Kind en Jongere Deel 3
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Percentage of boys born with undescended testicles
What does an APGAR score of less than 7 indicate?
What is OME?
Otitis Media met Effusie - a collection of fluid behind the ear drum. Resolves spontaneously within 3 months in 75% of cases. Carries a hearing loss of around 25 dB.
Upto what age must a symptomatic diagnosis be made for asthma?
Prevelence of asthma
Organic causes of asthma
IgE-mediated allergic reaction
Asthma is unlikely if there is no talk of _______.
Differential diagnosis of asthma
- Foreign body in airway
- Croup (swelling of airway causing 'steeple-sign')
Treatment for asthma
- Under 6: Use beta-2-adrenergic agonist until symptoms disappear - if asthma is suspected, continue with inhalation corticosteroids for 4-6 weeks
- Over 6: Short-action beta-2-adrenergic agonist (10-15 mins before effort if effort-induced asthma), then inhalation corticosteroids for persistent symptoms. If no improvements after 3 months, should be treated as serious asthma.
Medicine used to treat only severe asthma
Most important characteristics with regards to pharmacokinetics
- Remember DAME
Difference between off-label and unlicensed medication, with regards to medicating of children
- Off-label = used for a purpose other than that specified
- Unlicensed = should not be used for children
Babies have a (higher/lower) percentage body water than adults. This affects dosage of water soluble antibiotics, such as ________ and ________.
Higher, aminoglycosides, beta-lactams
Babies have a (higher/lower) percentage of body fat than adults. This affects dosage of fat soluble medicines such as _______.
Lower, Sedative H1 antagonists
Babies have a (higherl/lower) concentration of albumine. This means that medicines that bind albumine must be given in (higher/lower) doses
Very important barrier which is not fully developed in newborns
Describe process by which growth hormone is released and acts
GH (somatotropine) secretion incr by GRF (GH Releasing Factor) and decr by somatostatin (aka SRIF - Somatotropine Release Inhibiting Factor). GH circulates attached to GHBG (GH Binding Globulin) and incr release of IGF-1 from the liver.
Factors causing an INCREASE in IGF-1
- alpha-adrenergic stimulation, hypoglycemia, malnutrition, exersion, sleep and stress
- (Remember, GH incr blood glucose)
Factors causing a DECREASE in IGF-1
beta-adrenergic stimulation, hyperglycemia
When GH is high, IGF-1 is usually also high. What are the exceptions?
- Underfeeding (GH high to incr blood glucose, but IGF-1 low)
- Obesity (GH low to lower blood glucose, but IGF-1 normal)
- GH deficiency (GH low b/c duh, IGF-1 low)
Classic presentation (apart from being short) of a GH deficiency
- Round face and trunk adipositis
- (Thus round face and fat a**)
DD for short length
- Turner syndrome
DD for long length
Klinefelter, XXX, XYY, Fragile-X syndromes
Landmarks for beginning of puberty for boys and girls
- Girls (M2) - elevation of areola, beginning of hardening of nipple and formation of slight curve
- Boys (G2) - enlargement of scrotum/testes (min volume of 4mL)
Definition of pubertas praecox
Puberty beginning too early - breast development at less than 8 yrs for girls, thinning of scrotum or development of pubic hair before 9 yrs for boys
Differentiate actual central pubertas praecox from pseudo-pubertas praecox
Central involves the hypothalamic-pituitary axis
Who is more likely to experience pubertas praecox, boys or girls?
Girls (23 times more likely)
Tx for central pubertas praecox
- GnRH agonist (Decapeptyl)
- Side effect is decrease in final height
Precocious puberty and café-au-lait spots - treat with anti-androgens
Often associated with Coeliakie (Celiac's disease)
DM and thyroid disorders
The pH of a baby's GI tract is (higher/lower) than that of an adults
Baby's muscle is (more/less) vascularized
Baby's ratio of surface area to weight is (higher/lower) than that of adults
Baby's have a (higher/lower) body water percentage
Babies have a (higher/lower) concentration of plasma bonding proteins than adults
Enzyme responsible for most drug metabolism and equivalent in children
RBF and GFR for neonates and adults
- 12mL/min, 3mL/min for neonates
- 1000mL/min, 125mL/min for adults
Flows approach adult levels by approx 5 months
Effect of LH on girls, boys
- Girls: Estrogen production
- Boys: Testosterone production (via stimulation of cells of Leydig)
Effect of FSH on girls, boys
- Girls: Maturation of ovarian follicles
- Boys: Stimulation of Sertolli cells for spermatogenesis
When is it best to measure estrogen levels?
During the night
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