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• ICU 16
Renin activity; aldosterone
2D; CBC
Renal
U/A; US; BMP
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
• if < 4 joints and with systemic findings it's likely from other etiologies: infections..
• RF : negative except in multi joints format: 10% pos.
• ANA is 40% pos.
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.
spinal shock
solumedrol
caridiogenic
septic
> 1 yr
< 70 + 2* age
1-12 ms
< 70
< 1 m
< 60
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
asymtomatic TORCH
genetics
• can present any age
• can have normal newborn screening first
hearing test
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
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
no babling
9 ms
no responce to name
ADHD
Daily scales
School performance
learning disability
intelligibility
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
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
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
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
usually visilble only on one projection; either PA or lateral. unlike pneumonia
• 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.
• 1 gm glucose or protein ==> 4.5 kcal
• 1 gm fat ==> 9 kcal
•
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: 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
• 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
• 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.
• protopic: local tacrolimus (prograf) immunosupressant for severe atopic eczema for few weeks
• 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
•
