complications of roseola infantumFebrile seizures (in up to 15% of cases), usually without sequelae
☆Meningoencephalitis (very rare)
●HHV-6には遺伝学的に異なった2種類の株（HHV-6AとHHV-6B）が存在し，現在は異なる種として分類されている．突発性発疹の原因となるのはHHV-6Bであり，HHV-6Bを原因とする急性脳炎・脳症は年間約150例発生していると報告されている．HHV-6Aが引き起こす疾患はいまだに明らかになっていない．
●HHV-7ではHHV-6Bより臨床症状がやや軽症で，好発年齢もやや遅い pediatricsinfectious disease国試 Jan 4, 2021, 7:01 AM HirotoShishido
management of otitis media with effusionPatients without speech impairement at the time of diagnosis: ★monitor for 3 months
Patients with speech impairement or persistent OME at follow-up
Age < 4 years: placement of tympanostomy tubes
Age ≥ 4 years: placement of tympanostomy tubes and/or adenoidectomy ENTpediatricsUWorld step2CK Dec 16, 2020, 1:21 AM HirotoShishido
咽頭異物の除去喉頭異物による窒息時は，1歳以上の幼児の場合，Heimlich法（abdominal thrusts 急激に上腹部を圧迫し気道内圧を上げる方法）を行い，1歳未満の乳児の場合は，胸部突き上げ法や背部叩打法(back blow)を行って異物を除去する． pediatricsemergency medicine卒試 Oct 20, 2020, 4:41 AM HirotoShishido
Short Stature DDxABCDEFG
Alone (neglected infant)
Bone dysplasias (rickets, scoliosis, mucopolysaccharidoses)
Chromosomal (Turner, Down)
Delayed growth (constitutional) Endocrine (low GH, Cushing, hypothyroid)
Familial
GI malabsorption (celiac, Crohn’s) pediatricsendocrinology Oct 20, 2020, 2:58 AM HirotoShishido
treatment of vesicoureteral reflux• spontaneous resolution in 60% of primary reflux
■ in lower grades (I-III), goal is to prevent infection or renal damage via medical treatment
• medical treatment: daily ABx prophylaxis
• surgical treatment: ureteral reimplantation ± ureteroplasty, or subureteral injection with bulking agents (Deflux® or Macroplastique®)
■ indications include failure of medical management, renal scarring (e.g. renal insufficiency, HTN), breakthrough UTIs, persistent ☆high grade (IV or V) reflux urologypediatrics卒試 Oct 19, 2020, 8:47 AM HirotoShishido
common age with premature thelarcheIt occurs in females younger than 8 years, with the highest occurrence before the age of 2. PT is rare, occurring in 2.2-4.7% of females aged 0 to 2 years old. pediatrics卒試 Oct 19, 2020, 5:22 AM HirotoShishido
treatment of polydactylyAmputation of least functional digit Usually >1 yr of age (when functional status can be assessed) plastic surgerypediatrics卒試 Oct 18, 2020, 7:47 AM HirotoShishido
Indication for operative management of Intussusception発症後時間が経過して壊死が疑われるまたは腹膜炎を伴う場合や，高圧浣腸で整復されない場合は，Hutchinson手技（開腹して内筒を押し出す整復法）を用いる． pediatricssurgery卒試 Oct 18, 2020, 5:00 AM HirotoShishido
risk/ pathophysiology/ investigation/ treatment of Persistent Pulmonary Hypertension of the Newbornasphyxia, meconium aspiration syndrome, RDS, sepsis, pneumonia, structural abnormalities (e.g. diaphragmatic hernia, pulmonary hypoplasia)
(★)chest x-ray is often normal, and ★preductal oxygen saturation is typically higher than postductal saturation
★normal femoral pulses ⇔coarctation →diminished femoral pulses and often lower extremity pallor
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 10, 2020, 2:47 AM 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 10, 2020, 2:17 AM HirotoShishido
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, 9:17 PM HirotoShishido
乳児期の吸気性喘鳴の原因として最も多い疾患laryngomalacia
喉頭軟化症
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, 11:19 PM HirotoShishido
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
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 23, 2020, 2:04 AM HirotoShishido
