Kategoriak: All - nutrition

arabera ayood helo 11 years ago

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Pediatrics

The text deals with various medical fields such as pediatrics, dermatology, nephrology, and nutrition, providing specific guidelines and treatments. In pediatrics, it discusses the management of shock in ICU settings, including the identification of types like cardiogenic and septic shock, with initial treatment recommendations such as fluid boluses.

Pediatrics

Pediatrics

ICU 16

nephrology

HTN
Tx
diag

Renin activity; aldosterone

2D; CBC

Renal

U/A; US; BMP

etiology

secondary

neurologic

Inc. ICP

GBS

endocrine

steroids

renin

cardiac

aoric coarc

renal

vascular

stenosis

thrombosis

neonates

parnchymal

dysplastic kidneys

scars

from previous UTI and urinary reflux.

Essential

only after 10 yrs.

DBP

(age x 1.5) + 70

SBP

(age x 3) + 100

Rheumatology

JRA

if < 4 joints and with systemic findings it's likely from other etiologies: infections..

labs

RF : negative except in multi joints format: 10% pos.

ANA is 40% pos.

clinincal

sytemic

sever in the systemic form and mild in the multi joints form. absent in the oligo joints form.

uveitis

in the oligo joint form.

ICU

shock

spinal shock

solumedrol

  • 30mg/kg bolus then 5 mg/kg/hr
  • caridiogenic

  • large heart and liver on exam
  • if not sure try fluid bolud first, if it got worse it's likely cardiogenic
  • septic

  • like hypotensive shock with low BP and tachycarida but characterized with good peripheral perfusion
  • def

    > 1 yr

    < 70 + 2* age

    1-12 ms

    < 70

    < 1 m

    < 60

    development

  • language is the most predictive of development
  • screening tests measure current status only and are not predictive of future developments
  • language
    types

    bilangual

    the count of words of both languages is normal.

    Landau Kleffner

    Steroids

    IvIG

    EEG sz

    sudden loss of skills

    not gradual loss like autism

    Autism

    screen

    PDDST

    CHAT

    loss social or language skills

    any language warning

    abnormal if

    started > 5 yrs or lasted for > 6 ms

    associtaed with pausing and stresss

    expressive

    normal

    with normal IQ. more in boys

    outgrow by adolesents but can still have reading difficulties

    evaulation

    asymtomatic TORCH

    genetics

    can present any age

    can have normal newborn screening first

    hearing test

  • all children with delay
  • OAE

    evoked acoustic emission

    BAER

    PE

    MR

    all MR children have delayed expressive and receptive language

    can be the first presentaion for MR

    < 8 ms

    vocalized normally even if profoundly deaf

    look like they hear b/o responce to visual clues

    CLAM scale

    warinings

  • the lack of any of these fingings:
  • stuttering

    not fully understood to stranger

    persist echolalia

    not using pronouns/verbs

    speech not fully understood to parents

    no 2 words phrases

    no pointing to wants

    only mama/dada

    no pointing to objects

    no gesturing

  • shaking head; bye bye
  • no babling

    9 ms

    no responce to name

    scales
    behavioural tests

    ADHD

  • Conner's test
  • achievment test

  • WRAT: Wide achievement Range Test.
  • Daily scales

  • for children with MR to test the daily living skills
  • School performance

  • tests reading, writing and mathematic scales.
  • the most reliable predictor for school performance in first 3 yrs is Language.
  • IQ tests

  • Wechsler test
  • learning disability

  • Total IQ is normal
  • IQ performance >> IQ verbal skills

  • paternal screening
    milestones
    speech

    intelligibility

  • speech understood by strangers
  • age divided by 4
  • 100%

    75%

    50%

    receptive

    4 colors; count 5

    know sex; name

    2 steps command

    5 body parts; names pic of common obj

    1 step w/o gesture; 1 body part

    1 step w gesture

    4 sentenses; past tense

    3 w sentense; present tense

    telegraphic speech; pronouns appr

  • speech without articles
  • pronouns are correct
  • 50 words; 2 pronouns

    pronouns can be used wrong

    20 words; mature jargoning

    20 ms

    6 words

    2 words; immitate jargoning

    try to speak in sentense but makes non sense

    12 ms

    Fine motor

    eating

    cut w kife

    7 yr

    spoon & fork

    spoon/ solid

    convered cup

    dressing

    dress w/o assist; buttons & lace shoes

    dress w assis; unbuttons

    put on some

    take off

    draw

    tiangle

    5 yrs

    square

    4.5 yrs

    cross

    circle

    imitates horizontal

    30 ms

    imitates vertical & circular

    24 ms

    tower

    8

    30 m

    6

    24 m

    4

    18 m

    2

    15 m

    gross motor

    kicking & throwing

    hopping

    stand 1 foot

    sit self

    climbing

    down w 1 foot

    up w 1 foot

    3 yrs

    up and down no assits

    upstairs 2 feet w assist

    18 ms

    walking

    tandem walk

    4 yrs

    run

    2 yrs

    walk

    15 ms

    imaging

    atelectasis

    usually visilble only on one projection; either PA or lateral. unlike pneumonia

    FEN

    Nutrition
    daily

    normal feeding 60% carb, 10% protein, 30% fat

    requirment: prot 2-2.5 gm /kg/d,

    requirment: fat 1 gm/ kg/ d

    to gain 1 gm wt: you need 6-7 kcal

    daily need are 100-140 kcal/kg/d

    daily 100 kcal: 50 BMR, 20 growth, 15 tmp, 5 stool/urine.

    pts

    regular formula are 20 kcal/oz. special formula can be 22, 24, 28, 30

    calories intake must be increased in: 20% for resp or cardiac , 50% for infection, 100% for burns.

    basics

    1 gm glucose or protein ==> 4.5 kcal

    1 gm fat ==> 9 kcal

    growth

    abnormal finding on exam :

    Achondro plasia can be subtle presenting only as inpropertionate length

    Midline structural abnormalities can be subtle like flat nasal bridge

    hc

    HC: 0-3 month: growes by 0.5 cm/w; from 3-6 months grow: 0.25 cm/w ; then 6-12 ms: grow 0.125 cm/w

    ht

    the hight increase by 50% @ 1 yr and double @ 3 yrs

    the veocity percentile shifts in the first 3 yrs and stabilizes 3-9 yrs

    wt

    baby grows 15-30gm/day

    the normal newborn should double wt @ 5ms and triple @ 1 yr

    wt gain: 0-3 months: 15-30 gm/d; 3-6 ms: 15-20 gm/d; 6-12 ms: 10-12 gm/d; after 1 yr: 6-8 gm/d.

    drematology

    eczema
    tx

    protopic: local tacrolimus (prograf) immunosupressant for severe atopic eczema for few weeks

    acne

    TX: in the following order

    Benzamycine: bezoyic + erythromycine gel.

    minocycline or doxycyline: should be used for 6 ms

    Retenoid local: Retin-A; Differin. Dovonex is vit D local,

    Retenoid PO: Accutane is new one can be given to women in child bearing age as it says in the system only 1 m