Definition: Breathlessness inappropriate to the level of physical exertion or even occurring at rest (subjective and not a sign) Mechanisms: Chemoreceptors: Peripheral: Carotid and aortic bodies (to pO2, pCO2 and H+) Central: Medulla (to pCO2, not pO2, change in pH of CSF) a. Increased work of breathing: Airflow obstruction: Bronchial…
Tag: Pediatrics
Section Editor: Dr. Sujit Kumar Shrestha, MD Pediatrics, Fellowship Neonatology
PGMEE, MRCS, USMLE, MBBS, MD/MS 
Text Presentation on Empyema Thoracis
A) INTRODUCTION Empyema (aka Empyema Thoracs or Empyema of the chest) is an accumulation of pus in the pleural space that occurs when an infection spreads from the lungs. It comes from the Greek word empyein, which means : pus–producing (suppurates). Empyema itself is not a disease but it is actually a condition complicated by another disease….
Clinical Skills and Approaches 
Practical Procedures : Lumbar Puncture (LP)
Synonyms: Spinal tap Definition: Puncture of subarachnoid space in the lumbar region of the spinal cord to withdraw cerebrospinal fluid (CSF) for diagnostic or therapeutic purpose or inject drugs for anesthetic purpose. Indications: A. Diagnostic: CNS infections: Bacterial, viral, fungal, parasitic or TB meningitis Subarachnoid hemorrhage Carcinomatosis meningitis (CNS involvement…
Clinical Skills and Approaches 
Approach to a Child with Edema
Before beginning the clinical approach to a child with edema, it is necessary to understand the basics of fluid compartments, starling forces and technique of eliciting edema. Life threatening causes of Edema: Generalized: Cardiac disease Congestive Heart Failure Pericardial effusion Renal disease Nephrosis Nephritis Hepatic failure Localized: Allergic reaction with…
PGMEE, MRCS, USMLE, MBBS, MD/MS 
Salmonella Osteomyelitis in Sickle Cell Disease
Sickle Cell Disease (SCD) is a hereditary disorder of hemoglobin synthesis caused by a mutation in the globin gene that changes the sixth amino acid from glutamic acid to valine resulting in abnormal sickling (rigid, inflexibled and sickle-shaped) of Red Blood Cells (RBCs) under low oxygen conditions. Sickle cell anemia…
Case Reports 
A Case of Rheumatic Fever
A 12 year old female came with complaints of multiple joint pain for 10 days which started in the left knee and resolved within 3 days, then started on the bilateral ankles which also resolved in 3 to 4 days and started on the right knee. She currently complains of…
Clinical Skills and Approaches 
Digital Clubbing
Synonyms: Hippocratic fingers, Acropachy, Dysacromelia, Drumstick fingers, Watch glass nails, Parrot beak fingers, Serpent head nails, Lovibond’s sign Definition Focal and bulbous enlargement of the distal phalanges due to proliferation of connective tissue between the fingernail and the bone with increase in both the longitudinal and transverse curvatures of the…
Clinical Skills and Approaches 
Edema – Physical Examination
Synonyms: Oedema, Swelling Definition of Edema Accumulation of excessive amount of fluid in the extravascular interstitial space of the body. Interstitial space is the extravascular compartment of the extracellular fluid and surrounds the cells of a given tissue. Anasarca is a severe and generalized edema with profound subcutaneous tissue swelling. Further…