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 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 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.
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 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 HirotoShishido
GERD in pediatric patientsintermittent regurgitation, ☆nighttime coughing, persistent wheezing, decreased food intake, food aversion, poor weight gain, nausea, and abdominal pain gastrointestinalpediatrics 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 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 HirotoShishido