- Hutchinson�s Triad.

Hutchinson's triad

It is a common pattern of presentation for congenital syphilis.
It consists of :-

1. Interstitial keratitis
2. Hutchinson incisors
3. Eighth nerve deafness.

Dr Ibrahim

Return to other triads here.

-Complications of Tetralogy of fallot.

Complications of Tetralogy of fallot
"Inches"

Infective endocarditis,Low I.Q.
Neurological (e.g Brain abscess,cerebrovascular accidents)
Cyanotic spell,Clubbing.
Hematological(e.g polycythemia,IDA,Thrombosis).
Hyperuracemia and gout,Heart Failure (rare).
Exercise intolerance.
Squatting,scoliosis,Stunted growth.

Dr Ibrahim

-No in ASD.

No in Atrial septal defect.

No murmur due to ASD itself but murmur of relative MS,PS.
No ACEIs if HF occur but give diuretics and digitalis.
No spontanous closure of ASD.
No symptoms or signs in small ASD.

Dr Ibrahim

-Congenital Rubella Syndrome.

Congenital Rubella Syndrome

Aetiology:-
Maternal infection by rubella leads to Maternal viremia which lead to transplacental spread of the virus to the fetus causing fetal viremia whcih in turn leads to infection invloving many fetal organs and hence congenital anomalies.

N.B:- Newborn discharge virus in his secretions for 12-18 months after birth so he is infectious.
Incidence:-
*In the 1st trimester:- 15-20%.
*In the 4th month:- 5%.
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-Factors affecting human linear growth.

Factors affecting human linear growth.

• Age
• Sex
• Race.
• Hereditary factors:- Children of two short parents will probably be short and vice versa.
• Endocrinal factors e.g Growth Hormone which is responsible for stimulation of body growth in humans.
• Nutritional factors:- Adequate nutrients must be available for normal growth.
• General health:- Any serious systemic disease in childhood is likely to reduce growth (e.g. chronic kidney disease or chronic infection).
• Intrauterine growth retardation (small birth weight):-These infants often growpoorly in the long term.
• Emotional deprivation and psychological factors:- These can impair growth by complex, poorly understood mechanisms.
• Chromosomal abnormalities.
• Skeletal maturity.

Dr Ibrahim

- Medical treatment of hydrocephalus.

Medical treatment of hydrocephalus

*Aim:-

Medical treatment is used to delay surgical intervention.

*Medical treatment is not effective in long-term treatment of chronic hydrocephalus. It may induce metabolic consequences and thus should be used only as a temporizing measure.

*Lines of TTT:- "Fair"

• Furosemide:1mg/kg/day.(Decreasing CSF secretion).
• Acetazolamide 5mg/kg/day.(Decreasing CSF secretion).
• Isosorbide (Increasing CSF reabsorption).
• Restriction of water and salts.

Dr Ibrahim

- Skull causes of macrocephaly.

Skull causes of Macrocephaly.

"Oscar"

Osteogenesis imperfecta.
Secondaries especially neuroblastoma.
Chronic hemolytic anemia.
Achondroplasia.
Rickets.

Dr Ibrahim

-Guillain Barr� syndrome.

Guillain Barr� syndrome

Aetiology(theories):-

• Postinfection:50% of cases have preceding respiratory or GIT viral infection.
• Post vaccination:following vaccination against swine flu virus.
• Lymphoma.
• Autoimmune theory.

Clinical Picture:-
1-Initial febrile illness.
2-Motor affection:-

• Bilateral symmetrical ascending affection of both lower limbs,trunk,upper limbs,Bulbar muscles,facial muscles then diphragm and respiratory muscles.
• The Affection is proximal more than distal in adult.
• The Affection is proximal more than distal in infant and childrens.
• Weakness is associated with hypotonia and areflexia.
  

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