Cardiology

dizziness,loss of consciouness,seizures in adults ischemic cardiac diseases essential hypertension cardiac insuficiency rythms and conduction disturbances mitral and aortic valvulopathies infectious endocarditis acute pericarditis pathology of the aorta,peripheral arteries and venous pathologies of the inferior limb

Pneumology
dyspnea acute and chronic,COPD cough and hemoptysis in adults respiratory allergies in adult(rhinitis,asthma) tuberculosis bronchopulmonar infections pleural lesions lungs tumors chronic respiratory insufficiency respiratory distress in adults

emergency medicine
evaluation of the gravity and investigations of early complication in a patient with thoracic trauma cardiac and respiratory arrest and shock deep vein thrombosis and pulmonary embolism

neurology
cerebro vascular pathology intra cranian tumors

infectious diseases
acute fever in adults infectious meningitis and meningoencephalitis in adults flu !"# infections $e%ually &ransmitted diseases nosocomial infections sepsis acute diarrhea and dehydration in adults tetanus prophila%y

 gastroenterology
digestive hemoragy viral hepatitis duodenal and gastric ulcers 'aundice hepatic cirrhosis and complications crohn disease and ulcerative colitis hemoroids

visceral surgery
tumors of the (" tract )colon,rectum,stomach,liver,oesophagus and pancreatic tumors evaluation of the severity and identification of early complications in the patient with abdominal trauma occlusive syndrome appendicitis in children and adults parietal hernias biliary lithiasis and complication acute and chronic pancreatitis acute peritonitis

OB/GYN
normal and pathological pregnancy )labor,birth and normal post partum,principal complications and e%tra uterine pregnancy menstrual cycle disturbances and genital hemorages in female genital infections in female genital tumors and breast tumors in female

rheumatology
rheumatoid arthritis ankylosing spondylarthritis osteoporosis radiculopathy and nervous compression syndrome prescription and monitorization of *$+"D$ and corticosteroids antiinflammatory

orthopedic surgery ophtalmology ORL

 geriatrics psychiatry pediatric psychiatry pediatrics

nutrition and pediatric feeding
there are , periods of feeding ) until - . months ) breast milk of special formula e%clusive milk feeding meets the nutritional re/uirements of the infant after - . months till 01 months )milk or continuation of formula period of diversification of the alimentation daily comsuption of milk ) minimum 233ml4day from 0 , years old ) growth milk diversified alimentation I.from birth till 4-6 months : exclusive milk feeding 1 possible feeding ) maternal breast feeding or artificial milk maternal milk is the feeding of choice for the first months of life contraindication ) !"#,galactosemia benefits of breast feeding ) perfect composition adapted for the infant5s needs contains essential fatty acids needed for cerebral maturation doesn5t contain allergenic proteins(lactoglobulin of cow milk) contains protective proteins )"g+ no cost psychoaffective advantage in mother child relationship principles of breast feeding early,in the 0st hours of life at the kid5s demand ) . 6 times4day short duration(713mn) on each breast necessary supplements vitamin 8,once a week as long as breast feeding vitamin D, daily

formula feeding based on modified cow milk powder milk formula formula for infants(to start) antireflu% milk (with carob or starch) anti colic milk acidified hypoallergenic milk(obtained by partial hydrolisis of cow milk proteins,used if atopy milk without cow milk proteins )used for allergy to cow milk,or feeding after gastroenterocolitis under , months so'a milk)alternative in case of allergy lactose free milk )in case of lactose intolerance,galactosemia,(lycogen storage disease, feeding after enterocolitis under , months milk for low birth weight infants other milk ) goat etc9 +ren5t adapted for the nutritional needs of the kid,high risk of deficieny

*utritional needs from birth till . months old :irth ;ater Calories Proteins Calcium "ron 63 033 ml4kg4day <3kcal4kg4day 191g4kg4day -33mg4day .mg4day 6mg4day 03 days 013 023 013 , . months 023 003 1

II.from4-6months to 1 year old :transition and diversification period transition period ) after - .months milk feeding still necessary ) min 233ml4day continue with formula till 0 year old with higher iron content diversification ) the milk doesn5t cover all the nutritional needs introduction of vegetables then mashed fruits from - months old introduction of cereals without gluten from from - months old then with gluten from . months old introduction of animal proteins )meat fish eggs from = 6 months old progressive diminution of the number of meals ) -meals at . months old continue vit D supplementation *utritional needs from . months old to 0 year old ;ater Calories proteins Calcium iron 013 ml4kg4day 003kcal4kg4day 1g4kg4day 233mg4day 6mg4day 003 ml4kg4day 003kcal4kg4day 1g4kg4day .33mg4day 03mg4day

III.from 1 year old to 3 years old :diversified alimentation it5s necessary to maintain a milk intake of 233ml4day ) growth milk or complete milk - meals 4day water is the only recommended drink avoid sweet drinks and gaseous drinks continue the diversification and the developement of the taste

fever in children

acute diarrhea in children

I.identification of severity signs the diagnosis of dehydration is mainly through clinical e%am xtracellular dehydration ;eight loss >>> Plasmatic compartment shrinking) ?signs of hypovolemia,tachycardia,hypotension,increased capillary refilling time,oligouria,cyanosis of the e%tremities,collapsed 'ugular veins hemoconcentration,renal insuficiency interstitial compartment shrinking) persistent skin fold,depressed fontanelles,dry skin "ntense thirst,dry mucosa,sunken eyes,neurologic disturbances,fever Intracellular dehydration

Dehydration management 7 2 @ of body weight 2 03 @ of body weight Oral rehydration solution,in small /uantities &ry oral rehydration intravenous rehydration or in case of failure with nasogastric sonde &herapeutic emergency intravenous rehydration,even volemic e%pansion in case of hypovolemia

A03 @ of body weight

!ospitalisation criteria Clinical signs dehydration A03@ dehydrationA2@in case of failure of oral rehydration total digestive intolerance +ge 7, months,premature known chronic disease difficulty to monitorize the patient4compliance problems

Bisk factors

II.diagnostic of acute diarhea +namnesis) onset,evolution notion of contagion conse/uences on the child(general signs,systemic,sepsis,fever) risk factors treatment administered (antibiotics) clinical e%am dehydration signs sepsis signs ) signs of hemolytic uremic syndroms(infection with C9clo O02=!=)pallor,asthenia,oligoanuria,thrombocytopenic purpura) signs of malnutrition )(in case of chronic diarrhea or pree%isting malabsorption) III.causes of acute diarrhea #iral causes) the most fre/uent(63@ of cases) rotavirus(most fre/uent) adenovirus CD# C9coli pathogen $almonella $higella Campilobacter 'e'uni #ibrio cholerae Chlostridium Difficile (iardia intestinalis cryptosporidium hominis entamoeba hystolytica

:acterian causes

Parasitic causes

I!.other investigations" most of the time useless indication ) signs of sepsis,if systemic,or diarrhea enteroinvaziv(with blood) ) hemoleukogram, PCB,hemoculture,coprocultur severe dehydration )blood and urinary ionogram,renal function,bicarbonate,proteinemia and hematocrit,blood p! nosocomial conte%t,viral e%amination of stools return from endemic zone )coproculture,look for parasites

indication for coproculture ) blood in stools immunodepression coming back from endemic zone !# $herapeutic approach

Behydration Be feeding

!ydroelectric balance early milk without lactose hydrolate of cow milk proteins if 7 , months antibiotherapy adapted in case of proven bacterian diarrhea !ygien and diet

+ssociated treatments prevention

vomiting in infants and children

I.diagnostic +namnesis age and antecedents,family history characteristic ) fre/uency,bilious or food aspect evolution of the vomiting(aggravations,since birth) associated signs digestive and e%tra digestive medications or to%ic consumption clinical e%amination conse/uence on the state of the patient(dehydration,malnutrition) abdominal palpation for surgical causes associated infectious focus neurological e%am(meningitis signs or intracranial hypertension) all the bilous pro'ections (green) impose the research of a surgical cause

%&'$ !()I$I*+
)edical causes
Infectious causes) meningitis acute enterocolitis infectious focus OBE or pulmonar neurological causes meningeal hemorrages cerebral thrombophlebitis metabolic causes -to%ic or medications acute renal insuficiency diabetic ketoacidosis hydroelectric disturbances +bdominal causes)

,urgical causes

acute appendicitis occlusive syndrome intussusseption

&-.(*I& !()I$I*+
/igestive causes
pyloric stenosis food allergy(cow milk prot9)or feeding mistake gastro oesophagial reflu% intracranial hypertension migraines epilepsy adrenal insuficiency aminoacidopathies and other metabolic diseases

*eurological causes

)etabolic causes

0yloric stenosis

predominant in males appears after 1 6 weeks with progressive worsening vomiting in pro'ection,abondant,away from meals appetite conserved,in contrast with the failure to thrive dehydration and malnutrition can vary,with hypochloremic alcalosis abdominal palpation ) pyloric olive,peristaltic wave diagnostic confirmed with abdominal echo surgery after electrolytes e/uilibrium returned II.other examinations depending on the clinical findings +)acute vomiting evaluation of the conse/uences on the child5s status (dehydration,electrolites disturbances,hypoglycemia))blood ionogram,calcemia,renal function,p!,glycemia infectious focus ) hemoleukogram,PCB,hemocultures,lumbar puncture,thora% % ray,urinalysis rule out surgical causes) abdominal echo,F ray :)chronic vomiting cerebral imaging to detect intracranial hypertension(C& scan) hepatic function(bilirubinemia,transaminases,gama (&) for hepatitis hydroelectric and metabolic function eso gastro duodenal transit in case of suspiscion of mechanic cause

III.therapeutic approach and monitoring &reat the cause treat associated dehydration(oral of "#) antiemetic treatment) useless if surgical cause don5t substitute to treating to the cause

domperidone ? 3,1 3,- mg4kg46h per os metopimazine ? 3,1mg4kg46h "9# monitor ) the normalisation of the hydroelectric e/uilibrium and nutrion the abscence of side effects of anti emetic (dyskinesia )

convulsions and epilepsy in children respiratory tract infection in children respiratory allergy in children

urinary infection in children

I. 0yelonephritis
most fre/uent severe bacterial infection)suspicion in every case of prolonged fever without visible clinical cause9 Clinical diagnostic fever urinary signs (more or less evident depending on the age))polyuria,dysuria,smelly urine general status change(loss of consciouness) lombar pain(not constant,more fre/uent with older child) vomiting always look for hemodynamic changes (increase in capillary filling time,

nutritional diseases in children(diabetes 0G1 obesity) evaluation and care of the new born

 internal medicine

 radiology dermatology endocrinology urologic surgery nephrology hematology oncology