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100+ Clinical Cases in Pediatrics
R Arvind
CASE 1:
Down Syndrome
PRESENTING COMPLAINT
History of Presenting Complaint
Past History of the Patient
Examination
Investigation
Discussion
Clinical Features (Fig. 1)
Diagnostic Features of Down Syndrome at Birth
Diagnosis
Fetal Tests
Fetal Umbilical Blood Sampling
Fetal Cells in the Maternal Circulation
Karyotype
Radiological Findings
Dermatoglyphic Findings
Recurrent Risk
TREATMENT
Medical Management
Recommended health checkup for children with Downs syndrome
COUNSELING
Antenatal Counseling
Genetic Counseling
Health Maintenance Guidelines
Developmental Intervention
CASE 2:
Klinefelter Syndrome
PRESENTING COMPLAINTS
History of Presenting Complaints
Past History of the Patient
Examination
Investigation
Discussion
Clinical Features (Fig. 1)
Investigations
Treatment
CASE 3:
Turner's Syndrome
PRESENTING COMPLAINTS
History of Presenting Complaints
Past History of the Patient
Examination
Investigation
Discussion
Clinical Features (Fig. 1)
Differential Diagnosis
Investigations
Treatment
CASE 4:
Bronchial Asthma
PRESENTING COMPLAINTS
History of the Presenting Complaints
Past History of the Patient
Examination
Investigation
Discussion
Clinical Features (Fig. 1)
Diagnosis
Differential Diagnosis
Management of Acute Exacerbations
Step I: Assessment of Severity
Step II: Initial Bronchodilator Therapy and Management of Hypoxia
Step III: Monitoring the Treatment
Step IV: Transfer to the ICU
Long-term Management of Bronchial Asthma
Goals of Long-term Asthma Therapy
Identification and Elimination of Precipitating Factors
Drug Therapy
Mast Cell Stabilizers
Pharmacological Management
Inhalation Devices
Leukotriene Modifiers
Theophylline
Immunotherapy
CASE 5:
Bronchiectasis
PRESENTING COMPLAINTS
History of Presenting Complaints
Past History of the Patient
Examination
Investigation
Discussion
Causes of Acquired Bronchiectasis
Clinical Features (Fig. 1)
Diagnosis
X-ray Criteria Suggesting of Bronchiectasis
Differential Diagnosis
Treatment
Immediate phase
Long term or surgical plan
CASE 6:
Bronchiolitis
PRESENTING COMPLAINTS
History of Presenting Complaints
Past History of the Patient
Examination
Investigation
Discussion
Clinical Features (Fig. 1)
Differential Diagnosis
Diagnosis
Treatment
Supportive Treatment
Indications for Hospitalization
Ribavirin is indicated in:
CASE 7:
Croup
PRESENTING COMPLAINTS
History of Presenting Complaints
Past History of the Patient
Examination
Investigation
Discussion
Clinical Features (Fig. 1)
Diagnosis
Differential Diagnosis
Complications
Treatment
CASE 8:
Empyema
PRESENTING COMPLAINTS
History of Presenting Complaints
Past History of the Patient
Examination
Investigation
Discussion
Clinical Features (Fig. 1)
Diagnosis
X-ray Chest
Diagnostic Thoracocentesis
Ultrasound Chest
Computerized Tomography (CT) Scan
Treatment
Choice of antibiotics
Intercostal drainage
Decortication
CASE 9:
Otitis Media
PRESENTING COMPLAINTS
History of Presenting Complaints
Past History of the Patient
Examination
Investigation
Discussion
Acute Otitis Media
Otitis Media with Effusion
Chronic Suppurative Otitis Media
Pathogenesis of AOM
Microbiology of AOM
Complications
Treatment
Antibiotic Therapy
Treatment of Acute Otitis Media
Follow–up Visits
Tympanocentesis or Myringotomy
CASE 10:
Pneumonia
PRESENTING COMPLAINTS
History of the Presenting Symptoms
Past History of the Patient
Examination
Investigation
Discussion
Pathophysiology
Clinical Features (Fig. 1)
Diagnosis
Management
Specific Treatment
Supportive Treatment
Duration of treatment
Complications
Prognosis
CASE 11:
Tuberculosis
PRESENTING COMPLAINTS
History of Presenting Complaints
Past History of the Patient
Examination
Investigation
Discussion
PATHOGENESIS
EVOLUTION AND TIMETABLE OF UNTREATED PRIMARY TB IN CHILDREN
Clinical Features
1. Pulmonary tuberculosis
2. Tuberculous lymphadintis
3. Abdominal tuberculosis
4. Skeletal tuberculosis
5. Renal tuberculosis
6. Skin tuberculosis
7. Miliary tuberculosis
8. CNS tuberculosis
Congenital Tuberculosis
Differential Diagnosis
Diagnosis
BACTERIOLOGICAL DIAGNOSIS
Smear Examination
Culture Examination
Rapid Direct Tests
Serology and Antigen Testing
Radiological Diagnosis
Tuberculin Test (TT)
Mantoux Test
False-positive Mantoux Test
BCG Diagnostic Test
CT Scan
Demonstration of Bacilli
Fine Needle Aspiration Cytology (FNAC)
Polymerase Chain Reaction (PCR)
Kenneth Jone Diagnostic Criteria
Treatment
Indication for Specific Chemotherapy
Short Course Chemotherapy
Indian Academy of Pediatrics (IAP) ATT Regimens
PREDNISOLONE
Role of Steroids in TB
Indications
BCG Adenitis
Drug Resistant Tuberculosis
Newer Antituberculous Drugs
Prevention
Chemoprophylaxis in TB
Surgery
CASE 12:
Atrial Septal Defect
PRESENTING COMPLAINTS
History of Presenting Complaints
Past History of the Patient
Examination
Investigation
Discussion
Clinical Features (Fig. 2)
Diagnosis
Complications
Treatment
CASE 13:
Coarctation of Aorta
PRESENTING COMPLAINTS
History of Presenting Complaints
Past History of the Patient
Examination
Investigation
Discussion
Clinical Features (Fig. 1)
Complications
Treatment
CASE 14:
Patent Ductus Arteriosus
PRESENTING COMPLAINTS
History of Presenting Complaints
Past History of the Patient
Examination
Investigation
Discussion
Clinical Features (Fig. 1)
Complications
Differential Diagnosis
Treatment
CASE 15:
Pericarditis with Effusion
PRESENTING COMPLAINTS
History of Presenting Complaints
Past History of the Patient
Examination
Investigation
Discussion
Clinical Features (Fig. 1)
Diagnosis
Differential Diagnosis
Treatment
Pericardiocentesis
Management
CASE 16:
Sydenham's Chorea
PRESENTING COMPLAINTS
History of Presenting Complaints
Past History of the Patient
Examination
Investigation
Discussion
Clinical Features (Fig. 1)
Differential Diagnosis
Treatment
CASE 17:
Tetralogy of Fallot
PRESENTING COMPLAINTS
History of Presenting Complaints
Past History of the Patient
Examination
Investigation
Discussion
Clinical Features (Fig. 1)
Diagnosis
ECHO
Complications
Treatment
Indications for palliative shunt procedure:
Conventional Repair Surgery
CASE 18:
Ventricular Septal Defect
PRESENTING COMPLAINTS
History of Presenting Complaints
Past History of the Patient
Examination
Investigation
Discussion
Clinical Features (Fig. 1)
Diagnosis
Treatment
Surgical Indication
CASE 19:
Acute Gastroenteritis
PRESENTING COMPLAINTS
History of Presenting Complaints
Past History of the Patient
Examination
Investigation
Discussion
Acute Diarrhea
Intermediate Diarrhea
Dysentry
Types of Acute Diarrhea
Intestinal Pathogens Causing Diarrhea and/or Vomiting
Pathophysiology
Osmotic Diarrhea
Secretory Diarrhea
Inflammatory Diarrhea
Motility Diarrhea
Clinical Features (Fig. 1)
Diagnosis
Assessment of Dehydration (Table 1)
Investigation
Treatment
Plan A—No Dehydration
Plan B—Some Dehydration (Mild to Moderate) (Table 5)
Plan C (Severe Dehydration) (Table 6)
General Recommendations for IV Fluid Therapy
MANAGEMENT OF ELECTROLYTE DISTURBANCE
Hyponatremia
Correction of Hyponatremia
Hypernatremia
Hypokalemia
Metabolic Acidosis
Drug Therapy in Diarrhea
Bacterial Infections
Protozoal Infections
Zinc Therapy
Probiotics
Antisecretory Drug: Racecadotril
Nutrition in Diarrhea
Complications of Diarrhea
Follow-up Advice
CASE 20:
Appendicitis
PRESENTING COMPLAINTS
History of Presenting Complaints
Past History of the Patient
Examination
Investigation
Discussion
Clinical Features (Fig. 1)
Investigation
Plain x-ray abdomen shows:
Barium studies shows:
CT scan findings include:
Differential Diagnosis
Complications
Treatment
CASE 21:
Congenital Hypertrophic Pyloric Stenosis
PRESENTING COMPLAINTS
History of Presenting Complaints
Past History of the Patient
Examination
Investigation
Discussion
Clinical Features (Fig. 1)
Investigation
Infantile Form
Barium Study
Ultrasonography Findings
Differential Diagnosis
Treatment
Operative Procedure
Complications
CASE 22:
Diaphragmatic Hernia
PRESENTING COMPLAINTS
History of Presenting Complaints
Past History of the Patient
Examination
Investigation
Discussion
Clinical Features (Fig. 1)
Associated Anomalies
Diagnosis
Complications
Differential Diagnosis
Treatment
Vasodilator Therapy
CASE 23:
Gastroesophageal Reflux
PRESENTING COMPLAINTS
History of Presenting Complaints
Past History of the Patient
Examination
Investigation
Discussion
Physiology
Clinical Features (Fig. 1)
Differential Diagnosis
Investigations
Barium Swallow
pH Probe Study
Manometry
Scintigraphy
Endoscopy and Biopsy
Treatment
Follow-Up Management
CASE 24:
Hepatitis
PRESENTING COMPLAINTS
History of Presenting Complaints
Past History of the Patient
Examination
Investigation
Discussion
Etiology
Pathology
Clinical Features (Fig. 1)
Complications
Investigation
Treatment
Prevention
Passive Immunization
Active Immunization
HAV Vaccine
CASE 25:
Intussusception
PRESENTING COMPLAINTS
History of Presenting Complaints
Past History of the Patient
Examination
Investigation
Discussion
Clinical Features (Fig. 1)
Diagnosis
Differential Diagnosis
Complications
Treatment
CASE 26:
Necrotizing Enterocolitis
PRESENTING COMPLAINTS
History of Presenting Complaints
Examination
Investigation
Discussion
Clinical Features (Fig. 1)
Differential Diagnosis
Management
Surgical Treatment
CASE 27:
Tracheoesophageal Fistula
PRESENTING COMPLAINTS
History of Presenting Complaints
Past History of the Patient
Examination
Investigation
Discussion
Clinical Features (Fig. 1)
Differential Diagnosis
Treatment
CASE 28:
Wilson's Disease
PRESENTING COMPLAINTS
History of Presenting Complaints
Past History of the Patient
Examination
Investigation
Discussion
Pathophysiologic Staging
Clinical Features (Fig. 1)
Hepatic Disease
Neurologic Disease
Investigation
Conditions associated with low serum ceruloplasmin
Conditions associated with increased urinary copper levels
Differential Diagnosis
Complications
Treatment
Prognosis
CASE 29:
Hemophilia
PRESENTING COMPLAINTS
History of Presenting Complaints
Past History of the Patient
Examination
Investigation
Discussion
Types of Hemophilia
Clinical Features (Fig. 1)
Investigation
Differential Diagnosis
Management
Prevention of Bleeding
Replacement of Deficient Factor to Prevent Hemorrhage
Fresh Whole Blood
Fresh Frozen Plasma
Cryoprecipitate
Factor VIII Concentrate (Lyophilized Antihemophilic Factor)
Prothrombin Complex Concentrates (PCC)
Activated Prothrombin Complex Concentrates (APCC)
Porcine Factor VIII Concentrate
Duration of Treatment Depends on
For Mild Hemorrhage and Hemarthrosis
Plasma-borne Infections
Prophylactic Therapy
CASE 30:
Hemorrhagic Disease of the Newborn
PRESENTING COMPLAINTS
History of Presenting Complaints
Past History of the Patient
Examination
Investigation
Discussion
Clinical Features (Fig. 1)
Differential Diagnosis
Treatment
CASE 31:
Hereditary Spherocytosis
PRESENTING COMPLAINTS
History of Presenting Complaints
Past History of the Patient
Examination
Investigation
Discussion
Other possible diagnoses include:
Clinical Features (Fig. 1)
Laboratory Findings
Differential Diagnosis
Treatment
CASE 32:
Idiopathic Thrombocytopenic Purpura
PRESENTING COMPLAINTS
History of Presenting Complaints
Past History of the Patient
Examination
Investigation
Discussion
Clinical Features (Fig. 1)
Investigation
Differential Diagnosis
Complications
Treatment
Indications for treatment
Corticosteroid Therapy
Intravenous Immunoglobulin (IV-IgG)
Anti-Rh (D) Therapy
Splenectomy
Intracranial Hemorrhage
CASE 33:
Iron Deficiency Anemia
PRESENTING COMPLAINTS
History of Presenting Complaints
Past History of the Patient
Examination
Investigation
Discussion
Iron Metabolism
Absorption of Iron
Iron Losses
Iron Sources
Etiology
Increased Requirement
Decreased Availability
Increased Blood Losses
Pathogenesis
Predisposing Factors
Clinical Features (Fig. 1)
Diagnosis
Screening Tests (Table 1)
Red Cell Indices
Red Cell Size Distribution With (RDW)
Free Erythrocyte Protoporphyrin
Confirmatory test for IDA
Differential Diagnosis
Treatment
Oral Iron Therapy
Dose
Parenteral Iron Therapy
Dose
CASE 34:
Polycythemia
PRESENTING COMPLAINTS
History of Presenting Complaints
Past History of the Patient
Examination
Investigation
Discussion
Clinical Features (Fig. 1)
Treatment
CASE 35:
Sickle Cell Anemia
PRESENTING COMPLAINTS
History of Presenting Complaints
Past History of the Patient
Examination
Investigation
Discussion
Change in RBC Membrane
Clinical Features (Fig. 1)
Vaso-occlusive Crisis
Hand–Foot Syndrome
Avascular Necrosis of Femoral Head
Abdominal Crisis
Acute Chest Syndrome
Stroke
Treatment
Priapism
Sequestration Crisis
Aplastic Crisis
Investigation
Definite diagnosis is done by:
Differential Diagnosis
Treatment
Hydration
Drugs for Severe Pain
For Mild Pain
Role of Blood Transfusion
Drugs Augmenting Hb ‘F’ Synthesis
Antisickling Agents
CASE 36:
Thalassemia
PRESENTING COMPLAINTS
History of Presenting Complaints
Past History of the Patient
Examination
Investigation
Discussion
Pathophysiology
Clinical Features (Fig. 1)
Diagnosis
Differential Diagnosis
Treatment
Transfusion therapy
Amount and Frequency of Transfusion
Neocyte Transfusion
Iron Overload and Chelation Therapy
Desferrioxamine
Role of Vitamin C
Deferiprone
Splenectomy
Bone Marrow Transplantation
Newer Drugs
Pharmacological Methods to Increase Gamma Chain Production and Gene Manipulation
CASE 37:
Acute Poststreptococcal Glomerulonephritis
PRESENTING COMPLAINTS
History of Presenting Complaints
Past History of the Patient
Examination
Investigation
Discussion
Pathology
Clinical Features (Fig. 1)
Atypical Presentations
Complications
Investigation
Differential Diagnosis
Treatment
Course and Prognosis
CASE 38:
Hemolytic Uremic Syndrome
PRESENTING COMPLAINTS
History of Presenting Complaints
Past History of the Patient
Examination
Investigation
Discussion
Pathology
Pathogenesis of HUS
Clinical Features (Fig. 1)
Involvement of Other Organs in HUS
Diagnosis
Differential Diagnosis
Complications
Treatment
Prognosis
CASE 39:
Nephrotic Syndrome
PRESENTING COMPLAINTS
History of Presenting Complaints
Past History of the Patient
Examination
Investigation
Discussion
Pathogenesis
Clinical Features (Fig. 1)
Diagnosis
Urinalysis
Blood Examination
Indications for Renal Biopsy
Differential Diagnosis
Treatment
Treatment of the Initial Episode
Subsequent Course
Frequently Pelapsing Nephrotic Syndrome (FRNS)
Treatment of Relapse
Long-term Alternate-day Prednisolone
Long-term, Low Dose Daily Prednisolone
Levamisole
Alkylating Agents
Cyclosporine
Mycophenolate Mofetil (MMF)
Prednisolone Dependence
Initial Steroid Resistance
Other Therapies
General Care
Dietary Management
Eedema
DIURETICS
Furosemide and Bumetanide
Thiazides
Metolazone
Sprionolactone
Triamterene, Amiloride
Complications
Management of Complications
CASE 40:
Urinary Tract Infection
PRESENTING COMPLAINTS
History of the Presenting Complaints
Past History of the Patient
Examination
Investigation
Discussion
Pathogenesis
Predisposing Factors
Clinical Features (Fig. 1)
Neonates and Infants
Older Children
Recurrent UTI
Complicated UTI
DIAGNOSIS
Laboratory Investigations
Urine Examination
Urine Microscopy
Urine Culture
Dipstick Tests
Treatment
Response to Treatment
GENERAL MEASURES AND SURVEILLANCE
Imaging Studies
Ultrasonography
Intravenous Pyelography (IVP, Excretory Urogram)
Micturating Cystourethrogram (MCU)
Radionuclide Imaging
Evaluation Following the First UTI
Evaluation of Recurrent UTIs
CASE 41:
Acute Hemiplegia of Childhood
PRESENTING COMPLAINTS
History of Presenting Complaints
Past History of the Patient
Examination
Investigation
Examination
Investigation
Discussion
Causes
Clinical Features (Fig. 1)
Diagnosis
Treatment
Prognosis
CASE 42:
Cerebral Palsy
PRESENTING COMPLAINTS
History of Presenting Complaints
Past History of the Patient
Examination
Investigation
Discussion
Prematurity
Asphyxia
Infections
Prenatal Abnormalities
Biochemical Abnormalities
Postnatal Causes
Clinical Features (Fig. 1)
Clinical Types and Manifestations
Spastic Cerebral Palsy
Dyskinetic Cerebral Palsy
Ataxic Cerebral Palsy
Mixed Type
Diagnosis
Differential Diagnosis
Treatment
Rehabilitation
Physiotherapy
Speech Therapy
Orthopedic Management
Neurosurgery
MEDICATIONS
Antiepileptic Drugs
Antispasticity Drugs
Medication for Excessive Salivation
Medications for Dystonia
Prognosis
CASE 43:
Duchenne Muscular Dystrophy
PRESENTING COMPLAINTS
History of Presenting Complaints
Past History of the Patient
Examination
Investigation
Discussion
Clinical Features (Fig. 1)
Diagnosis
Differential Diagnosis
Treatment
CASE 44:
Epilepsy
PRESENTING COMPLAINTS
History of Presenting Complaints
Past History of the Patient
Examination
Investigation
Discussion
Classification
Clinical Features (Fig. 1)
Idiopathic Generalized Epilepsies
Partial Seizures
Simple Partial Seizures (SPS)
Complex Partial Seizures (CPS)
Generalized Seizures
Absence Seizures.
Generalized Tonic-Clonic Seizures (GTCS)
Neonatal Seizures
Myoclonic Seizures
Lennox-Gastaut Syndrome (LGS)
Investigation
Imaging in Epilepsy
EEG
Treatment
Stopping Antiepileptic Drug Treatment
New Antiepileptic Drugs (Table 1)
Epilepsy Surgery (Table 3)
Prognosis
Status Epilepticus
Management of Status Epilepticus
Emergency Drug Treatment
Premonitory Stage
Stage of Early Status
Stage of Established Status
Stage of Refractory Status
Prognosis
CASE 45:
Febrile Convulsions
PRESENTING COMPLAINTS
History of Presenting Complaints
Past History of the Patient
Examination
Investigation
Discussion
Clinical Features (Fig. 1)
Simple Versus Complex Febrile Seizures
Diagnosis
Electroencephalogram
TREATMENT
Temperature Control
Treatment of Acute Attack
Prophylaxis
Phenobarbital
Benzodiazepines
Valproic Acid
Parent Education
Conclusion
CASE 46:
Guillain-Barré Syndrome
PRESENTING COMPLAINTS
History of Presenting Complaints
Past History of the Patient
Examination
Investigation
Discussion
Pathology
Clinical Features (Fig. 1)
Investigation
Differential Diagnosis
Treatment
CASE 47:
Hydrocephalus
PRESENTING COMPLAINTS
History of Presenting Complaints
Past History of the Patient
Examination
Investigation
Discussion
Physiology of CSF Circulation
Pathophysiology of Hydrocephalus
Classification
Clinical Features (Fig. 1)
Neonatal/infant
Late Signs Include
Older Children
Investigation
CSF
Radiography
Ultrasonography
Computed Tomography (CT)
Magnetic Resonance Imaging (MRI)
Electroencephalography (EEG)
Intracranial Pressure Monitoring
Differential Diagnosis
Treatment
Complications
Follow-up
Prognosis
CASE 48:
Meningitis
PRESENTING COMPLAINTS
History of Presenting Complaints
Past History of the Patient
Examination
Investigation
Discussion
Pathogenesis and Pathophysiology
Clinical Features (Fig. 1)
DIAGNOSIS
CSF Examination
Differential Diagnosis
Complications
Treatment
Supprotive Therapy
Specific Antibiotic Therapy
Prognosis
CASE 49:
Meningomyelocele
PRESENTING COMPLAINTS
History of Presenting Complaints
Past History of the Patient
Examination
Investigation
Discussion (Fig. 1)
Clinical Features (Fig. 2)
Differential Diagnosis
Treatment
Prognosis
CASE 50:
Ambiguous Genitalia
PRESENTING COMPLAINTS
History of Presenting Complaints
Examination
Investigation
Discussion
Clinical Features (Fig. 1)
1. Abnormalities in Normal Gonadal Differentiation
2. Abnormalities in testosterone Synthesis or Action
3. Disorders of adrenal Androgen production
4. Miscellaneous
Clinical Features
Causes of Micropenis
Investigation
Differential Diagnosis
Treatment
CASE 51:
Congenital Adrenal Hyperplasia
PRESENTING COMPLAINTS
History of Presenting Complaints
Past History of the Patient
Examination
Investigation
Discussion
Clinical Features (Fig. 1)
Diagnosis
Differential Diagnosis
Treatment
A. Medical Treatment
B. Surgical Treatment
Course and Prognosis
CASE 52:
Cushing's Syndrome
PRESENTING COMPLAINTS
History of Presenting Complaints
Past History of the Patient
Examination
Investigation
Discussion
Clinical Features (Fig. 1)
Diagnosis
Laboratory Findings
Differential Diagnosis
Treatment
CASE 53:
Diabetes Insipidus
PRESENTING COMPLAINTS
History of Presenting Complaints
Past History of the Patient
Examination
Investigation
Discussion
Clinical Features (Fig. 1)
Diagnosis
Treatment
A. Medical Treatment
B. Other Therapy
CASE 54:
Diabetes Mellitus
PRESENTING COMPLAINTS
History of Presenting Complaints
Past History of the Patient
Examination
Investigation
Discussion
Classification
Pathogenesis
Clinical Features (Fig. 1)
Complications
Hypoglycemia
Diabetic Ketoacidosis
Clinical Features
Managing Ketoacidosis
Fluid Therapy
Insulin
Monitoring
Chronic Complications
CASE 55:
Hypothyroidism
PRESENTING COMPLAINTS
History of Presenting Complaints
Past History of the Patient
Examination
Investigation
Discussion
Clinical Features (Fig. 1)
Diagnosis
Laboratory Findings
Radiograph
Screening Programs for Neonatal Hypothyroidism
Differential Diagnosis
Prognosis
Treatment
CASE 56:
Precocious Puberty
PRESENTING COMPLAINTS
History of Presenting Complaints
Past History of the Patient
Examination
Investigation
Discussion
Precocious Puberty in Boys
Clinical Features (Fig. 1)
Diagnosis
Differential Diagnosis
Treatment
CASE 57:
Congenital Rubella
PRESENTING COMPLAINT
History of Presenting Complaint
Examination
Investigation
Discussion
Clinical Features (Fig. 1)
Diagnosis
Differential Diagnosis
Treatment
CASE 58:
Congenital Syphilis
PRESENTING COMPLAINTS
History of Presenting Complaints
Past History of the Patient
Examination
Investigation
Discussion
Clinical Features (Fig. 1)
Diagnosis
Differential Diagnosis
Treatment
CASE 59:
Dengue Fever
PRESENTING COMPLAINTS
History of Presenting Complaints
Past History of the Patient
Examination
Investigation
Discussion
Grading of Severity of DHF
Clinical Features (Fig. 1)
Criteria for Discharge
Investigation
Laboratory Diagnosis
Differential Diagnosis
Complications
Treatment
CASE 60:
Human Immunodeficiency Virus
PRESENTING COMPLAINTS
History of Presenting Complaints
Past History of the Patient
Examination
Investigation
Basic Findings
Discussion
Pathogenesis
Clinical Features (Fig. 1)
Diagnosis
Management
Antiretroviral therapy (ARV)
Cotrimaxazole Therapy HIV Exposed
Immunization
Prevention of Mother-to-child Transmission
CASE 61:
Malaria
PRESENTING COMPLAINTS
History of Presenting Complaints
Past History of the Patient
Examination
Investigation
Discussion
Life cycle of the Malarial Parasite
Clinical Features (Fig. 1)
Diagnosis
Complications
Differential Diagnosis
Treatment
CASE 62:
Measles
PRESENTING COMPLAINTS
History of Presenting Complaints
Past History of the Patient
Examination
Investigation
Discussion
Clinical Features (Fig. 1)
Diagnosis
Differential Diagnosis
Complications
Treatment
Prevention
CASE 63:
Mumps
PRESENTING COMPLAINTS
History of Presenting Complaints
Past History of the Patient
Examination
Investigation
Discussion
Clinical Features (Fig. 1)
Diagnosis
Differential Diagnosis
Complications
Treatment
Prevention
CASE 64:
Osteomyelitis
PRESENTING COMPLAINTS
History of Presenting Complaints
Past History of the Patient
Examination
Investigation
Discussion
Exogenous Osteomyelitis
Hematogenous Osteomyelitis
Clinical Features (Fig. 1)
Radiograph
Differential Diagnosis
Treatment
A. Specific Measures
B. General Measures
C. Surgical Measures
Prognosis
CASE 65:
Poliomyelitis
PRESENTING COMPLAINTS
History of Presenting Complaints
Past History of the Patient
Examination
Investigation
Discussion
Clinical Features (Fig. 1)
Inapparent Infections
Abortive Poliomyelitis
Non-paralytic Poliomyelitis
Paralytic Poliomyelitis
Diagnosis
Differential Diagnosis
Treatment
Abortive Poliomyelitis
Non-paralytic Poliomyelitis
Paralytic Poliomyelitis
Complications
Prognosis
CASE 66:
Septic Arthritis
PRESENTING COMPLAINTS
History of Presenting Complaints
Past History of the Patient
Examination
Investigation
Discussion
Clinical Features (Fig.1)
Diagnosis
Radiography
Joint Fluid Analysis
Differential Diagnosis
Treatment
Prognosis
CASE 67:
Tetanus Neonatorum
PRESENTING COMPLAINTS
History of Presenting Complaints
Past History of the Patient
Examination
Investigation
Discussion
Clinical Features (Fig.1)
Laboratory Findings
Differential Diagnosis
Management
A. Specific Measures
B. General Measures
Prognosis
CASE 68:
Typhoid
PRESENTING COMPLAINTS
History of Presenting Complaints
Past History of the Patient
Examination
Investigation
Discussion
Clinical Features (Fig. 1)
Diagnosis
Complications
Differential Diagnosis
Treatment
Prognosis
CASE 69:
Varicella
PRESENTING COMPLAINTS
History of Presenting Complaints
Past History of the Patient
Examination
Investigation
Discussion
Clinical Features (Fig. 1)
Investigation
Differential Diagnosis
Complications
Treatment
Prevention
Prognosis
CASE 70:
Whooping Cough
PRESENTING COMPLAINTS
History of Presenting Complaints
Past History of the Patient
Examination
Investigation
Discussion
Clinical Features (Fig. 1)
Diagnosis
Differential Diagnosis
Complications
Treatment
Prevention
Prognosis
CASE 71:
Birth Asphyxia
PRESENTING COMPLAINTS
History of Presenting Complaints
Examination
Investigation
Discussion
Pathophysiology of Asphyxia
Causes of Asphyxia
Maternal
Fetal
Placental
Delivery
Apgar Scoring
Inference
Steps in Resuscitation
Modalities of Intervention
No Further Action
Suctioning
Facial Oxygen
Bag and Mask
Indications for Bag and Mask
Intubation
External Cardiac Massage
Use of Drugs
Routes of Administration
Drugs and Dosages
Post-resuscitation Care
Subsequent Care
CASE 72:
Neonatal Seizures
PRESENTING COMPLAINTS
History of Presenting Complaints
Past History of the Patient
Examination
Investigation
Discussion
Clinical Features (Fig. 1)
Clinical Types
Presentations of Convulsions
Jitteriness and Clonus
Causes of Jitteriness
Etiology
Diagnosis
Investigations
Treatment
Anticonvulsants
Other Anticonvulsants
Treatment for Refractory Seizures
Follow-up of Anticonvulsant Therapy
Prognosis
Bad Prognostic Factors
CASE 73:
Neonatal Pathological Jaundice
PRESENTING COMPLAINTS
History of Presenting Complaints
Past History of the Patient
Examination
Investigation
Discussion
Infants with Severe Jaundice
Danger signs in Jaundiced Infants
Rh Isoimmunization
Pathogenesis
Clinical Features (Fig. 1)
Diagnosis
Hemolytic Disease
Antenatal Diagnosis
Postnatal Diagnosis
Investigations
Kernicterus
Blood-Brain Barrier
Clinical Classification of Kernicterus
Extrapyramidal Disturbances
Auditory Abnormalities
Gaze Abnormalities
Clinical Classification of Kernicterus
Biochemical and Biological Determinants or Bilirubin Encephalopathy
Treatment
Mechanisms and Principles
Phototherapy
Terminology
Light Spectrum
Indications for Phototherapy
Mechanism of Action in Phototherapy
Technique of Phototherapy
Side Effects of Phototherapy
Phenobarbitone
Contradictions of phototherapy
Exchange Transfusion
Technique
Complications of Exchange Transfusion
Supportive Treatment
CASE 74:
Normal Newborn
PRESENTING COMPLAINTS
History of Presenting Complaints
Examination
Investigation
Discussion
Gestational Age Assessment (Table 1)
Skin Texture
Skin Color
Breast Size
Ear Firmness
General Physical Examination
Regional Physical Examination
Head
Nose
Mouth
Neck
Chest
Cardiovascular System
Criteria for significant murmur
Abdomen
Liver
Spleen
Kidneys
Genitalia
Extremities
Back
Nervous System
Motor Functions
Behavior of the Newborn Infant
Examination of the Cranial Nerve
Hip Joint Examination
Stability of the Joint
Alarming Signs in Neonate
Reflexes
Skin of the Newborn
Vernix Caseosa
Angiomatous Lesion
Milia
Petechiae
Erythema Toxicum
CASE 75:
Premature Infant
PRESENTING COMPLAINTS
History of Presenting Complaints
Examination
Investigation
Discussion
Problems of Prematurity
Respiratory System
Central Nervous System
Cardiovascular System
Gastrointestinal System
Infection
Metabolic Disorders
Blood Disorder
Eye
Clinical Features (Fig. 1)
Problems of Premature Infant
Early
Late
Neonatal Management
Delivery Room Management
Admission to the Neonatal Intensive Care Unit
Respiratory Support
Cardiovascular Support
Fluid and Electrolytes
Nutrition
Glucose, Calcium and Phosphorus Homeostasis
Acid-base Balance
Jaundice
Interventricular Hemorrhage
Periventricular Leukomalacia (PVL)
Seizures
Hearing Impairment
Hematological Disorders
Homeostasis and Bleeding Diathesis
Apnea of Prematurity
Neonatal Infections
CASE 76:
Respiratory Distress Syndrome
PRESENTING COMPLAINTS
History of Presenting Complaints
Examination
Investigation
Discussion
Within 4–6 Hours of Birth
Incidence
Etiology
Risk Factors for HMD
Factors Which Hasten the Lung Development
Clinical Features (Fig. 1)
Pathology
Pathophysiology
Causes of Cyanosis in RDS
Investigation
Differential Diagnosis
Treatment
Supportive Treatment
Surfactant Replacement Therapy
Oxygen Therapy
Continuous Positive Airway Pressure
Intermittent Positive Pressure Ventilation (IPPV)
Indications
Initial Ventilator Settings
Ventilator Settings
Antibiotics
Vitamin E
Sedation
Weaning of IPPV
Extubation
Causes of Failure of Weaning of IPPV
Complications
CASE 77:
Protein-Energy Malnutrition
PRESENTING COMPLAINTS
History of Presenting Complaints
Past History of the Patient
Examination
Investigation
Discussion
Etiology
Classification of PEM
Clinical Features (Fig. 1)
Marasmus
Kwashiorkor
Differential Diagnosis
Treatment
Management
Dehydration
Correction of Electrolyte Imbalance
Dietary Management of Severe PEM
Initial Phase
Phase of High Energy Feeding
Therapeutic Diet
Assessment of Recovery and Follow-up
Prognosis
CASE 78:
Rickets
PRESENTING COMPLAINTS
History of Presenting Complaints
Past History of the Patient
Examination
Investigation
Discussion
Pathophysiology
Pathology of Rickets
Clinical Features (Fig. 1)
Diagnosis
Differential Diagnosis
Treatment
CASE 79:
Scurvy
PRESENTING COMPLAINTS
History of Presenting Complaints
Past History of the Patient
Examination
Investigation
Discussion
Clinical Features (Fig. 1)
Diagnosis
Differential Diagnosis
Treatment
CASE 80:
Ewing's Sarcoma
PRESENTING COMPLAINTS
History of Presenting Complaints
Past History of the Patient
Examination
Investigation
Discussion
Pathology
Clinical Features (Fig. 1)
Diagnosis
Differential Diagnosis
Treatment
Radiation Therapy and Chemotherapy
Prognosis
CASE 81:
Hodgkin's Disease
PRESENTING COMPLAINTS
History of Presenting Complaints
Past History of the Patient
Examination
Investigation
Discussion
Clinical Features (Fig. 1)
Clinical Staging of Hodgkin's Disease
Diagnosis
Differential Diagnosis
Management
Principles of Radiotherapy
Chemotherapy
Prognostic Factors
Late Effects
CASE 82:
Leukemia
PRESENTING COMPLAINTS
History of Presenting Complaints
Past History of the Patient
Examination
Investigation
Discussion
Clinical Features (Fig. 1)
Diagnosis
Differential Diagnosis
Treatment
Treatment of ALL
Treatment of AML
Supportive Care
Bone Marrow Transplantation
Treatment of Relapse
Prognosis
CASE 83:
Neuroblastoma
PRESENTING COMPLAINTS
History of Presenting Complaints
Past History of the Patient
Examination
Investigation
Discussion
Pathology
Clinical Features (Fig. 1)
Diagnosis
Evaluation of Patient
Diagnostic Criteria
The criteria is:
Staging of Neuroblastoma
Risk Stratification
Differential Diagnosis
Treatment
Radiotherapy
Indications
Conclusion
CASE 84:
Osteosarcoma
PRESENTING COMPLAINTS
History of Presenting Complaints
Past History of the Patient
Examination
Investigation
Discussion
Classification
Clinical Features (Fig. 1)
Diagnosis
Differential Diagnosis
Treatment
Prognosis
CASE 85:
Retinoblastoma
PRESENTING COMPLAINTS
History of Presenting Complaints
Past History of the Patient
Examination
Investigation
Discussion
Pathology
Genetics and Molecular Biology
Clinical Features (Fig. 1)
Diagnosis
Differential Diagnosis
Treatment
Prognosis
CASE 86:
Wilms' Tumor
PRESENTING COMPLAINTS
History of Presenting Complaints
Past History of the Patient
Examination
Investigation
Discussion
Pathology
Clinical Features (Fig. 1)
Diagnosis
National Wilms' Tumor Study (NWTS) Staging
Differential Diagnosis
Treatment
Chemotherapy
Prenephrectomy Chemotherapy
Absolute Indications for Prenephrectomy Chemotherapy
Radiotherapy for Wilms Tumor
Indications
Principles of Radiation Therapy
Target Volume
CONCLUSION
Prognosis
CASE 87:
Acute Rheumatic Fever
PRESENTING COMPLAINTS
History of Presenting Complaints
Past History of the Patient
Examination
Investigation
Discussion
Pathology
1. Exudative Stage
2. Proliferative Stage
Clinical Features (Fig. 1)
Clinical Manifestation and Diagnosis
Arthritis
Carditis
Clinical Features of Carditis
Others Include
Subcutaneous Nodules
Chorea
Erythema Marginatum
Minor Criteria
Laboratory Diagnosis of Rheumatic Fever
Throat Culture
Sero-diagnosis
Differential Diagnosis
Treatment
Management of Acute Stage
Eradication of Streptococcal Infection
Prevention
CASE 88:
Juvenile Rheumatoid Arthritis
PRESENTING COMPLAINTS
History of Presenting Complaints
Past History of the Patient
Examination
Investigation
Discussion
Clinical Features (Fig. 1)
Differential Diagnosis
Complications
Treatment
Medical Therapy
CASE 89:
Congenital Dislocation of Hip
PRESENTING COMPLAINT
History of Presenting Complaint
Examination
Investigation
Discussion
Clinical Features (Fig. 1)
Diagnosis
Differential Diagnosis
Complications
Treatment
CASE 90:
Leprosy
PRESENTING COMPLAINT
History of the Presenting Complaint
Past History of the Patient
Examination
Investigation
Discussion
Methods of Transmission
Clinical Features (Fig. 1)
Clinical Classification
Diagnosis
Bacteriological Examination
Tests for Humeral Response
Differential Diagnosis
Treatment
Treatment of Reactions in Leprosy
CASE 91:
Marfan's Syndrome
PRESENTING COMPLAINTS
History of Presenting Complaints
Past History of the Patient
Examination
Investigation
Discussion
Clinical Features (Fig. 1)
Differential Diagnosis
Treatment
CASE 92:
Talipes
PRESENTING COMPLAINTS
History of Presenting Complaints
Past History of the Patient
Examination
Investigation
Discussion
Clinical Features (Fig. 1)
Diagnosis
Differential Diagnosis
Management
CASE 93:
Infective Endocarditis
PRESENTING COMPLAINTS
History of the Presenting Complaints
Past History of the Patient
Examination
Investigation
Discussion
Pathogenesis
Organisms
Gram-positive Cocci
Gram-positive Bacilli
Gram-negative Organisms
Yeast and Fungi
Clinical Manifestations (Fig. 1)
Diagnosis
Complications
Treatment
Prevention
Standard Prophylaxis
In Patients Unable to Take Oral Medication
High-risk Patients
CASE 94:
Duodenal Atresia
PRESENTING COMPLAINTS
History of Presenting Complaints
Past History of the Patient
Examination
Investigation
Discussion
Clinical Features (Fig. 1)
Diagnosis
X-ray Abdomen
Ultrasonography
CT Scan Show
Upper Gastrointestinal (GI) Contrast Study
Fiberoptic Endoscopy
Treatment
CASE 95:
Hirschsprung's Disease
PRESENTING COMPLAINTS
History of Presenting Complaints
Past History of the Patient
Examination
Investigation
Discussion
Pathophysiology
Pathology
Clinical Features (Fig. 1)
Investigation
Radiographic Studies
Differential Diagnosis
Treatment
CASE 96:
Liver Abscess
PRESENTING COMPLAINTS
History of Presenting Complaints
Past History of the Patient
Examination
Investigation
Discussion
Pathogenesis and Pathology
Clinical Features (Fig. 1)
Diagnosis
Complications
Differential Diagnosis
Treatment
Antimicrobial Therapy
Prognosis
CASE 97:
Undescended Testes
PRESENTING COMPLAINT
History of Presenting Symptoms
Past History of the Patient
Examination
Investigation
Discussion
Clinical Features (Fig. 1)
Differential Diagnosis
Treatment
Surgical Treatment
Hormonal Treatment
CASE 98:
Chikungunya
PRESENTING COMPLAINTS
History of the Presenting Complaints
Past History of the Patient
Examination
Investigation
Discussion
Clinical Features (Fig. 1)
Diagnosis
Treatment
CASE 99:
Herpes Zoster
PRESENTING COMPLAINTS
History of Presenting Complaints
Past History of the Patient
Examination
Investigation
Discussion
Clinical Features (Fig. 1)
Complications
Laboratory Findings
Differential Diagnosis
Treatment
CASE 100:
Neonatal Hypoglycemia
PRESENTING COMPLAINTS
History of Presenting Complaints
Examination
Investigation
Discussion
Clinical Features (Fig. 1)
Clinical Features of Hypoglycemia
Causes
Causes of Hypoglycemia
Differential Diagnosis
Diagnosis and Treatment
Hypoglycemia
Treatment of Refractory Hypoglycemia
CASE 101:
Hurler's Syndrome
PRESENTING COMPLAINTS
History of Presenting Complaints
Past History of the Patient
Examination
Investigation
Discussion
Clinical Features (Fig. 1)
Diagnosis
Differential Diagnosis
Treatment
CASE 102:
Osteogenesis Imperfecta
PRESENTING COMPLAINTS
History of Presenting Complaints
Past History of the Patient
Examination
Investigation
Clinical Features (Fig. 1)
Diagnosis
Complications
Management
Prognosis
Glossary
INDEX
TOC
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