Topics For Pediatrics Exam 5th Year

First Semester

1. Tonsilitis Etiology:
Generally, by viruses (Adenoviruses, Coxsackie Virus, CMV, EBV, HPV, RSV, Rhinovirus) / Group A beta
haemolytic streptococci is the only bacterial agent.
2. Viral Pharyngitis Symptoms:
Viral: Conjunctivitis/ Cough/ Hoarseness/ Oral Mucosa Inflammation/ Common Cold Symptoms/
Diarrhea/ Rash.
3. Group A Streptococcus Symptoms:
Abdominal Pain/ Fever/ Headache/ Nausea/ Vomiting/ Sore Throat/ Exposure History/ Patchy Throat
Exudates/ Palatal Purple Spots/ Scarlatiniform Rash/ Tender Cervical Nodes
4. Diagnosis In Streptococcal (Infection) Amigdalitis:
Age>5yrs / Fever / Exudates / Throat Culture / Tender Anterior Cervical Lymphadenopathy /
Scarlatiniform rash / Exposure History / Rapid Ag test for Group A streptococci / (Antistreptolysion O)
for immune response after exposure.

5. Centor And Mcisaar Scores To Predict Group A Streptococcal Pharyngitis:

It’s a score to predict Group A Streptococcal Pharyngitis.
Fever 1, Absence of cough 1, Anterior cervical lymphadenopathy 1, Tonsillar exudate 1.
 4 points (treat with Antibiotics & Don’t test).
 2-3 points (+ Rapid AgT = treat with antibiotics) / (-RAgT = throat culture).
 0-1 point (no further tests, no antibiotics).
 McIsaac score adds the age criteria to Centor score: +1; >45yo—> -1
6. Lemierre Syndrome Stages: 3 Stages:
 Pharyngitis (sore throat for a week)
 Invasion of lateral pharyngeal space & IJV septic thrombophlebitis (swollen, tender neck)
 Metastatic complications (fever, pulmonary infiltrates, joint involvement).
7. Complication Of Infection With Group A Streptococcus:
Peritonsillar Abscess: dyspnea, dysphagia, abscess rupture, spreading the infection.
Rheumatic Fever: rheumatic heart disease, arthritis, Sydenham chorea.
Poststreptococcal GN: Hematuria, Edema, Hypertension
Scarlet Fever: Otitis media, Sinusitis, Pneumonia.
8. Gas Pharyngitis Treatment:
 Non-Allergic Pz (Penicillin or Amoxicillin)
 In Allergic Pz (Cephalosporin 10 Days or Clindamycin or Clarithromycin 10 Days / Or Azithromycin 5
Days)
 In Severe Throat Pain (Acetaminophen or Ibuprofen).
9. Diphtheria symptoms:
 Headache / Sore Throat / Dysphagia / Dyspnea / Cough / Hoarseness / Chills, Fever.
 Swollen Cervical Nodes / Pharyngitis / Grey Membrane in Throat / Nasal Passage.
10. Kawasaki disease criteria:
Fever / conjunctival injection / mouth: (erythema, fissuring, crusting of lips, strawberry tongue) / hands
& feet indurations / palms & soles erythema / fingertips desquamation, nails transverse grooves,
erythematous rash, enlarged lymph node (>1,5cm).

11. Herpangina clinical tests:

 Sudden Fever / Headache, Backache / Vomiting / Oropharyngeal Lesions (1-2 mm).
 Clinical tests: Throat swab or vesicle swab PCR testing.
12. Epstein Barr Main Symptoms:
fever, sore throat, malaise, pharyngeal injection with exudates, posterior cervical adenopathy,
hepatosplenomegaly
13. Infectious Mononucleosis Lab Test:
lymphocytosis, atypical lymphocytes on CBC, Monospot test, EBV- specific serology, CMV testing
14. Adenovirus pharyngitis:
(Pharyngoconjunctival Fever): Sore Throat / Fever / Dysphagia / Redeyes Conjunctivitis.
15. Hand foot mouth disease:
 Caused by contagious intestinal viruses of the Picornaviridae family.
 Characteristics: Rash / Bumps in (HFM) / Fever / Malaise / Sore throat / Anorexia.
 1st causes (Coxsackievirus A16) & 2nd cause (Enterovirus 71).
16. Aetiology of Acute Nasopharyngitis:
 Rhinoviruses and Coronaviruses (upper RT) / Adenoviruses, Enteroviruses and RSV.
17. acute nasopharyngitis Symptoms:
 <3m = Afebrile / 3m-3yrs (Fever) / >3yrs = Low Fever
 >3m: Fever, Irritability, Restlessness, Sneezing, Nasal Discharge, Vomiting, Diarrhea, 2nd - 3rd Day
Congested Eardrums
 > 3yrs: Nasal Dryness, Irritation, Discharge / Cough, Sneezing, Chills, Malaise, Anorexia, Headache,
Muscular Pain, Low Fever, Acute Phase 2-4 Days
18. Didderential Diagnosis Of "Common Cold":
Influenza/ Allergic Rhinitis/ Sinusitis/ Rhinosinusitis/ Acute Pharyngitis / Strep Throat/ COVID-19/
Pertussis/ Tonsillitis/ EBV/
19. Complications Of Common Cold:
Otitis Media, Mastoiditis, Peritonsillar Cellulitis, Sinusitis, Periorbital Cellulitis May Occur.
20. Treatment Of Common Cold:
No specific therapy, antibiotics is ineffective
Acetaminophen, Ibuprofen (reduce aching, irritability, malaise for the first 1-2 days).
Nasal instillation, sterile saline (mucus removal)/Phenylephrine (nasal decongestant).
Nasal spray (older children).
21. Laringitis – Etiology:
Viral (Parainfluenza viruses, Adenoviruses, RSV, influenza, and measles viruses)
Bacterial (Haemophilus influenzae b, Strepto pyogenes, Strepto pneumoniae, Staphylo aureus)
22. Acute Epiglottitis Symptoms:
(High Fever, Sore Throat, Dyspnea, Prostration, Dry Cough)/ (Muffled Potato Sound).
Awakens at Night: (High Fever, Aphonia, Drooling, Stridor). Dysphagia, Pallor, Cyanosis.
Hyperextended Neck, Sitting or Leaning Forward w/ Open Mouth & Tongue Out.
23. Symptoms Of Hypoxia:
Restlessness, anxiety, tachycardia/tachypnea, bradycardia, extreme restless, dyspnea.
In paediatrics: feeding difficulty, inspiratory stridor, nares flare, expiratory grunting, sternal retractions
24. Spasmodic Croup – Symptoms:
Occurs at Night With (Barking, Metallic Cough, Noisy Inspiration, Respiratory Distress).
Afebrile, Bradypnea, Pulse Accelerated, Skin Cool & Moist.
25. Complication Of Viral Croup:
Involves: (Respiratory Tract, Middle Ear, Terminal Bronchioles or Pulmonary Parenchyma).
Pneumonia / Interstitial Pneumonia / Bronchopneumonia / Pneumothorax / Otitis.
Bacterial Tracheitis / Suppurative Tracheobronchitis / Mediastinal Emphysema.
Septic Arthritis / Meningitis / Cervical Lymphadenitis.
26. Criteria For Hospitalisation In Croup:
Actual or suspected epiglottitis / Progressive stridor / Severe stridor at rest / Respiratory distress /
Hypoxemia / Restlessness / Cyanosis / Pallor / Depressed sensorium / High fever in a toxic appearing
child
27. Treatment With Racemic Epinephrine In Laringitis:
IV fluids in (moderate-severe respiratory distress). Oxygen for(hypoxemia).
Racemic Epinephrine by aerosol (2,25% solution, 0,05 ml/kg -max: 0,5 ml) for symptoms relief.
Dexamethasone (0,6 mg/kg single dose) with improvement within 4-6 hours.
28. Dexamethasone For Laringitis:
Dexamethasone (0,6 mg/kg single dose) with improvement within 4-6 hours.
29. The Antibiotic Treatment In Epiglottitis:
Medical emergency: should be treated immediately with artificial airway placement.
Ceftriaxone or Cefotaxime for 7-10 days should be given parenterally.
30. Bronchiolitis – Etiology:
Viral: RSV, adenovirus, parainfluenza 1–3, influenza A and B virus, human metapneumovirus, bocavirus,
rhinovirus, and coronavirus.
31. Bronchiolitis – Symptoms:
(Fever, Rhinorrhoea, Tachypnoea, Apnoea, Dry Cough)/ (Dyspnoea = Feeding Problems)/ (Subcostal,
Intercostal, Supraclavicular Recessions)/ Chest Hyperinflation/ Cyanosis)
(Nasal Flaring +/- Grunting)/ (O2 < 92%)/ lethargy/ (all lung Crackles, high pitched Wheezes).
32. Clinical Features For Severe Respiratory Disease:
Poor feeding (<50% of usual fluid intake in preceding 24 hours) / Apnea / Respiratory rate > 70/min /
Presence of nasal flaring and/or grunting / Severe chest wall recession / Cyanosis / Oxygen saturation ≤
94%
33. Bronchiolitis Investigations:
Rapid RSV test, nasopharyngeal aspirate immunofluorescence test, CXR (indicated in severe cases or
when diagnosis is uncertain), Blood: (gas, C-RP, culture, WBCs) / Urine & CSF: (culture, analysis).
34. Bronchiolitis Diferential Diagnosis:
Pulmonary: Pneumonia (Mycoplasma, Chlamydia), TB, Congenital lung disease, Cystic fibrosis, Inhaled
foreign body, Pertussis, Laryngotracheomalacia,
Non-pulmonary: Congenital heart disease, Sepsis, Severe metabolic acidosis, GERD, Vascular ring,
Allergic reaction, Mediastinal mass, Tracheoesophageal fistula.
35. Criteria For Admision In Acute Bronchiolitis: Admit children with: history of apnoea, Sat O2 <92%,
dehydration.

36. Treatment With Salbutamol In Bronchiolitis:

Consider a trial of salbutamol if: (6 months old, History of atopy, Previous history of wheeze)
If a trial is indicated, then give 6 puffs of 100mcg salbutamol via the spacer (one puff at a time through
the spacer).
Assess whether the child has improved 20 minutes after.
37. Ripavirin In Bronchiolitis:
Ribavirin should only be considered for IV therapy in immunocompromised children with severe RSV in
the ICU, where it may slightly reduce ventilation and hospital stay. Its use is controversial and carries
risks. Nebulized ribavirin requires a well-ventilated room with negative pressure and continuous
aerosolization for up to 18 hours daily. It is expensive and not recommended for routine use, except in
severe cases of immunocompromised patients or those with cardiopulmonary disease.
38. Discharge Planning In Bronchiolitis:
Child clinically stable and improving / Severity mild-moderate / SaO2 ≥ 92% on air (should be off O2 for
4 hours) / Feeding adequately (at least 2/3 of normal feeds) / Family feel confident in being able to
manage at home / Family has ability to return or seek assistance if deterioration occurs.

39. Complication Of Bronchiolitis:

Respiratory failure / Apnea / Pneumothorax / Bacterial superinfection / Hypoxemia / Dehydration /
Acute respiratory distress syndrome (ARDS) / Recurrent wheezing / Failure to thrive / Secondary
infections
40. Palimizumab For Bronchiolitis:
IM monoclonal antibody / given monthly for 5 months in winter (15mg/kg/Dose) / month. /
Decreases hospitalization rates from RSV in high risk patients.
41. Risk Factors For Pneumonia:
Medical factors: prematurity; age <1 year; immunosuppression; malnutrition
Environmental factors: passive smoke exposure; winter; overcrowding/inadequate housing; indoor fuel
exposure

42. Common Causes Of Cap In Children:

Bacteria: Strep Pneumoniae; H. Influenzae; Staph Aureus; Mycobacterium Tuberculosi
Atypical Bacteria: Mycoplasma Pneumoniae; Chlamydia Pneumoniae
Viruses: RSV; Human Metapneumovirus; Parainfluenza 1&3; Adenovirus; Influenza A&B; Rhinovirus
43. Lobar Pneumonia Stages:
First Stage: (within 24h of infection) microscopically visible vascular congestion & alveolar edema,
presence of many bacteria & few neutrophils.
Red Hepatization: erythrocytes, neutrophils, desquamated epithelial cells & fibrin within the alveoli.
Gray Hepatization: lung is gray/brown/yellow due to fibrinogen purulent exudate, RBC disintegration &
hemosiderin.
Resolution: resorption & restoration of pulmonary architecture. Fibrinous inflammation may lead to
organization & pleural adhesions.
44. Symptoms And Signs Of Pneumococcal Pneumonia:
Fever / Chills / productive Cough / Pleuritic chest pain / Dyspnea / Tachypnea / Tachycardia /
Hypoxemia / Fatigue / Nausea / Vomiting / Cyanosis / Signs of consolidation/ Confusion or altered
mental status/ Respiratory distress: nasal flaring, decreased breath sounds, retractions, cough.
45. Respiratory Distress Signs:
tachypnea {0-2mo >60; 2-12mo>50; 1-5y>40; >5y>20}, dyspnea, apnea, nasal flaring, decreased breath
sounds, retractions, cough; altered mental status, pulse oximetry <90%.
46. Phisical Signs In Pneumonia:
consolidation: dullness/ increased tactile fremitus / reduced normal vesicular breath sounds / increased
bronchial breath sounds / fine end-inspiratory crackles.
Signs of effusion: dullness/ decreased tactile fremitus / absent breath sounds, associated with
dehydration and/or sepsis.
47. Radiological Findings In Pneumonia:
Segmental or lobar opacity: S. Pneumoniae
Cavitary lesions and bulging lung fissures: K. Pneumoniae & S. Aureus
Cavitation and pleural effusions: S. Aureus and Gram-negative bacteria
Focal infiltrates: atypical pathogens, M. Pneumoniae & C. Pneumoniae.
48. Antibiotical Treatment In Pneumococcal Pneumonia:
First line therapy should be Amoxicillin 75-100 mg/kg/day (divided 3 times a day) for previously healthy,
immunised infants or preschoolers with suspected bacterial pneumonia.
Severe pneumonia—>Ceftriaxone IV/IM or Cefotaxime IV + Clarithromycin or Azithromycin
49. Antibiotic Treatment Of Atypical Pneumonia: Clarithromycin or Azithromycin are given orally
50. Hospitalization Criteria For Pneumonia: Respiratory distress or Hypoxemia (O2 <90%) / Suspicion
of infection caused by MRSA / Infants 3-6 months old / Family unable to provide appropriate care.
51. Oxygen Treatment In Pneumonia:
Oxygen therapy is used when there is: central cyanosis; lower chest in drawing; grunting; restlessness;
inability to drink or feed; and respiratory rate > 70 breaths per minute.
52. Complications Of Pneumonia:
Pulmonary: empyema/ pleural effusion/ pneumothorax/ lung abscess/ necrotizing pneumonia/ acute
respiratory failure. / Systemic: sepsis / hemolytic uremic syndrome.
Metastatic: meningitis / CNS abscess / endo/pericarditis / osteomyelitis / septic arthritis.

53. Signs And Symptomes For Viral Pneumonia: Fever / Cough (typically non-productive) / Dyspnea /
Tachypnea / Wheezing / Asthenia / Malaise / Pleuritic chest pain / Hypoxemia / Cephalalgia / Myalgia /
Pharyngitis / Rhinorrhea / Cyanosis (in severe cases) / Fine crackles (rales) on auscultation / Chills /
Headache / Fatigue.

54. Viral Pneumonia Treatment: Mild viral CAP doesn’t require antibiotics. For moderate/severe cases,
early antivirals (Oseltamivir, Zanamivir, Amantadine, Rimantadine) are recommended. Annual
vaccination is advised for children with chronic conditions, and Palivizumab is recommended for high-
risk infants.

55. Complication Of Viral Pneumonia: Focal necrosis and airway plugging, atelectasis,
bronchospasm, apnea spells, respiratory failure, bronchiectasis, bronchiolitis obliterans and pulmonary
fibrosis
56. Pleuresy – Symptoms: Sharp chest pain, worsened by breathing or coughing / Pain referred to the
shoulder or back / Dyspnea / Decreased breath sounds / Dullness to percussion (if exudate is present) /
Possible asymptomatic presentation / Child may lie on the affected side.
57. Dry Pleuresy – Treatment: NSAIDs for pain and inflammation / Analgesics for pain relief / Bed rest
to reduce respiratory excursion / Corticosteroids in severe cases
58. Pleural Effusion - Symptoms:
As fluid accumulates, pleuritic pain may disappear. Large collections cause retractions, tachypnea, or
cyanosis. Friction rubs are detected early or late in the plastic stage. /Cough / Dyspnea / Tachypnea /
Orthopnea / Pleuritic chest pain / Decreased breath sounds / Dullness to percussion / Decreased tactile
fremitus / Mediastinal shift away from affected side / Cyanosis (in severe cases) / Crackles or rhonchi (if
pneumonia present).

59. Pleural Effusion – Laboratory Findings: Leukocytosis / Low pH / Elevated LDH / Increased protein
concentration / Positive culture for pathogens (if infection).
CXR (Small effusions may cause obliteration of the costophrenic or cardiophrenic angles or widening of
the interlobar septa.
60. Pleural Effusion Complication:
 Empyema / Fibrothorax / Respiratory distress / Pulmonary fibrosis / Infection / Chronic pleuritic
pain / Pleural thickening / Mediastinal shift / Hypoxemia / Atelectasis / Persistent pleural effusion.

61. Pleural Effusion Treatment:

Address underlying disease / Drain fluid for large effusions to improve comfort / Avoid rapid removal of
≥1 L of fluid to prevent re-expansion pulmonary edema / Chest tube drainage if fluid reaccumulates and
causes respiratory distress / Tube thoracotomy if pleural fluid pH <7.20 or glucose <50 mg/dL in
suspected parapneumonic effusion / For purulent fluid, use tube drainage with thrombolytic therapy or
video-assisted thoracoscopic surgery / Provide analgesia and supplemental oxygen if necessary /
Administer specific antibiotics for acute pneumonia.

62. Empyema Laboratory Findings:

Bacteria present on Gram staining / pH <7.20 / >100,000 neutrophils/μL in pleural fluid / Positive
culture for pathogens (58% for pneumococcus) / Negative culture may be followed by pneumococcal
PCR test / High yield from blood cultures / Leukocytosis / Elevated sedimentation rate.

63. Staphylococcus Aures Pneumonia Symptoms And Signs: High fever / Abdominal pain / Tachypnea
/ Dyspnea / Localized or diffuse bronchopneumonia or lobar disease / Necrotizing pneumonitis /
Associated with empyema / Pneumatoceles / Pyopneumothorax / Bronchopleural fistula.

64. Staphylococcus Aures Pneumonia Treatment:Antibiotic therapy alone is ineffective for undrained
abscesses or infected foreign bodies; incision and drainage are required.
Initial treatment for MSSA infection: Nafcillin, Oxacillin, Dicloxacillin / Cefazolin, Cephalexin.
For Penicillin-allergic or MRSA: Vancomycin.
Trimethoprim-Sulfamethoxazole may treat MSSA and MRSA.

65. Early Children Risk Factors For Persistent Asthma

-Parental asthma /Exposure to chlorinated swimming pools / Reduced lung function at birth
-Allergy: eczema, allergic rhinitis, food allergy, inhalant allergen sensitisation,
-Severe LRTI: pneumonia, bronchiolitis requiring hospitalisation, wheezing apart from colds.
-Male gender / Low birthweight/ smoke exposure /Possible use of acetaminophen
66. Asthma Triggers:
viral respiratory infections, aeroallergens in sensitised asthmatic patients (indoor allergens, dust mites,
cockroaches, molds), seasonal aeroallergens (pollens, seasonal molds), tobacco or wood smoke, air
pollutants (particulate matter), strong odours (perfume, cleaning supplies), occupational exposure,
cold/dry air, exercise, co-morbid conditions (rhinitis, sinusitis, GE reflux).
67. Symptoms Of Asthma
Dry coughing (worse at night), expiratory wheezing / Dyspnea, chest tightness, and respiratory distress
68. Radiology In Asthma:
CXR: helpful in identifying abnormalities that are hallmarks of asthma masquerades (aspiration
pneumonitis, hyperlucent lung fields in bronchiolitis obliterans), and complications during asthma
exacerbations (atelectasis, pneumomediastinum, pneumothorax).
69. Inhaled Corticosteroids In Asthma:
ICS improve lung function & reduce asthma symptoms, AHR, and use of “rescue” medications; most
important, it has been found to reduce urgent care visits, hospitalizations, and prednisone use for
asthma exacerbations by about 50%.
Currently, 6 ICSs are approved for use in children ICS are available in Metered-dose inhalers (MDIs), dry
powder inhalers (DPIs), suspension for Nebulization. Fluticasone propionate, mometasone furoate,
ciclesonide, and budesonide are considered “2nd-generation” ICSs, Mouth rinsing after ICS use is
recommended.
70. Omalizumab In Asthma:
Humanised monoclonal antibody that binds IgE, preventing its binding to the high-affinity IgE receptor
and blocking IgE-mediated allergic responses and inflammation; given every 2-4 wk subcutaneously, the
dosage based on body weight and serum IgE levels.
71. Myocarditis Etiology:
Viral: coxsackie virus, enteroviruses, adenovirus, parvovirus, EBV, cytomegalovirus, HIV & Influenza,
HCV. Bacterial (Mycobacterial, Chlamydia Pneumonia, Strepto, Mycoplasma Pneumonia, Treponema
Pallidum). Diphtheritic myocarditis is unique as bacterial toxin may produce circulatory collapse and
toxic myocarditis characterized by AVB, BBB, or PVC. Additional non-viral infectious (rickettsia, protozoa,
parasitic infections, and fungal disease).
72. Myocarditis Clinical:
fever, respiratory distress, tachycardia, hypotension, gallop rhythm, and cardiac murmur. rash or
evidence of end organ involvement such as hepatitis or aseptic meningitis. chest discomfort,
palpitations, easy fatiguability, syncope. Hepatomegaly, peripheral edema.
73. Myocarditis Treatment:
Inotropes (milrinone) for severe HF / Diuretics, ACE inhibitors, or ARBs for compensated HF
Antiarrhythmic: amiodarone / Controversial Therapies: IV Ig and corticosteroids improve outcomes in
fulminant myocarditis. / Antiviral therapies not recommended.
74. Pericarditis Clinical:
sharp chest pain, positional, radiating, worse with inspiration, and relieved by sitting upright or prone.
nonspecific symptoms (Cough, fever, dyspnea, abdominal pain, vomiting). tachycardia, narrow pressure,
pericardial friction rub. Cardiac tamponade is recognized by the excessive fall of systolic BP (>10 mm Hg)
with inspiration. This pulsus paradoxus can be assessed by auscultatory BP determination. Signs:
hypotension, Jugular Distention, diminished heart sounds (Beck's triad)
75. Laboratory Findings In Pericarditis:
Blood Tests: Nonspecific findings like leukocytosis and elevated ESR.
ECG: ST-E and PR-segment depressions in acute cases / T-wave inversions after several days.
Echo: Detects effusion and confirm diagnosis / Normal in fibrinous pericarditis.
CXR: "Water-bottle heart" sign in massive pericardial effusion /CT: show pericardial effusion.
76. Infective Endocarditis Clinical:
Prolonged fever without other manifestations that persists for months may be the only symptom.
nonspecific (low-grade fever with afternoon elevations, fatigue myalgia, arthralgia, headache, chills,
nausea, vomiting, heart murmurs, Splenomegaly, petechiae). Serious neurologic complications:
(embolic strokes, cerebral abscesses, mycotic aneurysms, hemorrhage. Meningismus, increased
intracranial pressure, altered sensorium, and focal neurologic signs). Cardiac (Heart murmurs,
Myocardial abscesses (especially with staphylococcal disease), leading to AVB or purulent pericarditis.)
Dermatological findings, such as Osler nodes, Janeway lesions, and splinter hemorrhages, lesions
beneath the nails). These lesions may represent vasculitis produced by circulating antigen-antibody
complexes.

77. Laboratory Findings In Infective Endocarditis:

Lab: Positive blood culture; elevated ESR, elevated CRP, anemia, leukocytosis, presence of immune
complexes, hypergammaglobulinemia, hypocomplementemia, cryoglobulinemia, rheumatoid factor.
Urine: Hematuria and indicators of RF (azotemia, elevated creatinine levels, due to GN).
Imaging: CXR (bilateral infiltrates, nodules, pleural effusion).
Echo: (valve vegetations, prosthetic valve dysfunction, myocardial abscesses, valve insufficiency).
78. 2dry HTN Causes:
Renal: (Chronic GN, Reflux or obstructive nephropathy, Hemolytic uremic syndrome, PCK, Renovascular
htn caused by renal parenchymal disease or renal artery stenosis, leading to H2O & and Na+ retention
due to increased renin secretion.
Cardio: (Aortic Coarctation) / Drugs: (Cocaine, Phencyclidine, Tobacco).
Endocrine: (Hyperthyroidism, Hyperparathyroidism, Aldosterone-secreting tumors, Sodium-retaining
congenital adrenal hyperplasia, Cushing syndrome, Pheochromocytomas)
Therapeutic Agents: Sympathomimetic drugs, Oral contraceptives, Immunosuppressants, Toxins.
79. Clinical Manifestation In Hypertension:
1ry htn: asymptomatic / BP elevation is mild, detected during routine exam, obesity.
2ry htn: Growth failure in CKD /Headache, Dizziness, Epistaxis, Anorexia, Visual changes, Seizures.
Hypertensive Encephalopathy: Vomiting, fever, ataxia, stupor, seizures, and CT abnormalities.
Target Organ Damage: HF and pulmonary edema, RF, Decreased vision, Encephalopathy.
80. Signs And Symptoms Of Congestive Heart Failure:
Right-sided HF: Hepatomegaly, ascites, peripheral edema, jugular venous distention.
Left-sided HF: Tachypnea, pulmonary congestion, nasal flaring, retractions.
Low Cardiac Output: Fatigue, pallor, syncope, poor growth, altered consciousness.
81. Treatment Of Fallot:
Medical: Maintain body temperature and prevent hypoglycemia /Prostaglandin E1 (PGE1): IV infusion to
keep the ductus arteriosus open, ensuring pulmonary blood flow / Knee-chest position and O2 therapy
during hypercyanotic spells /Morphine or B-B (e.g., propranolol) to manage acute cyanotic episodes.
Surgical: 1. Corrective Surgery [Early total repair in infancy (4-6 months) for critically ill neonates
/Involves resecting obstructive muscle bundles, patch closure of the ventricular septal defect (VSD)]
2. Palliative Shunt Surgery: [Modified Blalock-Taussig shunt to augment pulmonary blood flow
temporarily].
82. Clincial Tetralogy Of Fallot:
Neonatal Period: (Severe cyanosis and circulatory collapse as the ductus arteriosus begins to close /Mild
cyanosis may progress as the right ventricular obstruction worsens).
Infants and Children:
a. Cyanotic episodes or "tet spells," triggered by crying or physical exertion, characterized by:
Hyperpnea / Restlessness / Increased cyanosis, potentially leading to syncope or seizures.
b. Older children: exertional Dyspnea / Squatting to relieve symptoms of dyspnea.
c. Signs of long-standing cyanosis: Dusky blue skin / Clubbing of fingers and toes / Gray sclerae with
engorged blood vessels.
d. Murmur: Loud, systolic murmur at left sternal border / RVH
83. Symptomes In Rheumatic Fever:
Abdominal pain, Fever, dyspnea, chest pain, Joint pain-swelling, arthritis (knees, elbows, ankles, wrists),
epistaxis, Skin nodules, erythema marginatum, Skin eruption (trunk, upper part of arms or legs),
Eruptions that look ring-shaped or snake-like, Sydenham chorea (emotional instability, muscle weakness
and quick, uncoordinated jerky movements that mainly affect face, feet, and hands).
84. Major Criteria Jones For Rheumatical Fever Diagnosis:
major criteria: (polyarthritis, carditis, subcutaneous skin nodules, Sydenham chorea, erythema
marginatum)
minor criteria: Fever, Elevated acute phase reactants (increased ESR, CRP& leukocytosis), Joint pain,
Abnormal ECG - prolonged PR interval.