tailieunhanh - Ebook The short textbook of pediatrics (11/E): Part 2

(BQ) Part 2 book "The short textbook of pediatrics" has contents: Pediatric endocrinology, pediatric envenomations, pediatric dental problems, pediatric neuromuscular disorders, pediatric surgery, pediatric ophthalmology, pediatric orthopedics,. and other contents. | 21 Pediatric Pulmonology Daljit Singh, Suraj Gupte INTRODUCTION Diseases pertaining to the respiratory system are responsible for a large proportion of pediatric admissions and outpatient attendance. In north India, the highest incidence is recorded in the winter followed by the relatively lower peak during rainy season. Like in other tropical areas. Indian infants and children demonstrate pattern of clinical presentation which is somewhat different from what is recorded by the western authorities. This variance is related to factors such as considerable delay in reporting to the hospital and high frequency of infestations and associated malnutrition. All these, individually or collectively, result in a rather changed clinical picture. CLNICAL EVALUATION OF A RESPIRATORY CASE For role of history-taking and clinical examination in evaluation of a respiratory case, see Chapter 1. SPECIAL DIAGNOSTIC PROCEDURES Radiology/Imaing Chest X-ray, PA and lateral views as a routine, decubitus film for pleural effusion, oblique film for focus on hilar shadow, and lung portion at the back of heart, lordotic film for apices, lateral neck film for upper airway obstruction round the level of retropharynx, subglottis and supraglottis. Barium swallow is useful in excluding tracheoesophageal fistula (TEF) of H-type, gastroesophageal reflux disease (GERD) and esophageal indentation with vascular rings. Screening is of value for stridor and movements of diaphragm and mediastinum. Ultrasonography is useful in pleural effusion and intrathoracic masses as also in guiding conduction of lung tap and pleural tap. CT scan is very helpful in pleural, mediastinal, and parenchymal (both solid and cystic) lesions, bronchiectasis, vascular structures (provided that IV contrast enhancer is employed), and guiding biopsy. MRI is particularly of great value in vascular rings and hilar structures. Serology Immunoglobulin, IgG, IgA, IgM, IgD and IgE, eosinophilic cationic protein levels are .