Business Strategy Evaluation Quiz

Pediatric Cardiology

• Congenital Heart Diseases (CHD) affect 8 per 1000 live births and have significant cardiac malformations.
• Risk factors for CHD include genetic predisposition, exposures during pregnancy (drugs or disease), and chromosomal abnormalities.
• Acyanotic CHD constitutes 80% of all CHD cases.
• Common lesions in ACHD with left-to-right shunts include ventricular septal defect (VSD), patent ductus arteriosus (PDA), and atrial septal defect (ASD).
• Manifestations of high pulmonary blood flow include poor feeding, exercise intolerance, recurrent chest infections and wheezes, and recurrent heart failure.
• Heart failure may occur in infants but less commonly in full-term neonates, due to declining pulmonary vascular pressure.
• Obstructive lesions, such as aortic coarctation, aortic stenosis, and pulmonary stenosis, are also types of ACHD.

Acyanotic Congenital Heart Diseases (ACHD)

• This category comprises 80% of all CHDs.
• Common lesions include Ventricular Septal Defect (VSD), Patent Ductus Arteriosus (PDA), and Atrial Septal Defect (ASD).
• Clinical features, determined by the size of the defect and pressure gradient, include degree of shunt, symptoms of high pulmonary blood flow, and heart failure.
• Eisenmenger syndrome involves prolonged high pulmonary blood flow leading to pulmonary hypertension and reversal of shunt with central cyanosis. It typically occurs with large, unrepaired defects.

Ventricular Septal Defect (VSD)

• A VSD is a defect in the interventricular septum.
• Hemodynamically, blood is shunted from the left ventricle (higher pressure) to the right ventricle (lower pressure).
• This leads to increased pulmonary blood flow, volume overload of the right ventricle/left atrium/left ventricle, and pulmonary congestive symptoms.

Atrial Septal Defect (ASD)

• An ASD is a defect in the inter-atrial septum.
• The hemodynamic effect is similar to that of the VSD.

Patent Ductus Arteriosus (PDA)

• A PDA is a persistent fetal duct that connects the aorta and pulmonary artery.
• The medical closure in premature infants is done with an injection of indomethacin in the first week of life.

Atrioventricular Septal Defect (AVSD)

• AVSD is a defect in the atrioventricular septum.
• It is often associated with Down syndrome.
• Common presentations are usually asymptomatic, dyspnea during suckling and recurrent chest infections, physical examination often reveals tachypnea, dyspnea, and tender enlarged liver (sign of heart failure).
• Complications include infective endocarditis, Eisenmenger syndrome, and heart failure.
• Treatment may be medical or surgically indicated, depending on the severity of the defects and the response to treatment.

Cyanotic Congenital Heart Disease (CCHD) - Fallot Tetralogy

• Fallot tetralogy is the most common cyanotic congenital heart disease with decreased pulmonary blood flow.
• It is characterized by pulmonary stenosis, right ventricular hypertrophy, ventricular septal defect (VSD), and overriding aorta.
• Common clinical presentations include central cyanosis, cyanotic clubbing of fingers and toes, growth retardation, and squatting position during physical exertion.
• The clinical picture depends on the degree or severity of the pulmonary stenosis.

Investigations in CHDs

• The common investigations include chest X-ray, echocardiography, ECG. The possible additional investigations may include Complete blood count (CBC).

Heart Failure

• Heart failure is defined as the inability of the heart to pump enough blood to meet the body's needs.
• Congenital heart diseases are the most common cause of heart failure in infancy, followed by Rheumatic heart diseases, Myocarditis, Infective endocarditis and Severe anemia.
• Clinical features include poor feeding (in infants), dyspnea, orthopnea, exertional intolerance, and ankle edema (in older children).

Acute Rheumatic Fever (ARF)

• ARF is an inflammatory disease of the heart, joints and CNS.
• It affects mainly the heart and joints (less frequently central nervous system) and skin.
• Risk factors include high risk populations, developing countries and peak onset between (5-15 year) in childhood &(20-30) years in adults.
• The pathogenesis involves a streptococcal infection (GAS) trigger that lead to an antibody-mediated reaction against host connective tissues, damaging the heart and other tissues.
• The major criteria of ARF include arthritis (migratory polyarthritis often resolving with salicylates within 48hrs), carditis (inflammation of the heart involving endocardium, myocardium and pericardium, can lead to valvulitis, commonly involving the mitral valve followed by the aortic valve), chorea (involuntary movements), and erythema marginatum (skin rash), and subcutaneous nodules.

Infective Endocarditis

• Infective endocarditis is an infection of the endocardium, commonly affecting heart valves, due to bacteria.
• Risk factors can involve prosthetic cardiac valves, previous infective endocarditis, congenital heart disease, and permanently damaged valves due to rheumatic heart disease.
  • Commonest Causative Organisms include Streptococcus viridans, Staphylococcus aureus and epidermidis, Group D enterococci and Fungal.
• A clinical presentation may include fever; poor appetite, weight loss, malaise, pallor-splenomegaly.
• Complications include myocardial abscess, recurrent emboli, heart failure and spread of infection (e.g meningitis).

Anemia

• Anemia is a condition defined as a reduction in hemoglobin and/or red blood cell count.
• It results in decreased oxygen carrying capacity.
• General features of anemia include fatigue, headaches, faintness, palpitations, shortness of breath and angina.
• Classification of anemia can be based on morphology (microcytic, normocytic, or macrocytic) or etiology (decreased production, increased destruction, or blood loss).
• Increased blood loss can be due to occult blood loss in cases like Ankylostoma, Peptic ulcer, polyps, GERD, Meckle's diverticulum, Drug induced gastritis and Esophageal varices.
• Specific factor deficiency resulting in dyshemopiotic anemia may involve minerals, vitamins and proteins.
• Increased destruction of red blood cells in hemolytic anemia occurs due to defects in their structures and immune mechanisms.
• The possible causes include autoimmune hemolytic anemia, and non immunologic hemolytic anemia .

Iron Deficiency Anemia (IDA)

• IDA is the most common cause of anemia in children.
• Causes involve reduced iron intake (in infants and young children), diminished iron absorption, increased iron loss, and increased requirements during rapid growth periods.
• Clinical findings include pallor; mild anemia is often asymptomatic; systemic manifestations like decreased alertness, language concentration, angular stomatitis; pale glazed tongue; brittle nails; and in some cases, palpable spleen.

Megaloblastic Anemia (Vitamin B12 & Folic Acid Deficiency)

• It's an anemia with Megaloblasts in the bone marrow and macrocytes in the peripheral blood.

• Causes for vitamin B12 deficiency include decreased intake, impaired absorption, and increased requirements (pregnancy or rapid growth).

• Causes for folate acid deficiency include decreased intake, impaired absorption, and increased requirements.

• Symptoms may include anorexia, pallor tiredness, jaundice, mild hepatosplenomegaly, and severe cases of megaloblastic anemia may have thrombocytopenia and leucopenia.

• Symptoms may involve Atrophic glossitis, Beefy, red glazed tongue, Atrophic gastritis, Dyspepsia and vomiting.

• Diagnosis includes CBC, peripheral blood smear, B12 and folate levels (serum).

Thalassemia

• Thalassemia is an autosomal-recessive disorder of abnormal hemoglobin production.
• Types include alpha-thalassemia (resulting from deletions or gene mutations in the alpha-globin chains) and beta-thalassemia (resulting from gene mutations in the beta-globin chains), causing defective globin chain production.
• Clinical presentations can involve mild to severe microcytic anemia.
• Diagnosis usually requires DNA analysis and hemoglobin electrophoresis.
• Commonest presentations include familial microcytic anemia commonly mistaken for iron deficiency, or hemoglobin H disease, or fetal hydrops.

Sickle Cell Disease

• Sickle cell disease is an autosomal recessive blood disorder affecting the structure and function of hemoglobin.
• It's caused by a substitution (genetic point mutation) of valine for glutamic acid in the beta-globin chain affecting its solubility, leading to the formation of abnormal RBCs.
• Clinical presentations include anemia, chronic hemolysis, impaired RBC survival, and potential complications like renal disorders.
• Investigations include blood film analysis, to detect sickle cells; and hemoglobin electrophoresis for diagnosing different types.

Hemophilia A (classic hemophilia)

• Hemophilia A is a sex-linked recessive coagulation disorder due to a deficiency of Factor VIII.
• It typically presents with unusual bleeding from the circumcision site or umbilical stump in neonates or other signs/symptoms such as epistaxis (bleeding from the nose), Dental /mouth bleeding, GIT bleeding, Hematuria, Easy bruising, Ecchymotic patches and Hematomas (bruises).
• Hemarthrosis (blood in the joints) is a hallmark, leading to joint pain and swelling, fibrosis, and muscle atrophy.
• Investigations include prolonged clotting time, prothrombin time (PT), and activated partial thromboplastin time (aPTT).
• Diagnosis usually involves Factor VIII assay, and prenatal diagnosis can use chorionic villous sampling/amniocentesis.
• Treatment includes Factor VIII replacement therapy and sometimes, prophylaxis.

Acute Pharyngitis

• Acute pharyngitis encompasses acute tonsillitis, pharyngitis or tonsillopharyngitis.
• Commonly caused by viruses or bacteria, especially Group A Streptococcus.
• Common symptoms include fever, anorexia, malaise, sore throat, red congested throat, inflamed tonsils with white/yellow exudates; swollen lymph nodes at the front of the neck.
• Possible associations including conjuntivitis (adenovirus), and minute vesicles/ulcers (Coxachie virus).
• Common treatments include symptomatic relief for fever, and antibiotics like penicillin V or Zithromax if bacterial infection is suspected (or established).

Acute Otitis Media (AOM)

• AOM is a common infection of the middle ear.
• A known complication of bronchiolitis, it can be caused by viral or bacterial infections (e.g. H. influenza, pneumococci, moraxella catarrhalis).
• Common symptoms include fever, earache (especially irritability in infants), otoscopic examination typically showing congested and bulging tympanic membrane, and middle ear effusion.
• Treatment usually involves symptomatic relief (e.g., ibuprofen or acetaminophen) and antibiotics (amoxillin-clavulanate for 10 days or alternatives like Ceftriaxone/Cefdinir/Cefpodoxime). Surgical options include tympanocentesis and drainage with tympanostomy tubes if needed, often used for chronic cases.

Acute Sinusitis

• This is an infection of the sinuses typically caused by mixed viral and bacterial infections (similar to otitis media).
• Common symptoms include fever, headache, purulent or mucopurulent nasal discharge and postnasal discharge and coughing.
• Possible other symptoms, include Nasal obstruction, Halitosis, Diminished smell and Periorbital edema
• Treatment typically focuses on alleviating symptoms (pain and fever with paracetamol) and using antibiotics for a minimum of 10 days, if bacterial infection is suspected or confirmed. Saline nasal washes can help.

Acute Infectious Stridor (Croup)

• Croup is a viral infection of the upper airway, typically affecting respiratory pathways.
• Common causes involve Para-influenza types 1, 3, RSV, influenza, adenovirus, and corona viruses.
• Usual presentation includes upper respiratory catarrh (rhinitis), mild fever, croupy barking cough, hoarseness of voice and toxic appearance.
• Management generally involves supportive care, such as hydration, oxygen if needed, and nebulized epinephrine if severe, or oral/intra-muscular dexamethasone.

Acute Epiglottitis

• Acute epiglottitis is a serious infection of the epiglottis often caused by Hemophilus influenzae type B, Streptococcus, Streptococcus pneumoniae, nontypeable H. influenzae and Staphylococcus aureus. It is a life-threatening emergency that necessitates immediate medical attention.
• Signs include high fever; Drooling of saliva (severe dysphagia) severe dysphagia; a muffled ("muffled" )voice and little to no cough.
• Affected patients usually prefer an upright position with their neck hyperextended to maintain airway.
• Treatment necessitates prompt hospitalization, securing the airway, blood cultures and start parenteral antibiotics like Ceftriaxone or Cefotaxime or Meropenem while awaiting results for culture and sensitivity and continue treatment for at least 10 days..

Pneumonia

• Pneumonia is an infection of the lower respiratory tract involving alveoli and often causes lung consolidation.
• Infections can be bacterial (streptococci, staphylococci) or viral (RSV, influenza) or caused by atypical microbes such as mycoplasma and chlamydia.
• Symptoms include variable onset (acute to subacute); fever, malaise, toxemia, chest cough (dry then productive) dyspnea. and respiratory distress.
• Management often involves supportive care (rest, humidified oxygen) and antibiotic treatment.

Asthma

• Asthma is a chronic inflammatory disease of the airways; causing hyper-responsiveness to various stimuli; resulting in, episodes of airflow obstruction.
• Key risk factors include parental asthma, other allergies (eczema, allergic rhinitis, food allergies), rhinitis, sinusitis & gastro esophageal reflux disease (GERD), early weaning from breast milk.
• Triggers include respiratory viral infections, animals with fur (dogs, cats), dust mites, cockroaches, aerosol chemicals, changes in temperature, drugs (aspirin, beta-blockers) and exercise.
• Diagnostic features may involve history of symptoms (cough, wheezing, difficult breathing, tightness in chest), allergic conditions, family history, and often respond to short-acting bronchodilators.
• Management may involve medication (inhalers) and avoidance of triggers.

Acute Bronchiolitis

• Acute bronchiolitis is a common, viral infection of the small airways in the lungs, affecting children, especially those younger than two years.
• A common cause of this respiratory infection is the respiratory syncytial virus (RSV), along with other viruses.
• Symptoms may be mild upper respiratory catarrh, a mild fever initially, dyspnea and cough that may increase in severity, wheezy chest, along with irritabiliy, difficulty feeding and air hunger.

Tuberculosis (TB)

• Tuberculosis is a chronic infectious disease caused by the Mycobacterium tuberculosis bacteria.
• It can involve the lungs (pulmonary TB), or other sites (extra-pulmonary TB).
• Risk factors include exposure to infected individuals, reduced immunity, and socioeconomic factors.
• Clinical presentations of pulmonary TB frequently involve asymptomatic periods, and when symptoms develop; may be mild fatigue, poor appetite, nonproductive cough, and mild dyspnea (shortness of breath)
• Diagnostic procedures include a careful history, physical examination, chest X-rays; and tuberculin skin tests. Investigations for extra pulmonary TB may require biopsy.
• Treatment normally involves several months of specific antibiotics (e.g., rifampin, isoniazid, pyrazinamide, ethambutol).

Scarlet Fever

• Group A Streptococcus (GAS), causes scarlet fever characterized by a sudden onset of fever, sore throat, and a distinctive skin rash.
• Common symptoms include severe sore throat; red, edematous pharynx, tonsils; white strawberry-like tongue initially that turns red as the disease progresses, and a diffuse red maculopapular skin rash that begins on the neck and spreads to the trunk.

Pertussis (Whooping Cough)

• Pertussis, caused by Bordetella pertussis bacteria is a highly infectious disease that primarily affects the respiratory system of infants and young children.
• Stages include catarrhal stage (mild cold-like symptoms), paroxysmal stage (severe, repetitive coughing) and convalescent stage (gradual return to health).
• The paroxysmal cough often develops after the catarrhal stage and is characterized by series of >5 coughs and a distinctive whooping sound during inspiration.

Measles (Rubeola)

• Measles is a highly contagious viral infection caused by a paramyxovirus
• Transmission is via droplet infection and highly infectious.
• The clinical picture includes a catarrhal stage with symptoms such as fever, conjunctivitis, coryza and cough, followed by an eruptive phase exhibiting a maculopapular rash that spreads from the head to the trunk and extremities. It typically fades after 3-7 days.
• Prevention is mainly by immunization with MMR vaccine.

Rubella (German Measles)

• Rubella is a viral infection transmitted by droplet infection, and it causes, fever, characteristic non purulent conjunctivitis, coryza and cough during the catarrhal stage.
• An eruptive stage with Maculopapular rash is followed that starts on the face and spreads to the trunk and extremities.
• The rash typically fades within 3-4 days without desquamation. Prevention involves immunization against rubella using MMR vaccine.

Chicken Pox (Varicella)

• Varicella is a highly infectious viral disease caused by the varicella-zoster virus (VZV), it is characterized by a distinctive rash that develops into itchy, fluid-filled blisters.
• Transmission is by droplet infection, and infectivity continues till the rash crusts over.
• Varicella also may cause, fever, malaise, and anorexia initially. Symptoms develop within 2-3 weeks and the rash appears on the trunk, face, and extremities.
• Prevention is mostly through vaccination with live-attenuated varicella vaccine. For cases, common treatment is by providing symptomatic relief.

Mumps

• Mumps is a viral infection primarily affecting the salivary glands, often causing swelling and inflammation of the parotid glands.
• The infection is contagious via direct contact with an infected individual; and causes symptoms such as; fever, malaise, myalgia, and swollen/tender parotid glands. Swelling of the gland usually develops on one side first and later the other side.

Meningitis

• Meningitis is an infection of the protective membranes (meninges) that surround the brain and spinal cord.
• Causes involve bacterial (e.g., Neisseria meningitidis, Streptococcus, Haemophilus influenzae), viral, or fungal infections.
• Signs and symptoms may involve high fever (possible hypothermia in neonates) or poor feeding, Rose spots may be present in meningeococcal septicemia, and features of raised intracranial pressure (e.g. tense bulging fontanel or bursting headache, projectile vomiting), neck rigidity, and other neurological symptoms (e.g., drowsiness, convulsions, coma).
• Investigations include complete blood count (CBC), blood cultures, and cerebrospinal fluid (CSF) analysis to help identify the pathogen and guide treatment with parenteral antibiotics.

Seizures

• Seizures are transient, paroxysmal, time-limited, involuntary disturbances of brain function; manifested by abnormal motor, sensory, behavioral, or autonomic activity; and may involve varying levels of consciousness. The causes could involve; Fever, infections, CNS insults, drug intoxications, metabolic disorders, and intracranial tumors.

Febrile Convulsions

• Febrile convulsions are seizures that occur in children in response to a rapid increase in body temperature.
• This is almost exclusively due to extra cranial causes (mostly viral).
• Diagnosing usually involves excluding other potential CNS causes. Investigations include neurological examinations, and blood tests, along with possible EEG and/or MRI; to guide further treatment.

Epilepsy

• Epilepsy is a neurological disorder characterized by recurrent unprovoked seizures, occurring over more than 24 hours.
• Common causes can frequently be idiopathic, but also involve congenital abnormalities, neurological infections or injuries, and metabolic disorders.
• Types include focal (partial) and generalized seizures.

Cerebral Palsy

• Cerebral palsy is a group of permanent disorders affecting movement and posture, resulting from non-progressive brain damage in utero or during infancy.
• Pre-natal causes include antenatal infections; congenital malformations; fetal asphyxia.
• Post-natal causes frequently include; premature delivery or very low birth weight with an intracranial hemorrhage, meningitis, encephalitis, hypoglycemia, hyperbilirubinemia, and hydrocephalus.
• Diagnosis involves a thorough neurological examination and possibly imaging tests to characterize the type & likely cause of cerebral palsy.

Test your understanding of key concepts in business strategy evaluation and planning. This quiz covers topics such as SWOT analysis, the importance of stakeholder engagement, and the significance of measurable objectives. Perfect for students and professionals looking to deepen their strategic management knowledge.