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Name :PUJAPPA Age :14yrs Sex :Male Address:Marenali Bagnur post ,yelanka ,Bangalore North. Informant :Father ,Mother & self(reliable) PowerPoint PPT Presentation


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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.

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Name :PUJAPPA Age :14yrs Sex :Male Address:Marenali Bagnur post ,yelanka ,Bangalore North. Informant :Father ,Mother & self(reliable)

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No h o chd

  • 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 chd

  • 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.


No h o chd

  • 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

  • No h/o CHD


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 2-3spoons .started breast feeding 2hr after birth till 5months.

    No h/o intermittent feeds

    No h/o sweating over forehead during feeding


No h o chd

  • No h/o fever ,cough, chest indrawing.

  • Immunisation h/o:

    Unimmunised(unawareness)

  • Development h/o:appropriate for age.


No h o chd

Required

Required

Getting

Getting

deficit

deficit

2400 Kcal

2400 Kcal

1400

1400

58%

58%

70 gms

70 gms

48

48

65%

65%

NUTRITION H/o


No h o chd

  • Socioeconomic h/o:Father 1st std ,Mother illiterate --coolie Rs 500/month.

    1room 1kitchen kerosene stove cooking

    out door sanitation.

    low socioeconomic status


Summary

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


No h o chd

  • CCHD with decrease pulmonary blood flow

  • TOF

  • TGV with VSD with PS

  • DORV with PS

  • Single ventricle with PS


Anthropometry

ANTHROPOMETRY

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

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 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


No h o chd

  • Thorax & abdomen –Branding marks +

  • Skin –N

  • Bones & joints –N

  • Spine– N

  • No facial dysmorphism

  • No extracardiac markers

  • No features of infective endocarditis.


Systemic examination

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.


No h o chd

  • 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.


No h o chd

  • 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+


No h o chd

  • RS :Trachea central

    B/L symmetrical chest movement+

    B/L air entry

    NVBS+

  • P/A:Soft

    no organomegaly ,BS+

  • CNS:No focal neurological deficits.


No h o chd

  • 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

Investigations

  • 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


No h o chd

  • 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


No h o chd

  • Chest X-ray:

  • ECHO:


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