 

 

 
 
2009
 

 
 

 
 tools 
  spots 

 round
 
 

SeMo

 

 

 
 
 


 
Dr TiGeRM@N 
ME GA copy center -1-
 
 Index

ECG 3
ABG 6
PEDIGREE 8
X RAY 9
CT  16
LIVER REPORT 20
RENAL FUNCTION TESTS 20
CSF 20
STOOL 21
BLOOD 21
ACTIVE RICKETS 23
NEONATE 24
URINE REPORT 24
HB ELCTRO PHORESIS 27
ENDOTRACHEAL TUBE 27
PICTURES 27
SCORES
29
 (DOWNES,APGAR,GLASGOW)




ME GA copy center -2-
 ECG
Full Comment
1- Rate
2- Rhythm
3- Axis
4- Hypertrophy
5- Insult
‫ھﺘﺒﺺ ﺗﻼﻗﻰ ﺻﻮره زى دى ﺑﺎﻟﻈﺒﻂ ﻋﺒﺎره ﻋﻦ‬
Lead I , III
Lead V1 , V6
Lead II

1- Rate:
60
0.04 × R ‫ﻋﺪد اﻟﻤﺮﺑﻌﺎت اﻟﺼﻐﯿﺮه ﻣﺎ ﺑﯿﻦ اﺗﻨﯿﻦ‬
‫ وﺳﺎﻋﺎت ﺑﯿﺒﻘﻰ ﻛﺎﺗﺒﮭﻢ ﺑﺨﻂ ﺻﻐﯿﺮ ﻋﻠﯿﮫ‬Lead II‫ﺑﺘﺘﺤﺴﺐ ﻣﻦ‬

2- Rhythm : >>>> Regular ( ‫) ﺛﺎﺑﺘﺔ‬

Comment :
P wave is positive ,
P wave is before every QRS
QRS is Normal

ME GA copy center -3-

 3- Axis :
( aVF ) Lead III ‫ و‬Lead I ‫ﺑﺒﺺ ﻋﻠﻰ‬
::: ‫ اﺣﺘﻤﺎﻻت‬3 ‫ﻋﻨﺪى‬

‫ اﻻﺛﻨﯿﻦ ﺑﯿﺒﺼﻮا ﻟﻔﻮق‬: ‫اﻻﺣﺘﻤﺎل اﻻول‬

QRS +ve in lead I
QRS +ve in Lead III

::: ‫ھﺘﻘﻮل‬

‫ وﻓﻰ ﻏﻠﻄﺔ ﺷﺎﺋﻌﺔ‬normal ‫ ﻣﻤﻜﻦ ﯾﺠﯿﻰ‬: ‫ﻣﻠﺤﻮﻇﺔ‬

Normal Axis Deviation ‫ﻣﺘﻘﻮﻟﺶ‬

‫ ﻛﻞ واﺣﺪ ﺑﯿﺒﺺ ﻓﻰ ﻧﺎﺣﯿﺔ ﯾﻌﻨﻰ‬: ‫اﻻﺣﺘﻤﺎل اﻟﺜﺎﻧﻰ‬

Leave each other >>> Left axis
QRS +ve in Lead I
QRS –ve in Lead III

::: ‫ھﺘﻘﻮل‬

ME GA copy center -4-

 ‫ ﺑﯿﺴﻠﻤﻮا ﻋﻠﻰ ﺑﻌﺾ ﺑﺈﯾﺪھﻢ اﻟﯿﻤﯿﻦ‬: ‫اﻻﺣﺘﻤﺎل اﻟﺜﺎﻟﺚ‬
Right hand >>> Right axis
QRS -ve in Lead I
QRS +ve in Lead III
I
::: ‫ھﺘﻘﻮل‬

4- Hypertrophy : LVH & RVH

V 1 , V6 ‫ھﻨﺒﺺ ﻋﻠﻰ‬

R 6 > 7 mm ‫ﻟﻤﺎ‬ R 6 > 35 mm ‫ﻟﻤﺎ‬

::: ‫ھﺘﻘﻮل‬ ::: ‫ھﺘﻘﻮل‬
‫ اﻟﺒﺎﯾﻆ‬Lead ‫ ﻓﻰ اﻟـ‬T wave ‫ ھﻨﺒﺺ ﻋﻠﻰ‬Hypertrophy ‫ﻟﻮ ﻟﻘﯿﺖ ﻓﻰ‬
Hypertrophy with Strain ‫ﯾﺒﻘﻰ ﻧﻜﺘﺐ‬ inverted ‫ﻟﻮ‬

R 6 > 7 mm So >>>> it's RVH

T wave is inverted So >>>> RVH with strain

ME GA copy center -5-

 5- Insult : ( ‫) ﺛﺎﺑﺖ‬
* No ischemia ( S T segment is Isoelectric & no pathological
inversion of T wave .
* No injury (S T segment is Isoelectric ) .
* No infarction ( no pathological Q wave )

ABG ( ‫) أﺳﮭﻞ ﺷﺮﯾﺤﺔ‬

Normal Values

1 ) Oxagention >>>>> P O2

80-90 normal oxygenation

60-79 mild
50-59 moderate YPOXEMIA
< 50 Sever

2 ) Ventilation >>>>>> P CO2

34-45 normal ventilation

< 35 Hyperventilation ‫ زاد ﻋﺸﺎن ﻃﻠﻌﮫ ﻣﻦ اﻟﺠﺴﻢ‬ventilation ‫↓ ﯾﺒﻘﻰ اﻟـ‬CO2 ‫ﻟﻮ ﻗﻞ‬
> 45 Hypoventilation
> 50 Respiratory Failure

3 ) Acid Base Balance >>>>> PH

Acidosis <<<<<< 7.35 – 7.45 >>>>>> Alkalosis

:: abnormality ‫وﺣﺴﺐ اﻟــ‬

Respriratoty <<<< ‫ﯾﺒﻘﻰ‬ P CO2 ‫ﻟﻮ اﻟﻤﺸﻜﻠﺔ ﻓﻰ‬

Metabolic <<<< ‫ﯾﺒﻘﻰ‬ NaHCO3 ‫ﻟﻮ اﻟﻤﺸﻜﻠﺔ ﻓﻰ‬
ME GA copy center -6-
 E.X.

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
Dr TiGeRM@N 
ME GA copy center -7-
 Pedigree
Mode of
inheritance

Autosomal X Linked

Dominant Recessive

‫أﻋﺮﻓﮭﻢ إزاى ﻣﻦ أول‬

‫ﻟﺤﻈﺔ‬

A D A R ‫ﻣﺮض ﯾﺼﯿﺐ اﻟﺬﻛﻮر ﻓﻘﻂ‬

‫ﯾﺼﯿﺐ أﻓﺮاد ﻓﻰ أﻛﺘﺮ ﻣﻦ ﺟﯿﻞ‬ ‫ﯾﺼﯿﺐ اﻟﺠﯿﻞ اﻻول ﺑﺲ‬ (‫)ھﻼﻗﻰ اﻟﻤﻈﻠﻞ ﻣﺮﺑﻌﺎت ﺑﺲ‬
‫وھﺘﻼﻗﻰ دواﯾﺮ ﻓﯿﮭﺎ ﻧﻘﻄﺔ‬

Hereditary Spherocytosis Thalassemia X Linked Recessive

acondroplasia Sickle cell Anaemia Eg. G6PD ↓
Huntington chorea Glycogen storage disease Haemophillia

Longitudinal Transmission Horizontal Transmission Oblique Transmission

ME GA copy center -8-

 X Ray
1- Rickets
Normal X ray

‫ اﺣﺘﻤﺎﻻت‬3

Active healing healed

1 ) Cupping >>> ‫ﻣﻘﻌﺮة‬

2 ) Fraying >>> ‫ﺣﺮف اﻟﻌﻈﻤﺔ ﻣﺸﺮر زى اﻟﻠﮭﺐ‬
3 ) Flarying >>> ‫اﻟﺤﺮﻓﯿﻦ ﺑﺘﻮع اﻟﻌﻈﻢ ﻣﻘﺮﺑﯿﻦ ﻣﻦ ﺑﻌﺾ‬
4 ) Wide Osteoid tissue >>> phalanges ‫اﻟﻤﺴﺎﻓﺔ ﻛﺒﺮت ﺑﯿﻦ ﺣﺮف اﻟﻌﻈﻤﮫ وﻋﻈﻢ اﻟـ‬
5 ) Rarified Shaft >>>Double contour ‫ وﻣﻤﻜﻦ ﯾﺤﺼﻞ‬calcification ‫ﺑﺪأ ﯾﺤﺼﻞ‬

ME GA copy center -9-

 2 - Chest
(Vascular Markings ) ‫ ﻟﻮﻧﮭﺎ أﺳﻤﺮ ) ھﻮا ( وﻓﯿﮭﺎ ﻋﻼﻣﺎت ﺑﯿﻀﺎء‬normal Lung ‫* اﻟـ‬
‫ ھﺘﻼﻗﻰ‬Lung ‫ ﺑﺺ ﻋﻠﻰ اﻻﺗﻨﯿﻦ‬X-Ray ‫* أول ﻣﺎ ﺗﺒﺺ ﻋﻠﻰ‬
‫ ( ﯾﺎ إﻣﺎ أﺳﻤﺮ زﯾﺎدة ﻋﻦ اﻟﻠﺰوم‬1 )
‫ ( ﯾﺎ إﻣﺎ أﺑﯿﺾ زﯾﺎدة ﻋﻦ اﻟﻠﺰوم‬2 )
‫ ( ﯾﺎ إﻣﺎ أﺷﻜﺎل ﻣﺨﺘﻠﻔﺔ‬3 )

( 1 ) Black

Emphysema Pneumothorax

‫( << دى ﺗﻔﺮق‬bilateral ) - unilateral

‫ ﺑﺘﻜﺒﺮ ﻓﻰ اﻟﺤﺠﻢ‬Voluminous
Trachea centeral shifted trachea ‫ﻟﻮ ﻟﻘﯿﺖ‬
Ribbon shaped Heart (‫) ﺷﺮﯾﻂ‬
Horizontal ribs tension pneumothorx

‫ﻟﻮ ﻟﻘﯿﺖ اﺑﯿﺾ ﻣﻌﺎھﺎ ﺗﺤﺖ‬

‫وﻣﺶ ﺷﺎﯾﻒ أى ﺿﻠﻮع ﺗﺤﺘﮭﺎ‬

Pyopneumothorax

ME GA copy center - 10 -
 2) White

Collapse Consolidation
( Lobar Pneumonia )

Concave ‫اﻟﺤﺮف ﺑﺘﺎﻋﮭﺎ‬ Horizontal ‫اﻟﺤﺮف ﺑﺘﺎﻋﮭﺎ‬

Wedge Shaped

‫ﺗﻔﺮق ازاى أﻛﺘﺮ ؟؟؟؟‬

Trachea ‫ھﺒﺺ ﻋﻠﻰ‬

‫ ﻟﻨﻔﺲ اﻟﻨﺎﺣﯿﺔ‬Shifted ( central ‫ ﻟﻠﻨﺎﺣﯿﺔ اﻟﺘﺎﻧﯿﺔ ) وﻣﻤﻜﻦ‬Shifted

A) Collapse B) Pneumonia

C ) Pleural effusion
base ‫ﺟﺰء أﺑﯿﺾ ﻓﻰ اﻟـ‬

rising to Axila
( characteristic )

massive ‫وﻟﻮ‬

Apex ‫اﻟﺠﺰء اﻷﺑﯿﺾ ھﯿﻜﺒﺮ وﯾﻘﺮب ﻣﻦ‬

‫ ﻟﻠﻨﺎﺣﯿﺔ اﻟﺜﺎﻧﯿﮫ‬trachea shifted ‫واﻟـ‬

Rt or Lt ,,,,,, Upper or Lower Lobe ‫ ﻣﺘﻨﺴﺎش ﺗﻜﺘﺐ‬: ‫ﻣﻠﺤﻮﻇﺔ‬

ME GA copy center - 11 -
 ‫ ( أﺷﻜﺎل ﻣﺨﺘﻠﻔﺔ‬3 )

‫ وﻣﺶ ﺷﺎﻛﻚ ﻓﻰ ﺣﺎﺟﮫ ﻣﻌﯿﻨﺔ‬lung ‫ﻟﻮ ﻣﺤﺘﺎر ﻓﻰ ﺷﻜﻞ اﻟـ‬

1 - Broncho Pneumonia

‫ﺑﻄﺶ ﺑﯿﻀﺎ ﻓﻰ اﻟﻨﺎﺣﯿﺘﯿﻦ‬ ‫ﻧﻘﻂ ﺻﻐﯿﺮة ﺟﺪا ﻓﻰ ﻛﻞ ﻣﻜﺎن‬

Alveolar Interstitial

2 – Hyaline membrane disease 3 – Lung Abscess

Ground glass appearance

Cavity with fliud level
‫ ﺗﺤﺲ أﻧﮭﺎ ﻣﻤﻮھﺔ‬Hazy field

ME GA copy center - 12 -
 3 - Cardio
C D / T D ratio ‫ﺳﺎﻋﺎت ﺑﯿﻜﺘﺐ‬
Normal >>>>>>> 50 % in (1St Year )
Cardiomegaly <<<<< 50 ‫ﻟﻘﺘﮭﺎ اﻛﺘﺮ ﻣﻦ‬

* RVE >>>>> angle acute ‫ ﺑﺘﺒﻘﻰ ﻣﺪورة واﻟـ‬base ‫اﻟـ‬

* LVE >>>>> ‫ ﺻﻐﺮت‬lateral chest wall ‫ و‬base ‫اﻟـﻤﺴﺎﻓﺔ ﺑﯿﻦ اﻟـ‬
* LAE >>>>> Oblitration of waist ‫اﺧﺘﻔﺖ‬
* RAE >>>>> ⅓ ‫اﻟﻨﺎﺣﯿﺔ اﻟﯿﻤﯿﻦ ﻛﺒﺮت أﻛﺘﺮ ﻣﻦ‬

‫ ﺣﺎﻻت ﺑﺲ‬3 ‫ﻣﻄﻠﻮب اﺳﻢ اﻟﻤﺮض ﻓﻰ‬

1 ) Pericardial effusion 2) Eissinmenger Syndrome
Flask Shaped dumple shaped

‫ﺷﺒﮫ اﻟﻘﺎرورة‬ prominent pulmonary artery ‫ﻓﻰ اﻟﻨﺎﺣﯿﺘﯿﻦ‬

3 ) Fallot tetrology
Wooden Shoe shaped ( Coeur en sapot )

ME GA copy center - 13 -
 ‫اﻟﺒﺎﻗﻰ ﻏﺎﻟﺒﺎ اﻟﺴﺆال ﺑﯿﺒﻘﻰ اوﺻﻒ اﻟـﻠﻰ ﺷﺎﯾﻔﮫ‬
What's the abnormalities ?? Chumber enlargement
‫وﻋﺮﻓﻨﺎ ﺑﻨﻌﺮﻓﮭﻢ ازاى‬

X – Ray Comment
1 ) Rickets

Plain X – Ray on wrist joint shows

1- active >>>> ‫اﻟﺨﻤﺴﺔ اﻟﻠﻰ ﻗﻠﻨﺎ ﻋﻠﯿﮭﻢ‬

2 - healing >>>> active + white line of calcification
3 - healed >>>> thick line of calcification + evidence of previous rickets
(Flaring , fraying of distal ends of radius & ulna )

2 ) Heart & lung


Chest

- PA view of child x-ray chest & heart

- The patient is centralized & straight ( not titled or rotated )
- Good quality of film
- Chest cage is symmetrical , no rib notching or fracture , trachea is centralized ,
no pathological mediastinal shadow , both copula of diaphragm are intact ,
no elevation with clear costophrenic & cardiophrenic angle

Heart

- Normal site in the middle (⅓ to the right & ⅔ to the left ) RAE ‫ھﻨﻐﯿﺮھﺎ ﻟﻮ ﻓﻲ‬
- Normal suits ( apex toward left side )
- No cardiomegaly (c/t ratio =50% ) cardiomegaly ‫ﻃﺒﻌﺎ ھﺘﺘﻐﯿﺮ ﻟﻮ ﻓﻲ‬

Pleura

- Appears normal
( no thickness , trapped air . or accumaltion of fluids ) pleural effusion ‫ھﺘﺘﻐﯿﺮ ﻟﻮ ﻓﻲ‬

‫ زادت وﻻ ﻗﻠﺖ‬Pulmonary vascular markings ‫ھﻨﻌﻠﻖ ﻋﻠﻲ‬

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 Heart
A ) Pericardial effusion >>>>>> cardiomegaly + flask shaped + ‫اﺳﻜﯿﻢ‬

B ) Eissenmenger syndrome >>>>>> LAH , RVH + lung oligemia + ‫اﺳﻜﯿﻢ‬

C ) Fallot >>>>>> Coeur en sabot + lung oligemia + ‫اﺳﻜﯿﻢ‬

Chest
A ) Lobar pneumonia homogenous opacity restricted to ( affected lobe Rt or Lt )
with straight upper border , lung clear and translucent + ‫اﺳﻜﯿﻢ‬

B ) Broncho Pneumonia patchy scattered of both lungs + ‫اﺳﻜﯿﻢ‬

C ) Tension pneumothorax heart shifted + trachea shifted

+ pleura >>trapped air with hypertranslucent jet black ( ‫ ) ﯾﻌﻨﻲ ﻓﻲ ھﻮا‬+ ‫اﺳﻜﯿﻢ‬

D ) Pleural effusion homogenous opacity rising to axilla + ‫اﺳﻜﯿﻢ‬

E ) Lung abscess cavity with fluid level + ‫اﺳﻜﯿﻢ‬

F ) Collapse Wedge shaped and triangular in shape + ‫اﺳﻜﯿﻢ‬

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 4 - Skull

‫ ﻣﺸﺨﺒﻄﺔ‬Skull ‫ھﺘﻼﻗﻰ اﻟـ‬ ‫ھﺘﻼﻗﻰ ﻓﯿﮭﺎ ﺷﻌﺮ ﻣﻦ ﻓﻮق‬

‫واﻟﻤﺴﺎﻓﺔ ﺑﯿﻦ اﻟﻄﺒﻘﺎت ﻛﺒﺮت‬

Craniostenosis Thalassemia

Comment Comment
Silver bitten appearance Hair on end appearance
( ↑ Intracranial tension ) Wide diploic space
Maxillary over growth

C.T
2 levels ‫ﻋﻨﺪى‬

‫ ﺑﺲ وﻛﺒﯿﺮ‬Lateral ventricle ‫ﺷﻔﺖ اﻟـ‬ ‫ ﻛﻠﮭﺎ‬Ventricles ‫ﺷﻔﺖ اﻟـ‬

High Cortical level Ventricular level
( High mid brain level )

‫ﻣﻠﺤﻮﻇﺔ <<<< رﻛﺰ ﻓﻲ ﺣﺠﻤﮭﻢ واﺿﺢ اﻧﮫ ﺻﻐﯿﺮ ﺟﺪا ﻋﺸﺎن ﻟﻤﺎ ﯾﻜﺒﺮوا ﺗﻌﺮف ﺗﻔﺮﻗﮭﻢ‬
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 1- Hydrocephalus

Sylvain fissure ‫ ﻛﻮﯾﺲ واﻟـ‬Ventricles ‫ﻻﺣﻆ ﺣﺠﻢ اﻟـ‬

‫ﻣﻮﺟﻮد وﻻ ﻣﺶ ﻣﻮﺟﻮد‬

Obstructive Communicating

‫ ﻇﺎھﺮ‬Ventricle ‫ﺗﺸﻮف أﺧﺮ‬ ‫ ﻇﺎھﺮة وﻛﺒﺮت أوى‬ventricles ‫ﻛﻞ اﻟـ‬

4th << ‫ ﺛﻢ‬3rd << ‫ ﺛﻢ‬Lateral ‫أﺑﺺ ﻋﻠﻰ‬

‫ أﺧﺮ واﺣﺪ واﻟﻠﻲ ﺗﺤﺘﮫ‬Obstructive between ‫ﯾﺒﻘﻰ‬

LV

V3 ‫أﺧﺮ واﺣﺪ ﻇﺎھﺮ‬ ‫ﻻﺣﻆ أن ﻛﻠﮭﻢ ﻇﺎھﺮﯾﻦ وﺣﺠﻤﮭﻢ ﻛﺒﯿﺮ‬

DILATED LV-NORMAL V3 & V4 = DILATED LV+V3+V4 =

OBSTRUCTIVE HYDROCEPHALUS COMMUNICATING

BETWEEN LV & V3 HYDROCEPHALUS

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 ‫ ﯾﺎ إﻣﺎ أﺑﯿﺾ ﯾﺎ إﻣﺎ رﻣﺎدى‬mass ‫ھﻼﻗﻰ‬
‫ اﻷﺑﯿﺾ‬:: ‫أوﻻ‬
1 ) Hemorrhage

edge ‫ﻻزق ﻓﻰ اﻟـ‬ ‫ﻓﻰ اى ﺣﺘﮫ ﻓﻰ اﻟﻮﺳﻂ‬ ventricle ‫ﺟﻮه اﻟـ‬

edge ‫و ﻣﺶ واﺻﻞ ﻟﻠـ‬

Subdural Intracranial Interventricular

subarachnoid hge <<< ( ‫ ﻛﺒﺮ ) ﻣﻤﯿﺰة ﺟﺪا‬Sylvain fissure ‫ﻟﻮ ﻟﻘﯿﺖ اﻟـ‬

2 ) Cephalhematoma 3 ) Brain calcification

‫ﺗﺠﻤﻊ دﻣﻮي ﻓﻲ اﻟﺮأس‬ ‫ﻧﻘﻂ ﺑﯿﻀﺎ ﻓﻲ ﻛﻞ ﺣﺘﮫ‬
INTERSTITIL PNEMONIA ‫ﺷﺒﮫ اﻟـ‬

Caused by
TOXOPLASMOSIS , CMV
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 ‫ اﻟﺮﻣﺎدي‬:: ‫ﺛﺎﻧﯿﺎ‬

abscess ‫ وزي أي‬brain ‫ﻓﻲ ﻧﺺ اﻟـ‬ hge ‫ وﻋﺸﺎن ﻣﺘﺘﻠﺨﺒﻄﺶ ﻓﻲ‬edge ‫ﻋﻠﻲ اﻟـ‬
cavity with fluid level ‫اذا ﻛﻨﺖ ﻣﺶ ﻗﺎدر ﺗﻔﺮق اﻟﻠﻮن اﺑﯿﺾ وﻻ رﻣﺎدي‬
Irregular edge

Brain mass Brain infarction

‫ ﺻﻐﺮ ﻓﻰ اﻟﺤﺠﻢ‬brain ‫ واﺿﺤﺔ واﻟـ‬gyri ‫ واﻟـ‬sulci ٍ ‫ھﻼﻗﻰ اﻟـ‬

( relative hydrocephalus ) ‫ ﺷﻜﻠﮫ ﻛﺒﺮ‬ventricle ‫واﻟـ‬

Brain Atrophy

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 Liver Report
↑ Total bilirubin N = 0.3 – 0.8 mg/dL

↑ direct ‫ ﺑﺲ‬N = 0.04 – 0.2 mg/dl ↑ indirect ‫ﺑﺲ‬ ‫↑ اﻻﺛﻨﯿﻦ‬

cholestatic Jaundice hemolytic Jaundice Hepatoceullar

Hepatitis
Inv Alk. phosphates N = 5 – 15 Bodanski U
Ultrasonography -- Inv >> albumin ( 4-6 gm / dl )

↓↓↓ Normal

Chronic Acute
Hepatitis Hepatitis

-- Inv >>> Hepatitis markers

* SGPT
n = 5 - 45 U/ L
* SGOT

Renal Function tests

Serum creatinine = 0.3 – 1 mg / dL
Blood Urea = 20 – 40 mg / dL If all are elevated >>>> Acute renal failure
BUN = 5 – 18 mg / dL

C S F Report
aspect ‫ﻃﺮﯾﻘﺔ اﻟﺤﻞ أﺑﺺ ﻋﻠﻰ اﻟـ‬

Turbid Clear

Pus or Neutrophilis ‫ﻟﻮ ﻓﻰ‬ lymphocyte ‫ﻟﻮ ﻓﻰ‬ ‫ﻟﻮ ﻣﻔﯿﺶ‬ lymphocyte ‫ﻟﻮ ﻓﻰ‬

Bacterial Meningitis T.B Meningitis normal CSF Viral Meningitis

‫وﻟﻮ ﺣﺒﯿﺖ اﺑﻘﻰ اﺗﺄﻛﺪ ﻣﻦ ﺑﻘﯿﺔ اﻟﺤﺎﺟﺎت‬
Bacterial ( Septic ) T.B Viral ( Aseptic )
Ptn ( n =20 -40 mg / dL ) ↑↑ ↑↑ ↑↑
Glucose (n = 60-80 mg% ) ↓↓ ↓↓↓↓↓ normal
Cells ( n = 0 – 5 / HPF ) ↑ Pus or Neutrophilis ↑ Lymphocyte ↑ Lymphocyte
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 Stool Report
Bacterial infection ‫<<< ﯾﺒﻘﻰ‬ Pus <<< ‫ھﺘﻼﻗﻰ ﯾﺎ إﻣﺎ‬
Dysentery ‫ <<< ﯾﺒﻘﻰ‬RBCs <<< ‫ﯾﺎ إﻣﺎ‬
Cause >>> entrobious vermicularis >>> TTT : Flubendazole , mebendazole
>>> entamoeba >>>>>>>>>>>>> TTT : diloxanide , metronidazole

Blood Report

‫اﻻﺳﻜﯿﻢ ﺳﮭﻞ ﻟﻜﻦ اﻟﻤﺸﻜﻠﺔ اﻟﻠﻰ ﺑﺘﻘﺎﺑﻞ اﻟﻨﺎس إن اﻻرﻗﺎم ﻛﺘﯿﺮ وﺷﻜﻞ اﻟﺮﯾﺒﻮرت ﯾﺨﺾ‬
‫ھﻨﺘﻔﻖ ﻣﻊ ﺑﻌﺾ إزاى ﻧﻔﻜﺮ وﻧﺤﻠﮫ ﺑﺴﺮﻋﮫ‬
‫ ﻣﺶ ﻛﻞ اﻻرﻗﺎم ﺑﻨﺤﺘﺎﺟﮭﺎ ﻓﻰ ﺣﻞ اﻟﺮﯾﺒﻮرت‬::: ‫ﻣﻠﺤﻮﻇﺔ‬
‫ ھﻨﺒﺺ ﻋﻠﻰ اﻟﺨﻼﯾﺎ اﻟﺮﺋﯿﺴﺔ‬... ‫أول ﺣﺎﺟﺔ‬
3
RBCs ( n = 4.6 – 5 million / mm )
WBCs (n = 4,000 – 11,000 cells / mm3 )
Platelets ( n = 150,000 – 400,000 cell / mm3 )

‫( ﻟﻮ ﻛﻠﮭﻢ ﻧﺎﻗﺼﯿﻦ ھﺒﺺ ﻋﻠﻰ ﺣﺎﺟﮫ ﻣﻦ اﺗﻨﯿﻦ‬1)

Blast cell Reticulocyte ( RC ) n = 0.5-1.5 %

Leukemia ‫وﺟﻮدھﺎ ﻣﻤﯿﺰ ﻟـﻠــ‬
( ‫) ﻣﺶ ﺷﺮط ﯾﺠﯿﺒﮭﺎ‬

↓↓ normal or↓↓

Aplastic anemia Leukemia

‫ ﺑﺲ اﻟﻠﻰ ﻧﺎﻗﺼﮫ‬RBCs ‫ ( ﻟﻮ اﻟـ‬2 )

‫ ﻋﺸﺎن أﻋﺮف ﻧﻮﻋﮭﺎ ھﺒﺺ ﻋﻠﻰ‬anemia ‫ﯾﺒﻘﻰ أﻛﯿﺪ‬

MCV n = 76 – 96 F L * fimto Liter *
MCH n = 27-32 PG * Pico gram *
MCHV n = 32 – 38 %
:::: ‫ﻛﻠﮭﻢ ھﯿﺒﻘﻮا زى ﺑﻌﺾ‬
Vit. B12 ↓ <<< ( Megaloplastic) ‫ ( ﻛﻠﮭﻢ زاﯾﺪﯾﻦ‬A
Folic acid ↓ <<<
( Normocytic normochromic ) ‫ ﻛﻠﮭﻢ‬normal ( B
helnz bodies ‫ ھﻼﻗﻰ‬G6PD assay ‫ <ھﻌﻤﻠﮫ‬acute haemolytic anaemia ( G6PD ↓ ) <<<
‫ ﻣﺶ ﻣﮭﻢ‬acute hge <<<
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 ‫‪ ( C‬ﻧﺎﻗﺼﯿﻦ ﻛﻠﮭﻢ‬

‫‪n = 50-180 µg %‬‬

‫↑ ‪Iron‬‬ ‫↓ ‪ Iron‬دى ﻛﻔﺎﯾﺔ أوى‬
‫) ‪HPF ↑↑ ( n = 1-2 %‬‬ ‫) ‪Ferritin ↓ ( n = 32 n gm / mL‬‬
‫) ‪Target Cell ( n = not found‬‬ ‫‪SIBC‬‬ ‫) ‪↑ ( n = 250 µg %‬‬ ‫ﻣﻤﯿﺰة‬
‫‪Red Cell Distribution width ( RDW ) n = 14.5‬‬

‫) ‪ ( 3‬ﻃﯿﺐ ﻟﻮ اﻟـ ‪ RBCS & PLATLETS‬ﻗﻠﯿﻠﯿﻦ واﻟـ ‪WBCS NORMAL‬‬

‫) ‪ITP ( idiopathic thrombocytopenic purpra‬‬
‫وﻧﺘﺄﻛﺪ ﻣﻦ ↓ ‪iron‬‬
‫واﻟـ ↑ ‪RC‬‬
‫ﻻن ﺳﺎﻋﺎت ﻓﻲ اﻟـ ‪ LEUKEMIA‬اﻟـ ‪ WBCs‬ﺑﺘﺒﻘﻰ ‪Normal‬‬

‫‪CORRECTED RITCULOCYTOSIS‬‬

‫ﻋﺪد اﻟـ ‪ RC‬اﻟﻤﻔﺮوض ﯾﺒﻘﻲ ﻓﻲ اﻟـ ‪ PATIENT‬دا ﻗﻠﯿﻞ ﺧﺎﺻﮫ إن اﻟـ ‪ HB‬ﺑﺘﺎﻋ ﮫ ﻧ ﺎﻗﺺ ﻓﺴ ﺎﻋﺎت ﯾﻄﻠ ﺐ ﻣﻨ ﻚ‬
‫ﺗﺤﺴﺒﮫ وﺗﺸﻮف ھﻞ ھﻮ ﻣﺘﻨﺎﺳﺐ ﻣﻊ ﻧﺴﺒﮫ اﻟـ ‪HB‬اﻟﺠﺪﯾﺪه وﻻ ﻷ‬
‫ﺑﻌﻨﻲ ﺗﺎﻧﻲ واﺣﺪ ﻋﺎدي اﻟﮭﯿﻤﻮﺟﻠﻮﺑﯿﻦ ﻣﺜﻼ ‪ 11‬و اﻟ ـ ‪ RC‬واﺣ ﺪ ﻓﻠﻤ ﺎ ﯾﻘﻮﻟ ﻚ ﻋﯿ ﺎن ﻋﻨ ﺪه اﻧﯿﻤﯿ ﺎ واﻟ ـ ‪ RC‬ﻧ ﺺ‬
‫ﻣﺜﻼ ﻣﺶ ﺷﺮط ﺗﺒﻘﻲ ﻗﻠﯿﻠﮫ ﻣﻤﻜﻦ ﺗﺒﻘﻲ ﻧﻮرﻣﺎل ‪RELATIVE‬ﻻن اﻟﮭﯿﻤﻮﺟﻠﻮﺑﯿﻦ اﻗﻞ ﻣﻦ اﻟﻄﺒﯿﻌﻲ‬

‫) ‪Hematocrite value ( HV ) ( n= 35-45%‬‬

‫) ‪RC ( n =0.5-2%‬‬
‫‪Hb‬‬ ‫) ‪( n= 7 gm/dl‬‬

‫اﻟﻌﯿﺎن‬ ‫‪HB × RC‬‬

‫= ‪Corrected RC‬‬
‫اﻟـ ‪NORMAL‬‬ ‫‪HB‬‬

‫‪OR‬‬

‫اﻟﻌﯿﺎن‬ ‫‪HV‬‬ ‫×‬ ‫‪RC‬‬

‫=‬
‫‪ HV‬اﻟـ ‪NORMAL‬‬

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 COAGULATION STUDY

Bleeding Time = 4 – 8 min

Coagulation time = 8 – 12 min
‫ اﺻﻐﺮ‬bleeding ‫اﻛﯿﺪ ﺑﯿﻨﺰف اﻻول وﺑﻌﺪﯾﻦ ﯾﺘﺠﻠﻂ ﯾﺒﻘﻲ اﻟـ‬

PT ( PROTHROMBIN TIME ) ( N=12 -14 sec )

TT ( THROMBIN TIME ) (N=15- 20 sec )

PTT ( partial thrmboplastin time ) ( N= 25-40 sec )

‫ ﯾﻌﻨﻲ ﻗﺒﻞ ﯾﺒﻘﻲ اﺻﻐﺮ‬Pro ,,,,,, ‫ أﻛﺒﺮھﻢ‬PTT ‫ﻻﺣﻆ إن‬

prolonged ‫ھﺒﺺ اﺷﻮف ﻣﯿﻦ اﻟﻠﻲ‬

F actor ( I ) Deficiency <<<<<<<<<<< ‫ ﺑﺲ‬TT *

Liver Disease OR Vit. K Deficiency <<<<<< PT + PTT *
DIC <<<<<<<<<<<<<<<< PTT+PT+TT *

Active rickets

* Ca ( normal ) Na ( n = 135 - 150 mEq / L )

K ( n = 3.5 - 5.5 c.c / mg )
* ↓ PH Ca ( n = 9 – 11 mg/ dL )
Phosphors ( n = 4.5 – 6.5 mg / dL )
* ↑ Alkaline phosphatase

BLOOD FILM

‫ﻣﺘﺘﺨﻀﻮش اﻟﻤﻮﺿﻮع ﺑﺴﯿﻂ ﻟﻜﻦ ﺳﺎﻋﺎت ﺑﯿﺤﺐ ﯾﺠﯿﺒﮫ ﻟﻤﺎ ﯾﺤﺐ ﯾﺮﺧﻢ‬
‫ﻋﺎﻣﮫ ھﻤﺎ ﻣﺶ ﻛﺘﯿﺮ‬
‫ﯾﻌﻨﻲ ﻣﺜﻼ‬
SPHEROCYTOSIS
SIKLE CELL ANAEMIA
TARGET CELL IN LEUKEMIA

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 NEONATE Age up to one month

JAUNDICE

Physiological Pathological
‫ﯾﻈﮭﺮ ﻓﻲ اﻻﺳﺒﻮع اﻻول‬ ‫ﯾﻈﮭﺮ ﻓﻲ اول ﯾﻮم‬
Total bilirubin ↑ but < 12.9mg % 12.9 mg % < Total bilirubin

pathological ‫ أو ﻓﻰ أول ﯾﻮم <<<< ﻣﻦ ﻏﯿﺮ ﻣﺎ ﺗﻔﻜﺮ‬since Birth ‫ﻟﻮ ﻗﺎﻟﻚ ﻇﮭﺮ‬

congenital biliary atresia (most commonly extra hepatic biliary atresia ) <<< ‫ ﺑﺲ اﻟﻠﻲ زاد‬direct ‫ﻟﻮ اﻟـ‬

neonatal sepsis <<<<<< ( n =6mg/L ) ‫ زاد‬CRP ‫ﻟﻮ اﻟـ‬

POLYCYATHEMIA <<<<<<< ‫ زادت‬HV ‫ﻟﻮ اﻟـ‬

breast milk jaundice <<<<<exclusive breast feeding ‫ﺣﺼﻞ ﺑﺴﺒﺐ‬jaundice ‫ﻟﻮ ﻗﺎﻟﻚ ان اﻟـ‬

haemolytic disease of newborn ‫ ﺑﺲ اﻟﻠﻲ زاد <<<<<<<<< ﯾﺒﻘﻲ‬indirect ‫ﻟﻮ ﻗﺎﻟﻚ اﻟـ‬

ABO incompatibility RH incompatibility

( O ) ‫اﻷم‬ ( - ve ) ‫اﻷم‬
( A ) or ( B ) ‫اﻻﺑﻦ‬ ( + ve ) ‫اﻻﺑﻦ‬

( 85 × weight × 2 ) <<<< ‫ﻟﻮ ﻗﺎﻟﻚ اﺣﺴﺐ ﻧﺴﺒﮫ اﻟﺪم اﻟﻠﻲ ھﻨﻘﻠﮫ ﻟﻠﻄﻔﻞ‬

Urine report

GN NEPHROTIC SYNDROME UTI

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 1 ) Urine volume

Oliguria Decreased Normal Increased Polyuria

0.8
1.5 3.5
5

‫اﻟﺘﻤﯿﯿﺰ ﻣﮭﻢ ﺟﺪاااااااااااااااا‬ CC/KG/HR

2 ) Protein in urine
Normal …. < 4 mg / m2 / hr
Significant proteinuria 4 – 40 mg / m2 / hr
Nephritic range > 40 mg / m2 / hr

‫ و ھﻨﺸﻮف ﻣﺜﺎل ﻋﺸﺎن ﻧﻔﮭﻢ أﻛﺘﺮ‬... ‫ ﻋﺒﺎرة ﻋﻦ ﻣﺴﺄﻟﺔ ﺣﺴﺎﺑﯿﺔ ﺑﺤﺘﮫ‬Problem ‫اﻟـ‬
** 3 years old ♂ infant with urine output 450cc over 24 hrs and
Ptn volume in urine = 1 gm
‫ﻧﻔﻜﺮ إزاي ؟؟؟؟؟؟؟؟‬
c.c / Kg / hr ‫ ﻛﺎم وﻃﺒﻌﺎ زى ﻣﺎ ﻗﻮﻟﻨﺎ اﻟﺘﻤﯿﯿﺰ‬proteinurea ‫ واﻟـ‬volume ‫ﻻزم أﻋﺮف اﻟـ‬
... ‫ﯾﺒﻘﻰ ﻣﻄﻠﻮب ﻣﻨﻰ ﺣﺎﺟﺘﯿﻦ‬
‫( أﻋﺮف وزﻧﮫ ﻛﺎم ﻋﺸﺎن أﻗﺪر أﺣﺴﺐ ﺑﯿﻄﻠﻊ اد اﯾﮫ ﻟﻜﻞ ﻛﯿﻠﻮ‬1
‫ﺑﺘﺘﺤﺴﺐ ﺑﺎﻟﻤﻌﺎدﻻت‬
( age in ms ) + 9
( 3 – 12 ms ) =
2

( 2 – 6 ys ) = ( age in ys Í 2 ) + 8

( age in ys Í 7 ) - 5
( 7 – 12 ys ) =
2

3 ys >>>> ( 3 Í 2 ) + 8 = 14 kg ‫ﻃﯿﺐ ھﻮ ھﻨﺎ ﻛﺎم‬

‫ ﻋﺸﺎن أﻋﺮف ھﻮ ﻛﻤﯿﮫ اﻟﺒﻮل اد اﯾﮫ ﻟﻜﻞ ﺳﺎﻋﺔ‬24 ‫أ ﻗﺴﻢ ﻋﻠﻰ‬
Volume = 450 / 14 / 24 = 1.33 c.c / Kg / hr

‫دﻟﻮﻗﺘﻰ اﻗﺪر أﺣﻜﻢ وأﻗﻮل ﻣﻦ اﻟﻤﺨﻄﻂ اﻟﻠﻰ ﻓﻮق أﻧﮫ‬

Decreased Urine Output
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 ‫‪ ( 2‬أﺣﻜﻢ ھﻰ ‪ NS‬وﻻ ‪GN‬‬

‫أﺣﺴﺐ اﻟـ ‪ Ptn‬ﻓﻰ اﻟـ ‪ Urine‬واﻟﺘﻤﯿﯿﺰ ﻣﮭﻢ ‪mg / m2 / hr‬‬

‫ﯾﺒﻘﻰ ﻋﻨﺪى ‪ 3‬ﺧﻄﻮات ‪:::‬‬
‫‪1gm = 1000 mg‬‬ ‫اﺿﺮب × ‪1000‬‬ ‫‪mg‬‬ ‫‪ ( 1‬أﺣﻮل ‪<<< gm‬‬
‫‪ ( 2‬أﺟﯿﺐ ‪ m2‬ﻃﯿﺐ أزاى ؟؟‬

‫= ‪m2‬‬ ‫‪( weight Í 4 ) + 7‬‬

‫‪weight + 90‬‬

‫وﻃﺒﻌﺎ ﻟﺴﮫ ﺟﺎﯾﺒﯿﻦ اﻟﻮزن ﻓﻮق ‪14 kg‬‬

‫= ‪m2‬‬ ‫‪( 14 Í 4 ) + 7‬‬

‫=‬ ‫‪0.6 m‬‬
‫‪2‬‬

‫‪14 + 90‬‬

‫‪ ( 3‬اﻗﺴﻢ ﻋﻠﻰ ‪ 24‬زى ﻣﺎ ﻗﻮﻟﻨﺎ ﻋﺸﺎن أﺟﯿﺐ أد اﯾﮫ ﻓﻰ اﻟﺴﺎﻋﮫ اﻟﻮاﺣﺪة‬

‫‪Protein in urine = 1000 / 0.6 / 24 = 69.44 mg / m2 / hr‬‬

‫‪Protein of Nephrotic range ,,‬‬

‫‪so it’s Nephrotic syndrome‬‬

‫ﻣﻠﺤﻮﻇﮫ ‪ :‬ﻟﻮ ﻋﻤﻞ اﻟﻌﻜﺲ و ﺟﺎﺑﻠﻚ اﻟﻨﺴﺒﮫ اﻟﻌﺎدﯾﺔ ﻟﻜﻞ ) ‪ ( kg‬وﻟﻜﻞ) ‪ ( hr‬وﻋﺎوز ﯾﺤﺴﺐ اد اﯾﮫ ﺑﯿﻄﻠﻊ ﻓﻰ اﻟﯿﻮم‬
‫ھﻨﻀﺮب ﻓﻰ ‪ 24‬وﻓﻰ وزﻧﮫ ﻣﺶ ھﻨﻘﺴﻢ <<< اﻟﻌﻜﺲ ﯾﻌﻨﻰ‬

‫‪U TI‬‬

‫‪PURIA‬‬ ‫‪PH‬‬ ‫‪WBCS CAST‬‬

‫) ‪( Pus in Urine‬‬

‫‪PYLONEPHRITIES‬‬
‫‪Alkaline‬‬ ‫‪Acidic‬‬
‫) ‪( by proteus‬‬ ‫) ‪( E. coli‬‬
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 HB ELCTROPHORESIS

THALASSEMIA ‫ ↑ <<<<<<<< ﯾﺒﻘﻲ‬HB F ‫* ﻟﻮﻟﻘﯿﺖ‬

SICKLE CELL ANAEMIA ‫ <<<<<<<<<<<< ﯾﺒﻘﻲ‬HBS ↑ ‫* ﻟﻮ ﻟﻘﯿﺖ‬

SICKLE CELL TRAIT <<<<<< ‫ ﯾﺒﻘﻰ‬HBF %10-20 + 80-90% ‫زاد اﻛﺘﺮ ﻣﻦ‬HBS ‫* ﻟﻮ ﻟﻘﯿﺖ‬

ENDOTRACHEL TUBE

‫ﻟﻮ ﻓﻜﺮ ﯾﺠﯿﺐ ھﯿﻘﻮﻟﻚ اﺣﺴﺐ ﺣﺎﺟﺘﯿﻦ‬

Size Length

Uncuffed Cuffed Oral Nasal

age /4 + 4 age/4 + 3 age / 2 + 12 age / 2 + 15

Pictures

‫ ﯾﻮﺿﺤﮭﺎ ﺟﺪا‬comment ‫اﻟﺤﻤﺪﷲ ﺑﻘﺖ اﺳﮭﻞ ﻛﺘﯿﺮ ﻣﻦ اﻣﺘﺤﺎن اﻟﺮاوﻧﺪ ﻻن اﻟﺪﻛﺘﻮر ﻗﺎل ھﯿﺠﯿﺐ ﻣﻌﺎھﺎ‬
‫واﻟﺼﻮر دﯾﻤﺎ ﺑﺘﺒﻘﻲ ﻣﺮﻛﺰه ﻋﺎﻟﺠﺰء اﻟﻠﻲ ﻋﺎﯾﺰك ﺗﺘﻜﻠﻢ ﻋﻨﮫ ﻓﻤﺘﺒﺼﺶ ﻓﻲ ﺣﺘﮫ ﺗﺎﻧﯿﮫ وﻏﺎﻟﺒﺎ ﺑﺘﺒﻘﻲ ﺣﺎﺟﮫ‬
‫ ﺟﺪا ﻟﻠﻤﺮض‬characteristic
:::: ‫زي ﻣﺜﻼ‬
jaundice ‫*** ﺟﺎب ﻋﯿﻦ ﺻﻔﺮا ﻋﺸﺎن اﻟـ‬

Down***
Simian crease
Clinodactyly ( incurved 5th finger )
Mongoloid facies

( PEM ) Kwashiorkor <<<<<<<<<<< lower limb ‫ ﻋﻠﻲ اﻟـ‬dermatitis ‫***ﺟﺎب‬

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 ‫وھﻨﺴﺘﻌﺮض ﺷﻮﯾﮫ ﺻﻮر ﻣﻊ ﺑﻌﺾ دﻟﻮﻗﺘﻲ وزي ﻣﺎﻗﻠﻨﺎ ﻧﺮﻛﺰ ﻋﻠﻲ اﻟﺤﺎﺟﺎت اﻟﻤﻤﯿﺰة ﺟﺪا‬
‫وھﻲ ﻏﺎﻟﺒﺎ ھﺘﺒﻘﻲ ﺑﺮوﺑﻠﯿﻢ زي ﺑﺘﺎع اﻣﺘﺤﺎن اﻟﻨﻈﺮي ﺑﺎﻟﻈﺒﻂ‬

‫‪Down‬‬

‫‪Clubbing‬‬ ‫) ‪Erethema marginatum (rheumatic fever‬‬

‫‪Kwashiorkor‬‬

‫‪Marasums‬‬

‫‪ME GA‬‬ ‫‪copy center‬‬ ‫‪- 28 -‬‬

 Rickets cyanotic heart disease

SCORES

‫ ﯾﺰﯾﺪ ﯾﺒﻘﻲ أوﺣﺶ‬score ‫ﻻﺣﻆ ان ﻛﻞ ﻣﺎ اﻟـ‬

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 APGAR score

Sign 0 1 2
HR Absent <100 >100
Respiratory effort Absent Slow & Irregular Good & Crying
Ms Tone Limb Some flexion Active
Respond to Catheter No Grimase Cough & Sneezing
Color Blue & Pale Body pink & Blue Extremities Completely Pink

Score 8- 10 needs mild care

5 – 7 needs moderate care
3 – 5 needs intensive care
downes score ‫ﻻﺣﻆ اﻧﮫ ﻋﻜﺲ اﻟـ‬
‫ ﺑﯿﻌﻠﻲ ﯾﺒﻘﻲ أﺣﺴﻦ‬score ‫ھﻨﺎ ﻛﻞ ﻣﺎ اﻟـ‬

Glasgow coma scale

activity Adult children Infant score

Spontaneous Spontaneous 4
to speech to speech 3
Eye opening
to pain to pain 2
None None 1
appropriate speech Coos . babbles 5
confused speech Irritable 4
Verbal Inappropriate word Cries to pain 3
none specific sounds Moans to pain 2
None None 1

Obeys commands Normal spontaneous movement 6

Localizes pain Withdraws to touch 5
Withdraws to touch Withdraws to pain 4
Motor
Decorticate to pain Decorticate to pain 3
Decerebrate to pain Decerebrate to pain 2
None None 1

Fully conscious given score 15

Lethargy . confusion or delirium 11 – 14
Stupor 9 – 11
Patient with coma 8 or less
‫ ﻣﻦ اﻟﻜﺘﺎب‬growth & development ‫ﻣﺘﻨﺴﻮش ﺗﻘﺮوا اﻟـ‬
 
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