ان شاء الله

انا اختبرت أطفال عند الدكتور انور الرجوي

طبعا كان اختباري الأربعاء بس طلبت أقدمه عشان اسافر البلاد
لذلك كان الدكتور متفرغ لي وجلس معي ما يقارب ساعة

جهزت حالة ليشمانيا هستوري واقزامنيشن

طلب مني اقدم له ال positive فقط من ال HOPI وعلى طول ال examination اذكر ال positive

خلصت، قام يسالني في ال leishmania
تعريف، سبب طريقة الانتقال.. انواعها.. اسماءها، ال Pathogenesis
Clinical picture
Investigations
وايش نشوف في كل واحد
والعلاج وكم الجرعة وايش الاليه حق كل علاج
ذكرت له ال pentostam وال pentamedin واذا ما نفع، ممكن نستخدم ال amphoterisin واكتفى الدكتور بهولا، لا عاد تزيدوا تحنبوا

وبعدين قال انت قلت pancytopenia
كيف الليشمانيا تعملها... ذكرت له حقه الثنتين
( hypersplenism and infiltration of Bone marrow)
طيب ايش اسباب ال pancytopenia غير الليشمانيا
ويسألني عن كل واحد
ال leukemia كيف.. ال metastasis كيف
Aplastic anemia كيف
Chemotherapy كيف
Drugs مثل ايش

طيب ايش اعراض ال leukemia
بالتفصيل ذكرتهم له اللي في baby Nelson وعجبه..
ايش اسباب ال splenomegaly.. ومتى نعمل splenectomy..
وعشان ذكرت من اعراض ال leukemia.
. Dyspnea du to infiltration
قال وايش السبب الاخر.. قلت له
infection bcz decrease immunity

ويسال عن ال respiratory اسباب وأنواع ال respiratory وايش الفروقات وايش ال complications، وايش اكثر سبب للوفاه

واحد عنده
Recurrent respiratory infection وكمان Diarrhea
ايش هو... قلت cystic fibrosis
صح... ليش يحصل اسهال، الاليه من البداية
كيف بيحصل المرض هذا
ايش الفرق بينه وبين ال celiac
مضاعفات ال celiac ايش ال associated autoimmune disease

كيف ال celiac يسبب other autoimmune disease
ما عرفت هذا.. قال بسبب مافيش absorption

?? إلى الآن ما فهمتها.؟؟

قال نقصت عند هذه، وانا ما اشتيش انقص درجتك.. لذلك بزيد أسألك
ويدخل kwashiorkor والفروقات وو و. و إلى عند العلاج
اللي في baby Nelson 😑
ودخل بعدها شويه TB
وسلم عليا وقال مبروك. 🎉

ما اعتقد ان التجربه هذه هتحصل لباقي الطلاب... لان الدكتور متعود يختبر 8 طلاب مع بعض، لذلك ما بيكون به وقت كافي لهذا كله... وبيسال كل طالب عن الحالة حقه بس.. ما يتفرعش كثير

وبدون قلق، جاوب بثقة اي اجابة متأكد منها
اجابة لو تحس انها مش اكيده.. لا تقولها بثقة عنده..
انتبه ترجم جواب ولو غلط ( حتى لو مقارب) .. لانه يقلب سريع

اذا جاب سؤال ما تعرف اجابته قول له نسيت ( لا تقول مش عارف.. ما يعجبه)

بالتوفيق ♥️

تجربتنا كانت عند الدكتور الاب اللطيف جدا
عبد الرحمن الهادي دخلنا اربعه طلاب كانت الاسئله متنوعه من شبتر الهيماتولوجي وباقي الاسئله من الحالات اللي قدمناهن وصحح لنا اللوق بوك ملاحظة الدكتور كانت انه يشتي نسقط الحاله اللي قدمناها في الgroth chart في اللوق بوك وبس

شكراً للزميل باسم الشرعبي على التجميعات الفخمة ✨✨

*🎗️*Growth part 3

☂️assessment of Development

🔖Gross motor:
🔅3 months:
▫️Head support.
🔅6 months:
▫️sit without support.
🔅9 months:
▫️crawling.

🔅10 months:
▫️standing.
🔅12 months:
▫️walking.
🔅18 months:
▫️Running.

🔅2 Years:
▫️climbs stairs.
🔅3 years:
▫️Rides bicycle.
▫️Dresses himself.

🔖Fine motor:
🔅at 6 weeks:
▫️Follows moving objects.
🔅4 months:
▫️play with hand in the middle line.
🔅6 months:
▫️outreaches objects, mouth it and transfer it.

🔅9 months:
▫️pencil grasp.
🔅12 months:
▫️pointing to an object by index finger.
🔅18 months:
▫️makes marks with a crayon.

🔅3 years:
▫️cut with scissors.
▫️copies circle.
🔅4 year:
▫️copies a cross and square.
▫️recognize 4 color.
🔅5 years:
▫️copies triangle.

🔖social development:
🔅2 months:
▫️social smile on social contact.
🔅4 months:
▫️recognize mother face.
🔅9 months:
▫️respond to his name.
▫️stranger awareness.

🔅10 months:
▫️waves bye bye.
🔅12 months:
▫️drink from cup with tow hands.
🔅18 months:
▫️holds spoon and get food safely to mouth.

🔅2 years:
▫️pull off some clothing.
🔅3 years:
▫️able to use toilet wash hand.
▫️brush teeth.
🔅4 year:
▫️albe to undress and combing hair.

🔖Speech and language:
🔅6th month:
▫️say Ma and Ba
🔅10 months:
▫️say mama and baba.
🔅1 year:
▫️Say three ward other than baba and mama.

🔅18 months:
▫️saying 2 ward sentence.
🔅2 years:
▫️saying 3 wards sentence.
🔅3 years:
▫️saying his name and age.

🔅5 years:
▫️saying clear speech.

🔖school achievement:
▫️if the child above 5 years.**

*🎗️*Growth 2

☂️Teathing

🔖Primary milky teath:
▫️started at 6-9 months and completed at 24 months.
🔅central incisors:
▫️6-9 months.
🔅lateral incisors:
▫️9-12 months.
🔅1st molar:
▫️12-18 months.
🔅canine:
▫️18-24 months.
🔅2nd molar:
▫️24 months.

🔥causes of Delayed teething:
🔅idiopathic:
▫️the commonest cause.
🔅local:
▫️rigid gum.
▫️cysts.
🔅Generalized: DACRO H2:
▫️Down syndrome.
▫️Achondroplasia.
▫️Congenital hypothyroidism.
▫️Rickets.
▫️osteogenesis imperfecta.
▫️hypopituitarism.
▫️hypoparathyrodism.

☂️Fontanels

🔖Post fontanel:
🔅normally:
▫️closed at birth or less than 0.5 cm and closed within 2 months.
🔅abnormally:
▫️open more than 1 cm or not closed within 4 months.
🔅causes of closure delay:
▫️prematurity.
▫️increase intracranial tension.
▫️Down syndrome.
▫️cretinism.

🔖anterior fontanel:
🪄clinical value:
🔸assessment of growth:
▫️at birth: admite 3 fingers.
▫️at 6th month: admite 2 fingers.
▫️at 12 months: admine 1 fingers.
▫️at 18 month: closed.

🔸size:
🔅Delayed closure: DACRO HI:
▫️Down syndrome.
▫️Achondroplasia.
▫️congenital hypothyroidism.
▫️Rickets.
▫️osteogenesis imperfecta.
▫️hypopituitarism.
▫️increased intracranial tension.

🔅Premature closure:
▫️Craniosynostosis.
▫️congenital hyperthyroidism

🔸surface:
🔅bulging:
▫️with increase intracranial pressure:
▪︎intracranial infection.
▪︎intracranial haemorrage.
▪︎hydroencephalus.

🔅depresed:
▫️Dehydration.

☂️Growth charts

🔖values:
▫️assess growth and normal growth variations among children.
▫️Early predictor of malnutrition.
▫️monitor success of treatment of malnutrition.

🔖Normal child on precentile curves:
▫️should lie between the 3rd and 97th precentile curves.
▫️value below 3rd or above 97th precentile are abnormal.**

*🎗️*Growth 1

☂️Growth parameters:
▫️Anthropometric measures.
▫️Teathing.
▫️Fontanelles.
▫️osseous Growth.
▫️Growth chart.

🔖factors affecting growth:
🪄Prenatal factors:
▫️familial factors.
▫️racial factors.
▫️constitutional factors.

🪄factors operating during pregnancy:
▫️maternal disease as DM and HTN.
▫️maternal exposure to infections or radiation.
▫️maternal nutritional state.

🪄After birth factors:
▫️age.
▫️sex.
▫️nutritional status.
▫️psychological and socioeconomic status.
▫️health status as chronic disease retard growth.

🪄hormonal role:
🔅intrautrine:
▫️chorionic gonadotropines.
▫️placental lactogen.
▫️insuin.
▫️thyroxin.

🔅infancy and childhood:
▫️Thyroxin.
▫️Growth hormone.

🔅adolescence:
▫️sex hormones.

☂️Anthropometric measures

🔖Weight:
🔅at birth:
▫️3-3.5 kg.
🔅1st 4th month:
▫️increase by 750 gm/month.
🔅next 4th months:
▫️increase by 500gm/month.
🔅last 4th months:
▫️increase by 250gm each month.
🔅beyond 1 year:
▫️weight= age in years × 2+8.

🔥causes of physiological weight loss during fist 3 days of life:
▫️scanty milk flow.
▫️poor suckling capacity.
▫️passage of meconium and urine.

🔖Length and hight:
🔅at birth:
▫️50 cm.
🔅at 1 year:
▫️75 cm.
🔅at 4 years:
▫️100 cm.
🔅after age of 2nd year:
▫️age in years × 5 + 80.

🔖occipto-head circumference:
🔅at birth:
▫️35 cm.
🔅at 6 month:
▫️43 cm.
🔅at 12 month:
▫️45 cm.
🔅at 12 years:
▫️55 cm.

🔖OFC and chest circumference ration:
🔅at bith:
▫️more than 1.
🔅at 6th month:
▫️equal to 1.
🔅at 1 years:
▫️less than one.

🔖mid arm circumference:
🔅in baby 1-4 years:
▫️MAC more than 14 cm.
🔅in borderline malnutrition:
▫️MAC is 12.5-14 cm.
🔅in server malnutrition:
▫️MAC is less than 12.5 cm.

🔖skin fold thickness:
🔅normal value:
▫️10 mm at 1 year.
▫️14 mm at 1-4 years

🔖proportion of upper and lower segment:
▫️at birth: 1.7 : 1.
▫️at 3 years: 1.3 : 1.
▫️after 7 years: 1:1**

Growth and development

🌟🔹🌟

*🧬*Vaccinations:

🔹Vaccinations:
▫️The act of introducing a vaccine into the body to produce protection from a specific disease. 

🔹Types of vaccine:

🔅Live attenuated:
▫️Bacterial: BCG.
▫️Viral: OPV, Measles and rotavirus.

🔅Killed vaccine:
▫️Bacterial: pertussis.
▫️Viral: IPV and rabies.

🔅Toxoid:
▫️Tetanus and diphtheria.

🔅Extracted cellular fraction:
▫️Bacterial: Hib, pneumococal and meningococcal.
▫️Viral: hepatitis B.

🔹Vaccinations schedule according to Yemeni protocol:
🔅At birth:
▫️BCG vaccine.
▫️OPV vaccine.

🔅At 1½ month:
▫️OPV vaccine.
▫️DTP - Hib- HepB vaccines.
▫️pneumococal conjugate vaccine.
▫️rotavirus vaccine.

🔅At 2½ month:
▫️OPV vaccine.
▫️DTP - Hib- HepB vaccines.
▫️pneumococal conjugate vaccine.
▫️rotavirus vaccine.

🔅At 3⅓ month:
▫️OPV vaccine.
▫️IPV vaccine.
▫️DTP - Hib- HepB vaccines.
▫️pneumococal conjugate vaccine.

🔅At 9 month:
▫️OPV vaccine.
▫️IPV vaccine.
▫️Measles and rubella.
▫️Vit A 100000 IU.

🔅At 18 month:
▫️OPV vaccine.
▫️measles and rubella.
▫️vit A 200000 IU.

🔅At school age:
▫️boster dose of measles and rubella vaccine.
▫️boster dose of vit A 200000 IU.
▫️boster dose of Tetanus and diphtheria vaccine.

🔹Doses of vaccines and The route of vaccinations:
🔅BCG:
▫️0.05 ml in neonates intradermal in Rt upper arm.
▫️0.1 ml in adults intradermal in Rt upper arm.

🔅OPV:
▫️2 drops orally.

🔅DTP, Hib, HepB:
▫️0.5ml intramuscular in outer mid thigh.

🔅Rotavirus:
▫️1ml orally.

🔅Pneumococal:
▫️0.5ml intramuscular in left outer mid thigh.

🔅Measles and rubella:
▫️0.5ml subcutaneous in outer mid thigh or upper arm.

🔹Adverse reactions to vaccine:
🔅BCG:
▫️regional lymphadenitis.
▫️abscess formation.
▫️dissiminated infection.

🔅OPV:
▫️Vaccine associated paralytic poli Very rarely.

🔅DTP:
▫️Fever and local tenderness.
▫️irritability and crying.
▫️Convulsion.
▫️encephalopathy.

🔅Hepatitis B vaccine:
▫️pain, tenderness, swelling and erthema.
▫️fever.
▫️Headache.

🔅Rotavirus vaccine:
▫️low grade fever.
▫️loose stool.

🔅Measles and Rubella:
▫️malaise, fever and rash.
▫️idiopathic thrombocytopenic purpura.
▫️rarly encephalitis and anaphylaxis.

⭕️General contraindication of vaccinations:
▫️serious allergic reaction after previous vaccine dose.
▫️immunocompromized children.
▫️malignancy and recent chemotherapy.
▫️pregnant mother or planned for pregnancy.

☂Notes:
🔅There is post exposure vaccines such as:
▫️Tetanus
▫️Rabies.

🔅The following groups should not be immunized with live attenuated vaccine:
▫️congenitally immunodeficient children.
▫️children with cancer.
▫️children receiving high doses of corticosteroid or other immunosuppressive drugs.**

Vaccinations