Business Strategy and Change Management Quiz

Pediatric Cardiology

• Incidence: 8 per 1000 live births have significant cardiac malformation.
• Risk Factors: Genetic predisposition, exposures during pregnancy (drugs or disease), chromosomal abnormality.

Acyanotic Congenital Heart Diseases (ACHD)

• Classification (ACHD with left-to-right shunt): Ventricular septal defect (VSD), Patent ductus arteriosus (PDA), Atrial septal defect (ASD).
• General Clinical Features: The degree of left-to-right shunting and consequently clinical manifestations depend on the size of the defect and pressure gradient across the defect. Manifestations of high pulmonary blood flow include: poor feeding, exercise intolerance, recurrent chest infections and wheezes, and recurrent heart failure.
• Heart Failure: Usually doesn't occur in full-term neonates, but can occur in infancy. Can be a manifestation of pulmonary vascular pressure decline.
• Classification (ACHD without shunt): Obstructive lesions (e.g., aortic coarctation, aortic stenosis, pulmonary stenosis).

Ventricular Septal Defect (VSD)

• Definition: Defect anywhere in the interventricular septum.
• Hemodynamics: Blood is shunted from the left ventricle (higher pressure) to the right ventricle (lower pressure), leading to increased pulmonary blood flow. Pulmonary congestive symptoms result from volume overload on the right ventricle, left atrium, and left ventricle.

Atrial Septal Defect (ASD)

• Definition: Defect in the inter-atrial septum.

Patent Ductus Arteriosus (PDA)

• Definition: Persistent fetal duct connecting the aorta and the pulmonary artery.
• Association: Congenital rubella syndrome and premature infants.
• Medical closure: IV indomethacin in the first week of life.

Atrioventricular Septal Defect (AVSD)

• Definition: Defect in the atrioventricular septum; often involves a complete defect.
• Association: Frequently associated with Down syndrome.
• General manifestations: Usually asymptomatic if the defect is small but may lead to dyspnea during suckling and recurrent chest infections if the defect is large. Manifestations may include tachycardia and an enlarged tender liver (heart failure).
• Complications: Infective endocarditis, Eisenmenger syndrome, and heart failure.
• Treatment: Medical (controlling heart failure) and surgical (for symptomatic large defects with uncontrolled heart failure).

Cyanotic Congenital Heart Disease (CCHD) - Fallot Tetralogy

• Definition: Commonest cyanotic congenital heart disease with decreased pulmonary blood flow; combination of defects. Includes :pulmonary stenosis (infundibular or valvular). Right ventricular hypertrophy, ventricular septal defect (VSD) and aortic dextroposition
• Clinical Picture: Central cyanosis (noted immediately in neonates or later in the first year of life), cyanotic clubbing of fingers and toes, growth retardation, squatting position (for relief of dyspnea), paroxysmal hypercyanotic spells (hypoxic).

Investigations related to CHD

• Investigations: Chest X-ray, echocardiography, ECG, Complete Blood Count (CBC showing polycythemia), and possible pulmonary tuberculosis.

Heart Failure

• Definition: Heart is unable to pump enough blood to meet body needs.
• Causes: Congenital heart disease (most common in infancy), rheumatic heart disease, myocarditis, infective endocarditis, severe anemia, nutritional deficiencies (e.g., kwashiorker), dysrhythmia, dilated cardiomyopathy, and cor pulmonale (pulmonary disease).
• Symptoms (Infants): Poor feeding, dyspnea while feeding, excessive sweating, and poor weight gain in infants.
• Symptoms (Older Children): Dyspnea on exertion, effort intolerance, and ankle edema.
• Signs: Tachycardia, gallop rhythm, weak pulse, cold sweaty skin, cardiomegaly, congested neck veins (hard to detect in infants), and edema (starting in ankles/sacral areas in bedridden).

Acute Rheumatic Fever (ARF)

• Definition: Immunologic disease mainly affecting the heart and joints, less frequently the central nervous system and skin.
• Peak onset: Between 5-15 years in childhood and 20-30 years in adults.
• High risk populations: Developing countries.
• Pathogenesis: After 1-3 weeks of Group A β-streptococcal (GAS) infection, antibodies form against streptococcal antigens, causing cross-reaction with host connective tissue and leading to inflammation of the heart (carditis) and joints (arthritis).
• Major criteria (Clinical Picture): Arthritis (big joints, migratory, dramatic response to salicylates within 48 hours), Carditis (inflammation of endocardium, myocardium, and pericardium with likely valvulitis), Sydenham chorea (emotional lability, and involuntary movements), Erythema marginatum (large erythematous macules), and subcutaneous nodules.

Infective Endocarditis

• Definition: Infection of the valvular and mural endocardium.
• Risk Factors: Prosthetic cardiac valve, previous infective endocarditis, congenital heart disease (except ASD), permanently damaged valves due to rheumatic heart disease.
• Commonest Causative Organisms: Streptococcus viridans (50%), Staphylococcus aureus and epidermidis, Group D enterococci, and some fungi (seen more often in immunodeficient conditions)

Pediatric Hematological Diseases - Anemia

• Definition: Reduction of hemoglobin and/or RBC count below the average for age and sex, interfering with oxygen-carrying capacity of blood.
• General Features (Symptoms): Fatigue, headaches, faintness, palpitations, breathlessness, and angina.
• Signs: Pallor, tachycardia (palpitation), hemolytic murmurs (functional, systolic), and heart failure in severe anemia (Hb <4 gm/dL).

Megaloblastic Anemia

• Definition: Anemia with megaloblasts in the bone marrow and macrocytes in peripheral blood.
• Vitamin B12 Sources: Animal products (milk, meat).
• Folate Sources: Animal and plant (green leaves, fruits).
• Causes: Vitamin B12 and folic acid deficiency.
• Clinical Picture: Anemia, anorexia, pallor, tiredness, possible slight jaundice, advanced megaloblastic anemia, thrombocytopenia, and leukopenia. Mild hepatosplenomegaly may result from intramedullary hemolysis. Gastrointestinal symptoms (in folate deficiency) can include glossitis, dyspepsia, vomiting, and abdominal pain with chronic diarrhea.

Thalassemia

• Definition: Autosomal recessive disorders due to defective globin chain production.
• Types: Alpha and Beta thalassemia syndromes (deletion of 1 or more of the alpha globin genes on chromosome 16 (alpha thalassemia), and a mutation on one or both of the beta globin genes on chromosome 11 (beta thalassemia)).
• Clinical Picture: Different types of thalassemia have manifestations ranging from asymptomatic to severe (thalassemia major), Mild to severe microcytic hemolytic anemia at birth (with some forms, such as Hb H disease). Hemoglobin electrophoresis helps distinguish.
• Complications: Heart failure, restrictive cardiomyopathy, dysrhythmias, liver cirrhosis, liver failure, hepatitis, diabetes mellitus, bronzed skin, short stature, hypothyroidism, hypogonadism, and delayed puberty.

Sickle Cell Disease

• Etiology: Autosomal recessive disorder caused by a single amino acid substitution (valine for glutamic acid) in the 6th position of the β-globin gene.
• Clinical picture: Features of anemia, chronic hemolysis, and renal disorders (such as proteinuria, nephrotic syndrome, and chronic renal failure).
• Crises: Aplastic, hemolytic, megaloblastic, hyperhemolytic, and vaso occlusive.
• Investigations: Anemia evaluation (low Hb and Ht), chronic hemolysis evaluation (RBC survival and erythropoiesis), and cause determination.

Acute Bronchiolitis

• Etiology: Usually, viral infection (Respiratory Syncytial Virus [RSV] in 50% of cases and other viruses).
• Incidence: Most common in infants (peak ~ 6 months of age).
• Clinical Picture: Mild upper respiratory catarrh (rhinitis), mild fever initially, then progressive dyspnea, cough (wheezy chest), irritability, difficulty in feeding, and/or air hunger. Apnea may be more prominent in infants less than 2 months or former premature infants. Signs include respiratory distress, tachypnea, retractions, and grunting.
• Investigations: Chest X-ray (for severe illness or suspecting bacterial superinfection), blood tests (CBC often normal, ESR, CRP and WBC counts are usually normal).
• Treatment: Supportive measures (bed rest, cool humidified oxygen inhalation, high-flow nasal cannula, frequent suctioning of nasal secretions). Treat with corticosteroids (oral/IV dexamethasone), and other supportive care as needed.

Acute Epiglottitis (Supraglottitis)

• Etiology: Infection of the epiglottis often caused by Haemophilus influenzae, streptococcal and staphylococcal species
• Clinical Picture: High fever, drooling, dysphagia, toxic appearance, muffled voice, mild stridor, little or no cough, the child prefers to have an upright posture and the neck is hyperextended.
• Management: Medical emergency, admission to the intensive care unit (ICU). Endotracheal intubation/tracheostomy is often necessary. Antibiotics (Ceftriaxone or Cefotaxime or Meropenem) are indicated based on the sensitivity testing results.

Acute Sinusitis

• Major risk factors: Upper respiratory tract infections and immunodeficiency.
• Causes: Mixed infections (viral and bacterial), and possibly otitis media.
• Clinical Picture: Fever, headache, purulent/mucopurulent nasal discharge, postnasal drip and cough.
• Investigations: Culture and sensitivity of an aspirate, and possibly a plain X-ray to check skull or CT scan for the skull.
• Treatment: Symptomatic treatment (paracetamol for fever and pain). Antibiotics (high dose amoxicillin-clavulanate for 10 days) or alternative antibiotics. Saline nasal washes/sprays to liquefy secretions.

Tuberculosis (TB)

• Definition: Chronic infectious disease caused by Mycobacterium tuberculosis
• Risk factors: Children exposed to high-risk adults, low socioeconomic standards, individuals with suppressed immune systems, and those of certain susceptible races or ethnicities.
• Clinical picture: May be asymptomatic (up to 50%), mild fatigue and poor appetite, nonproductive cough, and mild dyspnea, difficulty gaining weight and failure to thrive. Can be caused by pulmonary and extra pulmonary (cervical, mediastinal, mesenteric, miliary, intestinal, and peritonitis). There can be toxic manifestations, hectic fever, and complications such as pleural effusion or tuberculous meningitis, depending on type and location.
• Diagnostic criteria: History of exposure to an adult with infectious TB, tuberculin skin test (TST, checking induration after 48-72 hours).
• Treatment: Isolation of infected persons, milk sanitation, and specific regimens like six-month, 12-month, or 9-month regimens.

Pneumonia

• Definition: Infection of the lower lung involving airways and alveoli.
• Anatomic classification: Lobar, bronchopneumonia, and interstitial.
• Etiologic classification: Bacterial (gram-positive and gram-negative), viral.
• Atypical causes: Mycoplasma and chlamydia.
• Opportunistic causes: Fungi and protozoa (in immunocompromised patients).
• Symptoms: Variable onset (acute, subacute, gradual), fever, malaise, toxemia, chest cough (possibly productive), dyspnea, and grunting.
• Signs: Respiratory distress, tachypnea, nasal flaring, retractions, and cyanosis.
•  Investigations: Chest X-ray, blood tests (WBC count, ESR, CRP, and organisms isolation), and other appropriate investigations.
• Treatment: Supportive care (e.g., rest, humidified oxygen, fluid management). Specific antibacterial or antiviral therapy based on suspected cause, severity, and patient response.

Acute Infectious Stridor (Croup):

• Cause: Viral infection (often para-influenza virus type 1, 2, and 3). Other viruses may also be involved
• Presentation: Upper respiratory catarrh; low-grade fever, croupy barking cough, hoarseness or voice loss and toxic appearance.
• Management: Home treatment is usually successful. Hospitalization is needed in severe cases or progressive narrowing of the airway. Support care like humidified air, and oxygen as needed.

Acute Epiglottitis (Supraglottitis):

• Definition: Acute inflammation of the supraglottic structures, potentially life-threatening.
• Cause: Often caused by Haemophilus influenzae type B. Other species of bacteria may also cause it.
• Clinical Presentation: Severe and rapid onset of symptoms; high fever, drooling of saliva, dysphagia, difficulty in swallowing, toxic appearance, mild stridor (can be absent if epiglottis is severely affected), little or no cough, and upright posture with hyperextension of the neck to open the airway.
• Management: Emergency; secure the airway, intubation or tracheostomy (immediate intervention), supportive care, and antibiotics (e.g., Ceftriaxone) based on sensitivity testing.

Seizures

• Definition: Recurrent, uncontrolled bursts of electrical activity in the brain, causing abnormal motor, sensory, behavioral, or autonomic symptoms; transient, in a specific timeframe.
• Causes: Febrile seizures, first epileptic fit, symptomatic seizures (CNS causes- meningitis, encephalitis, abscess; brain tumor, trauma, toxic exposures, or inborn errors of metabolism), recurrent seizures (epilepsy, or due to inborn errors of metabolism, or degenerative brain disease).

Febrile Seizures

• Definition: Seizures in children due to sudden increase in body temperature.
• Incidence: Affects approximately 4% of children.
• Diagnostic Criteria: Age (6-60 months); seizures occurring within 8-12 hours of fever onset; no evidence of central nervous system infection or metabolic disease; no history of afebrile seizure; sometimes there is a history of extra cranial infection (e.g., tonsillitis, otitis media).
• Treatment: Symptom management (e.g., paracetamol or tepid sponging), investigation to rule out possible causes, and immediate control if seizure lasts more than 5 minutes.

Epilepsy

• Definition: Epilepsy is the occurrence of unprovoked seizures.
• Causes: Idiopathic (primarily genetic; the majority), organic seizures related to other conditions (congenital cerebral malformation; degenerative brain diseases; developmental conditions; post-traumatic, post-hemorrhagic, post-infectious, or post-anoxic issues and toxic conditions).
• Classification: Focal (partial) seizures (affect only a part of the body) vs generalized seizure (whole body involved; like grand mal, myoclonic, etc).

Cerebral Palsy

• Definition: A group of chronic movement disorders caused by abnormal brain development before birth or during the first few years of life..
• Causes: Pre-natal (e.g. prenatal infections, congenital malformations, fetal asphyxia). Natal causes (e.g. birth asphyxia), Post-natal causes (e.g., intra-cranial hemorrhage, meningitis, metabolic disorders - like phenylketonuria-, infections, and hypoglycemia).
• Clinical Types: Spastic diplegia, hemiplegia, quadriplegia, paraplegia, ataxic, extrapyramidal/dyskinetic, and mixed.
• Diagnosis: Through clinical history and physical examination in addition to CT or MRI or other imaging to rule out possible causes. Other associated investigations are to look for possible other conditions. EEG, genetic evalutations (if necessary), and other evaluations according to possible causes.

Pediatric Nephrology

Glomerulonephritis

• Definition: Group of kidney diseases with glomerular damage (involving glomerular capillaries) due to immunological or other mechanisms.
• Acute Poststreptococcal Glomerulonephritis (APSGN): A syndrome following a streptococcal infection (usually skin or throat). Characterized by hematuria, proteinuria, oliguria, hypertension, and edema.
• Clinical Presentation: Usually gradual onset occurring 1-3 weeks after a preceding streptococcal infection, characterized by cola-colored urine, edema (mainly periorbital), oliguria (low urine output), and increased blood pressure. These symptoms can arise in different patterns.
• Investigations: Urinalysis (color, microscopy, and protein determination), blood tests (electrolytes, BUN, creatinine, and complement levels -C3 in particular-), and renal biopsy to help determine diagnosis.
• Treatment: Bed rest, and fluid and salt restriction, management or control of hypertension, and antibiotics as per infection cause and sensitivity testing.

Nephrotic Syndrome

• Definition: A clinical syndrome defined by massive proteinuria (≥3.5 g/24 hours), hypoalbuminemia, generalized edema, and hyperlipidemia.
• Causes: Often idiopathic (most common cause); may be related to infections, diseases, or drugs.
• Clinical Presentation: Significant edema (peripheral pitting; abdominal/generalized).
• Investigations: Urinalysis to assess protein levels, blood tests for total protein, albumin, cholesterol, and appropriate immune status tests like complement C3 levels to help with diagnosing the underlying conditions (e.g., infection, and inflammatory condition). Renal biopsy to establish the diagnosis and aid the treatment plan.
• Treatment: Fluid balance management (with restrictions for edematous states), supportive care (antibiotics for possible infections), low-salt diet, and corticosteroids like prednisone for suppressing inflammation.

Urinary Tract Infections (UTIs)

• Causes: Infections due to various organisms (e.g., E. coli) in both upper (leading to pyelonephritis) and lower urinary tracts.
• Risk factors: Female gender (shorter urethra), uncircumcised boys, obstructive uropathy (stones), and instrumentation.
• Clinical Picture: Symptoms vary by age and location. Neonates may present with sepsis, irritability, poor feeding. Other presentations may vary from fever, pain, and/or discomfort in the lower urinary tract area and/or upper urinary tract (e.g., nausea, or vomiting in chronic cases); fever is more common in those cases of upper UTI
• Investigations: Urine analysis (culture, microscopy, and possibly looking for presence of nitrates), and blood tests (CBC, ESR, C-reactive protein, and blood culture to aid with diagnosis). Imaging studies (e.g., ultrasound) may be necessary based on the suspected location of the infection, and to rule out other possible conditions.

Meningitis

• Definition: Inflammation of the meninges (membranes covering the brain and spinal cord).
• Causes: Bacterial (most severe), viral, or fungal; bacteria include E.coli, Listeria monocytogenes, Streptococcus, and Haemophilus influenzae.
• Clinical Picture: High fever (may be hypothermia in neonates), poor feeding, non-specific symptoms like irritability and lethargy(or even coma), or more specific symptoms such as increased intracranial pressure (e.g., headache, bulging fontanels, projectile vomiting, severe neck stiffness, optic nerve symptoms), altered consciousness, meningeal irritation (e.g., neck rigidity [stiffness], opisthotonic posture]), neurologic signs (e.g., drowsiness, seizures, coma). Rose spots are rare but may occur with neisserian meningitis.
• Investigations: Blood culture and CSF analysis are important to isolate the bacterium or other pathogen to properly guide therapy. In addition to a CBC and blood cultures, to assess serum protein and ESR (and or CRP, depending on setting).
• Treatment Should be initiated in the Emergency Room.  Early antibiotic therapy is paramount.

Chicken Pox (Varicella)

• Etiology: Varicella-zoster virus (VZV).
• Transmission: Droplet infection, and also through contact with skin lesions.
• Clinical picture: Prodroma phase: fever, malaise, anorexia, followed by skin rash that appears on the scalp, face, or trunk, spreading centrifugally; very itchy rash of macular and papular lesions that ultimately develop into vesicles; itchy rash can last for 2-3 weeks.
• Treatment: Largely supportive: Antipruritic agents (calamine lotion), antihistamines, antipyretics (paracetamol). Avoid use of aspirin. Antibiotics are for secondary bacterial infections. Antivirals if indicated. 

Rubeola (Measles)

• Etiology: RNA measles virus, transmitted by droplet and air.
• Clinical Presentation: High fever, non-purulent (but watery) conjunctivitis, coryza (nasal discharge); cough, sore throat. Maculopapular rash appears behind the ears near the hair line, spreads to chest, arms, and legs.
• Prevention: MMR vaccination.
• Treatment: Largely supportive (antipyretics, fluids, and symptomatic treatment as needed)

Rubella (German Measles)

•  Etiology: RNA Rubella virus.
• Clinical Presentation: Mild fever, mild upper respiratory infection symptoms, typically accompanied by a characteristic, macular/maculopapular rash that starts on the face and spreads to the rest of the body. Often the rash lasts 2-3 days, can be very itchy.
• Treatment: Largely supportive (rest, and fluids). 

Mumps

• Etiology: RNA virus infection of the salivary glands. Transmitted by droplet.
• Clinical Presentation: Characterized by inflammation of the parotid glands (often unilateral initially, then often bilateral). Swollen gland; can affect other salivary glands, and can present with mild fever, myalgia, malaise. More intense discomfort/pain associated with the affected part(s).
• Treatment: Mostly supportive; symptomatic relief for pain and discomfort (e.g., warm or cold compresses). Acute pancreatitis may be a complication, which requires supportive care (IV fluids, electrolytes), and other complications need treatment based on their severity and nature.

Test your knowledge on business strategies and change management concepts. This quiz covers key aspects such as communication barriers, team collaboration, and employee motivation strategies. Assess your understanding of effective management practices in organizational settings.