Lec.1
Pediatrics
6
th
stage
Session+Tutorial Notes
د.رياض
The degree to which the pt is considered febrile =38.3centigrade.
*The tool for measuring temperature is "thermometer"
*Sites of measuring the body temperature:-
1-axillary:the most common route
2-oral
3-rectal:-the most accurate route
4-from tympanic membrane :-otometry
*Axillary temperature is 0.5 centigrade less than that of oral & 1
centigrade less than that is of rectal
*be careful drug fever ?but which drugs?
-Injections like ceftriaxoneEven Intravenous fluid could elevate our body
temperature
*Investigations :-
CBC
ESR
CRP
CXR (if cough is present or any sign of RD)
US
Even B.M exam
*PUO:-pyrexia of unknown origin :-8days of elevated body temperature
(fever)with basic physical examinations & investigations (as inpatient or
outpatient) but there is no clear cause.
*always in fever ask about travelling to other areas .
*Some of researchers put priority for these diseases as causative agents
for PUO:-
1-UTI
2-Kawasaki disease
3-EBV infection
*rash types also can give you clues about the underlying disease
*is there rigor ?"rigor in brucellosis is common",,is there any
sweating"as in T.B"
*2spikes of increased body temperature :-Falciparum malaria
*fever at morning & evening :- typical of Kala – azar
**Kawasaki disease:-fever for 5days,injected eyes,redness of mouth
with fissuring of lips ,increase ESR,increase CRP,leucocytosis
*most PUO remit with time ""pyrexia of unknown source""
NOTES : important points in Hx that shouldn't be forgotten:-
1-where do the pt lives,always ask about it?
2-the fever ,doctor diagnosed it or the mother?how?
3-the symptoms that the pt suffer are they in home or at
hospital?means write the pt condition now & before.
*In convulsion Hx taking:-
Ask about vaccination recently?
Vomiting and diarrhea?because this results in hypokalemia
tetany
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رؤى
sometimes Otitis media + feverconvulsion,so don't miss the
examination for sore throat
*Causes of big head?
1-congenital hydrocephalus.
2-storage disease
3-arnold chiari malformation.
*in pt with big head ,how would you proceed the exam?
Fontannelles ,sutures ,the back for spina bifida
(meningomyelocele).
**Dandy walker :-there is enlargement of the head posteriorly
(prominence +elongation)
The 4
th
ventricle is enlaged.
*in anuric pt :- try to concentrate on these points in the history:-
1-is the child /infant constipated?
2-Vomiting or /& diarrhea present?
3-dysuria?
*if we suspect imperforated hymen,we should check Tanner staging
Menstrual cycle mostly at 3
rd
or 4
th
stage.
Other causes of anuria:-
1-acute renal shutdown
2-drugs
3-GN
4-renal tubular necrosis
5-HUS
But these previous conditions came with the patient
"edematous+tired+acidotic"
*oliguria <1ml /kg/ hr
While anuria <180ml/24hrs.
Investigations in anuric pt:-accordingly:-means depending on the
condition you suspect:
RFT
CBC\Blood culture
US
CT scan