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PEDIATRICS > 3. SAQ (2) > Flashcards

3. SAQ (2) Flashcards

1
Q

Primary Pulmonary Tuberculosis (PPTB)

A
  • It includes Primary Complex and Tuberculosis of Tracheobronchial Lymphonodus
  • The main type of TB in children
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2
Q

Primary Complex of PPTB

A
  • Primary lesion
  • Enlarged lymph node
  • Linking lymphangitis exist at the same time
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3
Q

Primary Syndrome of PPTB

A
  • Tubercule bacillus enter lung to form Primary Lesion
  • Parts of TB invade the lymph node through lymphatic vessels to cause
    caseous necrosis
  • Primary lesion, enlarged lymph node and the linking lymphangitis exist at
    the same time
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4
Q

Tetralogy of Fallot (Malformation + Complication)

A
  • A congenital heart condition involving four abnormalities occurring together
  • The 4 Malformations of TOF include
    o Overriding aorta
    o Pulmonic stenosis
    o Ventricular septal defect
    o Right ventricular hypertrophy
  • Most common cyanosis in CHD
  • Complications include Cerebral Thrombosis, Brain Abscess, Bacterial
    Endocarditis
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5
Q

Age Group and the Characters

A
  1. Fetal period – formation of Embryo/Zygote to birth of fetus, usually 280 days
  2. Perinatal period – 28th week of gestation – 1 week after birth
  3. Neonatal period – 0 to <28 days from tying umbilical cord to 28 days
  4. Perinatalperiod–28weeksofgestationto7daysafterbirth
  5. Infancy – 0- <1 year including Neonatal Period; from Birth to one year of age
  6. Toddler/earlychildhood–1yearto<3years
  7. Preschool age/early school age – 3 years to 6-7 years before entering primary
    school
  8. Schoolage–6-7yearsofagetostartingofadolescencephase(pre-puberty)
  9. Adolescence/puberty
    - Boys – age 13-14 yrs to 18-20 yrs
    - Girls – age 11-12 yrs to 17-18 yrs
    - 2yr to 4yr variable among individuals
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6
Q

Introduction to Neonatalogy

A
  • Newborn – a recently born infant in 1st few hours of life
  • Neonate – infant in 1st 28 days of life
  • Perinatal period – period b/w 28 weeks of gestation age to 1 week after
    birth
  • Live-born – signs of life after birth
  • Still born – no sign of life at delivery in fetus at 28 weeks gestation or
    greater
  • Preterm (very/moderate/late) – gestational age less than 37 weeks
  • Fullterm – 37 weeks to less than 42 weeks
  • Postterm – 42 weeks or more
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7
Q

Development of Pediatrics

A
  • Establish medical institutes
  • Monitoring of Growth and Development
  • Screening of Congenital Hereditary Diseases
  • Vaccine Inoculation
  • Prevention and Treatment of common diseases
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8
Q

Indicators of Physical Growth

A
  1. Weight
  2. Recumbent length and standing height
  3. Sitting height
  4. Headcircumference
  5. Chest circumference
  6. Upperarmcircumference
  7. Subcutaneous fat
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9
Q

Dental Development

A
  • Deciduous teeth (20) eruption in 4-10 months old
  • Permanent teeth (32)
  • Eruption of Deciduous teeth – 4-10 months old
  • Erupt completely – 2.5 years old
  • Individual differences
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10
Q

Response to Disease

A
  • In some cases (infection, anemia) the liver, lymph nodes and spleen may resume their hematopoietic function
  • May cause these organs to increase in size substantially
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11
Q

Vaccination Schedule

A
  • Birth – BCG, hepatitis B
  • 1 month – hepatitis B
  • 2 months – TOPV (trivalent oral polio virus)
  • 3 months – TOPV, DTP (diphtheria, tetanus and pertussis)
  • 4 months – TOPV, DTP
  • 5 months – DTP
  • 6 months – Hepatitis B
  • 8 months – measles
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12
Q

Tuberculin Test

A

Test procedure
- Intracutaneous injection 0.1ml purified protein derivative (PPD) containing 5
tuberculin unit
- Palmar surface of Left Forearm at lower-middle 1/3 juncture to form a wheal
with diameter of 6-10mm
- Observe reaction result after 48-72hrs determine diameter of local
induration
- Take average diameter from vertical one and horizontal one to judge rxn.
intensity

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13
Q

Difference between Inoculation reaction and Natural Infectious Reaction

A

(photo)

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14
Q

Clinical Significance of Positive (+) Reaction

A
  • Inoculated with BCG before, caused by artificial immunity
  • Without clinical symptoms suggests Tuberculosis Infection but without
    Active Lesion
  • <3 yrs old, especially without inoculation of BCG, indicates new tuberculosis
    lesion, the younger the higher possibility of Active Tuberculosis
  • Strong positive suggests active tuberculosis in the body
  • Recent infection
    o Change from (-) to (+)
    o Or rxn strength change from <10mm to >10mm and extent of
    increase >6mm
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15
Q

Clinical Significance of Negative (-) Reaction

A
  • No history of TB infection
  • Prior period of TB allergic rxn (4-8 weeks after Initial Infection)
  • False negative rxn. Caused by Low or Suppressed immunological rxn. Of the
    body
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16
Q

Indication of ORS (Oral Rehydration Salt) Application

A

ORS is to children with Mild to Moderate dehydration
1. Mild Dehydration
- 50-80ml/kg for first 8-12 hours to replenish prior losses
- 1 dose/5-10 mins; 10-20ml/dose
2. Moderate Dehydration
- 80-100 ml/kg for first 8-12 hours to replenish prior losses

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17
Q

Characteristic of Fetus Circulation

A
  • Placenta provides for Gas and Metabolite exchange
  • RV and LV exist in a parallel circuit
  • Little blood in pulmonary circulation
  • Abnormal Cardiovascular structures maintain this parallel circulation
  • Not as efficient as adults
  • Convenient to adjust to the fetal to neonatal circulatory transition
18
Q

Symptoms and Signs of VSD

A
  1. Small VSD
    - Asymptomatic
    - Loud, harsh or blowing holosystolic murmur at Lower Left Sternal Border
    accompanied by a thrill
  2. Moderate and Large VSD
    - Dyspnea, feeding difficulties, poor growth, profuse perspiration, recurrent pulmonary infections, cardiac failure in early infancy
    - Prominence of Left Precordium
    - Palpable Parasternal Lift
    - Holosystolic murmur less harsh and more blowing in nature and a systolic
    thrill
    - Pulmonic component of the 2nd heart sound may be increased
    - Presence of a mid-diastolic, low-pitched rumble at the apex is caused by
    increased blood flow across the mitral valve
19
Q

Chest Radiograph of VSD

A
  • Pulmonary overcirculation
  • Dilated pulmonary artery segment
  • Cardiac enlargement
20
Q

Electrocardiography of VSD

A
  • Left + Right Ventricular Hypertrophy
  • Pulmonary HTN
21
Q

Complications of VSD

A
  • Bronchopneumonia
  • CHF
  • Pulmonary edema
  • Infective endocarditis
22
Q

Arterial Septal Defect

A
  • @ 2nd Intercostal Space (Systolic Murmur) is best heard
  • ECG for final diagnosis
  • Complication same
23
Q

Patent Ductus Arteriosus

A
  • Typical sign “machinery” murmur
  • Left – Right shunting
  • Peripheral vascular sign
24
Q

Adam Stoke Syndrome

A
  • Sudden, transient episode of Syncope
  • Followed by, seizure
  • Caused by, decrease CO to the brain
  • Due to, Cardiac Asystole, Heart Block, Ventricular Fibrillation, etc
25
Q

Complication of Nephrotic Syndrome

A
  1. Infection
    - Loss of IgG
    - Complements in Urine
    - Edema and immune-suppressed drugs
    o Respiratory Tract Infection (RTI) o Skin infection
    o Peritonitis
    o Urinary Tract infection (UTI)
  2. Hypovolemic Shock
    - Plasma Volume Reduced
    - Vomiting and diarrhea
    - Administration of Diuretics
  3. Misbalance of Electrolyte
    - Hyponatremia & Hypokalemia - Hypocalcemia
  4. Thrombosis
    - Loss of Anticoagulase III in urine
    - Evaluate Coagulate Fx. IV, V, VII and Fibrinogen in serum
    - Hyperlipidemia
    - Plasma volume reduced
  5. Acute Renal Failure
    - Plasma Volume Reduced
    - Diuretic Drugs
26
Q

Kawasaki Disease and Diagnosis

A
  • Condition that causes Inflammation @ walls of some BV in body
  • Most common in infants and young children
  • Formerly known as MLNS (Mucocutaneous LN. Syndrome)
  • Acute Febrile Illness
  • Age of onset
    o >5years – 20%
    o <5years – 80%
  • Gender difference
    o BOYS:GIRLS=60:40
  • Diagnosis
    o Fever persisting 5 days (at least) o 4OUTOF5(!!)
    § Change in Extremities
    § Change in Lips and Oral Cavity
    § Cervical LN. Swelling
    § Bulbar Conjunctival Injection w/o Exudate
    § Polymorphous Exanthema
  • Treatment
    o IVIG (IV Immunoglobulin)
    § 1g/(kg.d) ivgtt x 2d § 2g/(kg.d) ivgtt x 1d
27
Q

Extramedullary Hematopoiesis

A
  1. Reason
    - Infants suffer from infectious anemia or hemolytic anemia
    o Need enhanced hematopoiesis activity
    o Trigger extramedullary hematopoiesis
    o Reinstatement to the embryonic hematopoiesis
  2. Clinical manifestation
    - Hepatomegaly
    - Splenomegaly
    - Lymphadenosis
    - Erythroblasts and Leukoblasts may appear @ peripheral blood
28
Q

Diagnose Pneumonia – Tachypnea

A

Depends on baby’s age
- 0-<2months - >60bpm
- 2-12 months - >50bpm
- 1-5 years - >40bpm
- >5years–30or>20bpm

29
Q

Pneumonia Classification by Anatomic distribution

A
  • Lobar
  • Interstitial
  • Bronchopneumonia - Broncholitis
30
Q

Pneumonia Classification by Causative Agents

A
  • Bacterial pneumonia
  • Viral pneumonia
  • Mycoplasma pneumoniae pneumonia
  • Chlamydia
  • Mycotic infections
  • Aspiration of food/gastric acid, foreign bodies, dust, lipoid substances
31
Q

Clinical Findings of Pneumonia

A
  • Fever
  • Generalized toxicity
  • Cough, sputum production, wheezing
  • Rales, decreased breath sound, dullness to percussion
  • Abnormal tactile/vocal fremitus
  • Meningismus, abdominal pain
32
Q

Differential Diagnosis of Pneumonia

A
  • Acute bronchitis
  • Pulmonary TB
  • Foreign body aspiration
33
Q

Complication of Pneumonia

A
  • Empyema
  • Pyopneumothorax
  • Tension pneumothorax
  • Pneumatocele
  • Lung abscess
34
Q

Physiological Characteristic of Pneumonia

A
  • heart rate : 120-140bpm
  • WBC 15-20 x 10 pangkat 9/L
  • neutrophils predominate at birth and in the older child - lymphocytes
    predominate between 6days and 4 years
  • sucking reflex elicited by placing a sterile nipple in the mouth
  • rooting reflex
  • grasp reflex elicited in the palms and soles by placing a fingers at the bases
    of the fingers and toes—flexing
  • moro reflex elicited by slapping the examining table or jerkin the underlying
    blanket–extension-flexion
  • physiological jaundice : 2-3days of life
  • enlargement of breasts : 3-5 days of life
  • pseudomenses : 5-7days persisting 7 days
35
Q

Hypoxic-Ischemic Encephalopathy (HIE)

A
  • Clinical signs and Symptoms depend on the severity, timing, and duration of the insult
  • Seizure onset usually occurs <24 hrs of life
  • During the 12 to 24hrs period after injury
    o An apparent increase in level of alertness – not associated with improvement in neurologic function exaggerated
  • After 24 to 72 hours
    o Infant’s level of consciousness deteriorates, followed by Respiratory
    Arrest and signs of Brainstem Dysfunction
36
Q

HIE in Term Infants

A

(photo)

37
Q

Hyaline Membrane Disease (HMD)

A
  • Deficiency of Pulmonary Surfactant
  • Pulmonary alveoli collapse at the end of expiration
  • Mainly in Preterm Infant
38
Q

Neonate Respiratory Distress Syndrome (NRDS)

A
  • Usually occur in premature babies where lungs aren’t fully developed – cannot provide enough oxygen
  • Characteristic – frosted glass-like changes and air Bronchogram
  • White lung
39
Q

Etiology of Neonatal Icterus

A
  1. Infective Icterus
    - Neonatal hepatitis CMV, Hepatitis B virus are the usual pathogens
    - The illness onset slowly, the icterus appears in 1-3 weeks or later after birth
    - Neonatal septicemia E. coli more than staphylococcus aureus, there is
    Jaundice and Infectious Intoxication manifestation
    - Others UTI, Congenital Malaria
  2. Non-infective Icterus
    - Hemolytic disease of Newborn
    - Biliary Atresia
    - Breast Milk Icterus
    - Inherited Diseases
  3. Others
    - Hunger
    - Hypoxia
    - Dehydration
    - Acidosis
    - Constipation
    - Skull hematoma/intracranial hemorrhage
40
Q

CSF differences among diff. Meningitis and Normal Human

A

(photo)

41
Q

Guidelines of Antibiotic Therapy (Bacteria Meningitis)

A
  1. Choose Bacteriocidal Antibiotics
  2. Choose Antibiotics that can penetrate BBB
  3. Administered as soon as possible
  4. Therapyshouldcontinue10-14days
  5. Broad-spectrum IV antibiotic is initiated
  6. Afterspecificorganismareidentify,antibiotictherapycanbetailoredbasedon
    Antibiotic Sensitivity Pattern

PEDIATRICS (4 decks)

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