OSCE review

Pegah Katibeh

ϩέΎϤηϩΎ� Θδϳ1

ϝϮγϦΘϣ: ήδ�6ϪΘϔϫ ϳί ΩέΩϮϠ� ϭΐΗϪϘΑΎγΎΑ ϪϟΎγ ϣϪψΣϼϣήϳϭΎμΗέΩϪ$ ΘγϮ� ΕΎόϳΎο .ΖγϩΩή$ ϪόΟ ήϣζϴ�

βϤϟέΩΕΎόϳΎοϦϳ .ΖγϩΪηήϫΎχ ϧΎΘΤΗϡ ΪϧέΩΪϴϨ$ .ΪϨΘδϫ ΎϧΩέΩ

ˮΪϴδϳϮϨΑ έ ΘγϮ� ΕΎόϳΎοϡΎϧ -ϒϟ ˮΪϴδϳϮϨΑ έΕΎόϳΎοϦϳ ίϭήΑΖϠϋέΎϬ= -Ώ

ˮΪϴδϳϮϨΑ έέΎϤϴΑϦϳ ϥΎϣέΩ -Ν

:ϩΪη ΪϨΑϡέΎΑΦγΎ�1. Erythema Nodosum (3 )ϩήϤϧ 2. a. Inflammatory disease (eg: IBD, sarcoidosis) (4 )ϩήϤϧ

b. Infectious disease (group A strep, tuberculosis, yersinia, Histoplasmosis)

c. Drugs 3. Supportive treatment ( bed rest, elevation of legs, analgesics)

( 3)ϩήϤϧ

ϩέΎϤηϩΎ� Θδϳ2 :ϝϮγϦΘϣ ϳϪϘΑΎγϭΖγ ϩΪθϧϪϨΘΧϪ$ ήδ� έ ϮΧήϴη

Ζϳΰϳϭ έ έ ήϗ ΑϭΐΗΖϳΎH ηΎΑΩέ Ω έ έΩΖϧϮϔϋέΎΑ .ΪϴϳΎϤϧ ϣ

ϣϥΎθϧΖΒΜϣΕ ήΘϴϧˬ έϮϳήΘ$ ΎΑˬ έϮϴ� έ έΩζϳΎϣί.ΪϫΩ

.ΪϴϫΩΦγΎ� ήϳίΕϻ ϮγϪΑέ ϮΧήϴηϦϳ ΩέϮϣέΩ ˮΪϴΘγήϓ ϣέ έΩΖθ$ ΖϬΟϪϧϮϤϧ ηϭέϪ= ΎΑ -ϒϟ

ˮΪϴϨ$ ϣΖγ ϮΧέΩN ϮϟϮϳΩ έζΨΑςγϮΗ γέήΑϪ= ΪΘΑ -Ώ ϣ ΖγϮΧέΩ ˲ΪόΑ έ ϪΘδϫ Ύϳ ϳNϮϟϮϳΩέ εϭέ ϡΪ$ -Ν

ˮΪϴϳΎϤϧ ΪϳέΩ ϪϴλϮΗϪ= ϭϪϨΘΧΩέϮϣέΩ -Ωˮ

:ϩΪη ΪϨΑϡέΎΑΦγΎ� -ϒϟSuprapubic (ήΘΗΎ$ ΎΑΎϳϭ2 )ϩήϤϧ

( ϓ ή� ϮϧϮγ -Ώ2 )ϩήϤϧ -ΝDMSA Scan, VCUG( 4 )ϩήϤϧ

ϥΎϣέΩί β� ΖλήϓϦϴϟϭ έΩ -ΩUTI( .ΩϮηϡΎΠϧ ΘδϳΎΑ2 )ϩήϤϧ

ϩέΎϤηϩΎ� Θδϳ3

:ϝϮγϦΘϣϥίϭΎΑ Ω ίϮϧ2600έΩΎϣί ϡή�G2P2Ab0 Ϫ= ϩΎV θϳ ίί Ω ίϮϧϦϳ κϴΧήΗί ϞΒϗ .ΖγϩΪηΪϟϮΘϣέΩΪϳΪη ϤϨϴΑϭήϴϠϴΑήY ϴϫϝΎϤΘΣ ϦϴϴόΗΖϬΟ έ Ωέ Ϯϣ

Ϟϗ ΪΣ(ˮΪϳήϴ� ϣήψϧ10 .)ΪϴδϳϮϨΑ έΩέϮϣ

:ϩΪη ΪϨΑϡέΎΑΦγΎ�

ΩέϮϣήϫ1ϩήϤϧ1- V ϠϣΎΣϦγ 2- ΖΒδϨΟ 3- ϩ ήϤϫϥίϭζϫΎ$ ΎΑϪH ϴΗέϮλέΩέΩΎϣήϴηΎΑϪϳάϐΗ

ΪηΎΑ 4- ϠΒϗΪϧίήϓέΩϥϮΧξϳϮόΗΎϳ� ήΗϮΘϓϭ ΩέίϪϘΑΎγ

ϩΩ ϮϧΎΧ 5- Ω ίϮϧϭέΩΎϣϥϮΧϩϭή� 6- Ω ίϮϧϥίϭζϫΎ$ 7- ΪϳΪη ΩϮΒ$ ϭϡϮΗΎϤϫϝΎϔγ 8- έΩΎϣϦγ 9- έΩΎϣΖΑΎϳΩ

10- ΩϮΒϤ$ ϪϘΑΎγG6PDϩΩ ϮϧΎΧέΩ 11- ϪϘτϨϣέΩκϴΧήΗί ϞΒϗϦϴΑϭέ ϠϴΑHigh risk zone

ΪηΎΑϥΎΗϮΑ ϨΤϨϣ 12έΩϥΎϗήϳ -24� Ϊϧίϝϭ ΖϋΎγ13Ω ίϮϧϭέΩΎϣ ϧϮΧϩϭή� ΕϭΎϔΗ -14 )ϠΒϗΩ ίϮϧέΩ (� ήΗϮΘϓϪϘΑΎγ -

ϩέΎϤηϩΎ� Θδϳ4 :ϝϮγϦΘϣ$ ΩϮ$2ΎΑϪϟΎγ12 .ΖγϩΩή$ ϪόΟ ήϣΐΗίϭέ

.ΩϮη ϣϩΪϫΎθϣϡήϔϴϠϴΑήϣ Ύϫε έ ϭΖγϮ� ϭέ

ΕΎθϳΎϣί έΩCRP: 24 mg/dL, ESR:80mm/hr .ΩϮη ϣϩΪϫΎθϣ ήΘδΑϥΎΘγέΎϤϴΑέΩέΎϤϴΑϞΑΎϘϣήϳϭΎμΗϪΑϪΟϮΗΎΑ

έΎϤϴΑϥίϭ .ΩΩήV ϴϣ12 .ΪηΎΑ ϣϡή� ϮϠϴ$ ( ϳϭέ Ωϭ μϴΨθΗΕ έϮΘγΩ(Order Ϫ� ήΑέΩ έέΎϤϴΑϦϳ

OrderˮΪϴδϳϮϨΑϞΑΎϘϣ

:ϩΪη ΪϨΑϡέΎΑΦγΎ�:ϩΪϧϭή� ϩέΎϤη :ϪσϮΑήϣζΨΑ :έΎϤϴΑϡΎϧ

( 1 )ϩήϤϧWt:

Please: - Echo - IVIG 24gr in 24 hrs in infusion as prescubed - ASA 240 mg PO Q6hr - EKG - CX ray

Ϟϗ ΪΣ(3:ΩέϮϣ9 )ϩήϤϧ

ϩέΎϤηϩΎ� Θδϳ5 ϝϮγϦΘϣ :ϥίϭΎΑ ϪϟΎγϩΩϪ_ Αήδ�27Ϊϗϭϡή� ϮϠϴ$122

ϞϣΎ$ εέΎϤηΎϫ γέήΑέΩ .ΖγϩΩϮϤϧϪόΟ ήϣˬήΘϤϴΘϧΎγ ϟϮϠγ(CBC)� ϮH γϭήH ϴϣζϳΎϣί ϭέ έΩΖθ$ ϭΰϴϟΎϧ ˬ

:ϢϴδϠ$ .Ζγ όϴΒσωϮϓΪϣ10/2 :ήϔδϓˬ5/3ϦϴϟΎH ϟ ˬ :ίΎΗΎϔδϓ288ϝΩΎόϣ ϭ ϧ ϮΨΘγϦγ .Ζγ7ϭϝΎγ1ϩΎϣ

ϩέΎϤη ϨΤϨϣϪΑϪΟϮΗΎΑ .ΪηΎΑ ϣ1ΦγΎ� ήϳίΕϻ ϮγϪΑ.ΪϴϫΩ

ˮΖδϴ= έΎϤϴΑϦϳ έΩΎϤηκϴΨθΗ -ϒϟ ˮΪϴδϳϮϨΑ έκϴΨθΗϦϳ ϥΩϮϤϧΡήτϣΖϠϋ -Ώ

ˮΪϳέΩ ϭ ήΑ ϪϴλϮΗϪ= -Ν

:ϩΪη ΪϨΑϡέΎΑΦγΎ� -ϒϟConstitutional short stature ϨΤϨϣ ί έΎϤϴΑ Ϊϗ ϻ˱ϭ ήϳί

3 .ΪηΎΑ ϣήΗϦϴϳΎ� ϭϦγ %ί ϭΩήϫϭϩΩϮΑήΑ ήΑε ϧ ϮΨΘγϦγΎΑ ϭ ΪϗϦγ -Ώ

.ΪηΎΑ ϣήΘϤ$ έΎϤϴΑ ϤϳϮϘΗϦγΪϫ ϮΧ όϴΒσ ϭ ϳΎϬϧΪϗ ήϳίϢϴϫΩ ϣ έ ΪϟΩςϘϓ -Ν

.ΩϮΑ

ϩέΎϤηϩΎ� Θδϳ6

:ϝϮγϦΘϣ ήδ�5έΩϩΩϮϤϧϪόΟ ήϣϩΎΗϮ$ ΪϗΎΑϪϟΎγ ϣϩΪϫΎθϣ έϪϨϴγϪδϔϗβH ϋ .ΩέΪϧίϮϧΎϴγϪϨϳΎόϣ

:ΪϴϫΩΦγΎ� ήϳίΕϻ ϮγϪΑˬΪϴϳΎϤϧ

ˮΪηΎΑ ϣ έΰΑΐϠϗ ΎϫϩήϔΣί ϳϡ Ϊ$ .ϒϟ ˮΖγϪϧϮV= ϮϳέϕϭήϋΖϴόοϭ .Ώ

ˮΖδϴ= ΒϠϗ έΎϤϴΑ ϟΎϤΘΣ κϴΨθΗ .Ν ˮΪηΎΑ ϣΡήτϣϡέΪϨγϡ Ϊ$ ϭ ϩΎΗϮ$ ΪϗϪΑϪΟϮΗΎΑ .Ω

:ϩΪη ΪϨΑϡέΎΑΦγΎ�ˬΪηΎΒϴϣϪΘδΟήΑΏΎϧ ήϨϤϟϮ� -ϒϟRVˬϩΪη έΰΑRA έΰΑ

(ϩΪη5/2 )ϩήϤϧ(ΪηΎΑ ϣϝΎϣήϧ -Ώ5/2 )ϩήϤϧ

-ΝPs( 5/2 )ϩήϤϧ(ϡέΪϨγϥΎϧϮϧ -Ω5/2 )ϡέΪϨγ

ϩέΎϤηϩΎ� Θδϳ7

:ϝϮγϦΘϣ ΎϫΖΒϗ ήϣζΨΑέΩϪ$ έ$ ΩϮ$ ϪϨϴγϪδϔϗβH ϋΦγΎ� ήϳίΕϻ ϮγϪΑ .ΪϴϳΎϤϧ ϣϩΪϫΎθϣΖγ ήΘδΑϩh ϳϭ

.ΪϴϫΩ

ˮΪϴδϳϮϨΑ έβH ϋέΩ όϴΒσήϴ ϪΘϓΎϳϪγϏ -ϒϟ ˮΖδϴ= ϥΎϣέΩϦϳήΘϬΑ -Ώ

:ϩΪη ΪϨΑϡέΎΑΦγΎ� -ϒϟ

1. ET tube down to Rt- lung 2. Hyperaeration of Lt- lung 3. Collaps of Lt- lung

-ΏTube up

ϩέΎϤηϩΎ� Θδϳ8

:ϝϮγϦΘϣύ ήϔΘγϪϘΑΎγΎΑ έ ϪϟΎγϢϴϧϭϭΩ ΩϮ$ΕΪϣϪΑ ϭ ήϔλήϴϏ7ˬΪΘϓ ϣϕΎϔΗ άί ΪόΑϪ$ ϩΎϣϏ

έΩεΪϧίήϓΩέ Ω ϣέΎϬχ έΎϤϴΑέΩΎϣ .ΪϴϳΎϤϧ ϣΖϳΰϳϭΖΒΜϣϪΘH ϧΪηέϝϼΘΧ ΰΟϪΑϪϨϳΎόϣέΩ .Ωέ ΩϞH θϣ άϊϠΑϏ

ϩΪηϡΎΠϧ έΎϤϴΑ ήΑϞΑΎϘϣ έΎV ϧϮΗή� .ΩέΪϧ ήV ϳΩ .Ζγ

ˮΪϴδϳϮϨΑ έϞΑΎϘϣ έΎV ϧϮΗή� εϭέ -ϒϟ (ΪϴδϳϮϨΑ έβH ϋ ΎϫϪΘϓΎϳ -Ώ2ˮ)ΩέϮϣ

ˮΖγΡήτϣέΎϤϴΑ ήΑ μϴΨθΗϪ= -Ν ˮΪϴϫΩ ϣϡΎΠϧ ϣ ΪϗϪ= κϴΨθΗΕΎΒΛ ήΑ -Ω

(ΪϴϨ$ ϣΩΎϬϨθϴ� έΎϤϴΑ ήΑ ϳΎϫϥΎϣέΩϪ= -˰ϫ3 ˮ)ΩέϮϣ

:ϩΪη ΪϨΑϡέΎΑΦγΎ�

-ϒϟBarium Swallow ( 2 )ϩήϤϧ( ήϣ ϧΎΘΤΗήΘV Ϩϔγ ϞΤϣV ϨΗˬ ήϣ ΩΎθ� -Ώ2 )ϩήϤϧ

( ίϻΎη -Ν2 )ϩήϤϧ( ήϣ ήΘϣϮϧΎϣ -Ω2 )ϩήϤϧ

ϩ–ϦϟΎΑΎΑϥϮϴγΎΗϼϳΩ– ϣϮΗϮϴϣ Σ ήΟ–(β$ ΎΗϮΑϖϳέΰΗ2 )ϩήϤϧ

ϩέΎϤηϩΎ� Θδϳ9

ϝϮγϦΘϣ :ήδ�4Ϫγί ΩέΩήγϭΐΗΖϠϋϪΑ έ ϪϟΎγέΎϤϴΑ ϨϴϟΎΑϪϨϳΎόϣ .ΪϧϩΩέϭ ΎϤηΩΰϧˬζϴ� ϪΘϔϫ

ΦγΎ� ήϳίΕϻ ϮγϪΑϞΑΎϘϣβH ϋϪΑϪΟϮΗΎΑ .Ζγ όϴΒσ .ΪϴϫΩ

ˮΪϴδϳϮϨΑ έ έΎϤϴΑκϴΨθΗ -ϒϟ ˮ)ΩέϮϣϪγ (ΪϴδϳϮϨΑ έϕϮϓβH ϋ ΎϫϪΘϓΎϳ -Ώ

ˮΖγϡ Ϊ$ έΎϤϴΑϦϳ κϴΨθΗεϭέϦϳήΘϬΑ -Ν ˮΪϴδϳϮϨΑ έ ΩΎϬϨθϴ� ϥΎϣέΩ -Ω

:ϩΪη ΪϨΑϡέΎΑΦγΎ� -ϒϟBrain abscess ( 2 )ϩήϤϧ

-ΏRing enhanced lesion in Rt Parietal lobeˬshift of midline to the opposite sideˬInfarction of the adjacent Brain parenchyma ( 3 )ϩήϤϧ

-ΝCTΎϳϖϳέΰΗΎΑMRI( 1 )ϩήϤϧ -ΩVancomycin +3rd generalize of cephalosporine + Metronidazol +

Aspiration abcess ( 3 )ϩήϤϧ

When the cause is unknown, the combination of vancomycin, a 3rd-generation cephalosporin, and metronidazole is commonly used.

The same regimen is initiated when otitis media, sinusitis, or mastoiditis is the likely cause.

If there is a history of penetrating head injury, head trauma, or neurosurgery, vancomycin plus a 3rd-generation cephalosporin is appropriate.

When cyanotic congenital heart disease is the predisposing factor, ampicillin-sulbactam alone or a 3rd-generation cephalosporin plus metronidazole may be used.

Meropenem has good activity against gram-negative bacilli, anaerobes, staphylococci, and streptococci, including most antibiotic-resistant pneumococci, and may be used alone to replace the combination of metronidazole and a β-lactam in the previous regimens.

Notably, meropenem does not provide activity against methicillin-resistant S. aureus and may have decreased activity against penicillin-resistant strains of S. pneumoniae, indicating that vancomycin should remain a part of the initial regimen when these organisms are suspected.

Abscesses secondary to an infected ventriculoperitoneal shunt may be initially treated with vancomycin and ceftazidime.

When Citrobacter meningitis (often in neonates) leads to abscess formation, a 3rd-generation cephalosporin is used, typically in combination with an aminoglycoside.

Listeria monocytogenes may cause a brain abscess in the neonate and if suspected, ampicillin should be added to the cephalosporin.

In immunocompromised patients, broad-spectrum antibiotic coverage is used, and amphotericin B therapy should be considered.

• without surgery if• the abscess is <2 cm in diameter,• the illness is of short duration (<2 wk), • there are no signs of increased intracranial pressure, and• the child is neurologically intact. • Surgery • when the abscess is >2.5 cm in diameter,• gas is present in the abscess, • the lesion is multiloculated, • the lesion is located in the posterior fossa, or• a fungus is identified. • Associated infectious processes, such as mastoiditis, sinusitis, or a

periorbital abscess, may require surgical drainage. • The duration of antibiotic therapy depends on the organism and

response to treatment, but is usually 4-6 wk.

ϩέΎϤηϩΎ� Θδϳ10

.ΪηΎΑ ϣϪϟΎγϪγ� ΩϮ� ϪΑρϮΑήϣΐϠϗέ Ϯϧϭβ� ϋ

1. ˮΪϳήΒΑϡΎϧ έΐϠϗέ Ϯϧ όϴΒσήϴ ϪΘ� ϧϪγϏ 2. ϣϥΎθϧ έ ϳΎϬΘϤδϗϪ* ΎϬθϠϓϪϨϴγϪδϔϗβ� ϋέΩ

ˮΪϨϫΩ 3. ˮΖδϴ* έΎϤϴΑ ϟΎϤΘΣ κϴΨθΗ

:ϩΪη ΪϨΑϡέΎΑΦγΎ�1έϮΤϣϑ ήΤϧˬΖγ έΰϴϠϫΩ� έΰΑ -Superior AxˬPRΰϴϠϫΩˬ ϧϻϮσ

ϦτΑϭΩ� έΰΑˬ έΰΑ= 2 -1Ζγ έΰϴϠϫΩ -2= ΰϴϠϫΩ -3= ΰϴϠϫΩϞH ϳέ -4= ϦτΑ - 3-AVSD

ϩέΎϤηϩΎ� Θδϳ11

� ΩϮ� ϳϭέ ΩϥΎϣέΩϒϠΘΨϣϞΣ ήϣ13έΎθϓΎΑϪϟΎγϥϮΧ140/90ΎΑϪ�6ϝήΘϨ� ϳϭέ Ωήϴ ϥΎϣέΩϩΎϣϏ

ϩΪηϩΩ ΩϥΎθϧˮΖϣϼϋΎΑήϳίϢΘϳέϮ� ϟ έΩϩΪθϧ.ΪϴϨ� ή= έ ϟΎΧ ΎϫΎΟ .Ζγ

Step 1: Low dose of β-blocker

BP= 135/85

Step 2:↑dose

BP= 130/85

Step 3: Vasodilator or Ca-channel (blocker), α-blocker

BP: 125/85

Step 4: Converting enzyme AIRB

5/2 ϩήϤϧ

5/4 ϩήϤϧ

3ϩήϤϧ

ήΘΧΩ ϳέΩ16ήψϧί Ζγ γέήΑΖΤΗN έϮϨϣΖϠϋϪΑϪ$ ϪϟΎγ :ΖγήϳίΡήηϪΑϥ ΞϳΎΘϧϪ$ Ζγ ϩΪηϡΎΠϧ ΩΎϘόϧ ΕϼH θϣ

PLT: 258000 MCH: 26 MCV: 76 HB: 11.7 WBC : 6700, Nl diff.

BT: 6’ PTT: 56’’ INR: 1.1 PT: 13.5 control : 13

.Ζγ ϔϨϣϩΪϨϫΩ ΰϳήϧϮΧ Ύϫ έΎϤϴΑήψϧί ϠϴϣΎϓϪϘΑΎγ ˮΖγ ΡήτϣΖϴϤϫ ΐϴΗήΗϪΑ ϗ ήΘϓ ΎϫκϴΨθΗϪ= -ϒϟ

ˮΪϴϨ$ Ϣγέ έ ϳΎϬϧκϴΨθΗϪΑϥΪϴγέΖϬΟ μϴΨθΗϢΘϳέϮV ϟ -Ώ ˮΖδϴ= ΩήϓϦϳ ήΑκϴΨθΗϦϳήΗϞϤΘΤϣ -Ν

ˮΪϴϨ$ ϣϪϴλϮΗ έΎϤϴΑϦϳ ήΑ ϳΎϫϥΎϣέΩϪ= -Ω

:ϩΪη ΪϨΑϡέΎΑΦγΎ� -ϒϟ

1- Ϊϧ ήΒϠϳϭ έΎϤϴΑ2έϮΘ$ ΎϓΩϮΒϤ$ -11 3 -Lupus anti coagulant 4έϮΘ$ ΎϓΩϮΒϤ$ -8

5έϮΘ$ ΎϓΩϮΒϤ$ -9ϡ Ϊ$ ήϫ ( 25/0 )ϩήϤϧ ϳ Ύ˱όϤΟ

ˮΪϴϨ$ Ϣγέ έ ϳΎϬϧκϴΨθΗϪΑϥΪϴγέΖϬΟ μϴΨθΗϢΘϳέϮV ϟ -Ώ

Step 1: Redo PTT with mixing study

If PTT not corrected Request ANA, ds DAN, C3, C4, LAC, ACLA If PTT corrected: - VWF Ag, VWF RCO, RIPA test , - Factor VIII level, -Factor XI level, - Factor IX level

)ΪϴY ϴϟϮϔδϓ Θϧ ϡέΪϨγήψϧί γέήΑ (

(Ϊϧ ήΒϠϳϭϥϭ έΎϤϴΑ -Ν5/0 )ϩήϤϧ

-Ω1- DDAVP 2 -VWF concentrate( 5/0)ϩήϤϧ

ΩϮ$4 .ΖγϩΪηϩΩ ΩωΎΟέ ϩΎV ϧΎϣέΩϪΑ� Ϊϳή� ϧέΎΑ ϪϟΎγ τϴΤϣϥϮΧζϳΎϣί έΩ .ΩέϮΧ ϣΖγΩϪΑϝΎΤσ ϮϧϪϨϳΎόϣέΩ

ϦϴΑϮϠ� ϮϤϫ9ϩΪηϩΩ ΩϥΎθϧϞΑΎϘϣέΩ ϭ τϴΤϣϥϮΧϡϻ .ΪηΎΒϴϣˮΪϴδϳϮϨΑ έ ϳΎϬϧκϴΨθΗβY γˮΪϴϨ$ ϒϴλϮΗ έϥ .ΖγHb:9,

MCV:66, RBC: 3.5, Plt: 550000, WBC:5000

:ϒϴλϮΗTear drop, Pencil shape RBC, Hypochromia, Micrcytosis, ( 8)ϩήϤϧ

(Ϧϫ ήϘϓ Ϥϧ :έΎϤϴΑ2 )ϩήϤϧ

έΩΎϣ ϳί34έΩΖγ V ϠϣΎΣΖϴϣϮϤδϣϪΑϼΘΒϣϪ$ ϪϟΎγ37

ϪϨ� έΎ= Ω .ΖγϩΪϣ ΎϴϧΩϪΑΩ ίϮϧϦϳέ ΰγςγϮΗV ΘϔϫϩΪϨϨ$ ϡή� ήϳίέΩΩ ίϮϧ .ΖγϥϮΗϮY ϴϫˬϩίϮϧΎϴγˬ δϔϨΗ

ϭΐγΎϨϣΖϴόοϭ έ ήϗήΑί ΪόΑϭΩϮθϴϣϩΩ Ωέ ήϗ θΑΎΗϪϨ� ίϮϨϫ ϟϭΪη ϳήΤΗΩ ίϮϧˬ ϳ Ϯϫ ΎϬϫ έϥΩή$ Ύ�

ήΑϭΪηϡΎΠϧ έ ά� ϪϟϮϟ .ΩέΩϩίϮϧΎϴγϭ δϔϨΗ30 ϪϴϧΎΛPPVΐϠϗ .ΪηϩΩ Ω40 /minϣϩΪϴϨηϪΑήο ϥΩήθϓ .ΩϮη

ΎΑϩ ήϤϫϪϨϴγϪδϔϗPPV ήΑ30 ΎϬΘϧ έΩ .ΪηϩΩ ΩϪϨϳΎΛ90ίϮϨϫϪϴϧΎΛHR=50 /min ϣˮΖγϡ Ϊ$ ΪόΑϡ ΪϗΪηΎΑ 1Ϫϣ Ω -PPVϪϨϴγϪδϔϗϥΩήθϓϭ 2ϢϳΪγΕΎϨΑήH ϴΑϖϳέΰΗ - 3Ϧϳήϔϧ� ϖϳέΰΗ - 4ϥΎδ$ ϮϟΎϧϖϳέΰΗ - 5ϝΎϣήϧϦϴϟΎγϖϳέΰΗ -10 ml/kg

ϩέΎϤηϩΎ� Θδϳ15

ήδ�7ϩΩέϭ ΎϤηΩΰϧΪϳΪηϪϳή� ϭ έ ήϗ ΑΎΑ ϪϫΎϣΕέϮλϪΑ ΪΘΑζϴ� ΖϋΎγϦϳΪϨ= ί ϭ έ ήϗ Α .Ϊϧ

ϪΑ ΩϮ$ ϪϨϳΎόϣ .Ζγϡϭ ΪϣΕέϮλϪΑϥϮϨ$ ϭϪΘγϮϴ� ΎϧϊϔϧϪΑ ϪΘH ϧ ϟϭΪηΎΑ ϤϧϖϴϗΩ ϭΪϳΪη έ ήϗ ΑΖϠϋϞϠϋϦϳήΗ ΎϧήτΧί ΖϠϋέΎϬ= .ΩέΪϧΩϮΟϭΐϴγ ΎϳϪΑήοΖϠϋϥ μϴΨθΗεϭέϦϳήΘϬΑΎΑϩ ήϤϫ ΩϮ$ Ϧϳ έ ήϗ Α

ˮΪϴϳΎϤϧή$ Ϋ BP: 80/50, RR: 28, PR: 95, Temp: 38.2

-ϒϟIntussusception Barium or air enema

-ΏMalrotation Upper GI series

-ΝMeningitis LP

-ΩTesticular torsion Doppler sonography

 چیست؟- بیمار این رفتن راه نوع نام الف

Circumductive gait   

چیست؟- تشخیصبیمار ب Hemiplagic CP یاHemiplegia