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Burçin Flashcards

1
Q

Anamnesis

A

1.When ptx was entirely well?
2.Complaints:Time ,Place,Quality,Quantity,Provocative/alleviate factors/variations,Associated symptoms,Any treatment
3.systemic inquiry(general(weight loss/appetite),gis,gus,cns,cvs,rheumotologic)
4.birth history: antenatal,natal,postnatal history
5.feeding history
6.immunization
7.developmental history
8.past history
9.personal history
10. Drug history
11.family history
12.socioeconomic history

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2
Q

Monitoring frequency

A

Prenatal
Newborn: 3-5 days of birth or within 48-72 hours after discharge
2.week
1 month
2 3 4 5 6
9 months

12m, 15, 18,24,30, 3y, 4y, sonra every year

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3
Q

Newborn screening tests

A

Phenylketonuria
Biotinidase deficiency
Hypothyroidism
Cystic fibrosis
Congenital adrenal hyperplasia
Spinal muscular atrophy

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4
Q

Newborn immunizations

A

Hepatitis B before discharge
İnfluenza and pertussis(Tdap) for parents

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5
Q

1/2 month visit

A

!! Social smile
Height/ weight
Head circumference
Weight for length
Vision
Hearing
Hip usg
PE, immunization
Behavioral social emotional screening
Anticipatory guidance
Parents learn hunger cues
Maternal deppression scale(edinburg postpartum depression scale) -not in turkey

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6
Q

4 month visit

A

!!!sits with support
!!lifts head easily(deadline)
Anemia screening: iron supplement: 1-2mg/kg daily
Teething drooling: brush with grain of rice amount 2 times a day)
Measurements
Behavioral.. screening
Maternal depression

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7
Q

6 month visit

A

Sit without support
Roll over
Babble
İron def. Anemia screening: CBC/ ferritin test
Solid food introduction

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8
Q

9 month visit

A

History
Sit well without support
Dada mama nonspecifically
Turn when name is called
Pick up objects 3 fingers and thumb(cımbızlama)
Bye bye
Systems review
Parent infant interaction
PE
Immunization
Anticipatory guidance: table food introduction, self feeding, cup drinking
Screening:9,18 ay, 2.5 yıl

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9
Q

12 ay visit

A

Hikaye
Development surveillance:
Look for hidden objects, imitate gestures, dada mama specifically, 1 word other than them, stand without support, independent first steps, pick up with 2 finger grasp
Screening: anemia, oral(first dental check up,opthalmology
Anticipatory guidance(tantrums)

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10
Q

15 ay visit

A

İndividuation
Bedtime routine, night waking, no bottle in bed
Stranger/separation anxiety
Discipline, behaviour management

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11
Q

18 month visit

A

AUTİSM SCREENİNG
Development: engage w/ others,point, identify 2 body parts, sit in small chair
Anticipitory: signs of toilet training
New sibling planned/on the way
Phsycal activity promotion

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12
Q

2 year visit

A

2 words into sentence !
Follow 2 step command !
Dyslipidemia screening
Autism screening
Fluoride varnish every year
Limit tv and media to 1 hour per day
Speech %50 understandable, paralel play,kick ball, jump with 2 feet, draw lines
Teach personal hygiene

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13
Q

3 year visit

A

Blood pressure every year !
Vision screening!
Urinate by self, eat by self, 3 word sentences, draw circle, pedal tricycle

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14
Q

4 year visit

A

Anticipatory: school readiness
Promotimg physcal activity and safe play

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15
Q

5/6 year visit

A

Anemia screening!
60 min physical activity a day

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16
Q

7/8 visit

A

Hearing, vision screening

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17
Q

9/10 vist

A

Dyslipidemia screening
Review of systems(period in girls)
PE: spine: Adams forward bend test
Breasts and genitalia

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18
Q

11-14 vist

A

Anemia screening
Depression and bullyinf
System review, PE

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19
Q

13-17 visit

A

Dyslipidemia
Depression
Vision(15)

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20
Q

Newborn visit

A

First priority:Attend concerns of ptx
History
Social determinants, parent family health,newborn behaviour and care,safety
Observe parent-newborn interaction
Nutrition and feeding: vit D
TUMMY TİME
Development: social language,self help
Growth chart !
Measurements:head, weight, length
Palpate fontanels
Femoral pulse!
Inspection,palpation, auscultation
Labia open, testicular position
Screening: Hearing, bilibubin, congenital heart disease +- bp, vision
Critical congenital heart disease: pulse:
<%90 in right hand/foot: failed
90-95 arası orm>%3 difference between hand/foot: repeat 2 times: still same: failed

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21
Q

Well child visits: health supervision

A

Promote health, prevent disease, detect and treat early, guide parents(anticipatory guidance)

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22
Q

Prolactin

A

Ductal growth, epithelial proliferation, signals alveolar production of milk!
!Dopamine is its inhibitor( also neurepinephrine)
Highest at night/ 45 min after feeding

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23
Q

Severe acute malnutrition

A

6 months to 5 years
MUAC<11.5 cm or WHZ<-3 or pitting edema(kwashiorkor):
+1: edema in feet lower legs
+2: upper body arms
+3:face

Dgx for infant: 0 to 6 months:
WAZ/WLZ<-3 SD
MUAC<11
Edema

Above 5 years: BMI- for age Z score for wasting
Thinnes: Z-score<-2
Severe thinness<-3

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24
Q

Marasmus, kwashiorkor

A

Both: bradycardia,hypotension,hypothermia, thin skin, thin sparse hair

Marasmus: shrunken,skin folds, irritable
Kwashiorkor(edematous malnutrition):hepatomegaly,distended abdomen, dilated intestines,inguinal skin folds,apathetic,moon face,pursed mouth

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25
Chronic malnutrition
Stunting Moderate<-2. Severe<-3 +wasting,reduced height for age Deficit in fat and lean body mass, poor weight gain, reduced physical activity, mental apathy, retarded motor/mental development Etiology: malabsorption,nutrient loss,altered utilization,hypermetabolism, starvation. Ilness related: ınfection,burns,trauma, cystic fibrosis, chronic lung disease, cancer
26
Micronutrient deficiencies
Fat soluble vitamins, iron, zinc Malabsorptive disorders, neurologic conditions, restrictive intake children Eating disorders,picky eaters,homemade formulas, autism, cerebral palsy, ibd, intestinal failure, baritric surgery
27
EFA:
linoleic, alpha-linoleic acid Scaly dermatitis, alopecia, thrombocytopenia. Growth cognitive visual fnx
28
Calcium
By calcium, vit d or parathormone deficiency Tetany,chovstek sign,trousseau sign, seizures
29
Phosphate
Myopathy,rhabdomyolysis,bone pain, osteomalacia,rickets
30
Magnesium
Assoc w/ hypo calcemia/phosphatemia Muscle fasciculations,tremor,spasm,seizure,personality change
31
Iron
Microcytic hypochromic anemia Lethargy,pallor,irritability,cardiomegaly,tachypnea,impaired cognitive development Pica for ice,spooning/pallor of nail beds
32
Zinc
Dermatitis:peri oral/anal flaming red, denuded skin Abd pain, diarrhea,anorexia, delayed wound healing,depression, alopecia,corneal opacities, glossitis,fever, growth retardation,hypogonadism,immune dysfunction, nervousness, intention tremor, night blindness, nystagmus
33
Copper
Sideroblastic anemia, neutropenia, osteoporosis, cartilage enlargement, cupping flaring of bones, rib fractures
34
Selenium
Dilated cardiomyopathy w/ myocardial necrosis/fibrosis ( keshan disease) Muscle pain, myopathy, nail bed changes, hair pigment loss
35
İodine def
Moderate:Hypertrophy of thyroid gland or goiter Severe: hypothyroidism! İntellectual disability,hearing loss,spastic diplegia, strabismus Congenital hypothyroidism:hypotonia, macroglossia,hoarseness, constipation, growth retardation
36
Obesity evaluation
Bmi percentile (>95 obese >85 overweight, <5 underweight) (2-20 years) Fasting lipid,glucose, HbA1c Alt,ast,bun,creatinine,cbc,lh,fsh,testesterone,estradiol, vit d 500 gr loss per month (2-11 years) Intensive dietary therapy
37
Anthropometric measurments for malnutrition, growth charts
Height,weight,mid upper arm circumference (MUAC)(for wasting) <115cm for 6 months to 5 years, pitting edema Under 2 years, percentile, z score: <3
38
Moderate acute malnutrition
6 months to 5 years muac 11.5<, <12.4 or Z score -2 to -3 arası 1-2 weeks follow up Rutf: ready to use therapeutic food
39
Complicated SAM:
sepsis diarrhea w/ severe dehydration Skin breakdown- ulceration Poor apetite Management: Stabilizasyon :antibiotics, rehydration,feeding Rehabilitasyon Follow up
40
T dependent vaccine antigen mechanism
Protein antigen 1.Ag-dendritic cell 2. Activated DC- T follicular helper - ag specific B cell ( in lymph node) ( PRİMARY RESPONSE: 3-6 wk) 3. Antibody production(2 wk) - plasma cell- antigen spc. IgG ab / bone marrow 4. Affinity maturation( 4-6 m)- memory B cells- spleen, lymph nodes Or 1.Ag- naive B cell- ag specific B cell into lymph node, then 3, 4
41
T independent vaccine antigen mechanism
Polysaccharide antigen 23 valent pneumococcal vaccine 1.(spleen, lymph node)Ag+B cell - plasma cell (1-2 wk) 2.plasma cell- ag specific igG ab
42
Vaccines can be
Weakend microbes( live) Inactivated microbe Part of microbe Toxoids Dna, Rna
43
Live vaccines
Viral: MMR Rotavirus Varicella Influenza Oral poliovirus Yellow fever Bacterial: BCG
44
Conjugated vaccines
Pneumococal conjugate Menimgococcal H.influenza type B( HiB)
45
Vaccine ingredients
Antigens Conjugates( boosts response) Adjuvants: (“””””””””), aluminum salt, local/systemic reactions!!! Not in live vaccines Stabilizers: sugars, gelatine Preservatives: formaldeyhyde,phenols, thimerosal Antibiotics Diluents
46
Vaccine preservance and administration
Live vaccines soğukta, daha üstte, tarihi yakın olanlar önde Administration 1.review immunization history 2.assess needen immunizations 3.precautions/ contraindications 4.educate ptx 5. Prepare vaccine ( check expiration date) 6.administer vaccine 7.document vaccine 8.guidance for planning vaccination( if any dose >5 days before appropiate time is not valid, <4 is valid) ( 28 days between live viruses) ( wrong route, lack of dose, wrong diluent, expired) But its fine if: overdose, subcutan done IM, <5 days, spitting after oral rotavirus Subcutan: MMR, varicella, IPV, PPSV23( pneumococ). - 45 derece Intradermal: BCG - 10/15 derece Oral: OPV, Rotavirus Rest IM( vastus lateralis, deltoid >2y) No aspiration, Uzun iğne daha az ağrılı, yan etkili, 15mm Vastus lateralis and simultane injection <1y Holding the baby, breastfeeding,pacifier, sweet tasting solution (0-2 y)
47
Precautions and contraindications for vaccines
Precautions: ex. Moderate/ severe acute ilness ( fever not necessary) Contraindications: severe allergic reaction, immunocompromised, Encephalopathy within 7 days after pertussis vaccine SCID and pertussis for rotavirus vaccine For pregnant women: live attenuated viruses Not a problem: mild acute ilness, Preterm, current antimicrobial therapy, recent infection exposure, penicillin allergy, history of GBS, ab
48
Adverse events of immunization
Local tenderness, swelling, erythema Systemic: mild fever, fussiness, headache, fatigue, appetite loss, postvac. Syncope Resolve in 1-2 days Hypersensitivity reactions: immediate: in 1 hour and IgE mediated, delayed: several hours to day not ıgE Anaphylaxis: IM epinephrine: 0,01-05 max, yetmezse iv infusion
49
Hepatit B vaccination
0,1, 6 Im, inactive
50
BCG vaccination
2 m LİVE, intradermal, deltoid
51
Diphteria, tetanus, pertussis vaccination TDaP
2,4,6,18 m, 4y Booster at 13-14/ 11 y Inactive, IM
52
H. İnfluenza Type B conjugate vaccination (5li karmada)
2,4,6,18 İnactive im
53
Pneumococcal conjugate vaccination
2,4, 12-15m İnactive im
54
IPV/ OPV
IPV: 2,4,6m, 4-6y Inactive, im or subcutan OPV: 6,18m Live, oral
55
MMR vaccination
1y, 4y Live, subcutan
56
Varicella vaccination
1y 4y Live subcutan
57
Hepatit A vaccination
18m, 2y (1-2 yaş arası, 6 ay arayla 2 doz) Inactive im
58
Vaccines not included in routine schedule
Rotavirus Meningococcal Influenza Hpv Rabies
59
Rotavirus vaccine
Oral, live 2 doz İlk doz 1,5-3,5 ay arası (<15wk) 2.doz 8 aya kadar Rotarix(RV1): 2 doz RotaTeq(RV5): 3 doz
60
Influenza vaccine
Everyone >6 months Min 1 ay arayla 2 doz 6 ay arayla 2 doz 9 yaşından sonra 1 doz
61
Meningococcal vaccine
<1y 11-12 y adolescent should receive MENACWY Booster at 16y MENACWYler: Nimenrix: erken aşılama Menactra!: 9-23m, 2 doses 3 months apart, above 2 years one dose enough Menveo MENB: Bexsero: a booster dose important Tarihler gerekli değilmiş isimler yeterliymiş
62
Hpv vaccine
11-12y 9-14: 2 doses >15: 3 doses
63
Rabies vaccine
Only for people at risk( bleeding) Post exposure prophylaxis:0,3,7,14. Günler ER/HR ig
64
Preterm/low birth weght infants immunization
<2000g: lower hepatit b response: HbsAg negative mother: at 1 month HbsAg positivr mother: at birth, then 3 doses If stable by 2nd month, routine vaccination Rotavirus servistekine yapılmaz, NICUdan çıkınca yapılır After 6th month, 2 influenza doses with 1 month intervals BCG: >34 weeks. 2 months of calendar age, >2000g
65
Immunization in pregnancy
Tdap Nonlive influenza( IIV) Covid 19 Rsv Live vaccines comtraindicated
66
URTİ and treatments Group A strep Rhinosinusitis Laryngotracheit Epiglottitis Pertussis(whooping cough) Diphteria Influenza
Penicillin V, amoxicillin or im benzathine penicillin G, if allergic: claritjromycin 10-14 day Antibiotic: amoxicilline/ clavulanate or doxycyline, nasal saline/ inhaled steroid Steroids, iv fluids Antibiotics: 3rd gen cephalosporin/ ceftriaxone, steroids, iv fluid Macrolide/ antibiotic Macrolide/ penicillin Oseltamivir

Pediatrics (10 decks)

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