ABNORMAL PEDIA

MENINGITIS

  • Bacteria vs virus

  • Brudzinski and kernig

  • Lumbar puncture (CT scan)

  • SIADH vs DI

  • Sequelae: a condition which is the consequence of a previous disease or injury

  • Assess after 3 months (Visual - use steroids; Hearing loss - CNS)

  • Less communicable after approximately 24 to 48 hours of IV antibiotic therapy

HYDROCEPHALUS

  • 2ml/kg

  • CNS flow L3A4Subway

  • MS. IBD: Macewen’s sign, Sunset eyes, Increased ICP, Bulging fontanelles, Dilated scalp veins.

  • Comm (nonobstructive) vs Noncomm (obstructive)

  • VP shunt vs VA shunt

  • Mannitol

  • Flat in bed 24 hrs on unaffected side

  • Upright after 24 hrs

  • Avoid contact sports

  • Halo effect (leakage)

NEURAL TUBE DEFECT

  • Folic acid deficiency (B9) “green leafy vegetables”

  • Anencephaly and exencephaly

  • Spina bifida occulta, meningocele, and myelomeningocele

  • Latex allergy (kasi ung mga newborn nagdedevelop ng latex allergy, blood is made of latex)

CEREBRAL PALSY

  • Hypoxia

  • SAD Mixed: Spastic (spasm), Ataxic (wide gait/balance), Dyskinetic/Athetoid (“magaslaw”), or Mix of three

  • PDA: Persistent reflexes, Delayed development (universal sign), Abnormal postures

  • Lioresal (Baclofen)

  • Botulinum toxin

  • The neurologic injury is permanent, but the disorder itself is considered nonprogressive.

RHEUMATIC HEART DISEASE

  • Autoimmune

  • GABSH (Group A Beta Hemolytic Streptococcus) is the trigger

  • JONES CRITERIA for signs and symptoms: 2 major or 1 major with 2 minor

Major symptoms: (2 is required to confirm dx)

  • Carditis

  • Erythema marginatum

  • Polyarthritis (migratory)

  • Subcutaneous nodules

  • St. Vitus dance (Sydenham’s Chorea)

Minor symptoms: (2 is required if there’s only 1 major to confirm dx)

  • Fever

  • Arthritis

  • Raised erythrocyte sedimentation rate (ESR)

  • ESR is marker for inflammation (6-10)

  • ECG changes prolonged PR interval

Management

  • Corticosteroids

  • Aspirin

  • Penicillin (monthly injection sa pwet)

  • ASO (Antistreptolysin O) Titer

KAWASAKI DISEASE

  • Vasculitis (inflamed small and medium blood vessels)

  • Mucocutaneous (lymph node syndrome)

  • idiopathic (unknown) and self limiting

  • “winawasaki ugati maliiti mediumi lalaki” before mag 5

  • SIR RED (strawberry tongue, inflamed jts, red eyes, rashes or petechiae na namamalat, enlarged lymph nodes, desquamation)

  • Fever UNRESPONSIVE to meds

  • Dx: ESR > 20, increased platelet

  • Mgnt: DOC is Gamma globulin to shut down immune system, delay immunization, aspirin, abxicimab

  • Symptoms gone > platelet increase > MI

Similarity of RHD and KAWASAKI

  • Fever and inflammation

  • Arthritis

  • Rash

Complications

  • MI - severe abdominal pain

  • Aneurysm

  • Thrombosis

CONGENITAL HEART DEFECT

  • Acyanotic (left to right) vs. Cyanotic (right to left)

  • “AL nag CR”

  • If the disease starts with letter T or H: Cyanotic

  • If the disease starts with other letters: Acyanotic

Patent Ductus Arteriosus

  • Machinery like murmur

  • High prostaglandin affects patency

  • DOC Indomethacin (prostaglandin inhibitor)

  • Inotropes? pampalakas ng heart

Tetralogy of Fallot

  • “Boot shaped heart” or “Coeur-en-sabot”

  • “Tet Spell” or Cyanotic Spells. Immediately do knee-chest for infant and squatting for child to trap blood in lower extremities.

  • Four Defects “DROP”

    • Dextroposition of aorta (from left to the right)

    • Right Ventricular Hypertrophy

    • Opening in ventricular septum

    • Pulmonary stenosis

  • dx test: Echocardiography

  • Management

    • Give prostaglandin to keep ductus arteriosus open, para mag share ng blood from aorta since may pulmonary stenosis

    • Blalock taussig shunt

    • Corrective: Brock procedure

  • S/sx: fatigue, poor feeding, low birth weight

  • If not treated, will lead to chronic hypoxia (clubbing of fingernails or Schammroth’s sign) The body response is polycythemia.

  • Mngm: Beta blocker and Digoxin (Do not give if lower than 100 heart rate)

  • Digoxin toxicity: BANDAV

    • Bradycardia (<100)

    • Anorexia

    • Nausea & vomiting

    • Diarrhea

    • Abdominal pain

    • Visual disturbance

Cleft lip and Cleft palate

  • Cleft lip (male)

  • Cleft palate (female)

  • Risk factor: intake of valproic acid, nifedipine, thalidomide during pregnancy

  • CL: Cheiloplasty: 10 weeks 10 pounds 10 hemoglobin

  • CP: Palatoplasty: 12-18 months

  • Pre-op is special feeding bottle. Principles: ESSR

    • Enlarge nipple

    • Stimulate suck reflex

    • Swallow

    • Rest (burp)

  • Post-op is protect suture line

  • Logans bar and Elbow restraint to prevent infant in touching the suture

  • Remove restraints q 2 hours one at a time

The logan bow used on a patient after a cleft lip procedure.

Tracheoesophageal Fistula and Atresia

  • S/sx: 3C’s (Coughing, Choking, Cyanosis) + Drooling and saliva

  • Mgt: NPO and immediately refer for emergency surgery

Pyloric stenosis

  • “Olive shaped mass”

  • No food absorption

  • S/sx: Abdominal distention, olive shaped mass, peristaltic waves (left to right), projectile vomiting immediately (metabolic alkalosis)

  • Refer for emergency surgery (resection of affected part)

  • mgt: Pyloromyotomy (cut a portion of muscle to make a larger hole), aka Fredet-Ramstedt opening

Intussusception

  • “Sausage shaped mass”

  • Telescoping and invagination of intestine

  • Idiopathic

  • S/sx: Severe; intermittent abdominal pain

  • Currant jelly stool

  • Diagnostic and therapeutic: Barium enema (solution) and pneumatic enema (air)

  • Normal brown stool - effective treatment

  • mgt: Reduction surgery

Hirschsprung’s Disease

  • Aganglionic Megacolon (Ganglion pushes poop along intestine)

  • S/sx: Abdominal distention, bile stained vomitus, absent meconium stool 24-48, ribbon like stool

  • dx: Rectal biopsy (-) Ganglion

  • mgt: 2 stage surgery, corrective: pull through procedure for 12-18months