Pediatri Flashcards
Pylorusstenose
.
– Olive shape mass in epigaster
– Lab: Hypochloremic metabolic alkalosis!!
Kawasaki
.
Major Milestones
x
Når får nyfødte tilbake fødselsvekten?
Brystfødende: 6,5 dager
formula: 8,3 dager
Vektutvikling:
Vekttap første par dager 5-10% Tilbake etter 7-10dager (3,5kg) Dobbel vekt (7kg) 4-5mnd Trippel vekt (10kg) 1 år Kvadruppel vekt: 2-3 år
10kg: 1 år
20kg: 5 år
30kg: 10 år
Utvikling lengdevekst
Fødsel: 50cm 1 år: 75cm 90cm: 3 år 100cm: 4 år økning på 5-7,5 cm/1. år til pubertet
Speech - milestones
1 year: 1-3 words
2 years: 2-3 word phrases
3 years: routine use of sentences
4 years: routine use of sentence sequences
5 years: complex sentences, pronouns, prepositions
Normal gråt og kolikk
- Most infants cry little during the first 2 weeks of life. Between 2 and 6 weeks average from 2- 3 hrs per day
- 12 weeks: 1 hr daily crying
- Colic: Crying more than 3 hrs per day for more than 3 days a week for more than 3 weeks (”Wessels rule of 3”)
- < 5% of infants with excessive crying have organic etiology
normal sleep
- Full term infants sleep 2/3 of the day
- 1 year: 15 hrs (2-3 hrs during the day) • 12 years: 9 hrs
- Newborns start their sleep cycle (6o min cycle) in active sleep whereas older children and adults (90 min cycle) begin sleep in NREM sleep.
Phenylketonuria PKU
x
Screened for at birth
Congenital hypothyroidism (CH)
x
Screened for at birth
Vaksinering i Norge
6 weeks, 3 months
Rota virus
3 , 5 and 11-12 months:
Diphteria, tetanus and pertussis (DTP), Haemophilus influenzae type B (Hib), Poliomyelitis (IPV)
Pneumococcus (PKV)
15 months and 12-13 years:
Morbilli, Parotitis and Rubella (MMR)
6-7 year:
Diphteria, tetanus and pertussis (DTP) Poliomyelitis (IPV)
13-14 year:
HPV
15-16 year:
Diphteria and tetanus) (DT) Poliomyelitis (IPV)
Girls are offered HPV vaccine at the age of 12
Hepatitt B-vaccine recommended to children of parents from countries where Hepatitis B is common or children who are at risk for hepatitis B. Given in infancy/newborn period . BCG to risk population at 6 weeks
Normal puberty
The normal age for onset of puberty is: 9 - 13.5 years for girls,
10 - 14.5 years for boys
The first signs are respectively beginning of breast budding
at an average age of 10-11 yrs.
and testicular enlargement (volume >4 ml), at an
average age of 11 yrs.
Somatic development. Warning signs
If the child is not able to:
Reach for objects at latest 5 months
Sit at latest 10 months
Walk at latest 18 months
Språkutvikling
- 1 year 1 word: learn 1 new word per week
* 2 years 2 words together: 1 new word per day • 3 years 3 words together
milestones
- 2 months: response smiling •3 months: good eye contact •5 months: reaches for objects •10 months: sits unsupported •12 months pincer grip
- 18 months: walks unsupported
- 18 months : says single words with meaning •20 months: speaks in phrases
Fever, key point:
(Bruun Wyller)
• The younger the child, the more concerned!
• Lack of effect of temperature lowering attempts might signal more serious condition
• Temperature values in itself is not very informative
- Does the baby seem attentive?
- How is the general condition?
- Why is the mother so worried?
Diffdiagnoser v feber
• A localized infection (common!) Upper airway infection, incl. otitis Lower airway infection Urinary tract infection Gastroenteritis Meningitis/encephalitis Osteomyelitis/arthritis Skin infections • A generalised infection (possibly dangerous!) Generalised viral infection Generalised bacterial infection, incl. septicaemia • Other (rare!) Autoimmune disease Malignancies Immune deficiency
Tolkning av syre/ base-prøve
x
Se Bruun Wyllers forelesning fra 22/8
Metabolsk acidose
Metabolsk alkalose
Respiratorisk =
Apgar Score
x
- Range from 0 to 10. Routinely scored after 1, 5 and 10 minutes.
- Provides information on asphyxia (general lack of oxygen) during delivery
- Might be regarded a measure of general condition in the newborn
Nutritional deficiencies – key notes
- Affected nutrients • Proteins (low albumin) • Lipids (low triglycerides) • Minerals (calcium, iron) • Water-soluble vitamins (folic acid) • Fat-soluble vitamins (Vitamin A) - Possible diagnosis • No access to nutrients • Anorexia nervosa • General malabsorption, eg. celiac disease • (Excessive energy and nutrient consumption, eg. heart failure) - Acid-base balance • Often slight metabolic acidosis due to increased break-down of ketone bodies
Tonsilitt og Centor kriteriene:
4/5 må oppfylles for diagnose i allmenpraksis. Sår hals (akutt start) Temp over 38,5 Store innflammerte tonsiller m puss Såre/ forstørrede lymfeknuter på hals Fravær av hoste
wilms tumor
x
Ewings sarcoma
x
Diagnoser viktige hos premature barn
(IVH) Intraventricular hemorrhage (BPD) Bronchopulmonary dysplasia (NEC) Necrotizing enterocolitis (ROP) Retinopathy of prematurity (RDS) Respiratory distress syndrome (PVL) Periventricular leukomalacia
Key notes prolonged jaundice
- Possible diagnoses • Normal physiology Gilbert syndrome Breast milk jaundice • Hemolysis Rhesus incompatibility Other incompatibilities • Liver disease Hepatitis Biliary atresia • Other Inborn errrors of metabolism Hypothyreosis Gut obstruction
Key Notes rash
- Possible diagnoses
• Petecchiae/bruises/purpura
Septicaemia
Leukemia
Idiopathic/immune trombocytopenic purpura (ITP) Henoch-Schönlein purpura
• «Infectious rash»
Virus infections (measles, rubella, varicella, herpes simplex, erythema infectiosum, roseola
infantum, hand-, foot- and mouth disease, warts, molluscum)
Bacterial infections (scarlatina, borreliosis, impetigo)
Fungal/parasite infections/infestations (candida, scabies, tropical diseases )
• Skin inflammations
Kawasaki syndrome (mucocutaneous lymph node syndrome) Eczema
Acne
Toxic erythema
Hives
Limping key notes
- Possible diagnoses • Infections Osteomyelitis Arthritis (bacterial, viral/’reactive’) • Autoimmunity JRA Spondyloartheritis Reumatic fever • Malignancies Leukemia Primary bone tumor • Traumas Fractures Epiphysiolysis • Neuromuscular disorders • Congenital malformations/miscellaneous Congenital hip dislocation Calvé-Legg-Perthes disease - Supplemental investigations • Lab screening (haematology, infection/inflammation markers) • Imaging (x-ray, ultrasound, MRI)
SMA - spinal muskelatrofi
Tre typer:
III: Barn som kan gå og som ser vanlig ut, men kan ikke løpe, hoppe, hinke
Fecal Calprotectin
x
Jern i IBD
Gi aldri jern PO.
bare iv.
Exclusive Enteral nutrition
- Liquid diet
- 8 week course
- ”Liquid bandadge”
- Mucosal healing
- No side effects ( except compliance) • Does not work in UC
Celiac spesific angibodies
• IgA anti- transglutaminase ( tTG) • IgG anti deamidated gliadine
Cøliaki tester
Immunglobuliner
HLA-typing
biopsi
ENCOPRESIS
Involuntary passage of stools in children over 4 years of age
Kernicterus
x
Neonatal jaundice
• Jaundice is caused by accumulaJon of unconjugated bilirubin in the skin
– In most infants - normal physiology
– In some infants addiJonal factors may increase the degree of jaundice
Bilirubin toxicity
• Bilirubin encephalopathy - brain funcJon is
affected transitorily (probably): • Lethargy/anorexia • Neurophysiologic changes (ABR, VER)
• Kernicterus - brain damage
• Death in acute phase
– Typically in Rhesus isoimmunizaJon 100+ years ago – And sJll today in LMICs
• In survivors a CP-like condiJon with choreoathetosis, deafness, gaze palsy, ⇓I.Q.
”Physiologic” jaundice in neonates is due to the simultaneous occurrence of two phenomena:
– High bilirubin production (x2 relative to adults) due to breakdown of fetal erythrocytes
• fetal red cells have shorter survival time • hemoglobin higher in fetal life
– Hepatic excretory capacity for bilirubin is low • low ligandin in liver cells
• low activity of glucuronyl transferase
Empiric antibiotic treatment of most respiratory tract infections in Norway
• Drug of choice: Penicillin – Exceptions: • Pertussis: Erytromycin • Mycoplasma: Erytromycin • Allergy to penicillin: Erytromycin
