Pearls in Clinical Pediatrics Pushpendra Magon
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fm1Pearls in Clinical PEDIATRICSfm2
fm3Pearls in Clinical PEDIATRICS
Pushpendra Magon MBBS DCH MD (Pediatrics) Head Department of Pediatrics Patel Hospital Behind Sky Lark Hotel, Jalandhar Punjab, India Foreword A Radhakrishna
fm4
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© 2013, Jaypee Brothers Medical Publishers
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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
The Almighty and My Parentsfm6
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
Ariyur, Puducherry, Indiafm8
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.
Pushpendra Magonfm10
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