Remember:

-A spleen is said to be significantly enlarged if it is palpable at least 1 cm below the costal margin in a child more than 6 months of age.

-However in about 30% of newborns and in 15% of infants below 6 months, a palpable spleen is a normal variant.

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Remember:

-Tender splenomegaly is found in the following conditions:
(a) Infective endocarditis
(b) Splenic infarction
(c) Splenic abscess.

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Differences between Kidney and spleen swelling.

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The following points are helpful in differentiating spleen from kidney enlargement:
(a) Kidney is always bimanually palpable or ballotable.
(b) Splenic notch is felt in splenomegaly.

These two features are the most important.

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Bronchiolitis vs Asthma.

Also history of atopy may be present in Asthma but absent in the other.
Family history may be positive in asthma.

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What are the causes of tender Hepatomegaly?

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•What are the signs of Pulmonary HTN?

-Palpable P2
-Prominent ‘a’ wave in JVP
-Left parasternal heave (indicates RVH)
-Epigastric pulsation (indicates RVH)
-Loud P2 on auscultation
-Early diastolic murmur (Graham steel murmur due to PR).

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•To diagnose AR, remember the formula of 3:

-3 pulse: Collapsing (water hammer), dancing carotid and capillary pulsation.

-3 BP: Rise of systolic, fall of diastolic and wide pulse pressure.

-3 murmur: Early diastolic murmur, Austin Flint murmur and ejection systolic murmur.

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•What is collapsing pulse, causes?

-In collapsing pulse, there is rapid upstroke and descent of pulse, seen by raising the arm above the head.

-Causes are:
1-AR (the most common cause)
2-Hyperdynamic circulation due to any cause
3-PDA
4-Rupture of sinus of Valsalva
5-Large AV communication.

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•Are “high volume pulse” and “collapsing pulse” synonymous?

-Collapsing pulse is always high volume, but all high volume pulse are not collapsing..!

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Remember:

-S3 never occurs in MS.

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What are the signs of activity in rheumatic fever?

-Persistent fever
-Tachycardia
-High ESR
-Leukocytosis
-Evidence of carditis.

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-When Eisenmenger’s syndrome develops, there is cyanosis, clubbing and evidence of pulmonary hypertension.
-Pansystolic murmur may disappear, because of equalization of pressure in right and left ventricle.

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•What is Eisenmenger’s syndrome?

-Pulmonary hypertension with reversal of shunt is called Eisenmenger’s syndrome.

-Causes are:
VSD
ASD
PDA
-In VSD, this occurs in early life, in PDA a little later than VSD, in ASD this occurs in adult life.

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Will KWO develop ascites?

-Yes, late severe cases!

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Grades of Kwashiorkor.

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Grades of Marasmus.

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