3. SAQ (2) Flashcards
(41 cards)
1
Q
Primary Pulmonary Tuberculosis (PPTB)
A
- It includes Primary Complex and Tuberculosis of Tracheobronchial Lymphonodus
- The main type of TB in children
2
Q
Primary Complex of PPTB
A
- Primary lesion
- Enlarged lymph node
- Linking lymphangitis exist at the same time
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
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
5
Q
Age Group and the Characters
A
- Fetal period – formation of Embryo/Zygote to birth of fetus, usually 280 days
- Perinatal period – 28th week of gestation – 1 week after birth
- Neonatal period – 0 to <28 days from tying umbilical cord to 28 days
- Perinatalperiod–28weeksofgestationto7daysafterbirth
- Infancy – 0- <1 year including Neonatal Period; from Birth to one year of age
- Toddler/earlychildhood–1yearto<3years
- Preschool age/early school age – 3 years to 6-7 years before entering primary
school - Schoolage–6-7yearsofagetostartingofadolescencephase(pre-puberty)
- 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
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
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
8
Q
Indicators of Physical Growth
A
- Weight
- Recumbent length and standing height
- Sitting height
- Headcircumference
- Chest circumference
- Upperarmcircumference
- Subcutaneous fat
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
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
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
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
13
Q
Difference between Inoculation reaction and Natural Infectious Reaction
A
(photo)
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
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
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
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
- Small VSD
- Asymptomatic
- Loud, harsh or blowing holosystolic murmur at Lower Left Sternal Border
accompanied by a thrill - 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
Complication of Nephrotic Syndrome
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
Kawasaki Disease and Diagnosis
- 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
Extramedullary Hematopoiesis
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
Diagnose Pneumonia – Tachypnea
Depends on baby’s age
- 0-<2months - >60bpm
- 2-12 months - >50bpm
- 1-5 years - >40bpm
- >5years–30or>20bpm
29
Pneumonia Classification by Anatomic distribution
- Lobar
- Interstitial
- Bronchopneumonia - Broncholitis
30
Pneumonia Classification by Causative Agents
- Bacterial pneumonia
- Viral pneumonia
- Mycoplasma pneumoniae pneumonia
- Chlamydia
- Mycotic infections
- Aspiration of food/gastric acid, foreign bodies, dust, lipoid substances
31
Clinical Findings of Pneumonia
- Fever
- Generalized toxicity
- Cough, sputum production, wheezing
- Rales, decreased breath sound, dullness to percussion
- Abnormal tactile/vocal fremitus
- Meningismus, abdominal pain
32
Differential Diagnosis of Pneumonia
- Acute bronchitis
- Pulmonary TB
- Foreign body aspiration
33
Complication of Pneumonia
- Empyema
- Pyopneumothorax
- Tension pneumothorax
- Pneumatocele
- Lung abscess
34
Physiological Characteristic of Pneumonia
- 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
Hypoxic-Ischemic Encephalopathy (HIE)
- 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
HIE in Term Infants
(photo)
37
Hyaline Membrane Disease (HMD)
- Deficiency of Pulmonary Surfactant
- Pulmonary alveoli collapse at the end of expiration
- Mainly in Preterm Infant
38
Neonate Respiratory Distress Syndrome (NRDS)
- 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
Etiology of Neonatal Icterus
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
CSF differences among diff. Meningitis and Normal Human
(photo)
41
Guidelines of Antibiotic Therapy (Bacteria Meningitis)
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
