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    Janica Marie Ragsac
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    A newborn was assessed using the APGAR scoring system and found to have a score of 8, indicating the infant was in good condition at birth. A 3-year-old male child presented with vomiting, loose stools, sunken eyes, dry lips, and hyperactive bowel sounds, indicating some level of dehydration. Management included oral rehydration solution and instructions for home care. A 58-hour-old infant presented with jaundice extending to the abdomen and elevated bilirubin levels, placing the infant in the high-intermediate risk zone. Phototherapy and monitoring were indicated along with assessing the need for further testing.

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    A newborn was assessed using the APGAR scoring system and found to have a score of 8, indicating the infant was in good condition at birth. A 3-year-old male child presented with vomiting, loose stools, sunken eyes, dry lips, and hyperactive bowel sounds, indicating some level of dehydration. Management included oral rehydration solution and instructions for home care. A 58-hour-old infant presented with jaundice extending to the abdomen and elevated bilirubin levels, placing the infant in the high-intermediate risk zone. Phototherapy and monitoring were indicated along with assessing the need for further testing.

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    26 views11 pages

    PGI Pedia Pracs

    Uploaded by

    Janica Marie Ragsac
    A newborn was assessed using the APGAR scoring system and found to have a score of 8, indicating the infant was in good condition at birth. A 3-year-old male child presented with vomiting, loose stools, sunken eyes, dry lips, and hyperactive bowel sounds, indicating some level of dehydration. Management included oral rehydration solution and instructions for home care. A 58-hour-old infant presented with jaundice extending to the abdomen and elevated bilirubin levels, placing the infant in the high-intermediate risk zone. Phototherapy and monitoring were indicated along with assessing the need for further testing.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
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    of 11

    1.

    ) At the 1st minute of life, a newborn was noted to have a Cardiac Rate of 140, with active
    movement, grimace to stimulation, acrocyanosis and good respiration

    A. What is the APGAR score? ​8


    Cardiac Rate -140-2
    Muscle tone-good-2
    Reflex- Grimace- 1
    Color-Acrocyanosis-1
    Respiration-good-2

    B. What is the normal APGAR score? ​7-10


    C. What is the significance of APGAR score?
    To assess for need of immediate resuscitation

    2.) An irritable 3 y/o Male with history of ​vomiting and loose stools​ was seen at the OPD
    with pertinent physical examination of: ​sunken eyeballs, dry lips, hyperactive bowel
    sound​s and was noted to drink eagerly.

    A. What is the level of dehydration? ​Some Dehydration


    sunken eyeballs + dry lips + Drinks eagerly -> Moderate dehydration -> If with 2 or more signs
    in B-> SOME DEHYDRATION
    B. Give management (Drug/s and dosage) including home instruction. (see photos
    below. Some dehydration-yellow and plan B)

    a
    P.S. binago ko lng ung picture coz may part na di mabasa kanina pero same siya sa pic :)
    3.) Baby Girl A is on her 58th hour of life. You noted that the j​aundice was down to the
    abdomen. ​Bilirubin Levels revealed Total Bilirubin 14.3 mg/dl,B1 12.2 mg/dl and B2 2.1
    mg/dl.
    Facts to consider​: Physiologic jaundice: appears after 24 hours -> so this case is
    Physiologic jaundice​ Peaks: Day 2-3, Disappears 5th day of life
    Jaundice is level of abdomen: so estimate is 15 mg/dl -> DECREASED
    BIOTRANSFORMATION (CONJUGATION)

    Under normal circumstances, the level of indirect bilirubin in umbilical cord


    serum is 1-3 mg/dL and rises at a rate of <5 mg/dL/24 hr; thus, jaundice
    becomes visible on the 2nd or 3rd day, usually peaking between the 2nd and 4th
    days at 5-6 mg/dL and decreasing to <2 mg/dL between the 5th and 7th days
    after birth.
    In general, a
    search to determine the cause of jaundice should be made if (1) it appears in the
    1st 24-36 hr after birth, (2) serum bilirubin is rising at a rate faster than 5
    mg/dL/24 hr, (3) serum bilirubin is >12 mg/dL in a full-term infant (especially in
    the absence of risk factors) or 10-14 mg/dL in a preterm infant, (4) jaundice
    persists after 10-14 days after birth, or (5) direct bilirubin fraction is >2 mg/dL at
    any time.

    a.Using the Bhutani chart at what zone will the bilirubin levels fall?
    High-intermediate Risk zone ​ ( because baby is on the 58th hour of life with a total serum
    bilirubin of 12)

    B. Using Kramer’s Chart what will be the approximated bilirubin levels of this patient?

    j​aundice was down to the abdomen -> 14 mg/dl​ ( I can’t find this sa Nelson’s )
    C. What will be your plan of management?
    -Firstly, phototherapy is indicated in High-intermediate risk zone.
    -Explain that it resolves in 1 week in full term infants
    -Interview patient to assess for need to do COOMB’s Test.
    -Educate about breastfeeding and how it may ause jaundice

    4.) Baby Zoe a 7 month old female came in the OPD for well baby check up.

    What is her IBW? ​ 7 x 500 + 3000 grams = ​6500 grams


    7-12 months: Age (in mos) x 500 + BW
    *Average weight at birth: 3000 grams

    What is the expected HC? 44.5 cm


    At birth head circumference is 35 cm ( normal babies
    - Should be monitored routinely during the first 3 years of life
    o Especially in the first 2 year
    Measured over the most prominent part of the occiput and just above the supraorbital ridges
    Assuming Birth Head Circumference is 35 cm -> She is 7 months:
    35 cm ( birth ) + ( 6 cm -> 1st 3 months has 2 cm for the first month) + ( 3 cm -> 2nd 3 months has 1 cm per month) +
    ( 0.5 cm -> for the 7th month) = 44.5 cm

    Compute for the number of teeth/s expected for this age group?
    7-months old: ​so 2 central incisors from mandibular area ( 5-7 months) + 2 central incisors
    on maxillary area ( 6-8months) + 2 lateral incisors from mandibular area ( 7-10 months) = ​6
    teeth-> It is expected for her to have 6 teeth

    Cinco trans:
    Eruption usually occurs at 6 months mandibular central Incisors
    o You can wait until 15 months of age
    - Eruption of permanent teeth begins at around 6 y/o and completed around 18 y/o
    - Visit to the dentist could be done as early as the first tooth erupts

    Nelsons:
    Initial mineralization begins as early as the​ 2nd trimester ​(mean age for
    central incisors, 14 wk) and ​continues through 3 yr of age for the primary
    (deciduous) teeth and 25 yr of age for the secondary (permanent) teeth​.

    Eruption begins with the central incisors and progresses laterally.


    Nelsons:
    Central incisors: 5-7 months ( mandibular), and 6-8 months ( maxillary).
    Lateral incisors 7-10 months (mandibular), and 8-11 months ( maxillary)
    5.) Identify the lesion. ​Milia
    Is it Physiologic or Pathologic? ​Physiologic

    6.) During a physical examination to an adolescent you noted that there is breast bud with
    elevation of breast and papilla.
    a.) Identify the SMR. ​Tanner Stage 2

    b.) In getting the Personal and Social History of this patient using HEADSSS FIRST, what is
    letter E? ​Education
    c.) In interviewing the adolescent, what principle/s must you remember? ​Confidentiality? Lol

    7.)
    A. Identify Structure A? ​Anterior fontanelle
    B. When do you expect Structure B to close?
    2-3 months after birth

    8.) A one year old boy with unrecalled vaccinations given developed fever. On his 3rd day
    of illness, he was brought to the OPD. Upon oral examination, you saw:

    A. Identify the pointed lesion. ​Kopliks spot

    B. This is pathognomonic of what disease? ​Measles


    9.) PP, 5 years old was admitted because of 5 days fever. On the 8th hospital day , fever
    lysed and you noted the appearance of these skin changes in the legs.

    A. What do you call the skin lesion? ​Hermans rash


    B. In what disease is this rash seen? ​Dengue
    C. In what phase of the disease it is typically seen? ​Recovery phase
    10. 12 month old, male, came in the clinic for a well baby visit
    A. Expected Developmental milestones
    Motor: walks with one hand held; rises independently, takes several steps (Knobloch)
    Adaptive: Picks up raisin with unassisted pincer movement of forefinger and thumb, releases object to
    other person on request or gesture
    Language: Says a few words besides “mama,” “dada”
    Social: Plays simple ball game, makes postural adjustment to dressing

    B. Based on EPI, what vaccine should he receive?


    MMR vaccine
    C. What other vaccines will you recommend?
    PCV vaccine booster ( if compete First 3 doses of PCV 6 months prior)
    - Varicella
    -Hepa A
    -Influenza ( if not yet given)

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