The document provides guidance on performing a general examination of a child, including important steps such as setting, position, vital signs measurement, and anthropometric measures. Key parts of the examination include assessing consciousness, respiration, nutrition/hydration, examining the body from head to toe, and measuring vital signs like temperature, pulse, and blood pressure. Anthropometric measures to obtain include weight, height, and occipitofrontal circumference to monitor growth. The examination aims to identify any abnormalities, signs of illness, or indicators of conditions like dehydration.
COMPLETE EXAMINATION OF RESPIRATORY SYSTEM IN PEDIATRICS. IT HAS BEEN SUMMARIZED FROM ALL WELL KNOWN 32 BOOKS UNDER GUIDANCE OF ONE OF THE BEST PEDIATRIC DOCTORS AND PROFESSORS .
BY DR. SURAJ R. DHANKIKAR.
COMPLETE EXAMINATION OF RESPIRATORY SYSTEM IN PEDIATRICS. IT HAS BEEN SUMMARIZED FROM ALL WELL KNOWN 32 BOOKS UNDER GUIDANCE OF ONE OF THE BEST PEDIATRIC DOCTORS AND PROFESSORS .
BY DR. SURAJ R. DHANKIKAR.
This is the first part of my Neonatology Powerpoint series.
It comprises an illustrative demonstrations of:-
Introduction to neonatology.
The APGAR score
General are of the newborn.
Neonatal examination & assessment.
This is the first part of my Neonatology Powerpoint series.
It comprises an illustrative demonstrations of:-
Introduction to neonatology.
The APGAR score
General are of the newborn.
Neonatal examination & assessment.
Approach to cardiac murmurs and cardiac examination in childrenVarsha Shah
Cardiovascular examination in children for MBBS undergraduate, Residents, Trainees, pediatricians, GP, family physicians, nursing , dental, allied health students
- Thyroid approach regarding history and physical examination mainly from BROWSE.
- Done by: Dr. Anas Aljundi ( Medical school at Al-Quds University ).
Some slides are taken from different textbooks of medicine like Davidson, Kumar and Clark and Oxford, and some from other presentations made by respected tutors. I'm barely responsible for compilation of various resources per my interest. These resources are free for use, and I do not claim any copyright. Hoping knowledge remains free for all, forever.
Student Name:
Course Name:
Assignment Due Date:
Week 3 SOAP Note
Subjective Data:
Chief Complaint: coughing, follow-up lab results.
History of Present Illness: 37 year-old- Hispanic male, , who presents to the clinic for a follow up visit on abnormal triglyceride levels that were done 2 weeks ago, and a complaint of intermittent non-productive coughing x 2 weeks with mild clear nasal drainage and watery eyes. Cough worsens at night in supine position interfering with his sleep and is decreased during the day. Denies any. Constitutional symptoms or associated symptoms such as nasal congestion, headache, dyspnea or chest pain. Does anything make it better? Any OTC remedies? That all goes below.
Medications:
Lisinopril 20 mg once a day
Simvastatin 20 mg once a day
Metformin 1000 mg twice a day
Glimepiride 4 mg once a day
OTC- Loratadine 10mg once a day
Allergies: No known drug allergies or food allergies. Has seasonal allergies during spring and summer.Possibly environmental as well.
Past Medical History: hypertension, hyperlipidemia, diabetes, and seasonal allergies.
Past Surgical History: No past surgical history.
Personal/Social History: smokes one pack of cigarettes per day for 7 years. Still currently smoking. Drinks alcohol on occasion. Denies any drug use. States he does not exercise regularly and is not on any special diet, but is trying to start a diet and exercise program.
Immunizations: Up-to-date. Last DTAP was 2 years ago, flu shot was in November 2012.
Family History:. His father has diabetes and hypertension. His mother has hypertension and arthritis. He has one brother, still living with no medical problems. He is single, and has no children.
Review of Systems:
General: admits he is mildly obese, no recent weight change or loss, no fever, fatigue, or weakness.
Skin: reports no rashes, mumps, sores, itching, dryness.
Eyes: No changes in vision. No vertigo. No eye pain. Has watery eyes. Need to explain positive finding using the 7 variables
Ears: No recent hearing loss. No tinnitus. No ear discharge or ear pressure.
Nose: Seasonal allergies for which he takes Claritin but has been out for two months. Now symptoms are worsening. No nasal congestion. Has mild watery clear nasal discharge intermittently for three months with occasional cough at night. No epistaxis.
Throat: Denies sore throat. No hoarseness. No bleeding gums or dry mouth.
Neck: Denies neck pain or stiffness.
Respiratory: See HPI. Non-productive cough. No hemoptysis. No wheeze.
Cardiovascular: No palpitations, chest pain, edema, shortness of breath. States having history of diet controlled hypertension. Takes periodic readings at local pharmacy and ranges 130-140 systolic and 70 to 80 systolic. Has had difficulty controlling hyperlipedimia due to diet- likes eating fried food.
Gastrointestinal: No nausea, vomiting, diarrhea, constipation.
Endocrine: History DM type 2 which is control via diet and medication. Does not recall l.
Each examining system can be described using four elements;
- looking/inspection
- feeling/palpation
- tapping/percussion
- listening/auscultation
- assessment of function
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
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Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
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New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
1. 1
General examination
Important steps in general examination of a child:
Setting.
Position.
Consciousness and orientation.
Respiration.
State of nutrition and hydration.
Body examination.
Vital signs.
Anthropotric measures.
Special things if present.
1-Setting:
Introduce yourself.
Gel.
Good light.
Right side.
Patient lie flat and central.
Exposure from nipple to mid-thigh.
2-Position:
Flexed with fisted hands as the patient we saw in the ward.
Extended posture frog like.
Opisthotonous his head and his heels on the bed while his body is arched
commonly seen in kernicterus "bilirubin encephalopathy".
Tetanus neonatorum.
Decerberate and decorticate posture.
3-Consciousness and orientation:
Conscious, lethargic, comatose.
Lethargic with crying on examination only (implying serious problem).
Orientation: in child of more than 4-5 years old >> ask about (place, time, person).
Ibnlatef Notes Pediatrics
2. 2
4-Respiration:
Regular or not, seek about sign of respiratory distress if present.
Chyne stokes breathing hyperpnea + pause, indicates severe brain insult,
respiratory failure or heart failure, type 1 hypoxia is imminent PO2 <92%, type 2 PCO2
>45mmHg + hypoxia.
Chyne stokes breathing pattern is normal in premature or in neonate (1 week) old age.
5-State of nutrition and dehydration:
CHO deficiency.
Protein deficiency edema.
Fat deficiency medial aspect upper thigh & buttock "sites of storage of fat"
Vitamins and minerals.
Water and electrolytes (signs of dehydration).
Note: wrinkling of skin in the area around the thigh is sign of wasting look for
abdominal distension + eversion of umbilicus.
6-Body examination:
General:
o Age and sex.
o Any external corrections (cannula, IV fluid, oxygen mask).
o Built (average build, thin, emaciated, obese).
Shape of the head:
o Normal.
o Bracheocephaly.
o Scelocephaly.
Hair:
o Distribution.
o Fragile or not.
o Thick or silky.
o Discoloration reddish color of the hair in malnutrition, failure to thrive.
o Alopecia (loss of hair) localized as in skin disease or generalized as SLE.
Fontanels:
o Examine it when baby is sitting and not crying.
o Size normal 2.5 cm if large decrease of bone hypothyroidism.
o Depressed or sunken dehydration.
o Bulging increased intra-cranial pressure ICP – hypernatremia – fluid therapy.
o Anterior fontanel diamond shape – close in 6-18 months.
o Posterior fontanel triangular shape – close in 3 months.
3. 3
Face Skin color:
o Pallor anemia (pallor check), nephrotic syndrome (off colored), hypopituitarism,
shock.
o Jaundice increased serum bilirubin ((jaundice appears clinically when increase
more than 3.5 mg/dl in child and 5 mg/dl in neonate)).
o Plethoric face (red color face) polycythemia, vasodilation, vascular overload.
o Pinkish color face polycythemia, chronic hypoxia.
o Earthy pale complexion uremia.
o Pigmentation racial, actinic, in disease like Addison's.
o Malar flush in mitral stenosis.
Eye:
o Anemia look at palpebral conjunctiva.
o Polycythemia congested conjunctiva.
o Jaundice look at sclera.
o Puffiness (edema of the eyelids) in renal disease and myxedema and allergic.
o Xanthelasma yellowish plaques around the eye.
o Sub-conjunctival hemorrhage in bleeding tendency, conjunctivitis, severe cough.
o Sunken eye dehydration.
o Tears on crying or not.
o Any discharge (like pus).
o White spots in the iris Vit. A deficiency.
o Signs of dehydration sunken eye + dryness (tears and glistening).
Ear:
o Discharge.
o Large or small ears.
o Low set ears.
o Boat ear (congenital).
Nose:
o Nasal discharge.
o Look inside for any polyps.
o Bleeding.
o Flaring of ala nasi (sign of respiratory distress).
Lips:
o Cyanosis.
o Ulcer.
o Herpes labialis.
o Angular stomatitis and cheilosis Iron deficiency anemia & vitamin deficiency.
Gums:
o Red + swollen + suppuration gingivitis.
o Gingival hypertrophy in scurvy, leukemia, drugs like phenytoin.
o Bleeding gums inflammation, Vit. C deficiency.
4. 4
o Chelosis vitamin deficiency.
Teeth:
o Number of teeth.
o Dental caries.
o Teeth loss.
Tongue:
o Color red in glossitis, pale in severe anemia, yellow in jaundice, blue in central
cyanosis.
o Moisture dry tongue in dehydration and air and drugs like anticholinergic.
o Fur in air breathers.
o Smooth tongue in anemia.
Buccal mucosa:
o Thrush candida infection.
o Aphthus ulcer.
o Petechial hemorrhage bleeding tendency and infection.
o Pigmentation Addison's disease.
o Pallor anemia.
o Dryness of the mouth sign of dehydration.
Congenital anomalies:
o Cleft lip and cleft palate and Cleft uvula.
Neck:
o Lymphadenopathy ((L.N in neck + axillary + inguinal + epi-trochlear L.N near elbow
enlargement of two L.N in non-adjacent site called generalized
lymphadenopathy)).
o Neck mass and Thyroid.
o Swelling midline or lateral.
o Using of accessory muscle in respiration sign of respiratory distress.
Chest:
o Abnormal shape.
o Rachitic rosary beaded ribs in rickets.
o Signs of dyspnea flaring of ala nasi – cyanosis – dusky – suprasternal, intercostal,
subcostal rescission.
Abdomen:
o Abdominal distention distention (5F) – flat – scaphoid.
o Skin rash allergy, contact dermatitis, candidiasis.
o Sings of wasting loss of muscle + loss of subcutaneous fat + look at thigh,
buttock, arm and pectoralis major muscle.
o Sings of dehydration skin turgor – elasticity.
Groin:
o Wasting loss of muscle bulk.
o Thinning loss of subcutaneous fat (exam thickness of skin fold).
5. 5
o L.N.
o Hernia in pediatric (indirect inguinal hernia = swelling of the scrotum).
Lower limbs:
o Joint swelling and deformities (knee joint swelling) and Muscle wasting.
o Edema (on the shaft of the tibia – dorsum of foot pressure at least for 1 min).
o Bowing of leg in rickets.
o Ankle joint widening in rickets.
o Color jaundice, pallor, cyanosis.
o Nails pallor – koilonychias (chronic iron deficiency anemia) – leukonychia (in liver
disease and hypo-proteinemia).
o Fungal infection of the foot.
Back:
o Sacral edema.
o Pigmentation and Rash.
o Meningocele and myelomeningeocele.
o Vertebral column pass your finger along the vertebral column.
Upper limbs:
o Abnormal movements and Joint swelling and deformities.
o Muscle wasting (wasting of thinner or hypo-thinner muscles).
o Skin color anemia, cyanosis, jaundice, pigmentations.
o Skin lesions purpura, petechiae, purpupic spots, ecchymosis, hematoma.
o Palmer erythema, spider navei, central pallor of the palm.
o Nails clubbing, koilonychias, onycholysis ((GIT causes of clubbing in pediatric
are: celiac disease, cystic fibrosis, liver cirrhosis, IBD)).
o Hand moisture.
o Skin retraction.
o Creases indicate Hg less than 7 – pallor indicate Hg less than 12.
o Widening of wrist joint on rickets.
7-Vital signs: (all of them calculated by chart or using the following method)
Blood pressure:
o 5 methods:
Auscultation: cuff = 2/3 of arm circumference.
Palpitory method: only systolic.
Flushing pale red.
Osmometry.
Doppler.
o There is special chart for blood pressure:
Example: 4 years child BP = 4+90/4+60 = 94/64 mmHg
Age in years + 90
Age in years + 60
6. 6
Temperature:
o From Tympanic membrane (more common), Oral, Axillary (+0.5), Rectal (-0.5).
o One degree increase lead to 10 beat increase in the heart rate.
o 36.5 – 37.5 = normal.
o < 36.5 = sub-normal.
o < 35 = hypothermia.
o > 37.5 = febrile.
o Less than 38 = Low grade fever.
o More than 38 = High grade fever.
o > 39 = hyperthermia.
o > 41 = hyperpyrexia.
Respiratory rate:
o 2 months age 60/min.
o 2 months – 1 year 50/min.
o 1 year – 5 years 40/min.
o 5 yeas – 10 years 30/min.
o More than 10 years 20/min.
o Periodic breathing: occurs when the breath pause for up to 10 seconds at time,
there may be several such pauses close together, followed by series of rapid
shallow breaths, then breathing returns to normal. This is common condition in
premature babies in first few weeks of life. Even healthy full term babies sometimes
spells periodic breathing, usually after sleeping deeply. Home care: supine position,
avoid soft pillows and smoking, never snake your baby to breath brain injury.
Periodic breathing Apnea
Breathing stops up to 10 seconds Stops more than 20 seconds
No Infant may become limp
No cyanosis Cyanosis
No change in heart rate Decrease heart rate
Pulse rate:
o Measures:
Newborn (< 1 month) 120-160 bpm.
Infant (1-12 month) 80-140 bpm.
Toddler (1-3 year) 80-130 bpm.
Preschooler (3-5 year) 80-120 bpm.
School age (6-12 year) 70-100 bpm.
'Adolescent (> 13 year) 60-100 bpm.
o Rate:
Tachycardia: Fever, shock, drugs (salbutamol), sinus tachycardia, anemia,
thyrotoxicosis.
7. 7
Bradycardia: sick sinus syndrome, athletes, cretinism, drugs (propanol), sleeping,
heart block, heart failure.
o Rhythm:
Regular – regular.
Regular – irregular (ectopic).
Completely irregular.
Radio-femoral delay: post ductal coarctation of aorta.
Radio-radial delay: pre ductal coarctation of aorta.
Brachio-femoral delay.
o Character:
Jet of pulse: e.g. big and thrusting pulse.
Watson's water hammer pulse.
Gallop rhythm: can be assessed by palpation, we find S1, S2, S3, tachycardia.
DDx: heart failure and valvular heart disease.
o Volume: small volume, normal volume, large volume.
o Pulsus paradoxus: decrease in systolic blood pressure >15 mmHg with inspiration,
occur in asthma and acute pericarditis.
o Non-cardiac causes of large volume pulse Thyrotoxicosis, Severe anemia, Stress.
o Cardiac causes of small volume Aortic stenosis, Coarctation of aorta, Pericardial
effusion, Cardiac tamponade.
o Causes of radial pulse absence Arteriovenous fistula, TAR: Thrombocytopenia-
absent radius syndrome (Thrombocytopenia, absence of radial artery, congenital
absence of radius bone)
o Tachycardia + small volume in shock or diarrhea.
o Water hummer (collapsing pulse) large volume, dorsum of hand.
o Differential cyanosis: cyanosis present in foot, but not hand coarctation of aorta.
o By ending of pulse examination: 80 bpm, regular, normal character, good volume,
no radio-femoral delay, normal peripheral pulsation.
Capillary refill.
Pulse oximetry.
Blood glucose.
8-Anthropotric measures:
Weight:
o Normal Birth weight 2.5 - 4.5 kg.
o <2.5 kg low birth weight.
o <1.5 kg very low birth weight.
o <1 kg extremely low birth weight.
o Baby double his weight at 6 months.
Post ductal coarctation:
Bluish discoloration of
the lower limbs but not
the upper limbs & head
8. 8
o Triple at 1 year.
o Quadruple at 2 year.
o Every year 3.5 kg increase (10 g/day).
Height:
o Normal birth 50 cm.
o First year 75 cm.
o Second year 85 cm.
o Forth year 100 cm.
o After that 6 cm/year.
OFC = occiputo-frontal circumference:
o At birth 35 cm.
o 2 cm per month in the first 3 months.
o 1 cm per month in 3-6 months.
o 0.5 cm per months in 6 months – 1 year.
o 12 cm in one year.
o 10 cm in the rest of life.
o At birth = 35 cm.
o At 6 months = 44 cm.
o At 1 year = 47 cm.
Notes:
Indication for measuring blood pressure below 3 years:
o Cardiac case.
o Renal case.
o CNS case.
OFC in chart:
o 95-5 normal.
o Below 5 microcephaly.
o Above 95 macrocephaly – megalocephaly – hydrocephaly.
Height in chart:
o 95-5 normal.
o Below 5 short stature.
o Above 95 long stature.
o Measure length (lying) if baby less than 2 years.
o Measure height (stand) if baby more than 2 years.
Weight in chart:
o 95-5 normal.
o Below 5 marasmus – kwashiorkor – marasmus on kwashiorkor.
o Above 95 obese.
9. 9
Other notes:
o Causes of macrocephaly: Familiar, big ventricles, fluid (hydrocephalus), big bone
(rickets or thalassemia major).
o In acute illness weight is most affected anthropometric measure.
o In chronic illness length is most affected anthropometric measure.
o TB and bronchiectasis decrease weight.
o Asthma increase weight (due to steroids use) and cause short stature.
Tiny child vs. stunted growth:
o In tiny child the height and weight both decreased in a similar manner and often
there is a history of tinny child in family (seek about similar condition in family).
o While in stunted growth the height and weight are severely decreased and may be
not the same and there is no similar condition in the family and often associated
with other diseases.
9-Special things if present:
Hydrocephalus, clubbing, cyanosis.
Sown syndrome features.
Craniotabes
o It is a softening of the skull bones.
o Can be a normal finding in infants, especially premature infants.
o It may occur in up to one third of all newborn infants.
o It is harmless in the newborn, unless it is associated with other problems these
can include rickets and osteogenesis imperfecta (brittle bones).
o Maneuver press the bone along the area where the bones of the skull come
together "posterior parietal". The bone often pops in and out, similar to pressing on
a ping-pong ball if the problem is present. No testing is done unless osteogenesis
imperfecta or rickets is suspected.
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