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Pediatrics

Pediatrics

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Published by: @r@mis on Oct 19, 2008
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PEDIATRICS
Dr. S. Bernstein, Dr. J. Friedman, Dr. R. Hilliard and Dr. R. Schneider Reshma Amin, Dana Cohen, and Dhenuka Tennankore, chapter editorsSharon J. Kular, associate editor 
PRIMARY CARE PEDIATRICS
. . . . . . . . . . . . . .
3
Regular VisitsNutritionMilk CariesColicInjury Prevention CounsellingSudden Infant Death Syndrome (SIDS)Immunization A. Routine ImmunizationB. Delayed ImmunizationC. Other VaccinesDevelopmental MilestonesNormal Physical GrowthFailure to Thrive (FTT)Circumcision
CHILD ABUSE AND NEGLECT
. . . . . . . . . . . . . .
11 ADOLESCENT MEDICINE
. . . . . . . . . . . . . . . . . .
12
Health IssuesHEEADSS Interview
CARDIOLOGY
. . . . . . . . . . . . . . . . . . . . . . . . . . . . .
13
Heart MurmursCongenital Heart Disease (CHD) A. Acyanotic CHDB. Cyanotic CHDCongestive Heart Failure (CHF)Infective EndocarditisDysrhythmias
DERMATOLOGY
. . . . . . . . . . . . . . . . . . . . . . . . . .
18
Common Neonatal Skin ConditionsDiaper DermatitisSeborrheic DermatitisCandidaItchy Eruptions in Childhood Atopic Dermatitis (Eczema)ImpetigoScabiesErythema Multiforme (EM)
DEVELOPMENT AND BEHAVIOUR
. . . . . . . . .
20
Developmental DelayLanguage DelayFetal Alcohol Syndrome (FAS)Elimination Disorders A. EnuresisB. EncopresisSleep DisturbancesBreatholding Spells
ENDOCRINOLOGY
. . . . . . . . . . . . . . . . . . . . . . . . .
23
Diabetes Mellitus (DM)HypothyroidismHyperthyroidism Ambiguous GenitaliaCongenital Adrenal Hyperplasia (CAH)Normal Sexual DevelopmentNormal Variation in PubertyPrecocious PubertyDelayed PubertyShort StatureTall StatureObesity
MCCQE 2002 Review NotesPediatrics P1
GASTROENTEROLOGY
. . . . . . . . . . . . . . . . . . . . .
30
Vomiting A. Vomiting in the NewbornB. Vomiting After the Newborn Period Acute DiarrheaChronic Diarrhea A. Chronic Diarrhea without FTTB. Chronic Diarrhea with FTTConstipation Acute Abdominal PainChronic Abdominal Pain Abdominal MassUpper Gastrointestinal (UGI) BleedingLower Gastrointestinal (LGI) Bleeding
GENETICS AND METABOLISM
. . . . . . . . . . . . .
38
 Approach to the Dysmorphic ChildDown SyndromeOther TrisomiesTurner SyndromeNoonan SyndromeKlinefelter SyndromeFragile XPrader-Willi SyndromeDiGeorge SyndromeMuscular DystrophyVACTERL AssociationCHARGE AssociationMetabolic Disease
HEMATOLOGY
. . . . . . . . . . . . . . . . . . . . . . . . . . . .
42
 Anemia A. Physiologic AnemiaB. Iron Deficiency AnemiaC. Anemia of Chronic DiseaseD. HemoglobinopathiesE. Sickle Cell DiseaseF. SpherocytosisG. Glucose-6-Phosphate Dehydrogenase(G6PD) DeficiencyBleeding Disorders A. Idiopathic Thrombocytopenic Purpura (ITP)B. Neonatal ThrombocytopeniaC. Hemorrhagic Disease of the NewbornD. HemophiliaE. von Willebrand Disease
INFECTIOUS DISEASES
. . . . . . . . . . . . . . . . . . . .
46
Fever Sepsis in the NeonateMeningitisHIV InfectionPharyngitis and Tonsillitis A. Streptococcal PharyngitisB. Infectious MononucleosisPertussisVaricellaRoseolaMeaslesMumpsRubellaErythema Infectiosum
 
P2Pediatrics MCCQE 2002 Review Notes
PEDIATRICS
. . . CONT.
NEONATOLOGY
. . . . . . . . . . . . . . . . . . . . . . . . . . .
54
Infant MortalityNormal Baby at TermGestational Age and SizeNeonatal ResuscitationRoutine Neonatal CareRespiratory Distress in the NewbornCyanosis ApneaRespiratory Distress Syndrome (RDS)Transient Tachypnea of the Newborn (TTN)Meconium Aspiration Syndrome (MAS)PneumoniaDiaphragmatic HerniaPersistent Pulmonary Hypertension (PPHN)Bronchopulmonary Dysplasia (BPD)JaundiceNecrotizing Enterocolitis (NEC)Sudden Infant Death Syndrome (SIDS)Hypoglycemia
NEPHROLOGY
. . . . . . . . . . . . . . . . . . . . . . . . . . . .
62
DehydrationFluid and Electrolyte TherapyHematuriaProteinuriaHemolytic Uremic Syndrome (HUS)Nephritic SyndromeNephrotic Syndrome
NEUROLOGY
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
66
Seizure DisordersBenign Febrile SeizuresRecurrent HeadacheHypotoniaCerebral Palsy (CP)Neurocutaneous Syndromes
NEUROSURGERY
. . . . . . . . . . . . . . . . . . . . . . .
NS31
Neural Tube DefectsIntraventricular Hemorrhage (IVH)HydrocephalusBrain TumoursDandy-Walker CystChiari MalformationCraniosynostosis
ONCOLOGY
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
70
LeukemiaLymphomaBrain Tumours Wilm’s Tumour (Nephroblastoma)Neuroblastoma
ORTHOPEDICS
. . . . . . . . . . . . . . . . . . . . . . . .
OR36
Fractures in ChildrenEvaluation of the Limping ChildEpiphyseal InjuryPulled ElbowDevelopmental Dysplasia of the HipLegg-Calve-Perthes DiseaseSlipped Capital Femoral EpiphysisCongenital Talipes EquinovarusScoliosis
OTOLARYNGOLOGY
. . . . . . . . . . . . . . . . . . .
OT25
 Acute Otitis Media (AOM)Otitis Media with Effusion (OME) Acute TonsillitisTonsillectomy Airway ProblemsSigns of Airway Obstruction Acute Laryngotracheobronchitis (Croup) Acute EpiglottitisSubglottic StenosisLaryngomalaciaForeign Body
PLASTIC SURGERY
. . . . . . . . . . . . . . . . . . . .
PL21
Cleft LipCleft PalateSyndactylyPolydactylyHemangioma
PSYCHIATRY
. . . . . . . . . . . . . . . . . . . . . . . . . .
PS32
Developmental Concepts Attention-Deficit and Disruptive Behaviour DisordersTic DisordersLearning DisordersPervasive Developmental Disorder (PDD)Mental Retardation (MR)Childhood Schizophrenia Adolescent Mood Disorders Anxiety DisordersElimination DisordersChronic Recurrent Abdominal PainSleep DisturbancesChild Abuse
RESPIROLOGY
. . . . . . . . . . . . . . . . . . . . . . . . . . . .
72
Upper Respiratory Tract DiseasesLower Respiratory Tract DiseasesBronchiolitisPneumonia AsthmaCystic Fibrosis (CF)
RHEUMATOLOGY
. . . . . . . . . . . . . . . . . . . . . . . . . .
75
Evaluation of Limb PainGrowing PainsJuvenile Rheumatoid Arthritis (JRA)Henoch-Schönlein Purpura (HSP)Kawasaki Disease
UROLOGY
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
78
Urinary Tract Infection (UTI)Urinary Tract ObstructionVesicoureteral Reflux (VUR)Genital Abnormalities
REFERENCES
. . . . . . . . . . . . . . . . . . . . . . . . . . . . .
80
 
MCCQE 2002 Review NotesPediatrics P3
PRIMARY CARE PEDIATRICS
REGULAR VISITS
usual schedule: newborn, 1 week post-discharge, 1, 2, 4, 6, 9, 12, 15, 18, 24 monthsyearly until age 6, then every other year yearly after age 11
historypregnancy and neonatal historyfeeding and diet (see Table 1)immunizations (see Tables 3 and 4)developmental assessment (see Table 5)growth, energy, appetite, sleep and review of systemspast medical history, medications, allergies, family history and social history
physical examgrowth parameters: serial height, weight, head circumferencehead, eyes, nose and throat (HEENT): dysmorphic features, fontanelles(anterior closes between 9-18 months, posterior between 2-4 months),vision, red reflex, strabismus, hearing, tympanic membranes, palateCVS: auscultation, peripheral pulses (including femorals), blood pressure (BP) yearly after age 3respiratory, abdomen, genitourinary, dermatologymusculoskeletal: hips (Barlow and Ortolani tests), scoliosis, lumbosacral spine(hairy patch, pigmentation, sinus tract)neurological: primitive reflexes in newborns and in early infancy
immunization (see Immunization section)
counselling/anticipatory guidance (see Nutrition, Colic, sudden infant death syndrome (SIDS),and Injury Prevention sections)
NUTRITION
Breast Feeding
colostrum for first few days - clear fluid with nutrients (high protein, low fat) and immunoglobulins
full milk production by 3-7 days; mature milk by 15-45 days
support for mothers who want to breast feed should start while in hospital(nurses, primary care physician, breatfeeding clinics, La Leche League, lactation consultant)
assessment of adequate intake: weight gain, number of wet diapers (6 per day),number of bowel movements, pause during swallowing
feeding schedule (newborn baby needs 120kcal/kg/day: 180 cc most milks/kg/day)premature infants: q 2-3 hoursterm infants: q 3.5-4 hours, q 5 hours at night once 4.5 kg
breast-fed babies require following supplementsvitamin K (given IM at birth)vitamin D (Tri-Vi-Sol or Di-Vi-Sol); especially during winter monthsfluoride (after 6 months if not sufficient in water supply)iron (premature infants): from 8 weeks to 12 months
contraindicationsmother receiving chemotherapy or radioactive compoundsmother with HIV/AIDS, active untreated TB, herpes (in breast region)mother using alcohol and/or drugs(decrease milk production and/or directly toxic to baby)mother taking certain medications (some are safe)e.g. antimetabolites, bromocriptine, chloramphenicol, high dose diazepam,ergots, gold, metronidazole, tetracyclinematernal cytomegalovirus (CMV), hepatitis and antibiotic-treated mastitis are NOT contraindications
oral contraceptive pill (OCP): estrogen may decrease lactation but is not dangerous to infant
 Advantages of Breast Feeding – “Breast is Best”
composition of breast milkenergy: 67 kcal/100 mL (20 kcal/oz.)carbohydrate: lactoseprotein: whey - 80% (more easily digested than casein), casein - 20%, essential amino acids(lower content than cow’s milk, lower renal solute load for developing kidneys)fat: cholesterol, triglycerides, essential free fatty acids (up to 50% energy from fat)iron: higher bioavailability (50% of iron is absorbed vs. 10% from cow's milk),meets iron requirements only for first 6 months
immunologicprotection is greatest during early months, but is cumulative with increased duration of breastfeedinglower allergenicity than cow’s milk proteinIgA, macrophages, active lymphocytes, lysozyme, lactoferrin(lactoferrin inhibits
E.coli
growth in intestine)lower pH promotes growth of lactobacillus in the gastrointestinal (GI) tract(protective against pathogenic intestinal bacteria)
parent-child bonding
economical, convenient

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