Transcript Document

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Name :PUJAPPA
Age :14yrs
Sex :Male
Address:Marenali
Bagnur post ,yelanka ,Bangalore North.
• Informant :Father ,Mother & self(reliable)
• DOA:17-03-05
• No h/o cough, fever, chest indrawing
• No h/o palpitation,edema of feet,decrease
urine output.
• No h/o headache,vomiting,convulsions,
weakness of limbs.
• Past h/o:h/o URI 2-3 times /year
No h/o suggestive of ALRI
No h/o admission to hospital
• Family h/o:non consanguineous marriage.
– No h/o CHD
• Birth h/o:unbooked & unimmunised
1—no h/o drug intake,fever with rash
2--- no h/o suggestive PIH,DM
home delivery conducted by untrained dai.
BCIAB avg wt baby.prelacteal feeds sugar water 23spoons .started breast feeding 2hr after birth till
5months.
No h/o intermittent feeds
No h/o sweating over forehead during feeding
• No h/o fever ,cough, chest indrawing.
• Immunisation h/o:
Unimmunised(unawareness)
• Development h/o:appropriate for age.
NUTRITION H/o
Required
Getting
deficit
2400 Kcal
1400
58%
70 gms
48
65%
• Socioeconomic h/o:Father 1st std ,Mother
illiterate --coolie Rs 500/month.
1room 1kitchen kerosene stove cooking
out door sanitation.
low socioeconomic status
summary
• 14yr old male boy pujappa 5th child of non
consanguineous marriage presented with
h/o breathlessness on exertion with
squatting episodes since age of 3yrs.
h/o cyanosis
h/o not gaining wt.
no h/o repeated ALRI/CCF
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CCHD with decrease pulmonary blood flow
TOF
TGV with VSD with PS
DORV with PS
Single ventricle with PS
ANTHROPOMETRY
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expected
Wt 24kg (5th centile) 35kg
Ht 142cm(25th centile)150cm
HC 51cm
CC 57cm
Wt age
Ht age
13 yrs
weight more affected
Wt for ht 77.4
than height
US/LS
0.9
VITALS
• PR -72/min regular, good volume,all
peripheral pulses well felt,no R-R,no
R-F delay
• BP- 100/68mmhg—UL, 110/70 –LL.
• RR-18/min
• Temp –Afebrile
• JVP--N
HEAD TO TOE EXAMINATION
• Head –N
• Eyes –conjunctival xerosis,conjunctival
suffusion
• Ears –N
• Nose –N
• Neck –no lymphadenopathy
• Mouth – lips & tongue –cyanosis ,no caries
• Hands –nails –cyanosis,clubbing –grade 3
• Feet –toes-- cyanosis,clubbing –grade 3,no
pedal edema
• SMR –stage 2
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Thorax & abdomen –Branding marks +
Skin –N
Bones & joints –N
Spine– N
No facial dysmorphism
No extracardiac markers
No features of infective endocarditis.
SYSTEMIC EXAMINATION
• PR-72/min BP-100/68-UL,110/70-LL
JVP-N
• Inspection :Apical impulse seen in 4th ICS
medial to MCL.
No precordial bulge
No other visible pulsations.
• Palpation :Apical impulse seen in 4th ICS
0.5cm medial to MCL,Normal.
Thrill left 2,3,4 ICS along sternal border.
Parasternal heave grade 1
no epigastric pulsation,
no palpable P2
Percusion :left border corresponds to apex.
• Auscultation :heart sounds S1 S2 heard
ejection systolic murmur of grade 4
heard best in left upper sternal border with
diaphragm ,during inspiration,with sitting posture.
MA:S1S2+ same ejection systolic murmur +
PA : S1S2+, single S2,well heard , same
ejection systolic murmur .
TA: S1S2+
AA:S1S2+
• RS :Trachea central
B/L symmetrical chest movement+
B/L air entry
NVBS+
• P/A:Soft
no organomegaly ,BS+
• CNS:No focal neurological deficits.
• Impression :CCHD with decreased pul
blood flow in sinus rhythm, with out failure,
with no evidence of IE.
TOF
DORV with PS
TGV with VSD with PS
Investigations
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Hb :16.8 gm/dl
PCV:58.8%
TC-8,600cells/cumm
DC N-71% L-22% E-4% M-3%
RBC 7.55million/cumm
Platelet :2.23lac
PBS:normocytic normochromic
• ECG:HR-72/min
regular rhythm
PR interval 0.16sec
QT interval 0.32 sec
Right axis deviation (+120)
RVH –Tall R wave in V1 &deep S wave in
V6
• Chest X-ray:
• ECHO: