كورس الاطفال 2022
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| 2 | ملخص محاضره Rheumatic fever
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🫥 Cause :Acute rheumatic fever is immunologic response that occurs as a delayed sequela of group A streptococcal infection of the pharynx .
🫥 Important predisposing factors include family history of rheumatic fever, low socioeconomic status,and age between 6 and 15 years (with a peak incidence at 8 years of age).
🫥 Pathogenesis:
👾cytotoxicity theory suggests GAS produces a number of enzyme , as streptolysinO , which has a direct cytotoxic effect on mammalian cells in tissue culture.
👾An immune-mediated theory : The antigenicity of GAS epitopes cross-reactivity with cardiac antigenic epitopes and others mammalian tissues .
🫥 Diagnosis: Jones Criteria:
👾 Initial attack:2 major manifestations, or 1 major and 2 minor manifestations, plus evidence of recent GAS infection.
👾 Recurrent attack: 2 major, or 1 major and 2 minor, or 3 minor manifestations (in the Moderate/High-Risk population(developing countries)), plus evidence of recent GAS infection.
👾 Major Manifestations:
-Migratory Polyarthritis(75%, never deforming,migratory in nature)
-Carditis(50-60 %, pancarditis, usually tachycardia and cardiac murmurs,Mostly isolated mitral valvular disease or combined aortic and mitral valvular disease)
-Chorea(10-15%, neuropsychiatric, begins with emotional lability and replaced by chorea)
-Erythema Marginatum(rare 1%, erythematous, serpiginous, macular lesions with pale centers that are not pruritic,on the trunk and extremities, but not on the face)
-Subcutaneous Nodules(rare ≤1%, firm nodules, 1 cm in diameter along the extensor surfaces of tendons near bony prominences)
👾 Minor Manifestations:(Arthralgia, Fever ,Prolonged P-R interval,Laboratory features: ESR , CRP)
🫥 Treatment:bed rest and monitored closely👉 10 days of oral penicillin or amoxicillin or a single IM benzathine penicillin👉 If penicillin-allergic👉 erythromycin, azithromycin👉 Patients with migratory polyarthritis and those with carditis without cardiomegaly should be treated with oral salicylates(aspirin)👉 Patients with carditis and cardiomegaly should receive corticosteroids(prednisone)👉Chorea treatment(phenobarbital, haloperidol)
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🫥 Kawasaki Disease
🫥 KD is a vasculitis that predominantly affects the medium-size arteries,The coronary arteries are the most commonly involved
🫥 mean age of 3 yr
🫥 Clinical Manifestations: High fever ≥38.3 C ,unremitting, and unresponsive to antibiotics.The duration of fever without treatment is generally 1-2 wk
🫥 criteria of KD:
-non-suppurative cervical lymphadenopathy
-bilateral non-exudative conjunctival injection
-edema and erythema of the hands and feet
-rash of various forms (maculopapular, erythema multiforme, or scarlatiniform)
-erythema, dryness, fissuring, peeling, cracking, and bleeding of the lips, strawberry tongue
🫥 DIAGNOSIS :classic KD👉fever for at least 4 days and at least 4 of 5 of the other principal criteria.
🫥 Treatment:treated with 2 g/kg of IVIG and high dose aspirin (80-100 mg/kg/day divided q6h) within 10 days of disease onset👉The dose of aspirin decreased to 3-5 mg/kg/day as a single dose after the patient become afebrile👉 Aspirin is continued for 6-8 wk after illness onset and then discontinued. | 0 |
| 3 | ذني السلايدات اجه عليهن بنص السنه سؤالين وخصوصا الجدول يريد منك الانتي دوت | 0 |
| 4 |  +3No text... | 0 |
| 5 | No text... | 0 |
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| 7 | الدكتور ركز عليه كلش وكال احفظوا مثل اسمكم | 0 |
| 8 | 🌸treatment:
1-vaso-occlusive crisis(acetaminophen,NSAID early in the course of pain, hydrocodone, short- or long-acting oral opioid 👉Opioid dependency in children with sickle cell anemia is rare and should never be used as a reason to withhold pain medication )
-hospital indicated (for IV morphine or derivatives of morphine , increasing pain pattern , patient live in a remote area from the hospital )
-Intravenous hydration does not relieve or prevent pain.
2-Splenic Sequestration treatment: blood transfusions (5 mL/kg of red blood cells because the goal is to prevent hypoxemia ) ,Blood transfusion that results in hemoglobin levels above 10 g/dL may put the patient at risk for hyperviscosity syndrome, prophylactic blood transfusion its not recommended, Prophylactic splenectomy is the only effective for preventing future life-threatening episodes
3-Fever and Bacteremia treatment: intravenous (IV) 3rd-generation cephalosporin. Infants with sickle cell anemia, as early as 6 mo of age, develop abnormal immune function due to splenic infarction. By 5 yr of age, most have complete functional asplenia.
4-Antibiotic prophylaxis : oral penicillin V should be commenced at 3 months which prevents sickling by inhibiting HbS polymerization.
5-Hydroxyurea a myelosuppressive agent, is the only drug proven effective in reducing the frequency of painful episodes, safe and well tolerated in children >5 yr of age.
6-Red Blood Cell Transfusions:acute chest syndrome, aplastic crisis, splenic sequestration,and acute stroke, and to prevent surgery-related ACS and first stroke in patients with abnormal TCD or MRI findings (silent stroke).
7-Pneumococcus vaccine+ Meningococcus and Haemophilus influenzae type b | 0 |
| 9 | ملخص SCA احمد عبد الله ————————————————————————————————
🌸Hbs an autosomal recessive disorder.
🌸 Mutation substituting thymine for adenine in the sixth codon of the beta chain gene, GAG to GTG.This causes coding of valine instead of glutamate in position 6 of the Hb beta chain. The resulting Hb has the physical properties of forming polymers under deoxy conditions.
🌸 Under deoxy conditions, HbS undergoes marked decrease in solubility, increased viscosity, and polymer formation at concentrations exceeding 30 g/dL. It forms a gel-like substance containing Hb crystals called tactoids.
🌸 Sickle RBCs also adhere to macrophages may contribute to erythrophagocytosis and the hemolytic process
🌸Sickle RBCs have increased immunoglobulin G (IgG) on the cell surface.Vaso-occlusive crisis is often triggered by infection.
🌸 Signs and symptoms:
-Acute and chronic pain(The most common clinical manifestation of SCD is vasoocclusive crisis),
-Bone pain(in long bones due to bone marrow infarction), -Anemia(chronic and hemolytic in nature),
-Aplastic crisis,
-Splenic sequestration(Sequestration can occur as early as 5wk of age, but most often occurs in children between the ages of 6 mo and 2 yr, Characterized by the onset of life-threatening anemia with rapid enlargement of the spleen causing left-sided abdominal pain and high reticulocyte count . It may lead to signs of hypovolemia as a result of the trapping of blood in the spleen; profound anemia, with total hemoglobin falling below 3 g/dL),
-Infection(encapsulated respiratory bacteria👉 Streptococcus pneumonia;adult infections 👉 with gram-negative organisms👉 Salmonella)
-Acute chest syndrome(Young children 👉chest pain, fever, cough, tachypnea, leukocytosis, and pulmonary infiltrates in the upper lobes; adults 👉 afebrile, dyspneic with severe chest pain, with multilobar/lower lobe disease)
-Avascular necrosis of the femoral or humeral head
-Pulmonary hypertension
-Cholelithiasis is common in children; liver may become involved
-Cardiac involvement(Dilation of both ventricles and the left atrium)
-Hand-foot syndrome( bilateral painful and swollen hands and/or feet in children)
🌸 Triggers of vaso-occlusive crisis👉 Hypoxemia due to acute chest syndrome or respiratory complications, Dehydration, Changes in body temperature.
🌸 Diagnosis: Electrophoresis confirms the diagnosis,lab👉normochromic normocytic anemia,crescent shape cells with pointed ends (sickle cells), Positive sicklling test, Reticlocytes count 10-25 %,Xray for chest ,MRI for bone marrow,CT, Transcranial Doppler ultrasonography for stroke, Echo for pulmonary hypertension,Abdominal US for cholelithiasis. | 0 |
| 10 | مساء الخير ، باقي الكروبات ياريت تنزلون اسئلتكم هنا | 0 |
| 11 | للأطفال العملي ، كلش لطيفات ويفيدنكم ♥️
الي يلقيها شخص ياخذ كورسات وكلش متمكن ، وذني نزلهن مجاني ، موفقون ♥️ | 0 |
| 12 |  Ped Ex | 0 |
| 13 | Ped Hx | 0 |
| 14 | Pediatrics Examnation.pdf | 0 |
| 15 | وهذه اسئلة الاوسكي
And thanks🌸
Good luck 🤍 | 0 |
| 16 | بعض الاضافات والملاحظات من السشنات يم البارت الخاص بملف اللوك بوك
وهم اغلب الاchief complaint وشنو اسئلتها | 0 |
| 17 | Pediatric history taking.pdf | 0 |
| 18 | long case (Pediatric,Gyne,Medicine,Surgery).pdf | 0 |
| 19 | اسئلة متفرقة و جوابها من دكتور كرار
🦋نوع formula بالفيدنك هستري ، لازم نذكر medical or follow up formula بس منتعمق بالانواع مالتهم مثل lactose free formula و غيرها
🦋الحسابات مال الformula ، لازم نكتبهن بالهستري مال feeding يعني نحسب عدد الرضعات و الكلوري اللي بيهن يتطابقن ويه requirment of calorie need by baby according to his wieght لو لا
🦋weaning دكتور كرار يكول بعد عمر السنتين يعني من
يقطع الرضاعه و الممة و قبلها بعمر الست اشهر من ينطوا فهذا يعتبر complemntory مو weaning و كال حتى مذكورة بالقران و فصاله في عامين ، بس دكتوره زهراء و دكتور حيدر يكولون لا هو مو cessation of milk , هو اضافه solid food يعني بعمر الست اشهر
🦋بالpast medical history ، نذكر بس اسم المرض الكرونك ، مو نشرحة من جديد يعني مثل ما نشرح الهستري of present illness عود شلون بدت اعراض و شلون اكتشفوا و شي ، ميحتاج
🦋اذا كيس cerebral palsy بس نكول اسمة ميحتاج نحدد يا نوع بيهن لان هنة انواع بي
🦋بالhistory of feeding ميحتاج نسأل على position و attachement مال الطفل ، بس دكتورة زهراء مدري دكتور باسم يمكن اعتقد كالوا لازم نذكره بالهستري مال الفيدنك بس ما متاكده
🦋بالdevelopmental history اذا جان الطفل متاخر مثلا عمره تسع اشهر و لا يكعد و لا يزحف بس يكدر يكلب ، اكول baby rolls over و من اقدمة للدكتور هو بعدين عود يسالني المفروض هسه هو شيسوي النورمال بهالعمر
🦋بالdrug history اذكر فقط الادويه الكرونك اللي يستعملهن الطفل و كذلك الادويه اذا الام مستعمله اثناء فتره الرضاعه او الحمل
🦋السيجر اذا كالت الام ظل ساعه كامله مشكور معناها status epilipticus هاي الكيس
🦋هاي اكو جملة ادوار الام تكولها من نسالها صار عندج امراض خلال الحمل او لا فتكول صار عندي زلال الحمل معناها بالانكليزي preeclampsia , protien urea
DTaP🦋
هاي الa معناها acellular
وبالنسبة ل DTaP هذا جوابه حسب دكتور باسم
DTP associated with high risk of complications like fever and swelling and other and this complications associated with pertussis so modified it and converted from give whole organism (DTP) to give part of organism (DTaP) lead to same immunological response with less complications.
🦋الseziure اعرفها severe لو لا اذا جانت recurrent
🦋اذا الطفل صغير ما اسال عن الpersonal history
🦋بالsevere dehydration حتى اكدر اكول no pass urine لازم مدة ست ساعات او اكثر | 0 |
| 20 | general-exam.pdf | 0 |
