Pediatrics

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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

caridiogenic

septic

def

> 1 yr

< 70 + 2* age

1-12 ms

< 70

< 1 m

< 60

development

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

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

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

scales

behavioural tests

ADHD

achievment test

Daily scales

School performance

IQ tests

learning disability

paternal screening

milestones

speech

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

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

•