Interpretation of Medical Examination Results and Other Medical Information 2

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Interpretation of Medical Examination Results and
Other Medical Information - 2
Medical examination/19/2/03
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Medical examination/19/2/03
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Medical examination/19/2/03
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Medical examination/19/2/03
The Newborn Infant
Physical development BW 2.5 - 4
kg length 45 - 55 cm HC 32.6 -
37.2 cm body proportion umbilicus liver/spleen
commonly just below costal margin kidney o
ften palpable
Physiology RR 35 - 50 breaths/min HR 120 -
160 beats/min first stool pass within 24
hr first week weight loss 10
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Medical examination/19/2/03
The First Year
Physical development weight full- term infant
double wt 5 mo triple 1 yr prematu
re infant gain 6 - 7 kg in the first
yr length increase 25 - 30 cm anterior
fontanel close 9 - 18 mo posterior
fontanel close to palpable 4 mo head
circumfwrence 44 cm (6mo), 47 cm (1 yr)
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Age 0 - 2 mo weight gain by 2 wk of age 30
g/day, 1st mo development 1 ????? ???????? 2
????? ???????
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Medical examination/19/2/03
Age 2 - 6 mo weight ???? 3 - 4 mo 20
g/day development 4 ????? ?????? ??????? 6
????? ?????????????? ?????????? ??????????
??????????????
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Age 6 - 12 mo development 9 ????? ???? ????
??????? ???????????? ????
?????????? 12 ????? ???????? ?????????????????
??? 1 ?? ????? ?????? ????
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The second year
Medical examination/19/2/03
Age 12 - 18 mo development 15 ????? ???? ??? 4 -
6 ?? ???????????? ???????? 18 ????? ????
????????????????? ??? 10 ??
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Medical examination/19/2/03
Age 18 - 24 mo 2 ?? ????????????? ?????????
??? 2 -3 ???????? ???????????????????????
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Preschool years 2 - 5??
Medical examination/19/2/03
development 3?? ????????? ??????????????
???? ????????? 50 ?????? ???/?????????? ???
4 ?? ??????????????? ?????????????
???? ???? ???????????????????? ?????? 4 ??
?????????????????????????????? 5
?? ?????????????? ????????????? ??? ?????? 2
????? 4 ?? ??????????????? ??????????
????????????????
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Early school years (6 - 12 ??)
Medical examination/19/2/03
Development 6 ?? ????????????? ?????????
???????????????? ?????????? ??? ??????????????
2 ???? ??????????????? 7 ?? ?????????? 2 ???
???????? 12 ???? ??????????????? ??? ????????
???????????? 8 ?? ???????????????????????????????
??????????? ?????? ??????? ????????????????????
?????????????????????????? ??? 9 ?? ??????????
????????????? ?????????????????????? ???????????
?
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Medical examination/19/2/03
Age App daily App monthly growth in
Growth in wt gain (g) wt gain length(cm/m)
HC(cm/m) 0 - 3 mo 30 2 lb 3.5
2.00 3 - 6 mo 20 11/4 lb 2.0 1.00 6 - 9
mo 15 1 lb 1.5 0.5 9 - 12 mo 12 13 oz
1.2 0.5 1 - 3 yr 8 8 oz
1.0 0.25 4 - 6 yr 6 6 oz 3 cm/yr 1 cm/yr
Growth Curve
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Medical examination/19/2/03
Weight 3 - 12 mo age (mo) 9 (kg) 2 1 -
6 yr age(yr) x 2 8 7 - 12 yr age(yr) x 7 -
5 2
Height at birth 50 (cm) at 1 yr 75 2 - 12
yr age(yr) x 6 77
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Medical examination/19/2/03
Blood pressure
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Medical examination/19/2/03
Head Circumference ?????????????????? Head
circumference (HC) ??????? chest circumference
?????? 2 ??. ??????????????????? HC ????????? CC
???????
Enlargement of the head (Macrocephaly)
HC gt 2SD
?? 6 ???????? ??? HC ????????? ??????? 2
??./????? ?????????????
Cranial ultrasound, CT, MRI
Hydrocephalus
Large facial hemangioma ---gt Dandy-Walker
syndrome Suboccipital dermal sinus ---gt
hydrocephalus
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Medical examination/19/2/03
Microcephaly
HC lt 2 SD
Cerebral dysgenesis or hypoplasia, Primary or
familial
?????????????
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Medical examination/19/2/03
???????????? ??????????????? -
Thalassemia ???????????????????????? ? Thal ----gt
Intermedia HbH disease, beta thal/HbE disease
----gt Major Thal Homozygous beta thal, beta
thal/HbE disease
Hb, Hct
RBC morphology
OFT DCIP
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Medical examination/19/2/03
WHO classification Hblt Hctlt man 13 39 w
oman and children 12 36 pregnant
woman 11 33 children 3mo.- 4yr. 11 33
RBC morphology Thal. Dis.
Thal. Trait Nutritional hemolysis
in anemia other
condition Hypochromia 2-4
1-2 1-4 -ve Microcytosis
2-4 1-2 1-4
-ve
Anisocytosis 3-4 1-2 1-4
1-2 Poikilocytosis
3-4 1-2 0-2
2-4 Polychromasia ve 0-1 -ve
ve Target cell ve
few rare-few -ve Cell
fragmentation ve
-ve ve
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Medical examination/19/2/03
Reticulocyte count normal range child 1-2 ,
adult 0-1 Heinz body Inclusion
body Spherocyte, Elliptocyte, Schistocyte or
cell fragmentation (hemolysis), Burr
cell(microangiopathic hemolytic anemia or DIC),
Basophilic stippling, Target cell, Crenated
cell, Acanthocyte or spr cell, Howell-Jolly
body
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Medical examination/19/2/03
Homozygous beta thalassemia
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Beta thalassemia trait
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Medical examination/19/2/03
Hemoglobin H disease
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Medical examination/19/2/03
MCV mean corpuscular volume MCH mean
corpuscular hemoglobin MCHC mean corpuscular
hemoglobin concentration Anemia
type MCV MCH MCHC (??.??????)
(??????????????) (??./??.) Macrocytic
97-160 35-40
32-36 Normocytic 80-96
26-34 32-36 Microcytic-hypochromic
50-79 12-29
24-31
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Medical examination/19/2/03
??????????????????????????? ??????????????????????
?????? MCV lt 80 fl

• Osmotic fragility test
• ????????????????????? thal ??????? hypotonic
  saline ?????
• ??????????????????????? Thal, Homozygous HbE
  thal trait, ?????????????????????
• ?????????????, alpha 2 trait ????????????????
  Hb E trait

DCIP ????????????? Hb E (dichorophonolinophenol
) ????????????????????? oxidize HbE
????????????????????????????
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Medical examination/19/2/03
?????????? ??????? ??? ???????????
?????? ?????????????? ??? ??????? ???? Lab
CBC with RBC moephology Hb electrophoresis
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Medical examination/19/2/03
?????????????? Gestational age, Birth weight,
Apgar score, length of stay, hyperbilirubinemia
Birth asphyxia, SGA, prematurity, oxygen
therapy chronic lung disease, ROP
TTNB (transient tachypnea of the newborn)
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??????????
Medical examination/19/2/03
???????????????????????? ???????!
?????????????????
cause 1. Newborn birth injury, metabolic
defect, hereditary disease 2.
Infanttoddler congenital anomalies,
infection, epilepsy hereditary
disease 3. Childaldolescent epilepsy,
postnatal trauma 4. Aldolescent tumor,
vascular disease-AVM, aneurysm
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Medical examination/19/2/03
subsequence unprovoked seizures risk without
febrile seizure 0.4-0.5 simple febrile
seizure 1-2 complex febrile seizure 6-9.2
Atypical febrile seizures (complex febrile
seizure) ?????? 1. ???gt15???? 2. ???????? 24
??????? 3. ?? focal features ???? focal clonic
seizures, Todds paralysis
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Medical examination/19/2/03
Risk factors for subsequence unprovoked
seizures 1. ???????????????????????????????
afebrile seizure 2. Delayed development
???????????? 3. ?????? complex febrile
seizures ?? 1 feature ??? complex febrile
seizures 6-8 2 17-22
3 49
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Medical examination/19/2/03
Risk of febrile seizure recurrence ??????????????
?????????? 30 ?????????????????? (????????? 3
???????????) 9 ?????????????? 1 ?? 80 ????
1 ?? 3 1. ????????????????????????????????? ??
1 ??????? 44 1-24 23
gt24 13 2. ???????? ?????????????????????????
???????? 38.3 ??????????? 30 ???????? 40.6 ??
????????? 13 3. ?????????????????? ???? lt 1??
??????? 50 4. ??????????????? ?????????? first
degree relatives (?????? 36 ??? 20) 5. ??
Focal feature 6. Prolong febrile seizures
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Medical examination/19/2/03
Intellecture outcome ????????????????
Treatment diazepam phenobarb valproic acid
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Urinary Tract Infections
Medical examination/19/2/03
Acute pyelonephritis kidney damage ascent
of bacteria VUR
2/3 do not have demonstrable VUR nonreflux
pyelonephritis.
P-fimbriated E coli and other organisms----gt
turbulent flow Inflammation of ureter -----gt
alter function
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Medical examination/19/2/03

• ?????????????????????????????
• ?????????????????????
• obstruction
• reflux with dilatation
• young age
• delay of treatment
• number of pyelonephritic
• attacks
• voiding dysfunction

• ???????????????
• Ultrasonography
• Intravenous pyelography
• Voiding cystouretherogram
• (VCUG)
• Direct radionuclide voiding
• cystourethrogram
• Tc-99m DMSA scan

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Medical examination/19/2/03
Renal parenchymal infection ----gt renal
scar VUR ----gt renal scar
Highest risk of renal scar -----gt intrarenal
reflux ?? 5-15 gt5 ?? ??????
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Medical examination/19/2/03

• ??????????????????????????
• acute pyelonephritis
• bacteriuria before 1 year of age
• hypertension
• posterior midline anomaly
• cystitis before 2 years of age
• recurrent cystitis
• decreased renal concentrating capacity

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Medical examination/19/2/03
????????? ?? VUR ??????????????? 26 - 46
???????????? ??????? 1 ??????????????????????????
UTI ??????? 2 ?????????????? ??????? 3
?????????????????????????????
????????????????????????? ???? ??????????????
VUR ?????????????? VUR ??????????????????????????
85 VUR ??????????????????????????
85 ???????????????? ?????? 17 ??????? 1 ???? 2
??????????? 1 ???????
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Medical examination/19/2/03

• ??????????????????
• ???????????????????????? (Progressive renal
  failure)
• ?????????????????
• ???????????????
• ??????????????????????? glomerulosclerosis

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Kawasaki disease
Medical examination/19/2/03
???????????????? A. Fever lasting for at least 5
days B. Presence of 4 the following 5
conditions 1. Bilateral nonpurulent
conjunctival injection 2. Changes of the mucosa
of the oropharynx 3. Changes of the peripheral
extremities 4. Rash 5. Cervical
lymphadenopathy C. Illness not explained by other
known disease process
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Medical examination/19/2/03
Prognosis ????????????????????????????? coronary
artery ??? ???????, ???????????? 1 ??, serum
albumin ???, ?????????????????? 100,000 /??.??.,
?????????? 10 ???
95 ??????????????????? 6 ???????? ????????
aneurysm ????????????????????? 50 ??????
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Medical examination/19/2/03
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HR age 2 mean 98 1 - 2 mo 121 149 179 3
- 5 mo 106 141 186 6 - 11 mo 109 134 169 1
- 2 yr 89 119 151 3 - 4 yr 73 108 137 5 - 7
yr 65 100 133 8 - 11 yr 62 91 130 12 - 15
yr 60 85 119
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Hepatomegaly
Medical examination/19/2/03
Liver edge below rt costal margin newborn gt 3.5
cm children gt 2 cm
Liver span ???? 1 ??????? 4.5 - 5 cm ???????
7 - 8 cm ???????? 6 - 6.5 cm
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Medical examination/19/2/03
Mechanism/disease Inflammation infection,
toxins, drugs, neonatal
hepatitis Inappropiate storage glycogen, fat,
lipid, metal Infiltration hemangioma,
meatastasisor disseminated tumors
Congestion CHF, restrictive
pericarditis Biliary obstruction
cholelithiasis, biliary atresia
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Medical examination/19/2/03
??????? hyperbilirubinemia after 2 wk of
age,???????????? BA, alpha-1-antitrypsin
deficiency FH of early infant death,
neurodegenrative metabolic
disease maternal infection hepatitis B,
toxoplasmosis, syphilis,
cytomegalovirus, rubella, herpes
simplex, enterovirus, rubella, HIV history of
umbilical catheter hepatic abscess drug NSAI
D, isoniazid, propylthiouracil, sulfonamide
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Medical examination/19/2/03
??????????? splenomegaly portal hypertension,
storage disease, reticuloendothelial
hyperplasia, hepatic infiltration by malignant
cells FTT/dev delay glycogen storage disease,
organic acidemias, galactosemia vomiti
ng/diarrhea urea cycle defects neurologic
deterioration mucopolysaccharidosis,
Wilson disease skin, cutaneous hemangioma
hemangiomatosis purpura TORCH
infection eye, cataract TORCH
infection Kayser-Fleischer rings Wilson
disease
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Medical examination/19/2/03
Laboratory studies LFT, UA, CBC, reticulocyte
count ultrasound liver biopsy
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Medical examination/19/2/03
Splenomegaly
Normal spleen soft, smooth,
nontender Pathological firm, abnormal
surface or texture Need further gt 1 - 2
cm below evaluation left costal
margin frequency 1 - 2 cm 30 fullterm,
10 healthy children
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Medical examination/19/2/03
Etiology 1. Infectious diseases malaria, IM,
congenital infection 2. Blood disease
hemolytic disease of the newborn (blood group
incompatibility), hemolytic anemia,
thalassemia 3. Congestion hepatic cirrhosis,
splenic vein thrombosis 4. Metabolic disease
Gaucher disease, hemosiderosis 5. Neoplastic
disease leukemia, Hodgkin disease,
Hamartoma 6. Miscellaneous SLE, infant of
diabetic mother, acquired immunodeficiency
syndrome
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Medical examination/19/2/03
Lab Studies CBC pancytopenia --gt bone marrow
infiltration atypical lymphocytosis --gt
infectious mononucleosis HB, RBC smear,
reticulocyte count --gt hemolysis thrombocytopania
--gt bone marrow infiltration,
immune, drug, viral infection,
hypersplenism
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Medical examination/19/2/03
LFT hypoalbuminemia, prolonged PT,
hyperbilirubinemia --gt liver dysfunction
isolated indirect hyperbilirubinemia --gt
hemolysis elevated AST, ALT --gt liver
damage elevated GGT, ALP --gt biliary
obstruction
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Medical examination/19/2/03
Blood chemistry ALT infant lt 54
U/L children/adult 1- 30 U/L ALP infant 150
- 420 U/L 2 - 10 yr 100 - 320 U/L 11 - 18 yr
male 100 - 390 U/L 11 - 18 yr female 100 -
320 U/L adult 30 - 120 U/L AST newborn/infant
20 - 65 U/L child/adult 0 - 35 U/L
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Medical examination/19/2/03
Creatinine newborn 0.3 - 1.0 mg/dl infant 0.2
- 0.4 mg/dl child 0.3 - 0.7 mg/dl aldolesce
nt 0.5 - 1.0 mg/dl adult 0.5 - 1.2 mg/dl