftriaxone diastasis of sutures, lethargy, low
• Base skull fractured irritability, cell predominance (100mg/kg/24hr/d or enlarging head grade fever,
• Lumbosacral dermal hypertonia/hypotonia , • Elevated protein 50mg/kg/dose every circumference, irritability,
sinus resp distress (>100-500mg/dl) 12hr) emesis, fever, vomiting & wt
• Meningomyelocele • Beyond neonatal age • Glucose <50% of • Allergic to B-lactam—> abnormal results of loss
• Nonspecific blood glucose chloramphenicol cranial • Seizures. Gradual
○ Fever, poor (<40mg/dL) 100,g/kg/24hr every transillumination progressive
feeding • Cl conc dec 6hr • Ct/mri scan unconsciousness,
○ URTI, hypoTN • Gram stain +ve (70% • S. Pneumoniae —> confirmation CN deficits, motor
○ Petechia, ptns) 10-14d (subdural effusion) deficits & visual
purpura • Bacteria • Meningococcal —> IV • Rx aspiration open involvement
• Meninges irritation culture~+be penicillin 5-7d fontanel • Hydrocephalus &
○ Nuchal rigidity • Peripheral blood; WBC, NC • H. Influ type b • SIADH decerebration
○ Kernig sign high meningitis —> 7-10d • Hypothalamic/pitui • Systemic tb &
○ Brudzinski • CRP & pro-calcitonin • Gram -ve bacilary tary dysfunc family contact
• Inc ICP • Blood cultures menin—> 3w • Result in • Mangoes test
○ Headache, • PCR on CSF • Unidentified —> hyponatremia, ~+ve, primary
emesis • CT/MRI of brain (not ceftriaxone/cefotaxime reduce sr complex~on chest
○ Bulging necessary) 7-10d osmolarity, X-ray
fontanel • Corticosteroid hyponatremic • CSF clear, cobweb
○ Widening of • IV dexamethasone seizures coagulum, sugar
sutures, 0.15mg/kg/dose every • Hydrocephalus less reduced
○ Signs of 6hr 2d • Dysphoria, lethargy
herniation • 1-2hr before antibiotics emesis, pregressing
• Focal neurological • Supportive head circumf
signs & cranial • Control cerebral enlargement,
neuropathy edema: furosemide, bulging fontanel,
• Seizures mannitol osmotherapy widening of
• Alterations of • Fluid & electrolyte sutures,
mental status homeostasis • setting sun
• Anticonvulsant for phenomena,
seizures: diazepam, cerebral cortex
lorazepam atrophy, mental def
• Rx drainage
operation
• Ventriculitis
• Not Rx in time
• D/T inflammation
of ependymal lining
of ventricles
• Signs symp worsen
• Prolonged IV
antibiotics needed
• Deafness, blindness,
epilepsy, mental def
Tubercul • 1st stage (prodrome) • CSF measure • History • Anti-tuberculosis Rx • Fungal meningitis
ous • 1-2w, nonspecific • Opening pressure • Contact of • 1st line: isoniazid (INH), (cryptococcosis,
meningiti sym elevated adult ptn of Rifampicin (RIF), histoplasmosis,
s • Malaise, lassitude, • Fluid clear/ ground open pyrazinamide (PZA), blastomycosis,
low grade fever, glass appearance, & pulmonary Tb Ethambutol (EMB) coccidiomycosis)
intermittent delicate web-like in family • INH+RIF+PZA+EMB • Neurobrucellosis
headache, ~ vague clot at top • No inoculate 2m—> INH+RIF total • Neurosyphilis
discomfort in neck • CSF leukocyte BCG 7-10m • Neuroborreliosis
or back, 50-500x10^6/L; • Got Tb not Rx • PZA not tolerated, • Focal parameningeal inf
• 2nd stage (meningitic lymphocyte in a yr duration—>18m (sphenoid sinusitis,
phase) predominate • Inf d/s • Drug resistant TBM—> endocarditis, brain
• Protracted • Glucose <2.2mmol/L measles, 2nd line: ethionamide, abscess)
headache, (40mg/dl) rarely whooping cyclosporine, newer • CNS toxoplasmosis
meningismus, V, <1.1mmol/L cough aminoglycosides, • Partially Rx bacterial
mild confusion, (20mg/dl) • C/f fluoroquinolones meningitis
serizure, CN palsy, • Cl & glucose lower • CSF measure • Adjunctive corticosteroids • Neoplastic meningitis
long-tract signs than N • Routine studies • Dexamethasone 8mg/d (lymphoma, carcinoma)
• Infants- split of • CSF protein conc • Chest X-ray : wt<25kg & 12mg/d
cranial sutures/ 100-500mg/dl hilar adults & >25kg wt
eminence of ant • Extremely high adeno;achy, • Prednisone, children:
Fontanel protein conc interstitial 2-4mg/kg/d ; adult
• 3rd (paralytic phase) 2-6g/dl —> military 60mg/d
• Delirium—> stupor subarachnoid block; pattern, • Duration 3wk at initial
& coma, seizures, poor prognosis parenchymal dose—> gradual
multiple CN deficits, • Acid fast stain & infiltrate, tapering over next 3-4w
hemiparesis, culture +ve apical scarring • Symptomatic Rx
hemiplegias • Molecular diagnostic tech • Skin testing • Dec intracranial HTN
• Untreated—> death cin • NAAT —> rapid for tuberculin • Rx convulsions
5-8w of onset detection of specific hypersensitivi • Rx water-electrolytes
bacterial DNA ty disorder
• Molecular • Follow up visit: till 3-5yrs
C/F+CT evidence of basal diagnostic thech
enhancement + • Neuroradiological
hydrocephalus —> TBM evaluation
• Hydrocephalu
s (75%ptn)
• Basal
meninges
enhancement
(38%ptn)
• Cerebral
infarcts
(15-30% ptns)
• Tuberculosis
(5-10% ptns)