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PEDIATRICS Flashcards

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1
Q

ALUR RESUSITASI NEONATUS

A
  1. Konseling [UK, air ketuban, RF, manajemen tali pusat], tim [3 orang: ventilasi, sirkulasi, alat alat], alat [TABCD - termoregulasi, airway, breathing, circulation, drugs]
    1. Bayi lahir, jika prematur/napas ireguler/nangis lemah/tonus lemah —> LANGKAH AWAL - HP BEKAS PAK ESAN [hangatkan, posisikan, bersihkan jalan napas, keringkan, stimulasi, posisikan kembali, evaluasi]
      • Jika tidak —> RAWAT BERSAMA IBU
    2. Jika megap2/DJJ<100 —> VTP 30 DETIK; EVALUASI SRIBTA [SUNGKUP, REPOSISI, ISAP, BUKA MULUT, TEKANAN, ALT AIRWAY]
      • *Jika nafas spontan + DJJ≥100 —> CEK RETRAKSI/MERINTIH/TAKIPNEA. Jika ya —> CPAP; VTP; INTUBASI. Jika tidak —> CEK SIANOSIS/SPO2. Jika ya —> O2 ALIRAN BEBAS. Jika tidak —> RAWAT BERSAMA IBU. Apabila sudah mendapat CPAP/O2 ALIRAN BEBAS —> PERAWATAN PASKA RESUSITASI
    3. Jika DJJ <60 —> VTP + KOMPRESI 1:3 60 DETIK
      • Jika DJJ<100 —> KE POIN 3
      • JIka DJJ≥100—> KE POIN 3*
    4. Jika masih DJJ <60 —> VTP + KOMPRESI 1:3 60 DETIK + ADRENALIN 1:10000
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2
Q

SKORING NEONATUS
1. Asfiksia
2. Distres napas
3. Maturitas neuromuskular

A
  1. APGAR
  2. DOWN
  3. NEW BALLARD
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3
Q

Asfiksia: Preterm, x-ray (+) ground glass app / reticulogranular pattern / air bronkogram, surfaktan (-)

A

HMD

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4
Q

Asfiksia: Preterm, x-ray (+) atelektasis / hiperinflasi, CT scan (+) mosaic lung

A

BPD

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5
Q

Asfiksia: Lahir SC, x-ray (+) efusi, fuzzy perihilar

A

TTNB

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6
Q

Asfiksia: Postterm, x-ray (+) patchy infiltrate

A

MAS

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7
Q

TRAUMA LAHIR
1. Lewat sutura, klinis baik:
2. Lewat sutura, klinis buruk:
3. Tidak lewat sutura:
4. Refleks genggam (+):
5. Refleks genggam (-):

A
  1. CAPUT SUCCADANEUM
  2. PENDARAHAN SUBGALEAL
  3. SEFALHEMATOM
  4. ERB PALSY
  5. KLUMPKE PALSY
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8
Q

Rw prematur/KPD>24h/demam peripartum, sindrom infeksi sistemik
- ≤3d:
- >3d:

A

SEPSIS NEONATORUM
- DINI
- LAMBAT

Stabilisasi, ampisilin 100mg/kg/d + gentamisin 5mg/kg/d

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9
Q

IKTERUS NEONATORUM
1. Bisa kehamilan pertama, Ibu goldar O, anak A/B, ikterus hemolitik:
2. KEHAMILAN KEDUA, Ibu Rh(-) janin 1 dan 2 Rh(+), ikterus hemolitik:
3. Kurang ASI <8x/d:
4. ASI cukup, beta-glucoronidase dalam ASI:
5. <2mo, Ikterus obstruktif [urin gelap, feses pucat, hepatomegali, hiperbilirubinemia direk], USG (+) TRIANGULAR CORD SIGN:

A
  1. INKOMPATIBILITAS ABO
  2. INKOMPATIBILITAS RHESUS
  3. BREASTFEEDING JAUNDICE
  4. BREASTMILK JAUNDICE
  5. ATRESIA BILIER

Fototerapi (<20), transfusi tukar (>25), atresia bilier: metode kasai; transplantasi hati (definitif)

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10
Q

Rw persalinan tidak steril (paraji), spasme, tes spatula (+) menggigit

A

TETANUS NEONATORUM

stabilisasi, metronidazole 4x 30mg/kg / penisilin G 100rb IU/kg/d + HTIg 500 IU / ATS 5000 IU IM

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11
Q

SINDROM KONGENITAL
1. Perempuan, 45XO, pendek, webbed neck, hiperGT hipogonad:
2. Laki, 47XXY, tinggi, ginekomastia, hiperGT hipogonad: SINDROM KLINEFELTER
3. Trisomi 13, polidaktili, bibir sumbing, ggn SSP berat: SINDROM PATAU
4. Trisomi 18, overlapping finger, mikrognathia, club foot, ggn perkembangan berat: SINDROM EDWARDS
5. Trisomi 21, mongoloid face, makroglossia, epicanthal fold, simian crease: SINDROM DOWN
6. Delesi 5p autosomal, tangisan seperti kucing: SINDROM CRI DU CHAT
7. Webbed neck, garis rambut rendah, ROM leher terbatas: SINDROM KLIPPEL-FEIL

A
  1. SINDROM TURNER
  2. SINDROM KLINEFELTER
  3. SINDROM PATAU
  4. SINDROM EDWARDS
  5. SINDROM DOWN
  6. SINDROM CRI DU CHAT
  7. SINDROM KLIPPEL-FEIL
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12
Q

KLASIFIKASI BB/U (underweight)

A

<-3: BB sangat kurang
-3 sd -2: BB kurang
-2 sd 1: BB normal
>1: risiko BB lebih

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13
Q

KLASIFIKASI TB/U (stunted)

A

<-3: sangat pendek
-3 sd -2: pendek
-2 sd 3: normal
>3: tinggi

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14
Q

KLASIFIKASI BB/TB (wasted)

A

<-3: gizi buruk
-3 sd -2: gizi kurang
-2 sd 1: gizi baik
1 sd 2: risiko gizi lebih
2 sd 3: gizi lebih
>3: obesitas

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15
Q

KLASIFIKASI IMT/U (wasted)

A

<-3: gizi buruk
-3 sd -2: gizi kurang
-2 sd 1: gizi baik
1 sd 2: risiko gizi lebih
2 sd 3: gizi lebih
>3: obesitas

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16
Q

DEFINISI GIZI BURUK

A

BB/TB <-3 / lila <11.5 / pitting edema bilateral

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17
Q

Defisiensi kalori, edema (-), old man face, iga gambang, baggy pants

A

MARASMUS

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18
Q

Defisiensi protein, edema (+), crazy pavement dermatosis, rambut jagung, perut kembung

A

KWASHIORKOR

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19
Q

TATALAKSANA GIZI BURUK

A
  1. Hipoglikemia —> glukosa 10% 50mL PO / glukosa 10% 5mL/kg IV, lalu F75
  2. Hipotermia —> lampu / dekatkan ibu
  3. Dehidrasi —> resomal 5mL/kg @30m 2h lalu 5-10mL/kg/h selang seling F75 1h
  4. Elektrolit —> K+, Mg2+ (pisang, bayam)
  5. Infeksi —> amoksisilin 3x 15mg/kg PO 5d (komplikasi (-)), ampisilin 4x 50mg/kg IV 2d + gentamisin 5mg/kg/d 7d IV (komplikasi (+)), imunisasi campak
  6. Gizi mikro —> as folat 5mg lalu 1mg/d, zinc 2mg/kg/d, tembaga 0.3mg/kg/d, vitamin A sesuai usia; besi 3mg/kg/d (fase rehab)
  7. Stabilisasi-transisi —> F75 sesuai kebutuhan
  8. Kejar tumbuh —> peningkatan BB 5-10g/kg/d, ganti F75 dengan F100
  9. Kembang-stimulus —> lingkungan nyaman, terapi bermain
  10. Rumah —> pemberian makan sesuai, terapi bermain, kontrol, imunisasi booster
    • SESUAI STRT
      • Stabilisasi (hari 1-2) —> F75 [energi 80-100, protein 1-1.5, cairan 130]
        • 1,2,3,4,5,6,7,9
      • Transisi (hari 3-7) —> F100/RUTF [energi 100-150, protein 2-3, cairan 150]
        • 4,5,6,7-8, 9,10
      • Rehabilitasi (wk 2-6) —> F100/F135/RUTF [energi 150-220, protein 4-6, cairan 150-200]
        • 4,5,6,8,9,10
      • Tindak lanjut (wk 7-26)
        • 5,6,8,9
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20
Q

PEMILIHAN MPASI (USIA)

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A

0-6mo: ASI eksklusif
- 6-8mo: ASI + MPASI halus, 200kkal/d
- 6-7mo: ASI + bubur susu
- 8mo: ASI + bubur tim
9-11mo: ASI + MPASI bertekstur, 300kkal/d
- 9mo: ASI + bubur nasi
- 10mo: ASI + nasi tim
- 11mo: ASI + nasi lembek
≥12mo: makanan dewasa, 550kkal/d

21
Q

PRINSIP TATALAKSANA DIARE

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A

OZAWA: ORALIT, ZINC, ANTIBIOTIK, WEJANGAN, ASI-MAKAN

22
Q

TATALAKSANA DIARE: O - ORALIT

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A

BERAT, 2/4 [letargis, cekung, tdk minum makan, turgor sgt lambat] IV
- <12 bln: 30 ml/kg dlm 1 jam, 70 ml/kg dlm 5 jam
- ≥12 bln: 30 ml/kg dlm 0.5 jam, 70 ml/kg dlm 2.5 jm
- cek setiap 15-30 menit. periksa sesudah 6 atau 3 jam, klasifikasi dehidrasi, lanjut penanganan. kalo iv gabisa, ng tube.
RINGAN-SEDANG, 2/4 [gelisah, cekung, haus, turgor melambat]
- 3 jam pertama: 75ml/kg oralit, jika BB tdk tahu
- <6 kg 200-400
- 6-10 400-700
- 10-12 700-900
- 12-19 900-1400
- muntah: tunggu 10 mnt, lanjutkan dg pemberian lbh lambat
- gagal oral: cairan IV 70 ml/kg dl, 5 jam atau 2.5 jam (<12 dan ≥12 bln)
- stlh 3 jam ulang klasifikasi
TANPA DEHIDRASI, 2/4 [sadar baik, tidak cekung, minum biasa, turgor baik]
- beri cairan tambahan sebanyak anak mau: ASI/oralit
- cegah dehidrasi: <12 bln 50-100 ml/diare, ≥12 bln 100-200 ml/diare, diminumkan sedikit sedikit
- berikan 6 bungkus oralit 200 ml

CAIRAN PEMBEDA DI USIA <12 DAN ≥12 MO

23
Q

TATALAKSANA DIARE: Z - ZINC

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A

Zinc (tablet dispersibel)
- <6 bln: 1/2 tablet 10 mg/d 10 hari
- ≥6 bln: 1 tablet 20 mg/d 10 hari

ZINC PEMBEDA DI USIA <6 DAN ≥6 MO

24
Q

TATALAKSANA DIARE: A-W-A - ASI-WEJANGAN-ANTIBIOTIK

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A

A - sesuai usia, ASI
W - edukasi
A - sesuai indikasi

25
Diare, begah, feses asam, hydrogen breath test (+), pH tinja asam
INTOLERANSI LAKTOSA ## Footnote susu bebas laktosa
26
Diare, urtikaria/ruam, ELIMINASI PROVOKASI/FOOD CHALLENGE (+), IgE RAST (+)
ALERGI SUSU SAPI ## Footnote hindari dairy, susu terhidrolisis ekstensif/kedelai
27
PREMATUR MINUM SUSU, diare berdarah, distensi abdomen, neonatus, prematur, x-ray (+) pneumatosis intestinalis
ENTEROKLITIS NEKROTIKANS ## Footnote dekompresi NGT, bowel rest, ampisilin + gentamisin + metronidazole; laparotomi
28
Demam, makulopapular, wajah ke badan, slapped cheek/lacy, parvovirus B19
ERITEMA INFEKSIOSUM/FIFTH DISEASE
29
Demam, makulopapular, wajah ke badan, 3C, koplik spot, paramyxovirus
RUBEOLA/MEASLES/CAMPAK/MORBILI
30
Demam, makulopapular, wajah ke badan, limfadenopati postaurikular/suboksipital, forscheimer spot (+) bercak palatum-uvula, rubellavirus
RUBELLA/CAMPAK JERMAN
31
Demam, makulopapular setelah demam selesai, badan ke wajah/ext., HHV6
ROSEOLA INFANTUM/EKSANTEMA SUBITUM
32
Demam, papulovesikular, seluruh tubuh, VZV
VARICELLA/CHICKENPOX
33
Demam, papulovesikular, dermatomal, VZV:
HERPES ZOSTER/SHINGLES
34
Demam, papulovesikular, telapak dan mulut, coxsakievirus A16
HMFD
35
36
Demam, deskuamasi, leher-dada ke badan, strawberry tongue, sandpaper rash, ASTO (+), GAS
SCARLET FEVER
37
Demam, deskuamasi seluruh tubuh, limfadenopati servikal, konjungtivitis bilateral, strawberry tongue, edema perifer, ggn jantung
KAWASAKI DISEASE
38
Demam, TANPA RUAM, limfadenopati, sakit tenggorok, EBV
INFECTIOUS MONONUCLEOSIS
39
Darah/pus umbilikus purulen, gejala infeksi
OMFALITIS ## Footnote perawatan tali pusat, ampisilin 100mg/kg/d + gentamisin 5mg/kg/d
40
Gejala konstitusional lalu bengkak parotis
PAROTITIS ## Footnote simtomatis
41
USIA <2Y, demam, rinore, batuk kering, wheezing, x-ray hiperaerasi, RSV
BRONKIOLITIS ## Footnote O2, antipiretik, SABA; ICU
42
Batuk (+) rejan, daerah mata menghitam, KULTUR SWAB (+) batang gram (-) bordetella pertussis
PERTUSSIS ## Footnote azitromisin 10mg/kg/d 5d, O2
43
Batuk (+) menggonggong, stridor, x-ray (+) steeple/pencil/wine bottle sign, parainfluenza virus - Retraksi (-), interaksi (+): - Retraksi (+) minimal, interaksi (+), stridor (+): - Retraksi (+) jelas, interaksi (-), stridor (+) istirahat:
CROUP/LARINGOTRAKEOBRONKITIS - RINGAN - SEDANG - BERAT ## Footnote dexamethason 0.3-0.6mg/kg/d PO (ringan-sedang); O2 + nebulisasi adrenalin 2 mL 20m (berat)
44
Batuk (±), 4D [disfagia, demam, drooling, distres], hot potato voice, stridor, x-ray (+) thumbprint sign, Hib
EPIGLOTITIS ## Footnote airway management, seftriakson 1x 50mg/kg IV + vankomisin 2x 15mg/kg IV
45
Batuk (-), 1-8mo lalu remisi usia 2y, stridor inspirasi memburuk saat terlentang/makan, laringoskopi (+) omega shaped epiglotis
LARINGOMALASIA ## Footnote observasi
46
Kejang yang dipicu demam >38, usia 6mo-5y, kelainan intrakranial/elektrolit (-), rw kejang tanpa demam (-) <15m, general, 1x/d: SIMPLEKS ≥15m, fokal/menuju general, >1x/d:
KEJANG DEMAM - SIMPLEKS - KOMPLEKS ## Footnote diazepam 5mg supp / 10mg supp max 2x @5m (<12/≥12kg, prehospital); diazepam 0.2-0.5mg/kg IV 2mg/m max 10mg; fenitoin 20mg/kg dalam 50mL NaCl 0.9% 20m / fenobarbital 20mg/kg @IV; ICU midazolam / propofol / pentobarbital. Fenitoin 5-10mg/kg / fenobarbital 5mg/kg (maintenance jika kejang berhenti). Diazepam 3x 0.3-0.5 mg/kg PO-PR 48h demam (profilaksis)
47
Laki - laki saja, 2-5y, paresis atrofik hiporefleks progresif mulai pelvic girdle, waddling gait, gower sign (+) tangan bertumpu pada paha, ANALISIS GENETIK (+) mutasi distrofin
DMD
48
Kelahiran prematur, scissor gait, retardasi mental: - Satu sisi ext: - Ext bawah saja: - Semua ext: - Hipotonus, gerak involunter: - Gangguan keseimbangan: - Campuran:
CP - SPASTIK HEMIPLEGIK - SPASTIK DIPLEGIK - SPASTIK KUADRIPLEGIK - DISKINETIK/ATETOID - ATAXIC - CAMPURAN
49

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