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Percentage of boys born with undescended testicles
6%
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What does an APGAR score of less than 7 indicate?
Perinatal asphyxia
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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.
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Upto what age must a symptomatic diagnosis be made for asthma?
6 years
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Prevelence of asthma
5-10%
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Organic causes of asthma
IgE-mediated allergic reaction
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Asthma is unlikely if there is no talk of _______.
Wheezing (piepen)
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Differential diagnosis of asthma
- Foreign body in airway
- Bronchiolitis
- Croup (swelling of airway causing 'steeple-sign')
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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.
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Medicine used to treat only severe asthma
Oral prednison
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Most important characteristics with regards to pharmacokinetics
- Remember DAME
- Distribution
- Absortion
- Metabolism
- Elimination
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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
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Babies have a (higher/lower) percentage body water than adults. This affects dosage of water soluble antibiotics, such as ________ and ________.
Higher, aminoglycosides, beta-lactams
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Babies have a (higher/lower) percentage of body fat than adults. This affects dosage of fat soluble medicines such as _______.
Lower, Sedative H1 antagonists
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Babies have a (higherl/lower) concentration of albumine. This means that medicines that bind albumine must be given in (higher/lower) doses
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Very important barrier which is not fully developed in newborns
BBB
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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.
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Factors causing an INCREASE in IGF-1
- alpha-adrenergic stimulation, hypoglycemia, malnutrition, exersion, sleep and stress
- (Remember, GH incr blood glucose)
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Factors causing a DECREASE in IGF-1
beta-adrenergic stimulation, hyperglycemia
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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)
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Classic presentation (apart from being short) of a GH deficiency
- Round face and trunk adipositis
- (Thus round face and fat a**)
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DD for short length
- Hypopituitarism
- Hypothyroidism
- Turner syndrome
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DD for long length
Klinefelter, XXX, XYY, Fragile-X syndromes
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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)
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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
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Differentiate actual central pubertas praecox from pseudo-pubertas praecox
Central involves the hypothalamic-pituitary axis
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Who is more likely to experience pubertas praecox, boys or girls?
Girls (23 times more likely)
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Tx for central pubertas praecox
- GnRH agonist (Decapeptyl)
- Side effect is decrease in final height
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McCune-Albright syndrome
Precocious puberty and café-au-lait spots - treat with anti-androgens
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Often associated with Coeliakie (Celiac's disease)
DM and thyroid disorders
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The pH of a baby's GI tract is (higher/lower) than that of an adults
Higher
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Baby's muscle is (more/less) vascularized
Less
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Baby's ratio of surface area to weight is (higher/lower) than that of adults
Higher
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Baby's have a (higher/lower) body water percentage
Higher
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Babies have a (higher/lower) concentration of plasma bonding proteins than adults
Lower
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Enzyme responsible for most drug metabolism and equivalent in children
CYP3A4, CYP3A7
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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
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Effect of LH on girls, boys
- Girls: Estrogen production
- Boys: Testosterone production (via stimulation of cells of Leydig)
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Effect of FSH on girls, boys
- Girls: Maturation of ovarian follicles
- Boys: Stimulation of Sertolli cells for spermatogenesis
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When is it best to measure estrogen levels?
During the night
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