3. SAQ (1) Flashcards
(44 cards)
1
Q
⭐Characteristics of Bilirubin metabolism in a Newborn
A
- Increased Bilirubin Synthesis ↑
- Less effective Binding and Transportation of Bilirubin
- Premature Hepatic Function
- Enhanced Absorption of Bilirubin via the Enterohepatic Circulation
2
Q
⭐ Characteristics of Rotavirus
A
- Acute Diarrhea occurred in infants b/w 6 months – 2 years age
- Mostly in Autumn and Winter
o 1-2 days – Fever, Upper Respi. Tract Infection and Vomiting
o 3-8 days – Profuse Watery Diarrhea - Dehydration and Acidosis are common
- Stools are
o Profuse
o Frequent
o Watery
o Yellow-water/egg-soup like w/ small amt. of Mucus
o Mostly stool are Normal under Microscope w/o Blood (RBC) or Pus (WBC)
3
Q
⭐How to Diagnose CHF in child with Severe Pneumonia
A
- Tachypnea >60/min
- Tachycardia >180/min
- Extreme Agitation with Cyanosis and/or Duskiness
- Soft Heart Sound, Gallop Rhythms, and Engorgement of Neck Veins
- Rapid Hepatomegaly
- Oliguria, Anuria, Edema of the face or extremities
4
Q
⭐Typical Bone Deformity in Active Stage in Rickets of Vitamin D deficiency
A
- <6 months
o Lesion mainly at Skull
o Craniotabes
o Ping-pong ball sensation - > 6 months mainly Osteoid Tissue accumulation o Rachitic rosary
o Widening of wrists (bracelet) and ankles (anklets) o Caput quadratum
o Wide open Anterior Fontanels
5
Q
Definition of Iron Deficiency Anemia (IDA)
A
- IDA is a Microcytic and Hypochromic Anemia caused by Iron Deficiency
- Age: 6-24 months
6
Q
Classification stages of Iron Deficiency Anemia (IDA)
A
- Iron Depletion (ID)
- Reduced Iron Store
- Normal iron supply for Hematopoiesis
- Normal blood Hb value - Iron Deficient Erythropoiesis (IDE)
- Reduced Iron Store
- Reduced iron supply for Hematopoiesis
- Normal blood Hb value - Iron Deficiency Anemia (IDA)
- Reduced Iron Store
- Reduced iron supply for Hematopoiesis
- Reduced blood Hb value
7
Q
Differences from Physiologic Jaundice from Pathologic Jaundice
A
(photo)
8
Q
Classification (Birth Weight, BW)
A
- Macrosomia: >400g
- Normal BW: 2500-4000g
- Low BW (LBW): less than 2500g
- Very Low BW (VLBW): <1500g
- Extremely Low Birth Weight (ELBW): <1000g
9
Q
Diagnosis of Iron Deficiency Anemia (IDA)
A
- Clinical Manifestation
o Age 6-24 months
o Pallor, Fatigue, Dizziness o Tinnitus,
o Spoon-shaped nails - Extramedullary Hematopoiesis
o Hepatomegaly & Splenomegaly o Lymphadenosis - Blood Examination
o Low Hemoglobin and Iron Level
o Blood Smear microcytic and Hypochromic anemia
o Bone marrow -> an increased number of Erythroblasts with delayed
maturity of Cytoplasm
10
Q
Treatment of Iron Deficiency Anemia (IDA)
A
- General measures
o Special nursing o Avoid infection - Etiologic treatment
o Increased dietary intake of Iron
o Treatment of Hookworm disease, Chronic diarrhea - Iron supplement
o Oral dose of elemental iron is 4-6mg/kg/d in three divided daily doses - Efficacy observation
o Blood Hb Level begins to increase in 2 weeks after Iron therapy o Symptom and signs completely resolve within 4-6 weeks
11
Q
Definition of Congenital Heart Disease (CHD)
A
Congenital Heart disease is defined as an abnormality in circulatory structure or function that is present at birth
- Ventricular Septal Defect – VSD
- Atrial Septal Defect – ASD
- Patent Ductus Arteriosus – PDA
- Pulmonic Stenosis
- Coarctation of the Aorta
- Transposition of Great Arteries
- Tetralogy of Fallot
12
Q
Classification and Main Diseases of Congenital Heart Disease (CHD)
A
- Acyanotic
o L-R shunt: VSD, ASD, PDA o R-L shunt: ToF, T4, TOA
o No shunt: PS, AS, CoA - Cyanotic
o Pulmonary blood flow decreased: TOF
o Pulmonary blood flow increased: TGA, TAPVR
13
Q
Complications of CHD
A
- Developmental Problems
- Respiratory Tract Infections
- Endocarditis
- Pulmonary HTN
- Heart Rhythm Problems
- Heart Failure
- Blood Clots
14
Q
Diagnosis and Treatment of CHD
A
- Diagnosis of CHD o History
o Physical Examination
o Collect information from ECG, CXR, Echocardiogram,
Angiocardiography 2. Treatment of CHD
o ASD
§ Surgical or Transcatheter Device cLOSURE
§ Time for Elective Closure
* After the 1st year – before entry to school
o VSD
§ Small VSD monitored until VSD closed
§ Large VSD control Heart Failure – prevent development of
Pulmonary Vascular disease
§ Surgery
o PDA
§ Irrespective age, pts. With PDA needs surgical/catheter
closure
o ToF
§ Depends on severity of Right Ventricular Outflow Tract
Obstruction
15
Q
Etiology of CHD
A
- Genetic factor (internal factor) o Gene mutation
o Chromosome aberration - Environmental factor (external factor)
o Viral infection
o Maternal diabetes
o Alcohol consumption
o Other maternal teratogen exposure
16
Q
Moderate and long-term steroid therapy in Nephrotic Syndrome
A
- Moderate to Long term
o Everyday – 2mg/kg/d o Every other day – 4w
o Tapped everyday – 2-4w is 0.5-1mg/kg x 3m Moderate is more than 6 months
Long is more than 9 months - Short term – Prednisone
o Everyday – 2mg/kg/day divided into 2-3 dose/4wks
o Every other day – 1.5mg/kg/d every other morning/4wks
17
Q
Causes of Rickets of Vitamin D
A
- It’s a Calcium and Phosphorus disorder caused by insufficient vitamin D in the body of children
- Leading to insufficiency of mineralization in Metaphysis of Long Bone and Bone Tissue
- Bone change at the part of rapid growth bone
18
Q
Characters of different stages of vitamin D deficiency rickets
A
- Initial stage (Early stage)
- Non-specific psychiatric symptoms
- Neuro-excitability is increased
- Irritability, anxiety, alopecia - Active stage (Excitation period)
- Bone change
- Usually in pts <6 months
- Lesion @ skull
- Craniotabes
- Ping-pong ball sensation
- If pts >6months, pts may have accumulation of osteoid tissue - Recovery stage
- Clinical symptoms gradually disappear after sun-shining or treatment - Sequelastage
- Common in children >2 yrs old
19
Q
3 Signs in patients with Latent Tetany of Vitamin D deficiency
A
- Chovstek Sign
- Twitching of Homolateral facial muscles due to Hyperexcitability of the
Facial Nerve Anterior to the ear as it crosses Zygomatic arch elicited by
tapping lightly over it 2. Peroneal Sign
- Elicited by tapping Peroneal n. below Head of Fibula while the knee is relaxed and slightly flexed. A (+) response will cause Dorsal Flex and Abdutction of foot - Trousseau’s Sign
- Carpopedal spasm induced by Ischemia 2ndary to inflation of
sphygmomanometer cuff commonly to an individual’s arm to 20mmHg over systolic blood pressure for 3mins
20
Q
Treatment of Tetany (Vitamin D deficiency)
A
- First aid treatment
o Convulsion – O2 administration
o Laryngospasm – pull the tongue out of the mouth, mouth to mouth
respiratory resuscitation and sac pressure oxygen inhalation
o Control convulsion and laryngospasm – 10% chloral hydrate; 0-4-0.5
ml/kg e.a
§ Ca agent – 10% Ca gluconate 5-10ml + 10% Glucose liquid 5-
20ml
§ Vitamin D – oral administration of Vit D, according to them
methods
21
Q
Severe Manifestation of Acute Glomerulonephritis (AGN)
A
. Hypertensive Encephalopathy
- Approx 5% of hospitalized children
- HTN usually severe, accompanied by CNS dysfunction (e.g headache, vomit,
depressed sensorium, confusion, visual disturbances, aphasia, memory loss,
coma, convulsion)
2. Circulatory Congestion
- Dyspnea, orthopnea, cough – present
- Pulmonary Rales often audible
- Patient with otherwise normal Cardiovascular system, Cardiac failure is
unusual
- Pallor is common at onset and is not explained entirely by Anemia
3. Acute Insufficiency
- Glomerular inflammation (e.g Cellular Prolfieration, Edema)
- Capillary loop is narrowed
- Glomerular Filtration reduce
22
Q
ABCDE resuscitation for treatment of Asphyxia of Newborn
A
- A (Airway)
- Establish open airway
- Position of the infant (no extend/flex)
- Suction mouth, nose
- Suction any blood, secretion
- Placing a guedel airway - B (Breathing)
- Initiate breathing
- Tactile stimulation
- PPV if necessary (+ press ventilation)
- Mask ventilation placed over mouth and nose - C (Circulation)
- Maintain circulation
- Stimulate cardiac compression - D(Drugs)
- Adrenaline -> low HR
- Sodium bicarbonate acidosis
- Naloxone bradypnea - E (Evaluation)
- Respiration – if none/gasp, give PPV 21% oxygen 15-30 sec
23
Q
Neonates Asphyxia
A
- Asphyxia
o Failure to initiate and maintain spontaneous respiration - Hypoxia + Hypercapnia + Metabolic Acidosis (combination)
- Might lead to Irreversible Brain damage
24
Q
Neonatal Asphyxia Evaluation (APGAR Score)
A
(pic)
25
Criteria for Perinatal Asphyxia
- Prolonged Metabolic or Mixed Acidemia (pH <7) on an Umbilical Cord Arterial Blood Sample
- Persistence of an APGAR Score of 0-3 for >5 mins
- Clinical neurological manifestations (e.g Seizure, Hypotonia, Coma, or HIE in
immediate neonatal period)
- Evidence of multiorgan system dysfunction in immediate neonatal periods
26
Management for Neonatal Asphyxia
1. Preparation for Resuscitation
- Anticipation of high risk delivery
- Proper equipment
- Trained personnel
2. Purpose of Resuscitation – reverse Asphyxia before irreparable damage occurred
27
3 Assesment Questions before Resuscitation – Neonatal Asphyxia
1. Term gestation
2. Good tone
3. Breathing/crying
if one answer is NO, go to initial resuscitation step
28
Initial Resuscitation Steps
- Warm
- Position - Suction
- Dry
- Stimulate The Infant ˆ
Next
- Evaluate Respi + HR
- If apnea/gasping or HR <100bpm provide PPV with 21% O2(term), 30% O2 term
- Golden Minute (60 secs) mark for completing initial step, re-evaluating- begin ventilation (IF required)
Next
- After 30 secs of PPV
- Evaluate HR
- If HR is <100bpm, then correct PPV (Positive Pressure Ventilation)
- Reassess HR (30 sec later)
- HR less than 60 bpm? = start chest compression cooperating w/ PPV
Reassess
- After 60 secs, reassess !!!!!!
- HR greater 60bpm, stop compression, continue PPV
- 30 secs, reassess
- HR greater 100bpm and regular breathing, stop ppv
29
Levels of Asthma Control
(photo)
30
Complications of Malnutrition
1. Nutritional anemia
- Most common
- Microcytic hypochromic anemia
2. Vitamin deficiency
- Fat-soluble vitamin A and D deficiency
3. Zinc deficiency
- Around 3⁄4 children
- May lead to Lower immunal function
4. Infection
- Repeated respiratory infection
- Pneumonia
- UTI
- Protactred course of disease, malnutrition worse, vicious circle forms
5. Spontaneous hypoglycemia
- Happens suddenly
- Pale
- Unconsciousness
- Slow pulse rate
- Apnea
- Low temperature
- No seizure
- Death may happen if no injection of glucose IV w/o delay
31
Diagnosis of Malnutrition
Consider the age and feeding history of patient
- Sign and symptoms (e.g weight loss, subcutaneous fat loss, systemic
dysfunction and nutrient deficiency)
- Regular growth monitoring and follow-up (e.g use monitoring chart)
- Height (length) and weight are basic measures for diagnosis WHO classification
- Based on SD of body weight and height
- Underweight – 2SD or less
- Moderate – 2SD to -3SD
- Severe -3SD or greater which indicates Acute/Chronic Malnutrition
32
Spontaneous Hypoglycemia of Malnutrition
- Happens suddenly
- Pale
- Unconsciousness
- Slow pulse rate
- Apnea
- Low temperature
- No seizure
- Death may happen if no injection of glucose IV w/o delay
33
Protein-Energy Malnutrition (PEM)
- Disease caused by deficiency of energy and protein
- Weight not increased or decreased
- Wasting or edema
- Decreased or disappeared subcutenous fat
- Decreased function of organs
- Often accompanied by deficiency of Multiple Micronutrients
34
Rules of Growth and Development
- It’s a continuous and stage-by-stage process
- Unbalanced development of systems and organs
- Individual differences of Growth and Development
o Growth “track” among children are different
o Caused by inherited potential and environmental factors
- General principles of Growth and Development
o Up to Down – raise head, sit, stand
o NeartoFar–armtohand
o Gross to fine – palm to finger
o Elementary to senior – observe, feeling, remember analyze o Simple to complex – line, circle, whole picture
35
Tuberculous Meningitis
- A chronic infectious disease of CNS caused by tubercle bacillus
- Age of onset
o More common <3 yrs old infant and toddler
o Within 1yr (esp 3-6 months) after Primary Tubercular Infection
- Infant and toddler’s BBB function is not perfect, immunologic function is
poor
- Source of meningeal bacteria
o Hematogenous spread when systemic miliary tuberculosis
o Tuberculosis lesion spreading from Brain Parenchyma, Spine, Skull,
Middle ear, and Mastoid
36
Cerebrospinal Fluid Examination for diagnosis of Tuberculous Meningitis
- Pressure Increased
- Appearance – clear or round-glass appearance
- Leukocyte count – 50-500x106/L, mainly lymphocyte, reach 70-80%
- Protein quantitative analysis increase 1.0-3.0 g/L
- Glucose decrease usually <0.3 g/L
- Chloride decrease, 85.5-102.6 mmol/L (500-600 mg/dL)
- Both reduction of glucose and chloride is a typical change of TB Meningitis
37
Diagnosis of TB Meningitis
- PPD test (+) in later stage false negative may appear
- Chest X-Ray examination – 85% TB change in TB Meningitis
- Cerebral CT or MRI scan –
o shadow enhancement of basal ganglia, o increased density of cerebral cister,
o calcification,
o ventricular enlargement
o Cerebral edema
o Focal infarction
- Fundus examination – miliary nodules
38
Clinical Manifestation of TB Meningitis
1. Early Stage (Prodromal Stage)
- Personality change + symptoms of TB intoxication
- Few words say, easy get tired, irritable, fever, night sweat, vomiting,
diarrhea
- Headache (elder children), drowsiness (infant), gaze
2. Intermediate Stage (Meningeal Irritation Sign)
- Mainly Meningeal Irritation Sign
- Headache, projectile vomit, drowsiness, convulsion, neck rigidity
- Babinski sign, Kernig sign both (+)
- Cranial n. palsy, facial paralysis, optic papilla edema, tubercular nodus of
choroid
- Infant fontanel bulging
3. Advanced Stage (Coma Stage)
- Disturbance of Consciouss (mainly)
- Above manifestation aggravated
- Convulsion, coma, electrolyte disorder, cerebral hernia, death
39
Treatment of TB
- General treatment o Rest
o Diet
o Outdoor activity
o Full duration of Treatment
o Pay attention to Reexamination
- Medication
o Isoniazid
o Rifampin
o Streptomycin o PZA
o Ethambutol
o ETH
o PAS
- Standard therapy
o Daily take medicine orally, therapeutic course 9-12 months
- Therapy in stages
o Intensive phase of Treatment 3-4 months
o Consolidation phase of treatment 12-18 months
- Directly Observed Therapy Sort Course (DOTS)
40
ABCDE resuscitation for treatment of Asphyxia of Newborn
1. A (Airway)
- Establish open airway
- Position of the infant (no extend/flex)
- Suction mouth, nose
- Suction any blood, secretion
- Placing a guedel airway
2. B (Breathing)
- Initiate breathing
- Tactile stimulation
- PPV if necessary (+ press ventilation)
- Mask ventilation placed over mouth and nose
3. C (Circulation)
- Maintain circulation
- Stimulate cardiac compression
4. D(Drugs)
- Adrenaline -> low HR
- Sodium bicarbonate acidosis
- Naloxone bradypnea
5. E (Evaluation)
- Respiration – if none/gasp, give PPV 21% oxygen 15-30 sec
41
Severe manifestation of AGN
1. Hypertensive Encephalopathy
- Approx 5% of hospitalized children
- HTN usually severe, accompanied by CNS dysfunction (e.g headache, vomit,
depressed sensorium, confusion, visual disturbances, aphasia, memory loss,
coma, convulsion)
2. Circulatory Congestion
- Dyspnea, orthopnea, cough – present
- Pulmonary Rales often audible
- Patient with otherwise normal Cardiovascular system, Cardiac failure is
unusual
- Pallor is common at onset and is not explained entirely by Anemia
3. Acute Insufficiency
- Glomerular inflammation (e.g Cellular Prolfieration, Edema)
- Capillary loop is narrowed
- Glomerular Filtration reduce
42
Tuberculous meningitis (character, diagnosis)
PPD test (+) in later stage false negative may appear
- Chest X-Ray examination – 85% TB change in TB Meningitis
- Cerebral CT or MRI scan –
o shadow enhancement of basal ganglia, o increased density of cerebral cister,
o calcification,
o ventricular enlargement
o Cerebral edema
o Focal infarction
- Fundus examination – miliary nodules
1. Early Stage (Prodromal Stage)
- Personality change + symptoms of TB intoxication
- Few words say, easy get tired, irritable, fever, night sweat, vomiting,
diarrhea
- Headache (elder children), drowsiness (infant), gaze
2. Intermediate Stage (Meningeal Irritation Sign)
- Mainly Meningeal Irritation Sign
- Headache, projectile vomit, drowsiness, convulsion, neck rigidity
- Babinski sign, Kernig sign both (+)
- Cranial n. palsy, facial paralysis, optic papilla edema, tubercular nodus of
choroid
- Infant fontanel bulging
3. Advanced Stage (Coma Stage)
- Disturbance of Consciouss (mainly)
- Above manifestation aggravated
- Convulsion, coma, electrolyte disorder, cerebral hernia, death
43
Primary Complex of PPTB
- Primary lesion
- Enlarged lymph node
- Linking lymphangitis exist at the same time
44
4 deformities which compose tetralogy of fallot
The 4 Malformations of TOF include
o Overriding aorta
o Pulmonic stenosis
o Ventricular septal defect
o Right ventricular hypertrophy
