perianal abscess肛門周囲膿瘍
① 肛門陰窩に細菌が侵入し，そこに開口する肛門腺に感染することで炎症が括約筋などの肛門・直腸周囲組織に波及し，膿瘍が形成される病態である．
② 小児では，生後3ヵ月以内の男児に好発する．乳児期は肛門陰窩が深く，便が泥状・液状であり，腸管局所免疫が未熟であることが原因となる．
③ 肛門周囲の激しい疼痛がみられ，発熱を伴うことが多い．視診では，発赤，腫脹，硬結もみられる．
④ 慢性肉芽腫症，Crohn病に伴うものは難治性である．
⑤ 膿瘍の発赤・腫脹を認める場合は切開排膿を行うが，乳幼児では保存的療法で治癒することが多い． pediatricsgastrointestinal国試過去3回 Oct 4, 2020, 6:17 PM HirotoShishido
asymmetric tonic neck reflexprimitive reflex found in newborn humans that normally vanishes around 6 months of age. It is also known as the "fencing reflex" pediatrics国試過去3年 Oct 9, 2020, 11:47 PM HirotoShishido
management for croup■ ☆dexamethasone x 1 dose
■ if moderate-severe (stridor at rest), add ★nebulized epinephrine (racemic has limited availability)
After administration, patients are observed for 4 hours because symptoms can recur. Patients needing multiple doses of nebulized epinephrine typically require hospital admission.
■ consider bacterial tracheitis/epiglottitis if unresponsive to croup therapy
■ humidified O2 has no evidence for efficacy pediatricsUWorld step2CK国試直前 Sep 22, 2020, 11:04 PM HirotoShishido
nephroblastoma vs neuroblastomap vs u
p→does not cross the midline, smooth mass
u→cross the midline, irregular mass
etiology for chronic lung diseaseBPD (bronchopulmonary dysplasia)
人工換気療法，☆O2投与（肺の傷害）
Risk factors for BPD include prematurity, low birth weight (<2,500 g), respiratory distress syndrome, and mechanical ventilation. Surfactant therapy does not prevent BPD development but may reduce mortality from it. Most patients with BPD improve over 2-4 months; some develop pulmonary arterial hypertension.
New BPD →pulmonary dysplasia with pathologic findings of a ★reduced number and septation of alveoli
吸気性喘鳴 inspiratory stridor that is (★)worse in the supine position and exacerbated by feeding or upper respiratory illnesses; prone positioning improves symptoms
とともに閉塞性無呼吸などを起こす．特別な治療を必要とせず呼吸器感染に注意して，1年くらいの経過で自然治癒する症例が90％以上と多いが，一部重症例も存在し積極的な外科治療も行われ，人工呼吸管理が必要となった症例もある．確定診断は★Laryngoscopy (eg, omega-shaped [Ω] epiglottis)によるが，頸部側面X線では下咽頭腔の拡張所見を認める pediatricsUWorld step2CK国試過去3回 Sep 26, 2020, 8:19 PM HirotoShishido
FGR児のふるえfetal growth restriction
FGR児に低血糖，低カルシウム血症や★赤血球増多症(The polycythemia results from increased erythropoietin secretion in response to fetal hypoxia.)を認めることは頻度的に多いが，それ以外は少ない．四肢が小刻みに震えた場合は，児の全身状態とともに観察し，けいれんと考えにくい場合には，低血糖または低カルシウム血症の可能性を考え，少量の血液で両者を同時に迅速検査することが多い pediatrics国試過去3年UWorld step2CK Oct 9, 2020, 11:17 PM HirotoShishido
GERD in pediatric patientsintermittent regurgitation, ☆nighttime coughing, persistent wheezing, decreased food intake, food aversion, poor weight gain, nausea, and abdominal pain gastrointestinalpediatrics Jan 1, 2020, 3:49 AM HirotoShishido
infection caused by the single strand DNA virus(Parvovirus)
fifth disease(erythema infectiosum)
☆prodromal phase that includes non specific findings such as a low-grade fever, headache, and gastrointestinal symptoms
(similar to roseola infantum but this present in children age<2)
→ these are follwed by
erythematous rash that looks like both cheeks have just been slapped
and then, a pruritic maculopapular rash spread over trunk and extremities microbiologypediatricsUWorld Nov 19, 2019, 3:04 AM HirotoShishido
when should children be introduced to complimentary baby foodat 6 months of age
Breast milk contains very little iron, approximately 0.35 mg/liter. After 6 months, most infants’ iron stores have been depleted, so this iron needs to come from complementary foods +/- fortified formula biochemistrypediatrics Nov 1, 2019, 9:10 PM HirotoShishido
