List Of Medical Problems in Preterm Baby

1) BRAIN
    - Interventricular Hemorrhage

2) EYE
    - Retinopathy of Prematurity

3) RESPI
    - ARDS
    - Pneumothorax
    - Bronchopulmonary Dysplasia

4) CVS
    - PDA

5) GIT
    - GERD
    - Jaundice

6) METABOLIC
    - Hypoglycemia
    - Hypothermia
    - Hypocalcemia
    - Malnutrition --> Need more
    - Anemia

7) IMMUNOSUPRESSED
    - Risk of Infection

Cushing Syndrome

* Clinical syndrome resulting from excess circulating glucocorticoid

Causes
1) Exogenous: Steroid Toxicity (Tx for Nephrotic, SLE, JRA, IBD) 
2) Endogenous : Adrenal CA/Adenoma, CAH, Cushing disease, Ectopic-ACTH

Head-to-Toe Examination ---> Mainly for Exogenous Cause (as a cause for CS)

1) General
    - Orange on stick appearance
    - Central Obesity
    - Hyperpigmentation (ACTH-dep)

2) Face
    - Moon Face, Plethoric Face, Acne, Hirsuitism, Frontal balding (female)

3) Eyes
    - Cataract, Papilloedema (funduscopy)

5) Oral
    - Candidiasis

4) Back
    - Dorsal fat pad, Vertebaral tenderness (osteoporosis)
    - Neck: Skin Infxn

5) Arms
   - Bruises, Thin skin, Skin Infxn (folds area), prox m/s wasting
   - Test for Prox Myopathy

6) Fingers
   - Bad ungual infection

7)) Abdomen
   - Central Obesity, Striae (purple/red), Scar (any reason)
   - Palpate --> Epigastric tenderness (>> steroid usage --> PUD)
   - Check for Ascites

8) Legs
    - Bruises, Thin skin, Thin limbs, Prox m/s wasting
    - Palpate for leg edema also
    - Test for Prox Myopathy

9) Complete with
    - BP --> HPT
    - RBS/ Dipstick --> DM
    - Weight & Height --> Growth Failure
    - Ask Hx of Long Steroid Tx
    - Any Bony pain/ patho# --> Osteoporosis

Graphic presentation of Cushing Syndrome

Principle Management of AGN

* In General NO specific Tx for AGN. The Tx is SYMPTOMATIC only

1) Confirm Dx of AGN (Send Ix)
    - BP (High) --> plot at BP centile 
    - UFEME & C+S --> RBC
    - BUSE --> Renal Fx
    - Ser C3($), C4 (n)
    - ASOT (>200 IU/mL)/ Throat/Skin swab & culture
    - FBC; Hb, TWBC

2) 10 days course of Penicillin
     - Initially IV C. Pen 30 mg/kg QID (1mg = 1667U)
     - Then change to PO Pen V 7.5-15 mg/kg QID

3) Tx Edema (d/t salt & water retention)
    - ROF & salt intake

4) Tx Hypertension (Diuretics/ AntiHPT)
    - T. Frusemide 1-2 mg/kg BD
    - T. Nifedipine 0.5-1 mg/kg BD

5) Tx Fever with Anti-Pyretics
    - PCM 15 mg/kg 4HRly (max 4g/day)
    * 1 Tab = 500 mg

6) Monitoring
   - Strict I/O Charting (plus urine colour)
   - Nephrotic Charting (daily albumin & BP target < 90th centile)
   - VSx 4HRly
   - RP daily ---> Renal failure

7) Monitor for Cx & Tx appropriately
   - HPT Encephalopathy -->
     c/o headace, vomiting, blurry vision, seizure, altered conscious
     * do Fundoscopy 
   - Acute Cardiac Failure
   - Acute Renal Failure (Oliguria < 300 mg/m²/day)
   - Progressive Glomerulonephritis 
   - Nephrotic Syndrome (Pro; nephrotic range 3+/ > 1g/m²/day)

8) Follow Up

   - For at least 1 year

   - Monitor BP every visit

   - UFEME & RP ---> asses recovery

   - repeat C3 6 weeks later if not normalised on the time of discharge 

9) Outcome

  - Short term: Excellent, mortality < 0.5%

  - Long term: 1.8% dev CKD; should referred to Paeds Nephrologist

 

Down's Syndrome Features

My CHILD HAS PROBLEM

Glemer tak adik nie.... hehe...

Congenital heart disease/ Cataracts
Hypotonia/ Hypothyroidism
Incurve 5th finger/ Increased gap between 1st and 2nd toe
Leukemia risk x2/ Lung problem
Duodenal atresia/ Delayed development


Hirshsprung's disease/ Hearing loss
Alzheimer's disease/ Alantoaxial instability
Squint/ Short neck


Protruding tongue/ Palm crease single 
Round face/ Rolling eye (nystagmus)
Occiput flat/ Oblique eye fissure
Brushfield spot/ Brachycephaly
Low nasal bridge/ Language problem
Epicanthic fold/ Ear folded & low set
Mental retardation/ Myoclonus

Down's Syndrome: H to T

Principle Management of Nephrotic Syndrome

1) Confirm Diagnosis
    - Fulfill the criteria: 
        > 1g/m²/day urine protein, Albumin < 25g/L, Gen Edema
    - Exclude secondary causes ---> 
        Infection (Hep B, HIV. Malaria), Malignancy (Lymphoma, Leukemia), CTD (SLE)


2) General Measures
    - Control Edema --->
       Normal protein & less salt diet, +/- Frusemide with caution  (ROF in Chronic Edema) 
    - Asses Hemodynamic (Hypo/Hypervolemia) --->
       Daily Nephrotic Chart & I/O Chart
    - Penicillin V Prophylaxis ---> Dose according to age

3) General Advice
    - Nature of disease -->
       Most will relaspe (85%-95%) - Consult Dr if Pro 2+ in 3 conseq days/ edema+
       Mostly idiopathic, Not affect renal fx
    - Home dipstick monitoring --> Once daily at early morning 
    - Tx option & its Cx -->
       Long Term Steroid, Cushing's, Immunocompromised (avoid infectious contact)
    - Immunization : Pneumococcal Vaccine -->
       Give during remission

4) Specific Tx for Primary Nephrotic Syndrome 
    - Long Term Corticosteroid or
    - Cyclophosphamide --> For frequent relapse/ Steroid dependent 
    - Steroid Resistant --> Renal biopsy (specific Tx depend on HPE) + supportive 

5) Manage Cx of Nephrotic Syndrome/ Cx of the Tx (if any)
    - Hypovolemia --> Tx: Human Albumin fast infusion
    - Spont Bacterial Peritonitis --> Tx: IV C. Pen + 3rd Gen Cephalosporin
    - Thrombosis --> Prophylaxis

    - Cushing's Syndrome --> Tx: Taper down steroid/ change to Cyclophosphamide 
    - Immunocompromised --> 
       Immunization, avoid infectious contact, fever come to hospital
    - Acute Adrenal Crisis --> when udergone stress TX : HCT/ Prednisolone 
    - Loosing protein --> Muscle Wasting Tx: advice on diet (high calorie) 

Salter-Harris Fracture Classification

*        Type I - fracture through the physis (widened physis)

*        Type II - fracture partway through the physis extending up into metaphysic

*        Type III - fracture partway through the physis extending down into the epiphysis

*        Type IV - fracture through the metaphysis, physis, and epiphysis -- can lead to angulation deformities when healing

*        Type V - crush injury to the physis

The 5 Ts of Right to left shunt

The 5 Ts

1. Truncus arteriosus (1 vessel)
2. Transposition of great arteries (2 vessels transposed)
3. Tricuspid atresia (3 =Tri)
4. Tetralogy of fallot (4 =Tetra)
5. Total anomalous pulmonary venous return (5 =5 words)

Respiratory Failure

* mintak maaf kualiti gambar kurang memuaskan tapi yg penting still boleh baca kan....