1.Pharyngitis 2.Constipation 3.Gigantism 4.Urethritis 5.Meningitis 6.Cardiovascular Diseases

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List of lectures topics
1. Pharyngitis
2. Constipation
3. Gigantism
4. Urethritis
5. Meningitis
6. Cardiovascular Diseases
VIKRAM SINGH (GROUP:-511)

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 Pharyngitis is inflammation of the pharynx, which is
in the back of the throat.
 It’s most often referred to simply as sore throat.
Pharyngitis can also cause scratchiness in the throat
and difficulty swallowing.
 More cases of pharyngitis occur during the colder
months of the year. It’s also one of the most
common reasons why people stay home from work.
 In order to properly treat a sore throat, it’s
important to identify its cause.
 Pharyngitis may be caused by bacterial or viral
infections.
Causes of pharyngitis
 Viral and bacterial agents:-
They include:-
 Measles

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 Adenovirus, which is one of the causes of
the common cold
 Chickenpox
 Croup, which is a childhood illness distinguished
by a barking cough
 Whooping cough
 Group A streptococcus
 Viruses are the most common cause of sore throats.
Pharyngitis is most commonly caused by viral
infections such as the common cold, influenza,
or mononucleosis. Viral infections don’t respond to
antibiotics, and treatment is only necessary to help
relieve symptoms.
 Bacterial infections require antibiotics. The most
common bacterial infection of the throat is strep
throat, which is caused by group A streptococcus.
Rare causes of bacterial pharyngitis
include gonorrhea, chlamydia,
and corynebacterium.
 Frequent exposure to colds and flus can increase
your risk for pharyngitis. This is especially true for
people with jobs in healthcare, allergies, and
frequent sinus infections.
SYMPTOMS

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 The incubation period is typically two to five days.
Symptoms that accompany pharyngitis vary
depending on the underlying condition.
 In addition to a sore, dry, or scratchy throat, a cold
or flu may cause:-
 Sneezing
 Runny nose
 Headache
 Cough
 Fatigue
 Body aches
 Chills
 Fever
 The symptoms of mononucleosis include:-
 Swollen lymph nodes
 Severe fatigue
 Fever
 Muscle aches
 General malaise
 Loss of appetite
 Rash
 Strep throat, another type of pharyngitis, can also
cause:-
 Difficulty in swallowing

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 Red throat with white or gray patches
 Swollen lymph nodes
 Fever
 Chills
 Loss of appetite
 Nausea
 Unusual taste in the mouth
 General malaise
 The length of the contagious period will also
depend on underlying condition.
 The common cold usually lasts less than 10 days.
Symptoms, including fever, may peak around three
to five days.
DIAGNOSIS
Physical examinations
Symptoms of pharyngitis
Doctor have to check these symptoms:-
 White or gray patches, swelling, and redness.
 Ears and nose.
 To check for swollen lymph nodes

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Throat culture
 If doctor suspects that have strep throat, take
a throat culture.
 This involves using a cotton swab to take a sample
of the secretions from throat.
 Most doctors are able to do a rapid strep test in the
office.
Blood tests
If doctor suspects another cause of pharyngitis, they
may order blood work. A small sample of blood from
arm or hand is drawn and then sent to a lab for testing.
TREATMENT
Home care
If a virus is causing pharyngitis, home care can help
relieve symptoms.
Home care includes:-
 Drinking plenty of fluids to prevent dehydration
 Eating warm broth

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 Gargling with warm salt water (1 teaspoon of salt
per 8 ounces of water)
 Using a humidifier
 Resting until you feel better
For pain and fever relief, consider taking over-the-
counter medication such as acetaminophen
or ibuprofen. Throat lozenges may also be helpful in
soothing a painful, scratchy throat.
Alternative remedies are sometimes used to treat
pharyngitis.
Some of the most commonly used herbs include:-
 Honeysuckle
 Licorice
 Marshmallow root
 Sage
 Slippery elm
Medical treatment
 In some cases, medical treatment is necessary for
pharyngitis. This is especially the case if it’s caused
by a bacterial infection. For such instances, doctor
will prescribe antibiotics.
 According to the Centers for Disease Control and
Prevention, amoxicillin and penicillin are the most

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commonly prescribed treatments for strep throat.
It’s important that you take the entire course of
antibiotics to prevent the infection from returning
or worsening. An entire course of these antibiotics
usually lasts 7 to 10 days.
Benefits of early treatment include the following:-
 Therapy within 48 hours of symptom appearance
appears to shorten the duration of symptoms
 Early therapy limits spread to other children
 Early therapy allows the patient and family to return
to their usual routine sooner; because more than
80% of patients have culture-negative results after
24 hours of therapy, the child should remain out of
school or daycare for 24 hours after starting
therapy; they must also be fever free before
returning
 Early therapy limits losses to follow-up
Disadvantages of early treatment include the
following:-
 Early therapy may lead to a higher failure rate
secondary to an inability to create an immune
response to the infection
 Rheumatic fever may still be prevented if antibiotic
therapy is initiated within 9 days of symptom onset.

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 Possible drug reactions and expenses may be
avoided by refraining from immediately treating
cases caused by pathogens other than GABHS.
Make decisions on an individual basis, taking into
account available testing, the severity of symptoms, the
feasibility of arranging follow-up care, and the need for
patients and their families to quickly return to their
regular routine.
For patients with viral pharyngitis, care should be
supportive, with antipyretics for pain and fever.
PREVENTION
Maintaining proper hygiene can prevent many cases of
pharyngitis.
To prevent pharyngitis:-
 Avoid sharing food, drinks, and eating utensils
 Avoid individuals who are sick
 Wash your hands often, especially before eating
and after coughing or sneezing
 Use alcohol-based hand sanitizers when soap and
water aren’t available
 Avoid smoking and inhaling secondhand smoke
OUTLOOK

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Most cases of pharyngitis can be successfully treated at
home. However, there are some symptoms that require
a doctor visit for further evaluation.
Need Doctor if:-
 We have had a sore throat for more than a week
 We have a fever greater than 100.4°F
 Our lymph nodes are swollen
 We develop a new rash
 Our symptoms do not improve after completing
Our full course of antibiotics
 Our symptoms return after completing your course
of antibiotics
Reference:-
 Kapitan Pediatrics Book
 GHAI Essential Pediatrics (Eighth Edition)
 Health line ( https://www.healthline.com )
 WebMd ( https://www.webmd.com )
 Mayo Clinic ( https://www.mayclinic.org )
 My Self

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Constipation in children is a common problem. A
constipated child has infrequent bowel movements or
hard, dry stools.
Common causes include early toilet training and
changes in diet. Fortunately, most cases of constipation
in children are temporary.
Symptoms
 Signs and symptoms of constipation in children may
include:-
 Less than three bowel movements a week
 Bowel movements that are hard, dry and
difficult to pass
 Large-diameter stools that may obstruct the
toilet
 Pain while having a bowel movement
 Abdominal pain
 Traces of liquid or clay-like stool in child's
underwear — a sign that stool is backed up in
the rectum
 Blood on the surface of hard stool

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 If child fears that having a bowel movement will
hurt, he or she may try to avoid it.
When to see a doctor
Constipation in children usually isn't serious.
However, chronic constipation may lead to
complications or signal an underlying condition. Take
child to a doctor if the constipation lasts longer than two
weeks or is accompanied by:-
 Fever
 Vomiting
 Blood in the stool
 Abdominal swelling
 Weight loss
 Painful tears in the skin around the anus (anal
fissures)
 Intestinal protrusion out of the anus (rectal
prolapse)
Causes
Constipation most commonly occurs when waste or
stool moves too slowly through the digestive tract,
causing the stool to become hard and dry.

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Many factors can contribute to constipation in children,
including:-
 Withholding:-
 Child may ignore the urge to have a bowel
movement because he or she is afraid of the
toilet or doesn't want to take a break from play.
Some children withhold when they're away
from home because they're uncomfortable
using public toilets.
 Painful bowel movements caused by large,
hard stools also may lead to withholding. If it
hurts to poop, child may try to avoid a repeat of
the distressing experience.
 Toilet training issues:-
 If we begin toilet training too soon, child may
rebel and hold in stool.
 If toilet training becomes a battle of wills, a
voluntary decision to ignore the urge to poop
can quickly become an involuntary habit that's
tough to change.
 Changes in diet:-
 Not enough fiber-rich fruits and vegetables or
fluid in child's diet may cause constipation.

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 One of the more common times for children to
become constipated is when they're switching
from an all-liquid diet to one that includes solid
foods.
 Changes in routine:-
 Any changes in child's routine — such as travel,
hot weather or stress — can affect bowel
function.
 Children are also more likely to experience
constipation when they first start school outside
of the home.
 Medications:-
 Certain antidepressants and various other drugs
can contribute to constipation.
 Cow's milk allergy:-
 An allergy to cow's milk or consuming too many
dairy products (cheese and cow's milk)
sometimes leads to constipation.
 Family history:-
 Children who have family members who have
experienced constipation are more likely to
develop constipation.

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 This may be due to shared genetic or
environmental factors.
 Medical conditions:-
 Rarely, constipation in children indicates an
anatomic malformation, a metabolic or digestive
system problem, or another underlying
condition.
Risk factors
Constipation in children is more likely for kids who:-
 Are sedentary
 Don't eat enough fiber
 Don't drink enough fluids
 Take certain medications, including some
antidepressants
 Have a medical condition affecting the anus or
rectum
 Have a family history of constipation
Complications
Although constipation in children can be uncomfortable,
it usually isn't serious. If constipation becomes chronic,
however, complications may include:-

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 Painful breaks in the skin around the anus (anal
fissures)
 Rectal prolapse, when the rectum comes out of
the anus
 Stool withholding
 Avoiding bowel movements because of pain,
which causes impacted stool to collect in the
colon and rectum and leak out.
TREATMENT
 The likely cause is constipation, a very
common problem in children.
 Besides the obvious painful bowel
movements, look for these typical signs:-
Constipation Symptoms
 Stomach pain and bloating
 Bleeding with bowel movements
 Soiling accidents
 Sometimes a constipated child might actually
appear to have diarrhea, which can be
confusing. What’s happening here is that a
large formed stool has gotten stuck in child’s
rectum, and somewhat liquid stool gets
passed around it.
 When a child is constipated, he has less
frequent bowel movements, and when he
does go, his stool is dry, hard, and painful to

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pass. There are many possible causes for
constipation, including:-
 Withholding stool. This means that child is
trying to hold his bowel movements in --
maybe because he’s stressed about potty
training, maybe because he doesn’t want
to use the toilet in certain places (like
school), or maybe because he’s afraid of a
painful bathroom experience. (Constipation
can become a vicious cycle -- if it hurts to
“poop” once, the child may be more fearful
of going the next time.)
 A diet that’s low in fiber or doesn’t include
enough liquids (or both)
 There are three primary treatments for most
cases of constipation, and they usually work
hand-in-hand.
 A high-fiber diet with plenty of fluids.
This means loading child’s plate with plenty of
fresh fruits and vegetables, high-fiber cereals,
whole grain breads (look for at least 3-5 grams of
fiber per serving), and a variety of beans and
other legumes, like chickpeas and lentils. Two
good sources of fiber that kids are often happy to
eat are trail mix (let them make their own) and
popcorn with minimal salt or butter. Foods
containing probiotics, like yogurt, can also

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promote good digestive health. While focusing on
fiber, don't forget fluids.
If child is eating plenty of high-fiber food but not
getting enough fluid to help flush it through his
system. Child should be drinking plenty of water
throughout the day, along with some milk. Limit
sugary drinks to 4 ounces a day in younger
children and 6-8 ounces in school-aged kids.
 A stool softener to clear the bowels.
These are safe in children, but should be
used under the supervision of
pediatrician. Two common mistakes that
parents make when giving their child
a stool softener for constipation is not
using a large enough dose, or stopping it
too soon. For example, you might think
that we can stop giving a stool softener
after child’s first normal-looking bowel
movement, but stopping too soon may
just set child up for another bout of
constipation. Some children may need to
stay on a stool softener for a few weeks.
doctor can advise you on the
right dosing schedule for child.
Prevention
To help prevent constipation in children:-

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 Offer child high-fiber foods:-
 Serve child more high-fiber foods, such as
fruits, vegetables, beans, and whole-grain
cereals and breads.
 If child isn't used to a high-fiber diet, start by
adding just several grams of fiber a day to
prevent gas and bloating.
 Encourage child to drink plenty of fluids:-
 Water is often the best.
 Promote physical activity:-
 Regular physical activity helps stimulate normal
bowel function.
 Create a toilet routine:-
 Regularly set aside time after meals for child to
use the toilet.
 If necessary, provide a footstool so that child is
comfortable sitting on the toilet and has enough
leverage to release a stool.
 Remind child to heed nature's call:-

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 Some children get so wrapped up in in play that
they ignore the urge to have a bowel
movement.
 If such delays occur often, they can contribute
to constipation.
 Review medications:-
 If child is taking a medication that causes
constipation, ask his or her doctor about other
options.
Reference:-
 My Self

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 Overproduction of growth hormone causes
excessive growth. In children, the condition is called
gigantism. In adults, it is called acromegaly.
 Excessive growth hormone is almost always
caused by a noncancerous pituitary tumor.
 Children develop great stature, and adults
develop deformed bones but do not grow
taller.
 Heart failure, weakness, and vision
problems are common.
 The diagnosis is based on blood tests and
imaging of the skull and hands.
 Computed tomography or magnetic
resonance imaging of the head are done to
look for the cause.

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 A combination of surgery, radiation therapy,
and drug therapy is used to treat the
overproduction of growth hormone.
 Gigantism is a rare condition that causes
abnormal growth in children.
 This change is most notable in terms of
height, but girth is affected as well. It occurs
when your child’s pituitary gland makes too
much growth hormone, which is also known
as somatotropin.
 Early diagnosis is important. Prompt treatment can
stop or slow the changes that may cause your child
to grow larger than normal.
 The condition can be hard for parents to detect.
 The symptoms of gigantism might seem like normal
childhood growth spurts at first.
Classification
Endocrinology is allocated a number of options for the
development in children of such diseases as pituitary
gigantism.
 Gigantism, with signs of acromegaly, it is also called
acromegaly with gigantism. He opposed this
pathology as gibofsky dwarfism.

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 If you increase the mass of the organs located
inside of the sick child – pathology is called
splenomegaly or gigantism of the internal organs.
 A kind of gigantism, which is called the true – may
not represent any serious danger, as deviations
from the psyche and physiology of the body (in
proportion) there is little, except in size.
 Gigantism partial, or partial type, is a disease, when
there is an increase in bodies or body parts
separately.
 More dangerous and insidious form of the disease
is gigantism half type, thus there is an increase in
one part of the body, the other remains normal.
Appears imbalance and poor coordination.
 Gigantism cerebral type, is mainly caused by lesions
of the brain. In this case there is a violation of
intellectual abilities, as well as some mental
indicators.
CAUSES
 A pituitary gland tumor is almost always the cause
of gigantism. The pea-sized pituitary gland is
located at the base of brain. It makes hormones that
control many functions in body.

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 Some tasks managed by the gland include:-
 Temperature control
 Sexual development
 Growth
 Metabolism
 Urine production
 When a tumor grows on the pituitary gland, the
gland makes far more growth hormone than the
body needs.
 There are other less common causes of gigantism:-
 McCune-Albright syndrome causes abnormal
growth in bone tissue, patches of light-brown
skin, and gland abnormalities.
 Carney complex is an inherited condition that
causes non-cancerous tumors on connective
tissue, cancerous or non-cancerous endocrine
tumors, and spots of darker skin.
 Multiple endocrine neoplasia type 1 is an
inherited disorder that causes tumors in the
pituitary gland, pancreas, or parathyroid glands.

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 Neurofibromatosis is an inherited disorder that
causes tumors in the nervous system.
SYMPTOMS
Recognizing the Signs of Gigantism
 If child has gigantism, we should notice that they’re
much larger than other children of the same age.
Also, some parts of the body may be larger in
proportion to other parts.
Common symptoms include:-
 Very large hands and feet
 Thick toes and fingers
 A prominent jaw and forehead
 Coarse facial features
 Children with gigantism may also have flat noses
and large heads, lips, or tongues.
 The symptoms child has may depend on the size of
the pituitary gland tumor. As the tumor grows, it
may press on nerves in the brain.
 Many people experience headaches, vision
problems, or nausea from tumors.

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 Other symptoms of gigantism may include:-
 Excessive sweating
 Severe or recurrent headaches
 Weakness
 Insomnia and other sleep disorders
 Delayed puberty in both boys and girls
 Irregular menstrual periods in girls
 Deafness
DIAGNOSIS
 If child’s doctor suspects gigantism, Doctor may
recommend a blood test to measure levels of
growth hormones and insulin-like growth factor 1
(IGF-1), which is a hormone produced by the liver.
The doctor also may recommend an oral glucose
tolerance test.
 During an oral glucose tolerance test, your child will
drink a special beverage containing glucose, a type
of sugar. Blood samples will be taken before and
after child drinks the beverage.
 In a normal body, growth hormone levels will drop
after eating or drinking glucose. If child’s levels
remain the same, it means their body is producing
too much growth hormone.

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 If the blood tests indicate a pituitary gland tumor,
child will need an MRI scan of the gland. Doctors
use this scan to see the size and position of the
tumor.
TREATMENT
Treatments for gigantism aim to stop or slow child’s
production of growth hormones.
 Surgery
 Removing the tumor is the preferred treatment
for gigantism if it’s the underlying cause.
 The surgeon will reach the tumor by making an
incision in child’s nose. Microscopes or small
cameras may be used to help the surgeon see
the tumor in the gland. In most cases, child
should be able to return home from the
hospital the day after the surgery.
 Medication
 Surgery may not be an option. This can be the
case if there’s high risk of injury to a critical
blood vessel or nerve.

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 Child’s doctor may recommend medication if
surgery is not an option. This treatment is
meant to either shrink the tumor or stop the
production of excess growth hormone.
 Doctor may use the drugs octreotide or
lanreotide to prevent the growth hormone’s
release. These drugs mimic another hormone
that stops growth hormone production. They’re
usually given as an injection about once a
month.
 Bromocriptine and cabergoline are drugs that can
be used to lower growth hormone levels. These are
typically given in pill form.
 Doctor may be used with octreotide. Octreotide is a
synthetic hormone that, when injected, can also
lower the levels of growth hormones and IGF-1. In
situations where these drugs are not helpful, daily
shots of pegvisomant might be used as well.
Pegvisomant is a drug that blocks the effects of
growth hormones. This lowers the levels of IGF-1 in
child’s body.
 Gamma Knife Radiosurgery
 Gamma knife radiosurgery is an option if
child’s doctor believes that a traditional surgery

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isn’t possible. The “gamma knife” is a collection
of highly focused radiation beams. These
beams don’t harm the surrounding tissue, but
they’re able to deliver a powerful dose of
radiation at the point where they combine and
hit the tumor. This dose is enough to destroy
the tumor.
 Gamma knife treatment takes years to be fully
effective and to return the levels of growth
hormone to normal. It’s performed on an
outpatient basis under general anesthetic.
 However, since the radiation in this type of
surgery has been linked to obesity, learning
disabilities, and emotional issues in children,
it’s usually used only when other treatment
options don’t work.
Reference:-
 My Self

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 Urethritis is defined as infection-induced inflammation
of the urethra. The term is typically reserved to
describe urethral inflammation caused by an STD,
and the condition is normally categorized into either
gonococcal urethritis or non-gonococcal urethritis.
Symptoms
 Many patients with urethritis, including approximately
25% of those with NGU, are asymptomatic and
present to a clinician following partner screening. Up
to 75% of women with Chlamydia
trachomatis infection are asymptomatic.
 Signs and symptoms in patients with urethritis may
include the following:-
 Urethral discharge:-
May be yellow, green, brown, or tinged with blood;
production unrelated to sexual activity
 Dysuria (in men):-
Usually localized to the meatus or distal penis,
worst during the first morning void, and made worse
by alcohol consumption; typically not present are
urinary frequency and urgency
 Itching:-

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Sensation of urethral itching or irritation between
voids
 Orchalgia:-
Heaviness in the male genitals
 Worsens during menstrual cycle (occasionally).
 Systemic symptoms (eg, fever, chills, sweats,
nausea): Typically absent
Diagnosis
 Most patients with urethritis do not appear ill and do
not present with signs of sepsis.
 The primary focus of the examination is on the
genitalia.
 Examination in male patients with urethritis includes
the following:-
 Inspect the underwear for secretions
 Penis: Examine for skin lesions that may
indicate other STDs (eg, condyloma
acuminatum, herpes simplex, syphilis); in
uncircumcised men, retract the foreskin to
assess for lesions and exudate
 Urethra: Examine lumen of the distal urethral
meatus for lesions, stricture, or obvious
urethral discharge; palpate along urethra for
areas of fluctuance, tenderness, or warmth
suggestive of abscess or for firmness
suggesting foreign body
 Testes: Examine for evidence of mass or
inflammation; palpate the spermatic cord,
looking for swelling, tenderness, or warmth
suggestive of orchitis or epididymitis
 Lymphatics: Check for inguinal adenopathy

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 Prostate: Palpate for tenderness or bogginess
suggestive of prostatitis
 Rectal: During the digital rectal examination,
note any perianal lesions
 Examine female patients in the lithotomy position.
Include the following evaluation:
 Skin: Assess for lesions that may indicate
other STDs
 Urethra: Strip the urethra for any discharge
 Pelvis: Complete pelvic examination, including
the cervix
 Urethritis can be diagnosed based on the presence
of one or more of the following:
 A mucopurulent or purulent urethral discharge
 Urethral smear that demonstrates at least 5
leukocytes per oil immersion field on
microscopy
 First-voided urine specimen that demonstrates
leukocyte esterase on dipstick test or at least
10 WBCs/hpf on microscopy
 All patients with urethritis should be tested
for Neisseria gonorrhoeae and C trachomatis.
Laboratory studies may include the following:
 Gram stain
 Endourethral and/or endocervical culture
for N gonorrhoeae and C trachomatis
 Urinalysis: Not useful test in urethritis, except
to help exclude cystitis or pyelonephritis
 Nucleic acid–based tests: For C
trachomatis and N gonorrhoeae (urine
specimens) and other Chlamydia species
(endourethral samples)

34
 Nucleic acid amplification tests (eg, PCR
for N gonorrhoeae, Chlamydiaspecies)
 KOH preparation: to evaluate for fungal
organisms
 Wet mount preparation: To detect the
movement/presence of Trichomonas
 STD testing for syphilis serology (VDRL) and
HIV serology
 Nasopharyngeal and/or rectal swabs: For
gonorrhea screening in men who have sex
with men
 Pregnancy testing: In women who have had
unprotected intercourse
 Imaging studies, specifically retrograde
urethrography, are unnecessary in patients with
urethritis, except in cases of trauma or possible
foreign body insertion.
 Patients with urethritis may undergo the following
procedures:
 Catherization: In cases of urethral trauma; to
avoid urinary retention and tamponade
urethral bleeding
 Cystoscopy: In cases when catherization is
not possible, for placement of a catheter; to
remove foreign body or stone in the urethra
 Dilation of urethral strictures with filiforms
and followers
 Placement of suprapubic tube: In severe
cases of urethral trauma that prevent
placement of urethral catheters or in the
absence of adequate facilities for emergent
cystoscopy; temporizing measure to divert
urine and relieve patient discomfort

35
Management
 Symptoms of urethritis spontaneously resolve over
time, regardless of treatment. Administer antibiotics
that cover both GU and NGU. Regardless of
symptoms, administer antibiotics to the following
individuals:
 Patients with positive Gram stain or culture
results
 All sexual partners of the above patients
 Patients with negative Gram stain results and
a history consistent with urethritis who are
not likely to return for follow-up and/or are
likely to continue transmitting infection
 Antibiotics used in the treatment of urethritis include
the following:
 Azithromycin
 Ceftriaxone
 Cefixime
 Ciprofloxacin
 Ofloxacin
 Doxycycline
 Moxifloxacin
Causes
 Both bacteria and viruses may cause urethritis. The
same bacteria that cause this condition are E
coli, chlamydia, gonorrhea.
 These bacteria also cause urinary tract
infections and some sexually transmitted diseases.

36
Viral causes are herpes simplex virus and
cytomegalovirus.
 Other causes include:-
 Injury
 Sensitivity to the chemicals used in
spermicides or contraceptive jellies, or foams
 Sometimes the cause is unknown.
 Risks for urethritis include:
 Being a female
 Being male, ages 20 to 35
 Having many sexual partners
 High-risk sexual behavior (such as anal sex
without a condom)
 History of sexually transmitted diseases
Exams and Tests
 The health care provider will examine you. In men,
the exam will include the abdomen, bladder area,
penis, and scrotum.
 The physical exam may show:
 Discharge from the penis
 Tender and enlarged lymph nodes in the groin
area
 Tender and swollen penis
 A digital rectal exam will also be performed.

37
 Women will have abdominal and pelvic exams. The
provider will check for:
 Discharge from the urethra
 Tenderness of the lower abdomen
 Tenderness of the urethra
Your provider may look into your bladder using a tube
with a camera on the end. This is called cystoscopy.
 The following tests may be done:
 Complete blood count (CBC)
 C-reactive protein test
 Pelvic ultrasound (women only)
 Pregnancy test (women only)
 Urinalysis and urine cultures
 Tests for gonorrhea, chlamydia, and other
sexually transmitted illnesses (STI)
 Urethral swab
Treatment
 The goals of treatment are to:
 Get rid of the cause of infection
 Improve symptoms
 Prevent the spread of infection
 If we have a bacterial infection, we will be given
antibiotics.
 We may take pain relievers, urinary pain reliever
along with antibiotics.

38
 People with urethritis who are being treated should
avoid sex, or use condoms during sex.
 Our sexual partner must also be treated if the
condition is caused by an infection.
 Urethritis caused by trauma or chemical irritants is
treated by avoiding the source of injury or irritation.
 Urethritis that does not clear up after antibiotic
treatment and lasts for at least 6 weeks is called
chronic urethritis.
 Different antibiotics may be used to treat this
problem.
Complications
 Men with urethritis are at risk for the following:
 Bladder infection (cystitis)
 Epididymitis
 Infection in the testicles (orchitis)
 Prostate infection (prostatitis)
After a severe infection, the urethra may become
scarred and then narrowed.
 Women with urethritis are at risk for the following:
 Bladder infection (cystitis)
 Cervicitis
 Pelvic inflammatory disease (PID -- an
infection of the uterus lining, fallopian tubes,
or ovaries)

39
Prevention
 Things we can do to help avoid urethritis include:
 Keep the area around the opening of the
urethra clean.
 Follow safer sex practices. Have one sexual
partner only (monogamy) and use condoms.
Reference:-
 My Self

40
 Meningitis is a term used to describe an
inflammation of the membranes that surround the
brain or the spinal cord.
 Meningitis, especially bacterial meningitis, is a
potentially life-threatening condition that can rapidly
progress to permanent brain damage, neurologic
problems, and even death.
 Doctors need to diagnose and treat meningitis
quickly to prevent or reduce any long-term effects.
 The inflammation causing meningitis is
normally a direct result of either a bacterial
infection or a viral infection. However, the
inflammation can also be caused by more
rare conditions, such as cancer, a drug
reaction, a disease of the immune system or
from other infectious agents such as fungi
(cryptococcal meningitis) or parasites.
 Normally, meningitis causes fever, lethargy,
and a decreased mental status (problems
thinking), but these symptoms are often hard
to detect in young children.
 If the infection or resulting inflammation
progresses past the membranes of the brain
or the spinal cord, then the process is
called encephalitis (inflammation of the
brain).

41
 The highest incidence of meningitis is
between birth and 2 years, with the greatest
risk immediately following birth and at 3-8
months of age. Increased exposure to
infections and underlying immune system
problems present at birth increase an infant's
risk of meningitis.
 The focus of this article will be on the common
infectious causes of meningitis as they account for
the large majority of problems; however, less
common causes will be presented.
Causes
 Bacteria and viruses cause the great majority of
meningitis disease in infants and children.
 The most serious occurrences of meningitis are
caused by bacteria; viral-caused meningitis is
common but usually is less severe and, except for
the very rare instance of rabies infection, almost
never lethal.
 However, both bacterial and viral types of the
disease are contagious.
 Meningitis normally occurs as a complication from
an infection in the bloodstream.
 A barrier normally protects the brain from
contamination by the blood. Sometimes, infections

42
directly decrease the protective ability of the blood-
brain barrier.
 Other times, infections release substances that
decrease this protective ability.
 Once the blood-brain barrier becomes leaky, a
chain of reactions can occur. Infectious organisms
can invade the fluid surrounding the brain.
 The body tries to fight the infection by increasing
the number of white blood cells (normally a helpful
immune system response), but this can lead to
increased inflammation.
 As the inflammation increases, brain tissue can
start swelling and blood flow to vital areas of the
brain can decrease due to extra pressure on the
blood vessels.
 Meningitis can also be caused by the direct spread
of a nearby severe infection, such as an ear
infection (otitis media) or a nasal sinus
infection(sinusitis). An infection can also occur any
time following direct trauma to the head or after any
type of head surgery.
 Usually, the infections that cause the most
problems are due to bacterial infections.
 Bacterial meningitis can be caused by many
different types of bacteria. Certain age groups
are predisposed to infections of specific types
of bacteria.

43
 Immediately after birth, bacteria called
group B Streptococcus, Escherichia
coli, and Listeria species are the most
common.
 After approximately 1 month of age,
bacteria called Streptococcus
pneumoniae, Haemophilus influenzae type
B (Hib), and Neisseria meningitidis are
more frequent. The widespread use of the
Hib vaccine as a routine
childhood immunization has dramatically
decreased the frequency of meningitis
caused by Hib.
 Viral meningitis is much less serious than
bacterial meningitis and frequently remains
undiagnosed because its symptoms are similar
to the common flu. The frequency of viral
meningitis increases slightly in the summer
months because of greater exposure to the
most common viral agents, called
enteroviruses.
Symptoms
 In infants, the signs and symptoms of meningitis are
not always obvious due to the infant's inability to
communicate symptoms.
 Therefore, caregivers (parents, relatives, guardians)
must pay very close attention to the infant's overall
condition.

44
 The following is a list of possible symptoms seen in
infants or children with bacterial meningitis
 Classic or common symptoms of meningitis in
infants younger than 3 months of age may include
some of the following:
 Decreased liquid intake/poor feeding
 Vomiting
 Lethargy
 Rash
 Stiff neck
 Increased irritability
 Increased lethargy
 Fever
 Bulging fontanelle (soft spot on the top of the
head)
 Seizure activity
 Hypothermia (low temperature)
 Shock
 Hypotonia (floppiness)
 Hypoglycemia (low blood sugar)
 Jaundice (yellowing of skin)
 Classic symptoms in children older than 1 year of
age are as follows:
 Nausea and vomiting
 Headache
 Increased sensitivity to light
 Fever
 Altered mental status (seems confused or
odd)
 Lethargy

45
 Seizure activity
 Coma
 Neck stiffness or neck pain
 Knees automatically brought up toward the
body when the neck is bent forward or pain in
the legs when bent (called Brudzinski sign)
 Inability to straighten the lower legs after the
hips have already been flexed 90 degrees
(called Kernig sign)
 Rash
Diagnosis
 Upon arrival at the emergency department, the
child's temperature, blood pressure, respiratory
rate, pulse, and oxygen in the blood may be
checked.
 After quickly checking the child's airway, breathing,
and circulation, the doctor completely examines the
child to look for a focal source of infection, to
assess any alteration in mental status, and to
determine the presence of meningitis. If meningitis
is suspected, several tests and procedures are
needed to determine the diagnosis.
 The child will usually not need the following tests:
 A spinal tap, or lumbar puncture, is an essential
procedure in which cerebrospinal fluid is obtained from
the child and then analyzed in a laboratory.

46
 Cerebrospinal fluid is the fluid surrounding the brain
and spinal cord where the infection in meningitis
occurs.
 Occasionally, a CT of the brain is done before the
spinal tap if other problems are suspected by the
doctor.
 Most clinicians will treat the child
with antibiotics before the spinal tap if bacterial-caused
meningitis is strongly suspected because of the
possibility of a rapid decline in condition of the patient.
 To perform this simple procedure, the doctor
numbs the skin on the child's lower back with
a local anesthetic.
 A needle is then inserted into the lower back
to obtain the necessary fluid from inside the
spinal cord because the fluid bathing the
spinal nerves is essentially the same that
bathes the brain.
 The fluid is sent to a laboratory and is checked
for white and red blood cells, protein, glucose
(sugar), and organisms (bacteria, fungus,
parasites; viruses are not visualized). The fluid
is also sent for culture (cultures may take
about a week for viruses).
 After the needle is removed, a small bandage
is placed on the skin where the needle was
inserted.

47
 A spinal tap is not a dangerous procedure for
a child. The needle is inserted at a location
below the end of the main body of the spinal
cord. A spinal tap is a simple procedure that is
necessary to determine if a person has
meningitis. Currently, no other procedure is
available to aid in the diagnosis of meningitis.
 An IV may be started to obtain blood and to give fluids.
This helps prevent dehydration and maintain a good
blood pressure.
 Urine may be obtained to determine if any infection is
present in the child's urinary tract system.
 A chest X-ray film may be taken to look for signs of
infection in the child's lungs.
Treatment
 Because meningitis is a potentially life-threatening
infection, therapy (IV antibiotics) may begin before
all of the tests are performed and prior to having all
of the results available.
 If any indication of respiratory distress is
present, a breathing tube (intubation) may be
needed to provide oxygen to help the child
breathe.
 A heart and breathing monitor is connected to
accurately monitor the child's vital signs
(respiratory rate, oxygen level, heart rate and
rhythm).

48
 An IV is started to give fluids and to correct
any dehydration. An IV also helps to maintain
blood pressure and good circulation.
 A tube (catheter) may be placed in the bladder
to obtain urine and to help accurately measure
the child's hydration.
 A child who has bacterial meningitis or is
suspected to have bacterial meningitis is
admitted to the hospital. The type of
monitoring, such as in a pediatric intensive-
care unit, is determined by the doctor in the
emergency department and the doctors who
care for the child in the hospital.
 A child who has viral meningitis and is
improving may be sent home for supportive
therapy. Supportive therapy includes
encouraging fluids to prevent dehydration and
giving acetaminophen (Tylenol)
or ibuprofen(Motrin) for pain and fever. If the
child is sent home, a doctor must check the
child within 24 hours to make certain his or her
condition has improved.
Medications
 Antibiotics may be given early in treatment of
meningitis to help fight the infection as quickly as
possible. The type of antibiotic depends on the
child's age and any known allergies. Antibiotics are
not helpful for viral meningitis.
 Steroids may be given to help minimize
inflammation depending on which organism is
suspected to be causing the infection.

49
 More aggressive medications may be necessary
depending on the severity of the child's illness.
 In general, the Infectious Diseases Society
recommends vancomycin plus ceftriaxoneor cefota
xime IV be used; the extent (time span) of
treatment may vary with the bacterial species being
treated. The treatment may vary from about seven
to 21 or more days.
 Fungal or parasitic infections require special drugs
to treat these relatively rare infections and usually
are managed by infectious disease specialists.
 Noninfectious causes of meningitis, which are rare,
are treated according to the underlying problem(s)
such as cancer, drug-induced, or surgical
problems.
Prevention
 Specific vaccines are available to protect and
reduce the chances of developing both the bacterial
and viral types of meningitis.
 The antibacterial vaccines include Hib,
meningococcal, and pneumococcal and the antiviral
vaccines include influenza, varicella, polio, measles,
and mumps.
 Antibiotics are given to all intimate contacts of a
child with meningococcal meningitis, a very specific
type of bacterial meningitis.
 These intimate contacts may include family
members, friends, health-care workers, and even
day-care or nursery contacts.

50
 Adults can contract this type of meningitis and
become carriers of these bacteria.
 If adults have been given preventive antibiotics and
then become sick or develop any symptoms, they
need a full medical evaluation.
 Preventive antibiotics are not needed for cases of
viral meningitis or with other types of bacterial
meningitis except for some relatives or caregivers
who are caring for patients with Hib infections.
 Vaccine side effects vary from none to transient
pain or discomfort at the inoculation site. Some
children may develop a mild fever, headache, and
feel tired.
 In most individuals who get these side effects,
Tylenol can reduce the discomfort. These effects
rarely last more than 24 hours.
 Infrequently, some children may develop more
severe allergic reactions.
Reference:-
 My Self

51
Heart disease in children
 Heart disease is difficult enough when it strikes
adults, but it can be especially tragic in children.
 Many different types of heart problems can affect
children. They include congenital heart defects, viral
infections that affect the heart, and even heart
disease acquired later in childhood due to illnesses
or genetic syndromes.
 The good news is that with advances in medicine
and technology, many children with heart disease
go on to live active, full lives.
Congenital heart disease
Congenital heart disease is a type of heart disease that
children are born with, usually caused by heart defects
that are present at birth.
CHDs that affect children include:-

52
 Heart valve disorders like a narrowing of the aortic
valve, which restricts blood flow.
 Hypoplastic left heart syndrome, where the left side
of the heart is underdeveloped.
 Disorders involving holes in the heart, typically in
the walls between the chambers and between major
blood vessels leaving the heart, including:-
 Ventricular septal defects
 Atrial septal defects
 Patent ductus arteriosus
 Tetralogy of Fallot, which is a combination of four
defects, including:
 A hole in the ventricular septum
 A narrowed passage between the right ventricle
and pulmonary artery
 A thickened right side of the heart
 A displaced aorta
ATHEROSCLEROSIS
Atherosclerosis is the term used to describe the buildup
of fat and cholesterol-filled plaques inside arteries. As
the buildup increases, arteries become stiffened and
narrowed, which increases the risk of blood clots and
heart attacks

53
Treatment typically involves lifestyle changes like
increased exercise and dietary modifications.
ARRHYTHMIAS
 An arrhythmia is an abnormal rhythm of the heart.
This can cause the heart to pump less efficiently.
 Many different types of arrhythmias may occur in
children, including:-
 A fast heart rate, the most common type found
in children being supraventricular tachycardia
 A slow heart rate
 Long Q-T Syndrome
 Wolff-Parkinson-White syndrome
Symptoms may include:-
 Weakness
 Fatigue
 Dizziness
 Fainting
 Difficulty feeding
Treatments depend on the type of arrhythmia and how
it’s affecting the child’s health.
KAWASAKI DISEASE

54
 Kawasaki disease is a rare disease that primarily
affects children and can cause inflammation in the
blood vessels in their hands, feet, mouth, lips, and
throat. It also produces a fever and swelling in the
lymph nodes. Researchers aren’t sure yet what
causes it.
 The illness is a major cause of heart conditions in as
many as 1 in 4 children. Most are under the age of
5.
 Treatment depends on the extent of the disease,
but often involves prompt treatment with
intravenous gamma globulin or aspirin.
Corticosteroids can sometimes reduce future
complications. Children who suffer from this disease
often require lifelong follow-up appointments to
keep an eye on heart health.
HEART MURMURS
 A heart murmur is a “whooshing” sound made by
blood circulating through the heart’s chambers or
valves, or through blood vessels near the heart.
Often it’s harmless. Other times it may signal an
underlying cardiovascular problem.

55
 Heart murmurs may be caused by CHDs, fever, or
anemia. If a doctor hears an abnormal heart
murmur in a child, they’ll perform additional tests to
be sure the heart is healthy. “Innocent” heart
murmurs usually resolve by themselves, but if the
heart murmur is caused by a problem with the
heart, it may require additional treatment.
PERICARDITIS
 This condition occurs when the thin sac or
membrane that surrounds the heart becomes
inflamed or infected. The amount of fluid between
its two layers increases, impairing the heart’s ability
to pump blood like it should.
 Pericarditis may occur after surgery to repair a CHD,
or it may be caused by bacterial infections, chest
traumas, or connective tissue disorders like lupus.
Treatments depend on the severity of the disease,
the child’s age, and their overall health.
VIRAL INFECTIONS

56
 Viruses, in addition to causing respiratory illness or
the flu, can also affect heart health. Viral infections
can cause myocarditis, which may affect the heart’s
ability to pump blood throughout the body.
 Viral infections of the heart are rare and may show
few symptoms. When symptoms do appear, they’re
similar to flu-like symptoms, including fatigue,
shortness of breath, and chest discomfort.
Treatment involves medications and treatments for
the symptoms of myocarditis.
RHEUMATIC HEART DISEASE
 When left untreated, the streptococcus bacteria that
cause strep throat and scarlet fever can also cause
rheumatic heart disease.
 This disease can seriously and permanently damage
the heart valves and the heart muscle. According
to Seattle Children’s Hospital, rheumatic fever
typically occurs in children ages 5 to 15, but usually
the symptoms of rheumatic heart disease don’t
show up for 10 to 20 years after the original illness.

57
 Rheumatic heart disease is a condition in which the
heart was damaged by rheumatic fever. Typically,
this long-term damage occurs to the mitral
valve, aortic valve or both. This damage may cause
the valve to “leak” or become narrowed over time.
 Usually, the symptoms of rheumatic heart disease
show up 10 to 20 years after the original illness.
The mitral valve (between the left atrium and
left ventricle) is usually more affected than the aortic
valve (between the left ventricle and aorta).
Symptoms of Rheumatic Heart Disease
 Children with rheumatic heart disease may not have
any clear symptoms.
 If child has aortic or mitral valve abnormalities due
to rheumatic fever, they may have symptoms
related to these valve problems. Some symptoms
that may suggest a problem with these valves
include being short of breath, particularly with
activity or when lying down.
 Children with myocarditis or pericarditis may have
chest pain or swelling.
Diagnosing Rheumatic Heart Disease
 To diagnose this condition, your doctor will ask
about any recent strep infections or sore throat

58
episodes, examine your child and use a
stethoscope to listen to their heart. In children with
rheumatic heart disease, doctors can often hear
a heart murmur.
 The doctor will ask for details about your child’s
symptoms, their health history and your family
health history. Your doctor may order a throat
culture or a blood test to check for strep throat or
signs of a recent strep infection, as well as
performing other blood tests.
 Your child will also need tests that provide
information about how their heart looks and works.
These may include:-
 A chest X-ray
 Echocardiography
 Electrocardiogram
 MRI (magnetic resonance imaging) of the heart
Treatment
 Rheumatic fever requires treatment with medicine.
After initial treatment, preventative medicines are
needed to make sure the strep infection doesn’t
come back. Your doctor may also prescribe anti-
inflammatory medicine to treat the joint pain and
swelling. Bed rest may be recommended, and this

59
can range from 2 to 12 weeks, depending on the
seriousness of the illness.
 If diagnosed with rheumatic fever, your child will
need follow-up care with a heart doctor to check for
long-term damage to the heart (rheumatic heart
disease).
 Once a child gets rheumatic heart disease from a
strep infection, they may have to take medicine for
decades to prevent a return of rheumatic fever that
can cause more damage to their heart valves.
 If your child has a damaged heart valve that is
narrow or leaks enough blood to strain their heart,
they may need surgery to repair or replace the
valve. Sometimes, if the valve is too narrow, a
balloon catheter procedure (balloon valvuloplasty)
may be used to try to open the valve without
surgery. However, in many cases, the valve cannot
be opened with a balloon procedure, and a child
needs surgery to replace their valve with an artificial
one.
Treatment for patients following rheumatic
heart disease
 Preventive and prophylactic therapy is indicated
after rheumatic fever and acute rheumatic heart
disease to prevent further damage to valves.
 Primary prophylaxis (initial course of antibiotics
administered to eradicate the streptococcal
infection) also serves as the first course of

60
secondary prophylaxis (prevention of recurrent
rheumatic fever and rheumatic heart disease).
 An injection of 0.6-1.2 million units of benzathine
penicillin G intramuscularly every 4 weeks is the
recommended regimen for secondary prophylaxis
for most US patients. Administer the same dosage
every 3 weeks in areas where rheumatic fever is
endemic, in patients with residual carditis, and in
high-risk patients.
 Although PO penicillin prophylaxis is also effective,
data from the World Health Organization indicate
that the recurrence risk of GABHS pharyngitis is
lower when penicillin is administered parentally.
 The duration of antibiotic prophylaxis is
controversial. Continue antibiotic prophylaxis
indefinitely for patients at high risk (eg, health care
workers, teachers, daycare workers) for recurrent
GABHS infection. Ideally, one could argue for
continuing prophylaxis indefinitely, because
recurrent GABHS infection and rheumatic fever can
occur at any age.
 Patients with rheumatic heart disease and valve
damage require a single dose of antibiotics 1 hour
before surgical and dental procedures to help
prevent bacterial endocarditis.

61
 Alternate drugs recommended by the American
Heart Association for these patients include PO
clindamycin (20 mg/kg in children, 600 mg in adults)
and PO azithromycin or clarithromycin (15 mg/kg in
children, 500 mg in adults). The guidelines for
endocarditis prophylaxis in patients with valve
damage from rheumatic heart disease have
changed. Antibiotic prophylaxis is no longer
recommended.
Reference:-
 My Self

1.Pharyngitis 2.Constipation 3.Gigantism 4.Urethritis 5.Meningitis 6.Cardiovascular Diseases

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