DIMS Lectures Pediatrics PDF

Here is the complete pdf lecture of paediatrics by Dr. Tahir Malik

Introduction 

Pediatrics is the branch of medicine that focuses on the health, growth, and diseases of infants, children, and adolescents.

Growth and Development

Neonatal and Infant Growth

• Weight: Birth weight typically doubles by 5 months and triples by 1 year.
• Length: Increases by 50% by 1 year.
• Head Circumference: Grows rapidly in the first year due to brain development.

Developmental Milestones

• Gross Motor: Head control (3 months), sitting (6 months), walking (12 months).
• Fine Motor: Grasps objects (4 months), pincer grasp (9 months).
• Language: Babbles (6 months), first words (12 months).
• Social: Smiles (2 months), separation anxiety (9 months).

Common Neonatal Conditions

Neonatal Jaundice

• Definition: Yellow discoloration of the skin and sclera due to hyperbilirubinemia.
• Types:
  • Physiological Jaundice: Peaks at day 3-5, resolves within 2 weeks.
  • Pathological Jaundice: Appears within 24 hours, persists longer.
• Diagnosis: Serum bilirubin levels, Coombs test for hemolysis.
• Management: Phototherapy, exchange transfusion if severe.

Neonatal Sepsis

• Causes: Group B Streptococcus, E. coli, Listeria monocytogenes.

• Symptoms: Poor feeding, lethargy, temperature instability, tachypnea.

• Diagnosis: Blood cultures, CRP, lumbar puncture for suspected meningitis.

• Management: IV antibiotics (Ampicillin + Gentamicin).

Respiratory Distress Syndrome (RDS)

• Cause: Surfactant deficiency in preterm neonates.
• Symptoms: Tachypnea, grunting, nasal flaring, cyanosis.
• Diagnosis: Chest X-ray (ground-glass appearance).
• Treatment: Oxygen therapy, surfactant replacement.

Pediatric Infections

Measles

• Cause: Measles virus.
• Symptoms: Fever, cough, coryza, conjunctivitis, Koplik spots, rash.
• Complications: Pneumonia, encephalitis.
• Prevention: MMR vaccine.

Mumps

• Cause: Mumps virus.
• Symptoms: Parotid gland swelling, fever, myalgia.
• Complications: Orchitis, meningitis.
• Prevention: MMR vaccine.

Whooping Cough (Pertussis)

• Cause: Bordetella pertussis.
• Symptoms: Severe coughing fits, post-tussive vomiting.
• Complications: Apnea, pneumonia.
• Prevention: DPT vaccine.

Gastrointestinal Disorders in Children

Acute Gastroenteritis

• Cause: Rotavirus, Norovirus, bacterial infections.
• Symptoms: Vomiting, diarrhea, dehydration.
• Management: ORS, IV fluids in severe dehydration.

Intussusception

• Definition: Telescoping of one part of the intestine into another.
• Symptoms: Colicky abdominal pain, red currant jelly stools, vomiting.
• Diagnosis: Ultrasound (target sign).
• Management: Air/contrast enema, surgery if necessary.

Hirschsprung Disease

• Cause: Absence of ganglion cells in the distal colon.
• Symptoms: Delayed meconium passage, constipation, abdominal distension.
• Diagnosis: Rectal biopsy.
• Management: Surgical resection.

Pediatric Endocrine Disorders

Type 1 Diabetes Mellitus

• Cause: Autoimmune destruction of pancreatic beta cells.
• Symptoms: Polyuria, polydipsia, weight loss, ketoacidosis.
• Diagnosis: Fasting glucose, HbA1c, autoantibodies.
• Management: Insulin therapy, glucose monitoring.

Congenital Hypothyroidism

• Cause: Thyroid dysgenesis, iodine deficiency.
• Symptoms: Jaundice, lethargy, poor feeding, delayed milestones.
• Diagnosis: Newborn screening (TSH, T4 levels).
• Management: Levothyroxine replacement.

Hematological Disorders

Iron Deficiency Anemia

• Cause: Nutritional deficiency, chronic blood loss.
• Symptoms: Pallor, fatigue, pica, tachycardia.
• Diagnosis: CBC (low Hb, low MCV), iron studies.
• Management: Oral iron supplementation.

Hemophilia

• Cause: X-linked deficiency of clotting factors (VIII or IX).
• Symptoms: Easy bruising, hemarthrosis.
• Diagnosis: Prolonged aPTT, factor assay.
• Management: Factor replacement therapy.

Pediatric Cardiology

Congenital Heart Diseases

• Acyanotic CHD: ASD, VSD, PDA, Coarctation of the Aorta.
• Cyanotic CHD: Tetralogy of Fallot, Transposition of Great Arteries.

Hallmarks of Congenital Heart Disease (CHD)

Acyanotic Congenital Heart Disease (CHD)

Acyanotic CHD includes left-to-right shunt lesions that do not cause immediate cyanosis but can lead to heart failure, pulmonary hypertension, and increased cardiac workload over time.

1. Atrial Septal Defect (ASD)

• Hallmarks:
  • Wide, fixed splitting of S2.
  • Systolic ejection murmur at the left upper sternal border (pulmonary flow murmur).
  • Right atrial and right ventricular enlargement.
  • Chest X-ray: Increased pulmonary vascular markings, cardiomegaly.
  • ECG: Right axis deviation, right bundle branch block (RBBB).

2. Ventricular Septal Defect (VSD)

• Hallmarks:
  • Harsh holosystolic murmur at the left lower sternal border.
  • Palpable thrill in larger defects.
  • Signs of congestive heart failure in moderate to large defects (tachypnea, poor feeding, failure to thrive).
  • Chest X-ray: Cardiomegaly, increased pulmonary blood flow.
  • ECG: Left atrial and left ventricular hypertrophy.

3. Patent Ductus Arteriosus (PDA)

• Hallmarks:
  • Continuous "machine-like" murmur at the left infraclavicular area.
  • Bounding peripheral pulses with wide pulse pressure.
  • May present with heart failure symptoms in large PDAs.
  • Chest X-ray: Cardiomegaly, increased pulmonary markings.
  • ECG: Left atrial and left ventricular enlargement.

4. Coarctation of the Aorta

• Hallmarks:
  • Upper limb hypertension with lower limb hypotension.
  • Weak or delayed femoral pulses (radiofemoral delay).
  • Systolic murmur heard best in the back or left infrascapular region.
  • Chest X-ray: "Figure 3 sign," rib notching due to collateral circulation.
  • ECG: Left ventricular hypertrophy.

Cyanotic Congenital Heart Disease (CHD)

Cyanotic CHD includes right-to-left shunt lesions, which lead to systemic desaturation and cyanosis.

1. Tetralogy of Fallot (TOF)

• Hallmarks:
  • Cyanosis (often presents later in infancy or childhood).
  • Tet spells (paroxysmal hypercyanotic episodes, relieved by squatting).
  • Harsh systolic ejection murmur at the left upper sternal border (due to pulmonary stenosis).
  • Boot-shaped heart on Chest X-ray.
  • ECG: Right ventricular hypertrophy.

2. Transposition of the Great Arteries (TGA)

• Hallmarks:
  • Severe cyanosis at birth (ductal-dependent lesion).
  • Loud single S2 (aortic valve anteriorly placed).
  • No murmur unless associated with VSD or PDA.
  • Chest X-ray: "Egg-on-a-string" appearance due to a narrow mediastinum.
  • ECG: Right ventricular hypertrophy.

Early recognition and prompt intervention in CHD are crucial to prevent complications such as heart failure, pulmonary hypertension, and systemic hypoxia.

Pediatric Neurology

Febrile Seizures

• Definition: Seizures associated with fever in children aged 6 months-5 years.
• Types:
  • Simple: Generalized, lasts <15 min, no recurrence.
  • Complex: Focal, lasts >15 min, recurs within 24 hours.
• Management: Antipyretics, observation, benzodiazepines if prolonged.

Cerebral Palsy

• Cause: Non-progressive brain injury affecting movement.
• Symptoms: Spasticity, ataxia, delayed milestones.
• Diagnosis: MRI brain.
• Management: Physiotherapy, botulinum toxin for spasticity.

Pediatric Oncology

Leukemia

• Most common: Acute Lymphoblastic Leukemia (ALL).
• Symptoms: Fever, pallor, bone pain, hepatosplenomegaly.
• Diagnosis: Peripheral smear, bone marrow biopsy.
• Treatment: Chemotherapy.

Wilms Tumor

• Definition: Malignant renal tumor in children.
• Symptoms: Abdominal mass, hematuria, hypertension.
• Diagnosis: Ultrasound, CT scan.
• Management: Nephrectomy, chemotherapy.

Case Example: A 2-Year-Old with Recurrent Infections

1.A 2-year-old child presents with recurrent pneumonia, otitis media, and failure to thrive. Examination reveals lymphopenia and absent thymic shadow on chest X-ray. 

2.A newborn presents with persistent jaundice, hepatosplenomegaly, and cataracts. The mother reports that the baby has poor feeding and vomiting since birth. Laboratory tests show hypoglycemia and positive reducing substances in urine.

3.A 2-month-old infant presents with a history of projectile, non-bilious vomiting after feeding. The baby has progressive weight loss and dehydration. On examination, there is a palpable olive-shaped mass in the right upper quadrant.

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1.Diagnosis: Severe Combined Immunodeficiency (SCID).

2.Diagnosis: Galactosemia (Classic triad: Jaundice, Cataracts, Hepatosplenomegaly)

3.Diagnosis: Pyloric Stenosis 

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