Pedics at University of Cape Coast

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Study with flashcards and summaries for the course Pedics at the University of Cape Coast

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Hypertension in children 

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Causes of hypertension in Children 

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Organisms that can cause pneumonia 
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Xray findings in pneumonia 

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3 drugs that can be administered with a nebulizer 

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Devices that can be used in place of a nebulizer 

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Signs of dehydration 
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Exemplary flashcards for Pedics at the University of Cape Coast on StudySmarter:

Causes of neonatal jaundice 

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Other causes of macrosomia

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Neonatal examination

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GIT causes of clubbing
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ATLS protocol’s 

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Pedics

Hypertension in children 
Systolic and diastolic pressures greater than the 95th percentile for age and gender on at least 3 occasions

The normal blood pressure at birth is 70/50 and increases by 10systolic and 5diastolic every 3 years

Degrees according to increase above normal range for age:
Mild hypertension: by 10sys or 5 dia
Moderate hypertension: by 20sys or 10dia
Severe hypertension: by 40sys or 20dia


Pedics

Causes of hypertension in Children 
Renal
Acute; acute renal failure, acute glomerulonephritis and hemolytic uriremic syndrome
Chronic; Tumors or dysplasia, chronic pyelonephritis, hydronephrosis, renal artery stenosis, renal vein thrombosis

Endocrine
Cushing's syndrome
Hyperaldosteronism
Congenital adrenal hyperplasia
Hyperthyroidism

CNS; Neuroblastoma
Acute icp

Cardiac; coarctation of aorta

Drugs; sympathomimetics and steroids

Pedics

Organisms that can cause pneumonia 
All ages: TB
Neonatal:gbstrep
Infant to 4yrs: hemophilus influenza, staph aureus, respiratory syncytial virus, streptococcus pneumonia
>5yrs: mycoplasma pneumonia, strep pnemo 

Hospital acquired: proteus, klebsiella, enterobacter, pseudomonas

Pedics

Xray findings in pneumonia 
Homogeneous opacification
Central trachea
Air bronchogram overlying the cardiac shadow



Pedics

3 drugs that can be administered with a nebulizer 
Salbutamol
Budesonide
Adrenaline
Tolbutamine
Ipatropium

Pedics

Devices that can be used in place of a nebulizer 
An inhaler
Spacer
Metered dose inhaler

Pedics

Signs of dehydration 
Sunken fontanelles
Dry and sunken eyes
Dry mouth
Tearless cry

Pedics

Causes of neonatal jaundice 
1st 24hrs: 

Pedics

Other causes of macrosomia
Post dating
Excessive weight gain during pregnancy
Advanced maternal age >35
Maternal obesity
Previous Hx of fetal macrosomia


Pedics

Neonatal examination
1. Introduction, permission, and explanation of the procedure
2. Baby's surroundings; meds, cannula, nasal prongs etc
3. Inspection: State of the baby (active, alert, movement of limbs, well flexed or floppy, colour pink or blue, ill looking, birthmarks, petechiae, vernix, lanugo, milla, mongolian spots,hemangiomas, bullous)
4. Anthropometric measurements; length, weight, head circumference and plot on the appropriate chart.

5. Head
Hair; colour, texture, distribution and pluckability.
Swellings; caput[Caput succedaneum between skin and epicranial aponeurosis ; crosses suture lines and containd edematous fluid] hematomas [Subgaleal haematoma: is between epicranial aponeurosis and periosteum; can cross suture lines. The child will be pale and touching the head causes intense pain. The infant must be transfused within 12 hours], [Cephal haematoma: is between periosteum and skull; does not cross suture lines. May contain blood that will undergo haemolysis to cause jaundice] and if they cross suture lines, abnormalities and dysmorphic features.
Palpate fontanelles, anterior fontanel is diamond-shaped and posterior triangularly shaped, are they sunken, flat or bulging. Palpate sutures to see if they are widened.

Face: Dysmorphic features (hyper/hypo telorism, lowset ears, flat nasal bridge, philtrum, cleft lip)

Eyes: Sclera for jaundice, Conjunctiva for palor, red reflex.

Mouth: teeth and cleft palate

Neck: Masses, SCM muscle mass, torticollis, webbed, clavicle-fracture

Chest: Inspect Respi Rate, palpate for breast, auscultate for heatbeat, and lung activity

Abdomen: Inspect umbilical cord,

Genitals: ambiguous, penis chordae, scrotal sac, testes unndescennded/retracted/ectopic urethra for epi/hypospadias, circumcised. Vagina for vulva and clitoris.
Wear gloves
Check suckling reflex
Anus for patency

Ortolani (adduct and pull out) and Barlow (Adduct and push in) maneuver for hip dislocation

Check for pitting pedal edema

Back: For dimpling, spine deformities, a tuft of hair

Reflexes:
Suckling: Infant will press lips against object pressed against roof of mouth and make sucking motions report as strong and sustained if normal
Moro: Occurs when the baby’s head suddenly shifts in position or there is a sudden loud sound. The infant will extend legs and head while the arms are initially extended, but afterward, arms are flexed and the hands clenched into fists.
Grasp: When object is placed in infant’s hand and strokes the palm, infant’s fingers will close and grasp with a palmar grasp.
Rooting: Infant turns head towards anything that strokes mouth or cheek until object is found

Pedics

GIT causes of clubbing
Crohns Dx
Ulcerative colitis
Liver cirrhosis
Biliary atresia
Secondary hepatic amyloidosis
Severe acute malnutrition


Pedics

ATLS protocol’s 
Airway
Breathing
Circulation
Coma/Convulsions
Disability
Dehydration

Airway: Check patency of airway, ensure nothing is blocking the airways (foreign object, tongue, secretions) provide some relief using chin lift and jaw thrust.

Breathing: Ensure child is breathing and note respiratory rate and signs of respiratory distress. CPAP or use ambubag in neonates.

Circulation: Check pulse, if less than 60 or if absent start chest compressions. Check capillary refill, if more than 3 seconds, its indicative of shock (Dopamine and Dobutamine can be administered)
Malnourished children are given Ringers lactate in 5% dextrose solution at a slow rate.

Convulsions: Course of management;
1. Diazepam(0.5mg/kg or 0.1mL/kg)per rectum OR (0.25mg/kg or 0.05mL/kg)IV over 1 minute.
If convulsions persist after 10 minutes, the dose is repeated after which the drug is changed if still convulsing.

2. Phenobarbital: 20mg/kgwhich can be repeated after 10 mins if convulsions persist.

3. Phenytoin:18mg/kg

***In neonates, diazepam is not the first line***
1st Line:Phenobarbital at 20mg/kg
2nd Line: Phenytoin at 18mg/kg

Dehydration:Assess using WHO parameters;
  • Level of consciousness
  • Eagerness to drink
  • Sunken Eyes
  • Skin Turgor
They are then classified into
No dehydration (<5% of body weight lost)
WHO Tx Plan A: the child should be given
50-100mL of ORS (if below 24 months)
or 100-200mL of ORS (if ≥ 24 months) after every loose stool passed

Some dehydration (5-10% lost)
WHO Tx Plan B: the child should be given 75mL/kg over 4 hours and then reassessed to move to plan A or plan C

Severe Dehydration (>10% lost)
WHO Tx Plan C:
the general principle is that 100mL/kg is to be provided over 3 or 6 hours, depending
on the child’s age. If below 12 months, start with 30mL/kg over 1 hour and move to 70mL/kg over 5 hours
If over 12 months, start with 30mL over 30 minutes and then if positive assessment is made, move to 70mL/kg over 2.5 hours

**In malnourished children, IV fluids should not be given, Resomal is given per os

If child dehydrated due to diarrhea, Zinc must also be given 10mg/day for 10-14 days if below 6 months and 20mg/day for 10-14 days if above 6 months

If the child needs fluid replacement over 24 hours, the amount of fluid per 24 hrs is calculated using;
1st 10kg X 100
2nd 10kg X 50
Remaining kg X 20

Children who need to be transfused
30mL/kg of whole blood
20mL/kg of packed RBCs
10mL/kg of FFP

GLUCOSE
Check for hypoglycemia
Below 2.2mmol/L in older children
Below 2.6mmol/L in neonates
Below 3mmol/L in malnourished children

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