pediatrics

Question 1

1. age categories - newborn (adaptation to living conditions)

Answer 1

weight: 2,5-4kg + 5/10% lost after 3-4 days + gain after 10 days (750g at 1 month)

height: 47,5-53cm

flexed elbows/knees/hips

behavior: cry/sleep

reflex: sucction, swallowing, moro, grasping, light, noise

hearing: 10 days before birth

reflex:
- upper extremity flexion/extension
- head flexion/extension

skin: vernix + lanugo + caput succedanum + cephalhematoma + molding + milia + sudamina + toxic erythema

Question 2

1. age categories - infancy (development of motoric system)

Answer 2

weight: 2x at 6 month + 3x at 12 month

height: 3cm at 3 month + 2cm at 4-6 month + 1,5cm at 7-12 month

1 year average: 10kg + 75cm

milky teeth 5-6 month

Question 3

1. age categories - toddlers (development of speech)

Answer 3

first teeth

weight: 3kg per year
height: 12cm per year

speech:
2 years - 200/300 words
3 years - 700/900 words
5 years - >2000 words

Question 4

2. growth of child and assessment

Question 5

6B. Acid base homeostasis + disturbances

Answer 5

neonates - immature kidneys
premature - buffers not enough

buffers: HCO3, phosphate, proteins, organic acids

metabolic acidosis: diabetic ketoacidosis
- normal anion gap: HCO3 loss (renal/GIT)
- increased anion gap: respiratory distress syndrome, hypoxia
- effects: increased: lung vasoconstriction, heart, CNS, bone

metabolic alkalosis: pyloric stenosis
- causes: vomiting, CF, kidney loss
- effects: decreased: heart, lung vasodilation

respiratory acidosis:
- causes: failure, respiratory distress syndrome, obstruction, pneumothorax

respiratory alkalosis:
- diabetic ketoacidosis, vomiting

Question 6

7B. Adenohypophysis

Answer 6

hormones: ACTH, FSH/LH, GH/TSH, Prolactin

Tests:
- Basal tests: FSH/LH, TSH, Prolactin
- Stimulation test: GH, ACTH

ACTH:
- Deficiency: hypocorticism (addisons disease - energy, weight loss)
- Hypersecretion: hypercorticism (cushing syndrome - adenoma)

Prolactin:
- Deficiency: less milk, delayed puberty
- Hypersecretion: infertility, irregular periods, galactorrhea, hypogonadism

GH:
- Deficiency: Dwarfism (micropenis, hypoglycemia, psychomotor retardation, delayed bone maturation)
- Hypersecretion: Gigantism, acromegaly

FSH/LH: sex characteristics, delayed/fast puberty

Panhypopituitarism:
- Sheehan´s syndrome: postpartum hemorrhage (Vit. K injection)

Adrenal gland:
- Cushings: exogenous steroid treatment
- Addisons: fatigue, dizziness, dehydration
- aldosteronism: hyper/hypotension

Hyperthyroidism:
- goiter, exopthalmus, tachycardia

Hypothyroidism:
- mental, learning, bradycardia

Question 7

8B. Examination DM

Answer 7

Kussmaul breathing?
Hydration?
Electrolytes?

Clinical findings: fruity breath, weight-loss, blurred vision, Candida-infection, Nasopharyngeal-infection

Laboratory examination:
- Electrolytes, glucose, HbA1c, urinanalysis, oral glucose tolerance test

Severly ill patients:
- liver function
- ECG for potassium abnormalities

Question 8

9B. Neurological examination of newborns, infants, older children

Answer 8

positioning reflex

newborns:
- general observation:
- reflexes, pupillary reflex:
- senses:
- babinski sign:
- autonomic function:

infants:
- language/social:
- reflex
- sitting/standing:
- sensory:
- deep tendon reflex:
- autonomic function:

older:
- history:
- mental:
- CN:
- motor:
- sensory:
- autonomic function:

CNS disorders:
- seizures: duration, frequency

neuro-muscular:
- progressive muscular atrophy
- congenital myopathies
- spinal muscular atrophy

neurological disorders:
- ADHD, autism, CP, cognitive/motor skills

normal reflexes - pathological?:
- Doll´s eyes phenomenon
- Asymmetric tonic neck reflex (opposite flexion)
- inverted babinski sign (toe in, others out)

CSF:
- 2/3 glucose, proteins, no RBC/WBC
- bacterial infection: low glucose, neutrophilia
- viral infection: leukocytosis (meningitis, encephalitis)

Question 9

10B. Rheumatic diseases, musculoskeletal disorders

Answer 9

Diseases:
- juvenile idiopathic arthritis
- SLE
- juvenile dermatomyositis
- kawasaki

lab examination:
- ANAs (anti-nuclear antibodies)
- RF (Rheumatoid factor)
- HLA B27

• CRP

Muscular disorders:
- tests: family history, genetics, K+, biopsy, EMG
- Duchenne muscular dystrophy
- Becker muscular dystrophy
- Limb-girdle muscular dystrophy
- Facioscapulohumeral muscular dystrophy

• polymyositis
• dermatomyositis
• thyroid myopathies

examination of locomotor system:
- history, physical exam, lab tests, biopsy, EMG, X-ray

• newborns + older children:
  – reflexes
  – muscle: power, tone, coordination