Important knowledge

JIA = ⬆️WBC,Platelate SLE = ⬇️WBC , Platelate

⚡️Complications of malnutrition -------------------------------- 🔸️Early complications : ▪︎infection [especially sepsis, pneumonia, and gastroenteritis.] ▪︎Hypoglycemia (may be sign of sepsis) ▪︎ heart failure ▪︎Micronutrient deficiencies [Vitamin A and zinc deficiencies] 🔸️Delayed complications : ▪︎permanent growth stunting ▪︎delayed development

Bitot spot Vit. A deficiency

⚡️Causes of prolonged fever

⚡️Infectious mononucleosis: ---------------------- 🛑the cause is EBV 🛑 clinical features: _ fever , malaise _jaundic _hepatosplenomegaly _skin rash _pharyngitis _tonsillitis _soft palate petechiae DX : CLINICALLY Supported by : atypical T lymphocytes Treatment: supportive *{منقول}

If you are not asked about this in exam you will be asked about this in future .

⚡️Kawasaki disease ----------------------- Is systemic vasculitis for Unknown etiology. 🛑 age : more in children 6m to 4 years Especially in the end of first year More severe and atypical(not all features present) in young children. 🛑the most important thing in this disease is early diagnosis and early prompte treatment due to risk of aneurysm of coronary arteries ➡️ inflammation ➡️narrowing (scar formation)➡️myocardial ischemia ➡️sudden death. 🛑 clinical features(criteria): high fever (difficult to control) more than 5 days & 4 of 5 of the following criteria : 1-conjunctivitis ( severe red eye) 2-pharyngeal injection [enlarged cervical lymph nodes in other references] 3-red dry cracked lips. 4_skin rash (polymorphus) 5_red edematous palm and sole with peeling of fingers and toes. 🛑DX : clinically only  (no diagnostic tests) 🛑suppprtive tests: 1–very high c-reactive protein 2–high ESR 3–high WBC 4–high platelets count in (2nd week )of disease 🛑most important and serious complications of kowalski disease are: 1–aneurysm of coronary arteries (and other arteries) 2–myocarditis and endocarditis 3–gallop rhythm By ECHOCARDIOGRAM 🛑TX : 1–IVIG for first 10 days of illness (((🛑to reduce risk of aneurysm ))) 2–high anti inflammatory dose of aspirin for fever until subside then low anti platelets dose until ECHO study do afrer 6 weeks If no aneurysm stop aspirin If aneurysm present give long term warfarin. 3–if fever persists after treatment we shoulde give second IVIG dose 4–if fever and symptoms persist we should give Steroid , infliximab , cyclosporine *{منقول}

⚡️Homocystinuria ----------------------------- هذا يشبه ابو ال marfan syndrome يكون طويل واشكر نفرقة عن ابو ال marfan بشغلتين ▪︎ectopia lentis تكون up word بجماعة ال marfan بينما down word بجماعة ال Homocystinuria ▪︎IQ يكون طبيعي بجماعة ال marfan بينما يكون low بجماعة Homocystinuria

⚡️Notes in examination of DM patient د.اسامة ----------------------------------- 🔹️neck ▪︎lymph nodes ▪︎acanthosis nigricans ▪︎thyriod 🔹️upper limbs ▪︎Pryor sign (joint stiffness) 🔹️lower limb ▪︎periphral neuropathy -sensation -properioception -reflexes 🔹️sites of injection اذا يضل يضرب بنفس المنطقة يصير lipoatrophy وبعد ماكو pain بالمكان والطفل يكيف عليها لكن بنفس الوقت بعد ماكو absorption بالمنطقة لذلك لازم نغير مكان ال injection

⚡️Mx of cerebral odema in DKA ------------------------------- 1) Elevation head of the bed 2) decrease rate of fluid 3)mannitol 🔹️ don't jump immediately to mannitol

⚡️Acute complications of DKA ( د اسامة ) ----------------------------- ▪︎hypokalemia ▪︎cerebral edema ▪︎acute renal failure ▪︎hypophosphetemia ▪︎pulmonary odema ▪︎pneumothorax ▪︎chest infection (mucor mycosiss) ▪︎pancreatitis ▪︎bowel ischemic

⚡️Try to avoid mechanical ventilation in DKA

⚡️Any child >3Y old presented with acute abdomin (appendicitis picture) check random blood Sugar (RBS) may be DKA

⚡️Acidotic breathing is seen only in severe DKA

⚡️Criteria for DKA ------------------------------ ▪︎D = diabetes ( ⬆️ random blood sugar >250mg/dl) ▪︎K = ketone (in blood or urine [>2 in urine]) ▪︎A = acidosis (ph <7.35)

⚡️Euglycemic DKA = ماخذ انسلولين قبل ليجي للطوارئ

⚡️Don't miss Random blood sugar in any toddler presented with chest infection or diarrhea may be DKA (hyperglycemia)

⚡️There is two presentation of DM type -------------------------------- اما يجي بال classic presentation على شكل ▪︎Polyuria, ▪︎polydipsia, ▪︎increase appetite, ▪︎weigh loss او يجي على شكل DKA ▪︎nausea & vomiting ▪︎Abdominal pain ▪︎⬇️ level of conscious ▪︎rapid & deep breathing ------------------

⚡️neonatal DM can given any type of insulin (moderate acting is preferred) ▪︎ال Soluble يسويلنا hypoglycemia لذلك نتجنبه

⚡️Hb a1c in DM patient ▪︎<7 mg/dl controled ▪︎7-9 mg/dl fair or moderately controled ▪︎>9 mg/dl poorly controlled