Практикум по педиатрии. Practicum in Pediatrics. Учебное пособие для студентов 5-го курса

PEOPLES’ FRIENDSHIP UNIVERSITY OF RUSSIA

PRACTICUM IN PEDIATRICS

GUIDE FOR 5TH YEAR STUDENTS

Edited by

D.Yu. Ovsyannikov, M.G. Kantemirova

Moscow

Peoples’ Friendship University of Russia

2013

3

4

Case 2

A boy T. from first pregnancy, which occurred with hypotension (BP 90/65 mm Hg), anemia (Hb 86 g/l). During delivery, fetus stayed in the birth canal for 26 hours, due to discrepancy between the birth canal and the size of the fetus. At birth, due to oxytocin administration – a faint cry, RR 36, HR 120 per min, there was a flexion of the lower extremities, acrocyanosis. After 5 min, cyanosis of the skin increased. Cyanosis transformed into pallor. Breathing rare, superficial, HR 50 per min, muscle atony, reflexes are depressed, during oxygen therapy – a grimace on his face appeared. In the blood pH = 7.1, BE = –13 mmol/l.

Questions:

1.Rate newborn (Apgar).

2.Put presumptive diagnosis.

3.Which information in the medical record confirms the diagnosis?

4.Differentiate this condition.

5.Make a plan for urgent examination and treatment.

Case 3

A boy was born from a woman with thyroiditis, medical compensation, BP 160/100 mm Hg, nephropathy, prolonged delivery. During birth due to amniotic fluid aspiration syndrome, cyanosis of face and mucous membranes, lack of breath, muscle atony,

6

weak grimace, HR 70 per min. Reanimation measures were taken. After 5 minutes: weak cry, RR 30, HR 110 per min, the visible mucous membranes and skin were pale-pink, moderate acrocyanosis, muscular dystonia with a tendency to hypotension. In dynamics: lethargy, newborn reflexes: sucking and Moro reduced, eyelid edema, tonic convulsions were noticed. According to laboratory data: Creatinine 130 mmol/l, in analysis of urine protein levels from 0.075 – 0.05 – 0.065 mg%.

Questions:

1.Rate newborn (Apgar).

2.Put the diagnosis in this child.

3.Which neurological symptoms characterize this phase of CNS damage?

4.What are the reasons of the changes in the biochemical analysis of blood and urine?

5.Plan for examination and treatment.

Case 4

A 5 day-old boy transferred from the maternity hospital to the department of pathology because of continuous crying and sleep disorders.

Anamnesis: from the 2nd pregnancy (1st med. abortion) at 38 week: prenatal rupture of membranes, duration of delivery was 25 hours, obstetrician forceps were used. Cried directly, Apgar score 7/8 points; weight 3,500 g, length 51 cm, head circumference 35 cm.

7

The state was moderate, excitable. Skin was hyperemic. Laterally on the head there were marks of forceps and general swelling of tissues. In the left parietal bone was formation with palpable soft roller on the periphery within the bone. Fontanel 1.5x1.5 cm, not bulging. Neonatal reflexes were normal. In organs no pathology, RR 54, HR 154 per min. Radiography of the skull: no traumatic injuries, cranial sutures are closed, tissue of left parietal area thickened.

Questions:

1.Diagnosis.

2.Prognosis of this disease.

3.Which factors contributed to the disease?

4.Differential diagnosis.

5.What is the treatment strategy?

Case 5

A boy C., 15 days old, admitted to the hospital with complaints about anxiety, superficial sleep, fell asleep badly due to flatulence, abdominal colic pain (crying loudly, his face became red), from birth regurgitation after feeding was noticed, sometimes vomiting 2-3 times. He gained weight badly (about 70 g.).

The child was born from I pregnancy with toxicosis in the first and second halves (vomiting, dizziness, nephropathy), delivery at 37 weeks for 3 hours, cried after cleaning of the upper respiratory tract. Apgar score 5/8 points, weight 2,100 g, length 43 cm.

8

Objectively: regular constitution. While crying, tremor of the chin and hands was noticed. Sucking, swallowing reflexes are satisfactory, arms extended, feet flexed, muscle dystonia. Fontanel 1.5x1.5 cm, bulging, small fontanelle 1x1 cm. Hyperemic skin, lanugo hair on the shoulders, expressed cutis marmorata, perioral cyanosis; distal extremities are cold, moist. In the umbilical region there is no change. In the lungs, the breathing is weakened, RR 52 per min. Heart sounds are muffled, tachyarrhythmia (HR 168 per min). Abdomen is distended, rumbling. Thin stool, with undigested lumps, lean, up to 3-4 times daily.

Questions:

1.Is using the Apgar score only is enough for the diagnosis of neonatal asphyxia?

2.Name the risk factors of CNS in the child.

3.Diagnose, justify it.

4.Put differential diagnosis of gastrointestinal diseases in this child

5.Which drugs and nutritional correction does this child need?

Case 6

A boy F., 3 days old, was born from III pregnancy which occurred with toxicosis, threat of miscarriage at 15th week (abdominal pain, recurrent bleeding, was treated at hospital). Examination revealed a violation of placental blood flow, placental insufficiency,

9

mother received infusion therapy, spasmolytic, Magnesium, vit. B6. I pregnancy – medical abortion, II-miscarriage at 9 weeks. Mother 30 years old – working as a house painter, suffers from vascular dystonia – hypertensive type. Births at 37 weeks, duration – 27 hours, dripping of water for 14 hours, anhydrous period – 8:00, stimulation with oxytocin was carried out. Birth weight 2,350 g, length 47 cm, head circumference 33 cm, chest circumference 30 cm. After cleaning of the upper respiratory tract and oxygen therapy, within 1 min – gasping-breathing, muscle atony, heart rate = 94 min, inhibition of reflexes, acrocyanosis. pH = 7.2, BE = -18 mmol/l.

the limbs in the absence of active movements, acrocyanosis, a grimace on the face, SatO2 89%.

Questions:

1.Assess the newborn by Apgar score.

2.Evaluate his development.

3.Diagnose.

4.Explain the mechanism of this disease.

5.List the main measures of treating the child in the delivery room.

Case 7

A girl M., 5 days old, from the 4th of pregnancy occurred with placental insufficiency, preeclampsia I-II half; birth at 32-33 week, with prenatal rupture of

10