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Clinical Pediatrics for Undergraduates
Elizabeth KE
CHAPTER 1:
History Taking and Physical Examination
HISTORY TAKING AND CASE RECORDING
Personal or Sociodemographic Data
Presenting Complaints
History of Present Illness
History of Past Illness
Antenatal History
Natal History
Postnatal/Neonatal History
Developmental History
Dietary History
Immunization History
Family History
Socioeconomic History
Summary
PHYSICAL EXAMINATION
General Examination
1. General Comment
2. Vital Signs
3. Hand to Head to Foot Examination
4. Assessment of Growth
Classification of Nutritional Status
5. Assessment of Developmental Milestones
Systemic Examination
1. Gastrointestinal Tract (GIT) and Abdomen
2. Respiratory System
3. Cardiovascular System (CVS)
4. Central Nervous System (CNS) and Musculoskeletal System
Summary
DIAGNOSIS
CHAPTER 2:
Growth and Development
INTRODUCTION
GROWTH (ALSO REFER CHAPTER 6)
Stages of Growth
Growth of Different Tissues
Important fetal growth events are:
Fetal Growth
Newborn
Underfive
Weight
Length
Head Circumference
Chest Circumference
Teeth Development
Skeletal Maturation/Bone Age
Growth Charts
Percentile Charts
Growth Velocity
Predicted Height, Target Height in a Child Based on Mild Parental Height (MPH) of a child
Midparental Height (MPH) Centile
DEVELOPMENT
Gross Motor Development
Fine Motor Adaptive Development
Language Development
Personal Social Development
ASSESSMENT OF DEVELOPMENT
INTELLIGENCE
PUBERTY/ADOLESCENCE
DISORDERS OF GROWTH
PSYCHOLOGICAL AND RELATED DISORDERS
Resistance to Feeding and Sleeplessness
Three Month Colic
Breath Holding Spell
Head Banging
Thumb Sucking
Nail Biting
Teeth Grinding/Bruxism
Stuttering
Pica
Nocturnal Enuresis
Temper Outbursts and Temper Tantrums
Stealing
Tics, Habit Spasm, Blinking
Masturbation in Boys
Gratification Phenomenon in Girls
Juvenile Delinquency
Attention Deficit Hyperactivity Disorder (ADHD)
Psychosomatic Illness
Munchausen's Syndrome and Munchausen's Syndrome by Proxy
Rumination
Encopresis
Suicidal Tendency
Infantile Autism
Gilles de la Tourette Syndrome (TS)
Anorexia Nervosa and Bulimia Nervosa
Child Abuse
FAILURE TO THRIVE (FTT)
MENTAL RETARDATION (MR)
SPECIAL SENSE ORGAN DEFECTS
Speech and Hearing Defects
Visual Defects
DYSLEXIA
THE BARKER HYPOTHESIS/FETAL ORIGIN OF ADULTHOOD DISEASES (FOAD)
Developmental Milestones
CHAPTER 3:
Neonatology
DEFINITIONS
Dimensions of the Fetus
LBW BABIES
Classification of SGA Babies
What are the causes of SGA Babies/Intrauterine growth Retardation (IUGR)?
How to differentiate Preterm and Term Babies?
NORMAL NEWBORN CARE
Neonatal Anthropometry
GENERAL EXAMINATION OF NEWBORN
SICK NEWBORN
Neonatal Jaundice
Respiratory Distress Syndrome
NEONATAL CONVULSIONS
BIRTH ASPHYXIA AND NEONATAL HYPOXIC ISCHEMIC ENCEPHALOPATHY
Neonatal Convulsion–Causes
Clinical Staging of HIE (Sarnat and Sarnat)
Management
Birth Injuries
Intrauterine Infections (IU Infections)
Neonatal Sepsis
Danger Signs in the Newborn
Neonatal Sepsis Score (Bhakoo et al)
Interpretation
Normal CSF Findings in Various Age Groups
Neonatal Reflexes
ASSESSMENT OF GESTATIONAL AGE
NEONATAL RESUSCITATION
MEDICATIONS
Post-resuscitation Care
Apgar Score
Fallacies of Apgar Score
When to Stop Resuscitation
Non-initiation of Resuscitation/No Active Resuscitation Indicated (NARI)
What are the strategies needed to resuscitate outside the hospital?
Care of family
Mnemonics
Drugs which can be given through endotracheal tube → LANES
CHAPTER 4:
Immunization
VACCINES AND IMMUNIZATION SCHEDULES
Terminologies
Prerequisites
Types of Vaccines
National Immunization Schedule: Universal Immunization Program (UIP)
IAP Immunization Time-Table
Vaccines That can be Given After Discussion with Parents
Immunization in Special Circumstances
Recommendations of WHO/UNICEF and the Advisory Committee on Immunization Practices (ACIP)
Vaccination Schedule for Adolescents
ADVERSE EFFECTS OF VACCINES
Adverse Reactions Following Immunization
COLD CHAIN
Sensitivity of Vaccines to Freezing (T Vaccines should not be Frozen)
Cold Chain
Equipment
Storage of Vaccines
CHAPTER 5:
Community Pediatrics and National Programs
VITAL STATISTICS
Health Indicators (Table 5.1)
Estimation of Beneficiaries/Age-wise Population
BREASTFEEDING AND BABY FRIENDLY HOSPITAL INITIATIVE (BFHI)
Initiation of Breastfeeding
Reflexes that help in Breastfeeding
Common Problems During Breastfeeding
Baby Friendly Hospital Initiative (BFHI)
PULSE POLIO IMMUNIZATION (PPI)
ACUTE FLACCID PARALYSIS (AFP) SURVEILLANCE AND POLIO ERADICATION PROGRAM
High Routine Immunization Coverage
Mopping-up
ACUTE RESPIRATORY INFECTION (ARI) CONTROL PROGRAM
CONTROL OF DIARRHEAL DISEASE (CDD) AND ORT PROGRAM
ReSo Mal
VITAMIN A PROPHYLAXIS PROGRAM
IODINE DEFICIENCY DISORDERS (IDD) AND GOITER CONTROL PROGRAMS
ANEMIA PROPHYLAXIS PROGRAM
INTEGRATED CHILD DEVELOPMENT SERVICES (ICDS) SCHEME
SUPPLEMENTARY FEEDING PROGRAMS
CHILD SURVIVAL AND SAFE MOTHERHOOD (CSSM) PROGRAM
REPRODUCTIVE AND CHILD HEALTH (RCH) PROGRAM
Definition
Components
Implementation
RCH II
First Referral Unit (FRU)
National Rural Health Mission (NRHM)
NRHM AND NUHM PROJECT
THE INTEGRATED MANAGEMENT OF NEONATAL AND CHILDHOOD ILLNESS (IMNCI)
CHAPTER 6:
Nutrition
DEFINITIONS
ANTHROPOMETRY (Refer chapter 2 for NCHS percentile charts)
Weech's Formula for Calculation of Expected Weight
SPECTRUM AND CLINICAL FEATURES OF MALNUTRITION
Comparison between Marasmus and Kwashiorkor
MANAGEMENT OF SEVERE MALNUTRITION
WHO Guidelines for the In-patient Treatment of Severe Acute Malnutrition (SAM)
Step 1. Treat/Prevent Hypoglycemia
Step 2. Treat/Prevent Hypothermia
Step 3. Treat/Prevent Dehydration
Step 4. Correct Electrolyte Imbalance
Step 5. Treat/Prevent Infection
Step 6. Correct Micronutrient Deficiencies
Step 7. Start Cautious Feeding
Step 8. Achieve Catch-up Growth
Step 9. Provide Sensory Stimulation and Emotional Support
Step 10. Prepare for Follow-up after Recovery
Severe Anemia
Emergency Treatment of Shock and Severe Anemia
Nutritional Dermatosis
Failure to Respond to Treatment
Discharge
Micronutrient Deficiency Disorders (MDD)
Vitamin D Deficiency
FAILURE TO THRIVE (FTT) – CASE STUDY
What nutritional advice should be given to the mother?
Causes of Failure to Thrive (FTT)
SEVERE MALNUTRITION – CASE STUDY
EDEMATOUS MALNUTRITION – CASE STUDY
Assessment of Growth
Nutritional Requirement- Therapeutic Calculation
CHAPTER 7:
Infections and Immunity
EXANTHEMATOUS FEVERS
Definitions
1. Varicella (Chickenpox)
Epidemiology:
Clinical Features
Complications
2. Measles (Rubeola)
Epidemiology:
Reservoir- Man
Clinical Features
Prodromal Phase
Eruptive Phase
Variants of Measles
Complications
Differential Diagnosis
Treatment
Prevention
Immunization against Rubella
A CHILD WITH PROLONGED FEVER WITHOUT A FOCUS – CASE STUDY
Diagnosis and Discussion: FUO/PUO- Febrile Neutropenia Probably Agranulocytosis – Drug induced
Durack and Street FUO Classification
PUO WITH HEPATOSPLENOMEGALY – CASE STUDY
Diagnosis and Discussion
Time table for Salmonella Diagnosis
Tuberculosis (Koch's Disease)
Time Table of TB Infections after Primary Infection Welgrens Calendar
Treatment of Malaria
Diagnosis of Malaria Drug Resistance using Peripheral Smear
Manifestations of Dengue Fever – Flavivirus (DF virus 1 – 4 serotypes)
MALNUTRITION, IMMUNOSUPPRESSION AND PERSISTENT DIARRHEA – CASE STUDY
Diagnosis and Discussion: HIV – AIDS with Opportunist Infection and Marasmic Kwashiorkor
Interpretation of CD4 Counts
WHO Criteria for Diagnosis of AIDS
WHO Staging of HIV Infections
HIV Treatment
Drugs available
Prevention of Parent to Child Transmission (PPTCT) Schedule
Postexposure prophylaxis (PEP) (Within 2 – 72 hours)
RECURRENT AND MULTIPLE ABSCESS – CASE STUDY
Diagnosis and Discussion: Chronic Granulomatous Disease (CGD)
Congenital Immunodeficiency States
FEVER AND RECURRENT POLYARTHRITIS – CASE STUDY
Diagnosis and Discussion: Systemic Onset Juvenile Rheumatoid Arthritis (JRA)/Juvenile Idiopathic Arthritis.
Criteria to Diagnose SLE (4 or more)
KAWASAKI DISEASE – CASE STUDY
Diagnosis and Discussion
Diagnostic Criteria of KD
CHAPTER 8:
Cardiovascular System
FEATURES OF ACYANOTIC CONGENITAL HEART DISEASE (ACHD)
Features of Congenital Cyanotic Heart Disease (CCHD)
Features of Acquired Heart Diseases (Rheumatic Valvular Disease)
EARLY ONSET CCF – CASE STUDY
Natural History of VSD
Differential Diagnosis: Other CHDs
CONTINUOUS MURMUR IN THE BASE OF THE HEART – CASE STUDY
Differential Diagnosis of Continuous Murmur in the Base
Various Syndromes and Various Conditions associated with CHD
BLUE BABY WITH CRYING AND APNEIC AND BLUE SPELLS – CASE STUDY
RHEUMATIC FEVER WITH CARDITIS – CASE STUDY
INFECTIVE ENDOCARDITIS (IE)
CHAPTER 9:
Respiratory System
ARI AND RESPIRATORY DISTRESS
Definition
Signs of Respiratory Distress
Location of Respiratory Distress—Examples of Conditions
Risk Factors for Pneumonia
Diagnosis of ARI (Refer Chapter 5, Page 108)
STAPHYLOCOCCAL INFECTION WITH EMPYEMA – CASE STUDY
Differences between Transudate, Exudate and TB Effusion
ASTHMA – CASE STUDY
DD: Pneumothorax
INTERNATIONAL GLOBAL INITIATIVE FOR ASTHMA (GINA) GUIDELINES
How is Asthma Severity Classified?
What is the step-care Approach to Pharmacotherapy?
UNRESOLVED PNEUMONIA – CASE STUDY
Diagnosis and Discussion
CHRONIC LUNG INFECTION – CASE STUDY
CHAPTER 10:
Gastrointestinal System
DIARRHEAL DISEASES
Diagnosis of Dehydration
PERSISTENT DIARRHEA – CASE STUDY
Watery Diarrhea
Dietary Management
CHRONIC DIARRHEA – CASE STUDY
Causes of Chronic Diarrhea
HEPATITIS – CASE STUDY
Clinical Staging of Hepatic Encephalopathy
Pathogenesis of HE
CHRONIC LIVER DISEASE (CLD) – CASE STUDY
Causes of Chronic Persistent/Chronic Active Hepatitis
HEMATEMESIS – CASE STUDY
Classification of Ascites based on SAAG
CHAPTER 11:
Genitourinary System
DEFINITIONS
ACUTE NEPHRITIS – CASE STUDY
Different Causes of Hematuria
NEPHROTIC SYNDROME – CASE STUDY
Various Definitions in Nephrotic Syndrome
Other types of Nephrotic Syndrome
URINARY TRACT INFECTION (UTI)
CHAPTER 12:
Hemato-Oncology
NUTRITIONAL ANEMIA – CASE STUDY
Response to Iron Therapy
Conditions that lead to Hypochromic Microcytic Anemia
THALASSEMIA – CASE STUDY
1. RBC Membrane Defects
2. Hb Defects /Hemoglobinopathies
ECCHYMOSIS – CASE STUDY
Cause of Thrombocytopenia
An Approach to Bleeding Diathesis
HEMOPHILIA – CASE STUDY
LEUKEMIA – CASE STUDY
Types of ALL and AML (French American British- FAB Classification)
Treatment of Acute Leukemias
Phase I.- Induction of Remission. (4–6 weeks)
Phase II - CNS Prophylaxis *(Triple intrathecal—Triple IT)
Phase III—Maintenance Phase
Phase IV - Reinforcement Therapy
Total duration is 36 months in boys and 30 months in girls
CHAPTER 13:
Endocrine and Chromosomal Conditions
HYPOTHYROIDISM – CASE STUDY
Diagnosis and Discussion: Congenital Hypothyroidism
DOWN SYNDROME – CASE STUDY
Major and Minor Anomalies
Maternal Age-related Risk for Down Syndrome
Common Chromosomal Trisomies
Sex Chromosome Anomalies
Major Deletion Syndromes
Prenatal diagnosis: Surrogate markers of Pregnancy outcome Triple Test and Quadruple Test
CHAPTER 14:
Central Nervous System
LOCALIZATION OF CNS PATHOLOGY
CNS INFECTIONS
MICROCEPHALY – CASE STUDY
Differential Diagnosis of Small Head
Cause of Hydrocephalus
CEREBRAL PALSY – CASE STUDY
Various Classifications of CP
Levels of Retardation and Functional Rehabilitation
ACUTE FLACCID PARALYSIS (AFP) – CASE STUDY
Differential Diagnosis of AFP (Refer Chapter 5)
ABCS of Bladder Innervations
CHAPTER 15:
Pediatric Emergencies
1. GENERAL CONSIDERATIONS
A. Quick ABC Assessment
B. Vital Signs
C. Maintenance Fluid Requirements-Holliday and Segar Formula
D. Calculation of Body Surface Area (NB 0.7M2, Adult 1.73M2)
E. Arterial Blood Gas Analysis
ABG interpretation
2. CARDIOPULMONARY RESUSCITATION
A. International Pediatric Basic Life Support (BLS) Algorithm
B. International Advanced Life Support (ALS) Algorithm
C. Tachycardia Algorithm
D. Bradycardia Algorithm
E. Pulseless Arrest Algorithm
3. ACUTE ADRENAL INSUFFICIENCY
4. ACUTE ASTHMA
Acute Asthma Algorithm
5. ACUTE RENAL FAILURE
Management of Acute Renal Failure
General Measures:
6. COMATOSE CHILD
7. CYANOTIC SPELL
8. DENGUE FEVER
Management
9. DIABETIC KETOACIDOSIS (DKA)
10. DROWNING
11. FOREIGN BODY ASPIRATION
Infant Back Blow and Chest Thrusts
12. HEMATEMESIS
13. HYPERKALEMIA
14. HYPONATREMIA
15. HYPERNATREMIA
16. HYPERTENSIVE CRISIS
17. SHOCK IN CHILDREN
18. STATUS EPILEPTICUS
19. STRIDOR
20. POISONING –GENERAL GUIDELINES
Hydrocarbon Poisoning
Supportive Management is the Mainstay of Treatment
Note
Organophosphorus Poisoning
Notes
21. ENVENOMATIONS
Scorpion Envenomation
Snake Envenomation
CHAPTER 16:
Instruments and Procedures
CHAPTER 17:
OSCE, Viva and X-rays
OSCE
OSCE Station I
Station II: Performance Station
Station III: Procedure Station
Station IV: Communication Skill Station
Station V: Diagnostic Station
VIVA (TILL 2008 BATCH)
Station I: Drugs and Vaccines
Station II: Instruments, Equipments and Procedures
Station III: Food Items and Nutritive Values
Station IV: X-rays
X-RAYS
CHAPTER 18:
Drugs and Dosages
Appendix
ELIZ HEALTH PATH FOR UNDER FIVE CHILDREN (EHPUC) (FIG. 1)
ELIZ HEALTH PATH FOR OLDER CHILDREN (EHPOC) (Fig. 2)
ELIZ HEALTH PATH FOR ADOLESCENT CHILDREN (EHPAC) (FIG. 3)
ELIZ HEALTH PATH FOR ADULTS (EHPA) (FIG. 4)
WHO GROWTH CHARTS
PRACTICAL TIPS ON FLUID THERAPY
GLASGOW COMA SCALE
MILLENNIUM DEVELOPMENT GOALS-ACHIEVEMENT AND GOAL
TRIVANDRUM DEVELOPMENTAL SCREENING CHART (TDSC)
INDEX
TOC
Index
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