E-Loops

Part 1
Please try to study everything about
these condi:ons and try to look at more
pictures.
All the images are from Google.
10 Kg baby.. Calculate the uid requirements.

Maintenance:
10 kg x 100 mL = 1000 mL.
Decit:
10% (severe dehydra:on) x 10 kg x 10 = 1000 mL.
Ongoing losses:
An es:mate ~ 100 mL.
8 mo old baby brought for irritablity

Right 2 signs?
- Red.
- Bulging.
- Loss of normal cone of light.

Diagnosis?
- Acute O::s Media.

What happened?
- Perfora:on.
 Full-term newborn boy. No meconium.

X-ray abnormali:es?
- Double bubble, no intes:nal gas a\er the bubbles.
What symptoms do expect based on the x-ray?
- Abdominal distension, bile stained vomi:ng.
What blood test do you want to order?
- Karyotyping.
What do they present with antenataly?
- Polyhydramnios.
2 year-old presents with a 6-days history of fever. He is found to have enlarger
cervical lymph nodes. He was giving amoxicillin without improvement.

Whats your dieren:al diagnosis?

- Kawasaki disease.
- Scarlet fever.
2 year-old asthma:c pa:ent presents with a sudden cough.

What do you see in the x-ray?

- Hyperina:on and air trapping on
the right.

Whats your diagnosis?

- Foreign body aspira:on.
1 year old with chronic diarrhea

What do you see in the x-rays?

- Widening of the wrist, cupping, poor mineraliza:on of the carpal bones.
- Ricke:c rosaries.
- Bowing of the legs.
8 month-old boy presents with fever and irritability.

Whats the most important test to do?

- Lumbar puncture.
Whats the most likely diagnosis?
- Meningi:s.

List other causes of fever and irritability

- UTI.
- O::s Media.
18 month-old presents with fever, refusal to eat or drink, and mued
voice.

What do you see in the picture?

- Tripod posi:on.
- Open mouth indica:ng breathing diculty.

What should you do to this pa:ent?

- Examine the throat with the tongue depressor?
- NO, it interferes with breathing.
- Do a lateral x-ray?
- No, may not be helpful.
- Reassure the mother?
- This is a serious condi:on.
- Call the anesthe:st?
- YES, this pa:ent need intuba:on.

The diagnosis is epigloi:s caused by Hemophilus inuenza B.

- Hib epigloi:s is almost never seen now due to the vaccine.
8 months-old girl presented with diarrhea. Her weight was 10 kg now its 9 kg.

The pictures show:

- Reduced skin turgor.
- Depressed anterior fontanel.

Calculate her uid requirements:

- Degree of dehydra:on = weight loss = 10% = severe.
- Maintenance = 10 kg (original weight) x 100 ml = 1000 ml/24 hrs.
- Decit = 10% x 10 x 10 kg (original weight) = 1000 ml/24 hrs.
- Ongoing losses = an es:mate ~ 100 ml.
- Overall = 2000 ml/24 hrs + es:mate for ongoing losses.
A 10 year-old presented with abdominal pain, diarrhea, and painful skin lesions.

Whats the most likely diagnosis?

- Crohns disease.
2 month-old baby with a concerned mother.

Whats your diagnosis?

- Hemangioma

How will you manage it?

- Protect it as it is liable for bleeding and hemorrhage.
- Beta-blockers.
- Steroids.
2 year-old boy presented with delayed speech. He sat at 7 months, walked at 14
months, obeys commands and plays with other kids.

Whats your diagnosis?

- Secretory o::s media

What will you do next?

- Refer for ENT.
- Gromet tube inser:on.
- Decongestants.
10 month old boy, previously healthy, just started crawling, afebrile, presented with
his rst apack of wheezing.
X-ray ndings:
- Decreased lung volume and
haziness in the right side.
Medias:nal shi\ to the right.
(atelectasia). (A).
- Peanut. (B).

Whats the next step?

- Bronchoscopy.
A 7 year-old previously healthy boy presents with abdominal pain.

What complica:ons might the pa:ent have?

- Renal complica:ons nephro:c/nephri:c syndrome and
ESRD.
- Intussuscep:on.
- Trs:cular torsion.
3 year-old girl presents with fever for 4 days.

Pas:a lines

Whats the most likely diagnosis?

- Scarlet fever.
 Describe the skin lesios:
- Macules, papules, vsicles, and dry crusts.
- Dierent stages and sizes.

Whats your diagnosis?

- Chicken pox.

What are some of its complica:ons?

- Celluli:s.
- Necro:zing fascii:s.
- Ataxia.
- Pneumonia.
- Pyogenic arthri:s.
- Osteomyeli:s.
- Encephali:s.
- Myosi:s.
- Etc..
Well baby but concerned mom.

What is this called?

- Salmon patch or naevus simplex.
- On the back of the neck: stroke bite.

These are pink at lesion on the face.

They usually disappear by 18 months.
A 7 month-old boy with a history of upper respiratory tract infec:on. He was given 3
courses of an:bio:cs.

What do you think the pa:ent has?

- Candida infec:on.
A 4 year-old presents with fever and sore throat.

Where else would you like to examine?

- The feet.

Whats the causa:ve organism?

- Coxsackie virus.
A 1 year-old presents with irritability, seizures, and delayed development.
Describe two clinical signs from the picture:
- Macrocephaly.
- Sun seing eyes.
How will you manage?
- ABC
- Seizure management (diazepam,
lateral posi:on, etc..)
- Call neurosurgeon (for VP shunt).

What examina:ons and tests will be helpful?

- Serial head measurements for increased ICP.
- Check the fontanel for increased ICP.
- Check the blood pressure (will be high) and the heart rate (will be slow) do to
the increased ICP.
- CT to see the ventricles.
What is this called?
- Infan:le seborrheic derma::s, or cradle cap.

Where else you might nd it?

- Face.
- Neck.
- Axilla.
- Diaper area.
A 9 month-old presents with fever of 40oc for 3 days and seizures. The fever subsided 3
days later and a rash appeared at the same :me.
What is this called?
- Roseola infantum.

Whats the causa:ve organism?

- Human Herpes Virus 6.
A 6 year-old girl presents with convulsions. His father also has some skin lesions.

The pa:ent.
The pa:ents father.

Whats your diagnosis?

- Neurobromatosis.

Whats the inheritance papern of this condi:on?

- Autosomal dominant.
 A 4 year-old presents with a main complaint of short stature.

What abnormali:es do you see in the picture?

- Armor chest.
- Webbing of the neck.
- Low posterior hairline.
- Spooning or U shaped nails.
What complica:ons do you expect this pa:ent to have?
- Cardiac (coarcta:on of the aorta).
- Infer:lity.
- Failure of sexual matura:on.
- etc..
This 3 year-old recently joined a nursery. What do you expect his main complaint to be?
The main complaint would be:
- Itching mainly at night.

This condi:on is highly communicable so the

en:re household might need to be treated.

Pinworm, or thread worms

(Enterobius vermicularis)