I feel that I lack lot of clinical skills and knowledge and although at the clinic I swear that I will look them up, study and master them when I get home - I become so lazy - my mind floats to being that lazy girl still in highschool with no worries and if so, such simple worries such as friendship, boyfriend and etc. I forget about the embarrassment and sign of perspiration still lingering in my dress shirt as I do mindless things.
Am I still going through puberty?
--DIARRHOEA AND VOMITING--
Anyway, in 3rd year OSCE, diarrhoea/vomiting is one of the important thing to study about.
And one of the key things to note are acute and chronic and being able to tell which is which to determine the severity so that appropriate response could be taken.
For example, urine output will be less, HR goes up and blood pressure will be low when you are dehydrated. Skin will also not be as firm anymore (turgor). Capillary refilling/perfusion will also take longer with severe chronic dehydration (1-2 sec is normal)
For vomiting, you can prescribe ondansetron which is a serotonin HT3 receptor ANTAgonist that prevents nausea and vomiting (Zofran). Gosh this is probably second time going over this!!!
--CRYING BABY--
Colicky baby or Baby colic or infantile colic.
I hear them often enough but what is it really?
It is episodes of crying for 3 h ++/day for more than 3/7 for 3 weeks in an otherwise healthy child between the ages of 2 weeks and 4 months. The cause is unknown!
--PHARYNGITIS AND G.A.S--
Pharyngitis - often associated with strep throat -- group A streptococcus (streptococcus pyogenes) and swift response with antibiotics is absolute as if not treated this will develop into acute rheumatic fever.
I always think about strawberry tongue (this is due to streptococcal pyogenic exotoxin) but this is actually related to scarlet fever than acute rheumatic fever - BOTH caused by streptococci!
--FAILURE TO THRIVE--
assessment of growth consists of 8 different indices.
1. Chronological age
2. Height, weight age
3. Sexual age
4. Neural age
5. Mental age
6. Physiological age
7. Dental age
8. Bone age
Failure to thrive: calories in < calories out
non-organic causes: Inadequate intake -- lack of knowledge, deprivation --poor family?, abuse--parents not taking good care of the kid.
Organic causes: GI disease, CNS disease, Renal disease, Cardiovascular disease, lung disease -- for the organ disease energy expanded must be considered.
Approach to failure to thrive
1. Hx
2. Physical examination (behaviour, child's interaction, signs of disease, abuse, neglect)
--NORMAL NEW BORN GENITALIA--
Female:
- Clitolis <1.0cm
- no labial fusion
- no gonads palpable
- separate vaginal & urethral openings
Male:
- Penis >2.5 cm
- scrotum fused
- 2 gonads palpable
- urethra at tip of penis
Disorder of sexual development: Ambiguous genitalia
Any 2 of:
- micropenis
- hypospadias -- urethra opening is not at the tip of penis
- undescended testes
If you see this, DO NOT SEND THE BABY HOME!!!! REFER URGENTLY!!!
Ahh,,, the word I was searching for was hypospadias.
--PRECOCIOUS PUBERTY--
Girls: breast development and or pubic hair before 8 yr - consists of 5 stages (I saw stage 2!)
** this is because according to the graph it's between 8-14 when the breast development and growth of pubic hair takes place. Menarche typically 10-16 and half, height 9and half to 14 and half
--DELAYED PUBERTY--
Girls: no breast development by 13 yo
--HERPANGINA-- New word of the day~!
Mouth blisters - it refers to the painful mouth infection by coxsackieviruses.
Most cases in Summer and in children.
Apparently Babinski reflex <1 year old is not reliable (run finger through the middle of baby's foot instead of out to inner!
No comments:
Post a Comment