NBE CME programme for DNB consultants - National Board Of ...

NBE CME programme for DNB consultantsSurgical Treatment - Not indicated unless there is tracheo esophageal compression or for cosmeticpurpose. [Goitre]Neonatal screening and prevention - Neonatal screening by measurement of TSH or T4 levels inheel prick blood sample . when diagnosis is confirmed thyroid supplements are given. Iodinesupplements to prevent iodine deficiency.PEDIATRICSCongenital Heart DiseaseAcyanotic Congenital Heart DiseaseHistory- Onset of cong heart disease in infancy or if later then slow and insidious onset; CHF- Suckrest suck cycle and feeding diaphoresis in infancy in shunts, respiratory distress, edema feet rarein infants,periorbital oedema; Adequacy of feeding e.g. adequate urine, sleeps well after feed,number of sucking movements with each breath; Exertional dyspnoea in older children; H/O LRTIi.e. cough, fever,respiratory distress; H/O IE –Sudden worsening over previous status, fever,petichae,increasing pallor or worsening CCF;Treatment history e.g. digoxin, diuretics, antibiotics; Coursein hospital- F/H , SE history for treatment options.Examination-Cyanosis circumoral, tongue, fingers, toes, baseline or intermittent on crying;Clubbing; Pallor; Abnormal facies e.g. Downs in VSD,Elfins in AS; Pulse- Collapsing in PDA, allpulses important for Co and takayasu, rate fast in CCF, volume poor in AS; BP in all limbs- Co,takayasu, AR; CCF- tachycardia, tachypnoea, hepatomegaly , JVP is difficult to see in infants dueto short neck and oedema feet rare in infants; Anthropometry for FTT;If fever then look for Signs ofIE e.g. splinter haemmorhages,spleen tip, Roth spots; CVS-precordial buldge or pulsations e.g.suprasternal of xiphisternal, visible apex; Palpate for sounds and thrills , parasternal heave andapex; Percussion of borders and second space; Auscultate all sounds e.g. S1 S2 S3 S4; S1 inmitral area loud or faint in pansystolic murmers, S2 in pulmonary or aortic area for intensity,splitting; S3 and S4 at mitral area; Listen carefully whether pansystolic e.g. VSD or ejectionsystolic murmur e.g. ASD, AS,PS or continuous murmur e.g. PDA; Radiation; Grade systolicmurmurs; Liver spleenDiscussion-Type of CHD; Single defect or more than one e.g. ASD and VSD, VSD and AR; Know thecommon associations and look for features; Size of defect in VSD, PDA OR ASD; Signs ofEisenmenger in shunts; Severity of valvular stenosis in AS,PS; Severity of coarctation; Any IE; X raychanges; ECG changes; ECHO interpretation; Need for surgery /medial management e.g. in VSDsmall or large, chances of spontaneous closure,, ASD if very small no need to intervene, PDAalways needs closure, AS if mild to be followed up otherwise balloon dilatation and if unfit forballoon then surgery, PS if significant then balloon, CO balloon or surgery; Time for surgery; Tellcomplete diagnosis e.g. type of heart disease, rhythm, IE, CHF, reversal of shuntCyanotic Congenital Heart DiseaseHistory - Spells e.g. excessive crying , getting more blue, and respiratory distress; squatting;Dyspnoea on exertion; FTT; H/O palliative surgery e.g. BT shunt and whether it is functioning.Examination - Cyanosis ,Clubbing,Pallor; S2 single or split or loud P2; Usually an ejection systolicmurmur; Features of CHF suggest increased pulmonary blood flowDiscussion - Type of CHD-Generally groups diagnosed e.g. TOF physiology covers TOF,DORV, TA,Pulmonary atresia; Increased pulmonary blood flow or decreased; Decreased pulmonary bloodflow with S2 single ejection systolic murmurs - TOF physiology; Increased pulmonary blood flow-Features of CHF with cyanosis and S2 not single, look for pulse volume e.g. high volume pulse intruncus, LA enlargement for Ebstiens anomaly, X ray and ECG almost essential for diagnosis; X raychanges; ECG changes; ECHO interpretation; Need for palliative/ total correction surgery; Timefor surgery; prognosisRHD138