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Wednesday, March 31, 2010

Pediatric Neuromuscular Examination

Pediatric Neuromuscular Examination

  1. Child looks alert, conscious, active and has no dysmorphic features.
  2. Gait is normal.
  3. Limb tone is normal, power is 5/5 in all muscle components, and reflexes are intact. Babinski negative.
  4. Spine is normal.
Eg; CP, spastic diplegia.
Child looks alert, conscious, cooperative and has no dysmorphic features. Child has a scissoring gait. The calf muscles are wasted. Limbs are spastic, power is 5/5 in all muscle component. Reflexes are brisk. Babinski negative. Spine is normal.

Spasticity is a motor disorder characterized by a velocity-dependent increase in tonic stretch reflexes with exaggerated tendon jerks, resulting from hyperexcitability of the stretch reflex.


Tuesday, March 30, 2010

Pediatric Abdominal Examination

  1. Child is lying comfortably, alert, conscious, pink and not in pain.
  2. No jaundice, pallor, oral mucosa is moist and gum is healthy.
  3. No clubbing, capillary filling less then 2s. No stigmata of chronic liver disease. (Palmar erythema, flapping tremor, spider naevi, or gynecomastia)
  4. No pedal edema.
  5. Hernial orifices are intact.
  6. Abdomen is soft and non tender, scaphoid in shape, moving with respiration, no scars or dilated veins. No hepatomegaly, splenomegaly and the kidneys are not ballotable. No ascites. (Describe if there is a mass.) Bowel sounds present 3/min.
  7. The spines are normal and no sacral edema.
Eg; Malaria with splenomegaly.
Child is lying comfortably, alert, conscious, slightly pale and not in pain. There is pallor and slight tinge of jaundice. Oral mucosa is moist and gum is healthy. No clubbing, capillary filling time <2s, no stigmata of chronic liver disease. No pedal edema and hernial orifices are intact. Abdomen is soft and non tender, scaphoid in shape, moving with respiration, no scars or dilated veins. Liver is enlarged by 3 cm, smooth, firm, non tender and regular. Spleen is not enlarged, kidneys not ballotable and no ascites. The spines are normal and no sacral edema.

Monday, March 29, 2010

Pediatric Cardiovascular Case

  1. Child is lying comfortably on the bed, looks alert, conscious, (pink, bluish, dusky, pale) and not in distress.
  2. Pulse is 110, regular, good volume, no collapsing pulse, with no radio-radio and radio-femoral delay. Blood pressure is 100/60.
  3. No clubbing, no stigmata of infective endocarditis (Janeway lesions, splinter hemorrhages, or Osler nodes), no pedal edema. Oral hygiene is good and no central cyanosis seen. JVP not raised.
  4. No scars or dilated veins seen.
  5. Apex beat not displaced. No precordial heaves.
  6. S1 and S2 heard, sinus rhythm. (If got murmurs, describe it.)
  7. No hepatomegaly or sacral edema.
Eg; (VSD)
Child is lying comfortably on the bed, looks alert, conscious, pink and not in distress. His pulse rate is 110, regular, good in volume, no collapsing pulse, or radio-radio or radio-femoral inequalities. Blood pressure is 100/60. No clubbing, no stigmata of infective endocarditis. Oral hygiene is poor but no central cyanosis. No scars or dilated veins on the chest. Apex beat not displaced. A grade 3 pan-systolic murmur, best appreciated over the lower sternal edge heard. No hepatomegaly.

Need your feedback. Thank you.





Hey people,

So lets talk about Raden.

Raden is an orphan. He was delivered in a house and his mother passed away soon after childbirth. Father left the child to another unrelated Indonesian guy. Whereabouts of the child's father is unknown.

The Samaritan, the Indonesion guy, brought the child to hospital after the child started having nose bleed. He then treated for pneumonia with sepsis, and few weeks later confirmed to be RVD +ve.

I am not going to talk about the disease right now because you cannot change anything now. But, we can help him to eleviate his suffering and improve his quality of life.

Right now, he has one set of clothes (a shirt and a pant). One miss-matched mitten.

How can you help? It is easy.
1. I am collecting some money. You can give your donation to me. Cash or bank transfer.
2. It is okay if you don't trust me, this donation drive is not official anyway. So you can help by giving materials.

Items needed,
1. Baju and seluar.
2. Pampers.
3. Wet tissues
(Any suggestions are welcomed.)

Hopefully, before Good Friday, we can do something. I rather help this fella then buying some stupids pirated CDs.

Thursday, March 25, 2010

Pediatric Respiratory Case

  1. Child is lying comfortably on the bed, looks alert, conscious, active, (pink, bluish, dusky, pale).
  2. Respiratory rate is 110 (Do not use adjective like 'about', 'lebih kurang' or 'probably'. It indicates that you are bull shitting or unsure).
  3. He/She is not in respiratory distress as there are no signs of use of accessory muscles, subcoastal or intercostal recessions, stridor/ grunting, tachypnea or nasal flaring.
  4. No clubbing, flapping tremor (asterixis).
  5. There is pectus carinatum/excavatum. (Say this if there is deformity. Skip if there is none)
  6. There is no chest deformities, scars or lesions.
  7. However chest is slightly inflated and Harrison's sulcus can be seen. (Again skip this if not relevant)
  8. Trachea is not deviated and apex beat is not displaced. (Do not say, "Apex beat is located at the 5th intercoastal space 1 cm medial to midclavicular line." That is too long. Say if only asked)
  9. Lung is resonant, and has equal air entry. (If the is any pathology, describe the pathology first.)
  10. Spine is normal.
Eg; (Asthma)
Child is lying comfortably on the bed, looks alert, conscious, active, and pink. Respiratory rate is 110. He is not in respiratory distress as there are no signs of use of accessory muscles, subcoastal or intercostal recessions, stridor/ grunting, tachypnea or nasal flaring. No clubbing, flapping tremor (asterixis). There is no chest deformities, scars or lesions. However chest is slightly inflated and Harrison's sulcus can be seen. Trachea is not deviated and apex beat is not displaced. Ronchi heard bilaterally over the lower lobes, otherwise lung is resonant and has equal air entry.

This is an example. The whole thing is supposed to be articulated in about 2 minutes. Please give some feedback. Please leave comments below.
So I finally decide to do something useful this time. We all know short cases are easy, but yet we still screw up. But don't be surprised, articulation, simple as that. The thing is some bloody examiners don't even look at you when you're actually doing, listening is what they do. You say the right thing you save the trouble.

I though of devising a script on what to say (not what to do, because you know what to do).

It might not be perfect but need you feedback and comment to make it as perfect as Shakespeare's play.

I post system by system soon.

Once again,
You find it useful please click on the ads because ads generate money.

Wednesday, March 24, 2010

I back in blogging business. I have no particular reason or whatsoever.