Beruflich Dokumente
Kultur Dokumente
T >38C rectal
T
>40C
o Central
o Heat
stroke
o Malignant
hyperthermia
o Drug
fever
REGULATION
OF
BODY
TEMPERATURE
Thermosensitive neurons
3 Mechanisms of Fever
Endogenous
Pyrogens
o Cytokines
IL1
and
IL2
o TNF
o Interferon
and
Lipid
mediator
PGE2
o
Exogenous Pyrogens
Infectious
pathogens
o Microbes
and
toxins
stimulate
production
of
endogenous
pyrogens
o Endotoxins
O2 Consumption
CO2 Production
Cardiac Output
Infections
Inflammatory disorders
Neoplasms
Miscellaneous
FEVER PATTERNS
History
PE
Labs
TREATMENT
OF
ACUTE
FEVER
Tx of self-limiting illness
Antipyretics
FEVER
WITHOUT
A
FOCUS
o Malignancy
Toxic
o Clinical
picture
consistent
with
sepsis
syndrome:
lethargy
cyanosis
hypoventilation
hyperventilation
all
febrile
children
less
than
36
months
of
age
who
are
toxic-
appearing
should
be
hospitalized
for
evaluation
and
treatment
of
possible
sepsis
or
meningitis
NEONATES:
FEVER
W/O
LOCALIZING
SIGNS
Etiology
o Viral
o Bacterial
o GBS
o L.
monocytogenes
o Salmonella
o E.
coli
o N.meningitidis
o S.pneumoniae
o Hib
o Staph
aureus
low
risk
o Normal
physical
examination
o Uncomplicated
medical
history
o Normal
labs
Urine:
<10
WBC/HPF,
(-)nitrite
(-)leukocyte
esterase
o Stool
studies
if
diarrhea
(-)
RBC
and
<5
WBC/HPF
o CSF
cell
count
<8
WBC/mm3
(-)
Gram
stain
o Peripheral
blood:
5,000-15,000
WBC/mm3
<1,500
bands
or
band:total
neutrophil
ratio
<0.2
o Chest
radiograph
without
infiltrate
Etiology
o Viral
o Bacterial
(occult
bacteremia)
S. pneumoniae
H.
influenzae
type
B
2
PEDIA
N.
meningitidis
Salmonella,
S.
aureus.
S.
pyogenes
3-36
mos.
Fever
38-39C
without
localizing
signs
(low
risk)
Reassure:
diagnosis
is
most
likely
a
self-limiting
viral
infection
no antibiotics
advise return
meningitis,
cellulitis,
pneumonia,
pericarditis,
epiglotitis,jt.infections,
osteomyelitis,
suppurative
arthritis,
otitis
media,
sinusitis,
enteritis,
urinary
tract
infection
SEPTIC
WORKUP
Blood
culture
o Option
1:
All
children
with
temperature
39C
o Option
2:
Temperature
39C
and
WBC
count
15
000
Lumbar
puncture
o Clinician
determines
LP
based
on
hx,
observational
assessment,
and
PE
Blood
culture
o (+)
Streptococcus
pneumoniae,
FUO
Etiology
o Infections
36%
o Neoplastic
diseases
19%
o Collagen
Vascular
Diseases/Autoimmune
Disorders
o
o
13%
No
Diagnosis
7%
FUO
is
more
likely
an
unusual
presentation
of
a
common
disease
than
an
uncommon
disease.
FUO:
4
SUBTYPES
Classic FUO
Immunedeficient FUO
HIV-related
FUO
FUO:
DIAGNOSTIC
CONSIDERATIONS
Abscesses
Bacterial disease
Localized infections
Fungal disease
Parasitic disease
Viral disease
Rheumatologic disease
Hypersensitivity disease
Neoplasms
Granulomatous disease
Familial/hereditary diseases
Drug Fever
Miscellaneous
DRUG
FEVER
Age
Pica
Ophthalmic examination
Sinuses
Pharynx
Thyroid
Murmur
Abdomen
Rectal exam
CBC
Urinalysis
Cultures
Tuberculin test
Radiographic examinations
Serologic tests
Radionuclide scans
Echocardiogram
Ultrasonography
CT scan/ MRI
Biopsy
Characterized
by:
o enduring
predisposition
to
generate
seizures
o neurobiologic,
cognitive,
psychological,
and
social
consequences
History
Focal
or
generalized?
Description
of
seizure
Atonic = flaccidity
Treatment of epilepsy
4
PEDIA
CEREBRAL
PALSY
Static
encephalopathy
EPIDEMIOLOGY
&
ETIOLOGY
3.6/1000 incidence
Genetic: interleukin 6
Infertility
treatments
CLINICAL
MANIFESTATIONS
Genetic
evaluation
TREATMENT
Multidisciplinary
Long-term Complications
Retinopathy
Nephropathy
Neuropathy
Boys = girls
Autoimmunity
Hyperglycemia
Polydipsia
Monilial vaginitis
Weight loss
Dehydration
Polyuria
Hyperglycemia
Glycosuria, ketonuria
Electrolyte abnormalities
Baseline
HbA1c
DIABETIC
KETOACIDOSIS
Insulin therapy
Nutritional management
Monitoring
BRONCHIAL
ASTHMA
Inflammatory
condition
ETIOLOGY
Genetics
o Interleukin-4
gene
o ADAM
33
Environment
o Allergens,
infections,
microbes,
pollutants,
stress
EPIDEMIOLOGY
Boys
Airflow obstruction
Mucus
hypersecretion
CLINICAL
MANIFESTATIONS
Expiratory wheezing
Labored breathing
Tobacco smoke
Exercise
History
PE
Asthma triggers
Environmental
history
PEDIATRICS2
LE6
Handout
[by:
msredlips
DIFFERENTIAL
DIAGNOSIS:
Upper
Respiratory
Tract
Conditions
Allergic rhinitis
Chronic rhinitis
Sinusitis
Middle
Respiratory
Tract
Conditions
Laryngotracheobonchomalacia
Pertussis
Viral bronchiolitis
Gastroesophageal reflux
Tuberculosis
Pneumonia
Radiology
TREATMENT
1:
Regular
Assessment
and
Monitoring
Severity
o Age
group:
0-4
yr,
5-11
yr,
>12
yr
1. Intermittent
Asthma
-
<2
days/wk
sx
2. Persistent
Asthma
a.
Mild
-
>2
days/wk
but
not
daily
b.
Moderate
-
daily
c.
Severe
throughout
the
day
Control
o Well-controlled:
sx
<2
days/wk
but
not
more
than
once
on
each
day
o Not
well-controlled:
sx
>2
days/wk
or
multiple
times
on
<2
days/wk
o Very
poorly
controlled:
sx
throughout
the
day
Responsiveness
to
therapy
o The
ease
with
which
asthma
control
is
attained
by
treatment
o Can
encompass
monitoring
for
adverse
effects
related
to
medication
use
2:
Patient
Education
o
o
o
Rhinitis
Sinusitis
GER
4:
Pharmacotherapy
Quick-Reliever Medications
Spacer
devices
o For
preschool-aged
children
Inhalation
Technique
2/3 improve
Active lifestyle
Healthy
diet
CHRONIC
ILLNESS
Initial
Impact
o Shock
o Denial
o Loss
and
grief
o Anxiety
and
depression
Contributing
Factors
Illness-Related
Factors
o Degree
of
illness
acceptance
o Degree
of
lifestyle/functional
impairment
Cognitive
appraisal
o Meaning
or
significance
of
the
illness
o Threat
and
coping
ability
Adaptive
tasks
o Formulation
of
tasks
to
help
cope
with
illness
Coping
skills
o Denial,
information
seeking,
goal
setting,
recruiting
support,
catharsis
Outcome
of
Crisis
Quality
of
Life
o Degree
of
quality
people
appraise
their
lives
to
contain
PEDIATRICS2
LE6
Handout
[by:
msredlips
Family
Centered
Approach
&
Developmental
Approach
Infancy
Toddlerhood
Preschool
SchoolAge
Adolescence
Trust
Autonomy
Initiative
Industry/Accomplishment
Identity
Assessing
Family
Strengths
Coping Mechanisms
Available Resources
Concurrent
Stresses
Tasks
of
Parents
of
Children
with
Chronic
Conditions
1.
2.
3.
4.
5.
6.
7.
Constant Attention
Details/preplanning
Social Relationships
Effects on Siblings
Marital
Relationships
Meeting
the
Childs
Normal
Developmental
Needs
Meeting
Developmental
needs
of
others
in
the
Family
Sibling
issues
Parental
roles
Single
parenting
Normalcy
Extended
family
Coping
with
ongoing
stress
and
Periodic
Crises
How
is
the
family
affected
with
this
ongoing
stress?
How
do
they
react
when
there
is
an
exacerbation?
How
do
families
endure
this?
What
are
their
coping
mechanisms?
Assisting
Family
Members
in
Managing
their
Feelings
Establishing
a
Support
System
Examples
of
Chronic
Illnesses
Cancer
Asthma
Muscular dystrophy
Diabetes
HIV
CKD
NEUROLOGIC:
Cerebral
Palsy
Definition
Static encephalopathy
Term
infants
who
are
ill
in
the
neonatal
period:
HIE,
low
st
APGAR
score(
<5),
seizures
in
1
day
of
life,
continuing
neurologic
abnormality
:
55%
risk
for
chronic
motor
disability
Hyperbilirubinemia : kernicterus
Choreoathetoid
Dystonic
3.
Ataxic
cerebellum
and
adjacent
brainstem
involved
4.
Mixed
type
large
areas
of
cortex
and
subcortical
area
including
basal
ganglia
involved
CP
hemiplegic
type
When
the
child
is
held
vertically,
the
legs
extend
and
assume
a
scissored
position.
Swallowing difficulties
Drooling
CP
ataxic
Wide-based
stance
Etiologies
Unknown
Prenatal factors
Perinatal factors
Postnatal
factors
DIAGNOSTICS
Cranial ultrasound
EEG
Associated
conditions
Cognitive/behavioral
o Mental
retardation
(65%)
o Learning
disabilities
o ADHD
and
other
behavior
problems
Epilepsy (33%)
GI
o Dysphagia
o GE-reflux
o Failure
to
thrive
Orthopedic
o Hip
dislocation
o Scoliosis
o Joint
contractures
o Arthritis
Hearing
and
visual
loss
Respiratory
problems
o Obstructive
sleep
apnea
Factors
affecting
prognosis
Pathologic reflexes
Emotional
adjustment
Treatment
Physiotherapy
o manipulation
of
or
exercising
affected
muscles
can
help
contain
contractures
o Night
splints
to
ankles
stretching
of
achilles
tendon.
o Soft
splinting
lessens
knee
contractures
o Serial
plastering
may
restore
range
of
movement
o Ankle-foot
orthoses
Pharmacologic
o Diazepam
o Baclofen
Surgery
o Lengthening
of
muscles
(achilles
tendon)
o Soft
tissue
surgery
around
the
hips
and
knee
o Correction
of
dislocations
(hip)
o Transferring
a
tendon
Newborn
screening
o Early
detection
of
amino
acid
disorders,
hypothyroidism
and
galactosemia
PEDIATRICS2
LE6
Handout
[by:
msredlips
Allergic
Rhinitis
Classic
Asthma
Cough-variant Asthma
Immunodeficiency Syndromes
Cystic Fibrosis
Ciliary Dyskinesia
Swallowing Dysfunction
Gastroesophageal reflux
Habit cough
Pulmonary sequestration
Bronchogenic cyst
Mediastinal tumors
MOST
COMMON
CAUSES
OF
CHRONIC
COUGH
Asthma
cough
chest tightness
wheezing
Breathlessness
10
DIAGNOSIS
OF
ASTHMA
Clinical
Control
of
Asthma
Differentials
Vasomotor rhinitis
NARES
Infectious rhinitis
Rhinitis medicamentosa
CSF rhinorrhea
Foreign
body
Classification
of
allergic
rhinitis
Monitoring
to
maintain
control
Symptoms
o Rhinorrhea
o nasal
obstruction
or
blockage
o nasal
itching
o Sneezing,
o postnasal
drip
o Allergic
conjunctivitis
PEDIATRICS2
LE6
Handout
[by:
msredlips
11
IMMUNOLOGY
ATOPIC
DERMATITIS
INFANT
PHASE
o birth-2yo
o cheeks,
abdomen,
extensor
CHILDHOOD
PHASE
o 2-12
yo
o
Flexural
ADOLESCENT/ADULT
PHASE
o diffuse
lesions
with
increased
scaling
&
decreased
excoriations
(3
major,
3
minor)
MAJOR
MINOR
family
hx
of
atopy
xerosis
(dry
skin)
area
of
distribution
nipple
eczema
relapsing
course
pityriasis
alba
pruritus
dermatographism
keratosis
pilaris
(chicken
skin)
food
intolerance
palmar
hyperlinearity
dennie
morgan
fold
DIFFERENTIALS
Seborrheic Dermatitis
Diaper Dermatitis
Scabies
Psoriasis
Dishydritic
Eczema
Management
Hydration
Eliminate Triggers
Antihistamines
Emollients
Steroids
UV light
Antibiotics
IMMUNODEFICIENCY
Failure to thrive
HIV/AIDS
AIDS
is
a
disease
o Virus
attacks
immune
system
o Utilizes
CD4
T-cell
to
reproduce
its
genome
o T-cells
die
leading
to
increased
vulnerability
to
rare
opportunistic
diseases
o Complications
and
death
result
from
these
diseases
Epidemiology
Routes
of
Infection
Prevention
o Behavioral
Measures
o Personality/Coping
Psychosocial
Impact
or
3.
2-hour
postload
glucose
11.1
mmol/l
(200
mg/dl)
during
an
OGTT.
The
test
should
be
performed
as
described
by
WHO
(86),
using
a
glucose
load
containing
the
equivalent
of
75
g
anhydrous
glucose
dissolved
in
water
or
1.75
g/kg
of
body
weight
to
a
maximum
of
75
g
(65).
Pathogenesis
of
type
1
diabetes
Diet
Medication
o Insulin
injections
o Meds
to
control
glucose
in
other
ways
Exercise
Stress
management
Adherence
to
Diabetic
Regimen
Self-image: Adolescents
13
Prevalence
1:10,000
Definition
of
Terms
Metabolic
Syndrome
21-Hydroxylase
Deficiency
>90% of CAH
Types:
o Classical
Simple
Virilizing
o Non-Classical
mildly
elevated
androgens
Genetics: chromosome 6
Symptoms:
o Progressive
wt
loss,
anorexia
o Vomiting,
dehydration
o Weakness,
hypotension
o Hypoglycemia,
hyponatremia,
hyperkalemia
Aldosterone low
Hypokalemic
alkalosis
Treatment
Hydrocortisone 10-15mg/BSA/day
Steroidogenesis
14
ONCOLOGY
Leukemia
PE
o Lymphadenopathy
o Hepatosplenomegaly
o CNS
involvement
Treatment
o Chemotherapy
o Cell
transplantation
Tumors
AGE
is
important
Most
frequently
encountered
malignant
abdominal
masses
Neuroblastoma
Wilms tumor
Hepatoblastoma
Lymphoma
Neuroblastoma
Exophthalmos
Horners syndrome
Massive hepatomegaly
Rare in infants
Laboratory
Findings
Abdominal pain
Vomiting
Diarrhea
Abdominal distention
Intussusception
Peritonitis
Ascites
CBC
Coagulation studies
Urinalysis
Tumor markers
History
Physical Examination
Chest X-Ray
EKG
2DEchocardiography
Maternal
History
st
Infections:
1
trimester
of
pregnancy
1. German
measles
-
Congenital
Rubella
Syndrome;
PS;
PDA
2. Cytomegalovirus
-
teratogenic
Herpes
-
myocarditis
last
trimester
Coxsackie
B
Illness
1. DM
-
cardiomyopathy
(HOCM)
-
structural
(VSD,
TGA,PDA)
2. SLE
-
Heart
Blocks
3. CHD
-
15%
incidence
of
CHD
(vs
1%
general
pop.)
PEDIATRICS2
LE6
Handout
[by:
msredlips
15
Medications
1. Amphetamines
(uppers)
VSD,
PDA,
ASD,
TGA
2. Anticonvulsants
a) Diphenylhydantoins
PS,
AS,
COA
b) Trimethadione
TGA,
TOF,
HLHS
3. Progesterone/Estrogen
VSD,
TGA,
TOF
Alcohol
-
Fetal
Alcohol
Syndrome
-
VSD,
PDA,
ASD,
TOF
Past
History
1. Cyanosis
including
spells
Others:
o Chest
pains
o Joint
swellings
o Neurologic
symptoms
Family
History
2.5
%
(TOF)
Distension ascites
Liver
o Infants
:
soft
palpable
2
3
cm
BRCM
1
year
old
:
2
cm
&
4
5
years
old
:
1
cm
o Hepatomegaly
:
hallmark
of
systemic
venous
congestion
in
infants
o Pulsatile
liver
:
TR
or
inc.
RA
pressure
Palpation:
Pulses
Rate
Regularity
Quality
:
o Rate
of
rise
o Pulse
volume
Simultaneous
palpation
of
peripheral
pulses
delay
in
lower
extremities
is
suggestive
of
coarctation
HEART
MURMURS
Location
PEDIATRICS2
LE6
Handout
[by:
msredlips
16
Inspection
&
Palpation:
Extremities
Inspection
&
Observation:
Genetic
Abnormalities
Does
the
patient
have
congenital
heart
disease?
Cyanotic
Congenital
Heart
Disease
Truncus Arteriosus
Tricuspid Atresia
Tetralogy of Fallot
Ebsteins Disease
Eisenmengers
Syndrome
COMMON
CXR
OF
CHD
Ventricular
Septal
Defect
Increased vascularity
Chamber
prominence:
o either
or
both
ventricles
o left
atrium
Decreased vascularity
Prominent aorta
Egg
on
its
side
RV
cardiomegaly;
narrow
pedicle;
hypervascular
markings
Increased vascularity
Cardiomegaly
Chamber
prominence:
o right
atrium
o right
ventricle
Type
I
(Supracardiac)
o left-sided
vertical
vein
connects
pulmonary
venous
confluence
to
the
left
innominate
vein,
right
SVC
or
azygos
vein
o SNOWMAN
APPEARANCE
EBSTEINS
ANOMALY
Cardiomegaly,
decrease
pulmonary
vascular
markings;
WALL
TO
WALL
HEART
Rheumatic
Heart
Disease
RENAL
Chronic
Kidney
Disease
Treatment
o
Multidisciplinary
o
Symptomatic
treatment
eg.
Acidosis
NaHC03;
ROD
phosphate
binders;
anemia
erythropoietin
o
dialysis
o
Optimal:
renal
transplantation
--END
J--
PEDIATRICS2
LE6
Handout
[by:
msredlips
17