Pushpendra
Magon
MBBS DCH MD (Pediatrics)
Head Department of Pediatrics Patel Hospital Behind Sky Lark Hotel,
Jalandhar
Punjab,
India
Foreword
A
Radhakrishna
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This book has been published in good faith that the contents provided by the author contained herein are original, and is intended for educational purposes only. While every effort is made to ensure accuracy of information, the publisher and the author specifically disclaim any damage, liability, or loss incurred, directly or indirectly, from the use or application of any of the contents of this work. If not specifically stated, all figures and tables are courtesy of the author. Where appropriate, the readers should consult with a specialist or contact the manufacturer of the drug or device.
Pearls in Clinical Pediatrics
First Edition: 2013
9789350250211
Printed at
fm5To
fm7Foreword
Upon reading this text, I realized that it is a simple presentation of sophisticated ideas. Physicians often do not understand the value that lies in providing a palatable approach for systematic diagnosis and management.
Based on my experience with students, I already had no reason to question the need for such a “concept book”. We scarcely acknowledge the role of such most skillfully written books. I wish this book will have wide acceptance on recognizing the need to break away from total dependency on symptomoriented medical care.
Dr Pushpendra Magon is a tireless crusader with natural love towards patient care and is an energetic cheerleader for many clinicians providing invaluable direction, whenever needed by his colleagues and students.
A Radhakrishna MD
Professor of Pediatrics
Sri Venkateswara Medical College, Hospital and Research Centre
fm9Preface
The objective of this book is to present the subject matter of pediatrics from the clinical point of view in as concise form as possible to help in the diagnosis and treatment of ailments in children.
By means of the clinical approach, we are able to analyze the problems in pediatrics that baffle clinicians. History-taking and examination form its essence, of course, supported by investigations. Special care has been taken regarding nutritional aspect, immunization and development of a child to enable clinicians deal with the patient as a whole and not merely treat the acute disease state. The expert knowledge about use of the basic instruments, bedside tests and X-rays, frequently not given their due importance, are useful for practical purposes. Care has been taken to include what is likely to be of value especially in practical examinations, for example, for considerable proportion of students, even the use of sphygmograph is not stressed.
It is intended, however, not to confine the scope of the book to a description of the usefulness of bedside tests and examination alone but special emphasis has been given to procedures as well, the knowledge of which comes handy in diagnosis, prognosis, and treatment of disorders. Also, by including information and discussions on common problem cases, which may clear diagnostic and therapeutic dilemma. I hope the medical practitioners would take the fullest possible advantage of this book.
fm11Acknowledgments
I acknowledge Dr Soibam Pritam Singh and Ms Seema Magon, Master Srijan Magon and Dr Ranju Raj for their valuable help in completing my endeavor of writing this book. At the same time, I cannot refrain from expressing my sense of obligation and gratitude to Dr Manorama Verma, Dr Jugesh Chatwal, Dr Tejinder Singh, Dr Betty Chacko, and my parents who shaped my destiny. I am thankful to administration of Vinayaka Mission's Medical College, Karaikal, Puducherry, India, for kindly allowing me to use the medvarsity and X-ray records of some of the patients at this institution. I wish to express my thanks to my colleagues, postgraduate students, and Professor Dr A Radhakrishna for the generous disposal of their time in offering many hints, directed towards compiling the scattered and fragmentary knowledge into a concise book form.
Although I have taken help from many people, directly or indirectly and it is impossible to acknowledge my indebtedness to all of them separately, so I wish to express my deep sense of gratitude to all of them, collectively.
I am extremely pleased to add in this book a chapter on Developmental Assessment written by Dr Rakesh Magon (MD, MRCP) and another chapter on Neural Tube Defects written by Dr Shally Magon.fm12fm13fm14fm15fm16fm17fm18
Abbreviations
ABG Arterial Blood Gas
ACTH Adrenocorticotropic Hormone
ADH Antidiuretic Hormone
AFB Acid-fast Bacilli
AFP Alpha-fetoprotein
A/G Albumin/Globulin Ratio
AI/AR Aortic Insufficiency
ALL Acute Lymphocytic Leukemia
AML Acute Myelogenous Leukemia
ANA Antinuclear Antibody
ANS Autonomic Nervous System
ARF Acute Renal Failure
AS Aortic Stenosis
ASD Atrial Septal Defect
AV Atrioventricular
A-V Arteriovenous
BBB Bundle Branch Block
BMR Basal Metabolic Rate
BP Blood Pressure
BT Shunt Blalock-Taussig Shunt
BUN Blood Urea Nitrogen
BW Body Weight
C&S Culture and Sensitivity
CAD Coronary Artery Disease
CBC Complete Blood Count
CF Cystic Fibrosis
CHD Congenital Heart Disease
CHF Congestive Heart Failure
CMV Cytomegalovirus
CN Cranial Nerves
CNS Central Nervous System
CoA Coarctation of the Aorta
COPD Chronic Obstructive Pulmonary Disease
CP Cerebral Palsy
CPK Creatine Phosphokinase
CPR Cardiopulmonary Resuscitation
Cr Creatinine
CRP C-reactive Protein
CSF Cerebrospinal Fluid
CT Computerized Tomography
CVP Central Venous Pressure
CXR Chest X-ray
D5W 5% Dextrose in Water
DCM Dilated Cardiomyopathy
DI Diabetes Insipidus
DIC Disseminated Intravascular Coagulopathy
DKA Diabetic Ketoacidosis
DM Diabetes Mellitus
DPT Diphtheria, Pertussis, Tetanus
DTR Deep Tendon Reflexes
ECG Electrocardiogram
EMG Electromyogram
ECMO Extracorporeal Membrane Oxygenation
ENT Ears, Nose, and Throat
ESR Erythrocyte Sedimentation Rate
ET Endotracheal
FFP Fresh Frozen Plasma
FRC Functional Residual Capacity
FUO Fever of Unknown Origin
GFR Glomerular Filtration Rate
GI Gastrointestinal
GU Genitourinary
HAV Hepatitis A Virus
HCG Human Chorionic Gonadotropin
HCM Hypertrophic Cardiomyopathy
HCT Hematocrit
HDL High Density Lipoprotein
HB Hemoglobin
HIV Human Immunodeficiency Virus
HLA Histocompatibility Locus Antigen
HLHS Hypoplastic Left Heart Syndrome
H/O History of
HPF High Power Field
HR Heart Rate
HSV Herpes Simplex Virus
HTN Hypertension
I&D Incision and Drainage
IG Immunoglobulin
IM Intramuscular
IT Intrathecal
ITP Idiopathic Thrombocytopenic Purpura
IV Intravenous
IVP Intravenous Pyelogram
KUB Kidneys, Ureters, Bladder
LAD Left Axis Deviation
LDH Lactate Dehydrogenase
LE Lupus Erythematosus
LMP Last Menstrual Period
LP Lumbar Puncture
LV Left Ventricle
LVH Left Ventricular Hypertrophy
MAP Mean Arterial Pressure
MCH Mean Cell Hemoglobin
MCHC Mean Cell Hemoglobin Concentration
MCV Mean Cell Volume
ML Milliliter
MMR Measles, Mumps, Rubella
MRI Magnetic Resonance Imaging
MRSA Methicillin Resistant Staph Aureus
MS Mitral Stenosis
MVP Mitral Valve Prolapse
NCV Nerve Conduction Velocity
NG Nasogastric
NPO Nothing by Mouth
NSAID Nonsteroidal Antiinflammatory Drug
OM Otitis Media
OPV Oral Polio Vaccine
PA Posteroanterior, Pulmonary Atresia
PAC Premature Atrial Contraction
PaO2 Alveolar Oxygen
PAP Pulmonary Artery Pressure
PAT Paroxysymal Atrial Tachycardia
PDA Patent Ductus Arteriosus
PEEP Positive End Expiratory Pressure
PFT Pulmonary Function Tests
pg Picogram
PKU Phenylketonuria
PMI Point of Maximal Impulse
PMN Polymorphonuclear Leukocyte
PND Paroxysmal Nocturnal Dyspnea
PO By Mouth
PPD Purified Protein Derivative
PR By Rectum
PRBC Packed Red Blood Cells
PRN As Needed
PS Pulmonic Stenosis
PT Prothrombin Time
PTH Parathyroid Hormone
PTT Partial Thromboplastin Time
PVC Premature Ventricular Contraction
Q Every
QID Four Times
RA Rheumatoid Arthritis or Right Atrium
RAD Right Axis Deviation
RAE Right Atrial Enlargement
RAP Right Atrial Pressure
RBBB Right Bundle Branch Block
RBC Red Blood Cell
RDA Recommended Daily Allowance
RDW Red Cell Distribution Width
RIA Radioimmunoassay
RNA Ribonucleic Acid
R/O Rule Out
RTA Renal Tubular Acidosis
RVH Right Ventricular Hypertrophy
Rx Treatment
SA Sinoatrial
SBE Subacute Bacterial Endocarditis
S1 First Heart Sound
S2 Second Heart Sound
S3 Third Heart Sound
S4 Fourth Heart Sound
SEM Systolic Ejection Murmur
SGA Small for Gestational Age
SGGT Serum Gamma Glutamyl Transpeptidase
SGOT Serum Glutamic Oxaloacetic Transaminase
SGPT Serum Glutamic- Pyruvic Transaminase
SIADH Syndrome of Inappropriate Antidiuretic Hormone
SLE Systemic Lupus Erythematosus
S/C Subcutaneous
STAT Immediately
TA Tricuspid Atresia, Truncus Arteriosis
TAPVC Total Anomalous Pulmonary Venous Connection
TB Tuberculosis
TBG Total Binding Globulin
TD Tetanus-diphtheria Toxoid
TGA Transposition of the Great Arteries (same as TGV)
TGV Transposition of the Great Vessels (same as TGA)
TIBC Total Iron Binding Capacity
TIG Tetanus Immune Globulin
TOF Tetralogy of Fallot
TOPV Trivalent Oral Polio Vaccine
TPN Total Parenteral Nutrition
TSH Thyroid Stimulating Hormone
TT Thrombin Time
TU Tuberculin Units
URI Upper Respiratory Infection
UTI Urinary Tract Infection
VCUG Voiding Cystourethrogram
V/Q Ventilation - Perfusion
VSD Ventricular Septal Defect
VT Ventricular Tachycardia
vWD von Willebrand's Disease
VZV Varicella Zoster Virus
WBC White Blood Cell or Count
WPW Wolff-Parkinson-White
ZDV Zidovudine
Zn Zinc
Chart - 1: Growth Chart for Boys
Chart - 2: Intrauterine Growth