1. Step 8
1.1. Diagnostic decision
1.2. Mechanism
1.3. Presentation
1.4. Supporting data
1.5. 10 minutes
1.6. next session
1.6.1. management of dehydration
1.6.2. grwoth
1.6.3. gastroentritis
2. Step 7
2.1. Inquiry plan and info gathering
2.1.1. History of presenting complaint
2.1.1.1. 10 dirty nappies with green stool
2.1.1.2. vomited all formulas
2.1.1.3. not eating well
2.1.1.4. hot to touch
2.1.1.5. sleeping more
2.1.1.6. 2 siblings got diarrhea this week
2.1.1.7. tends to cry a lot and wake regularly at night
2.1.1.8. tried different formulas
2.1.1.9. her sister mentioned the wight loss
2.1.2. Previous medical / surgical history
2.1.2.1. 2 episodes before of gastroentritis
2.1.2.1.1. 4
2.1.2.1.2. 7
2.1.2.2. breastfead for 2 weeks
2.1.2.3. stool was soft mustard color once a day, then it became firm after shifting to formula
2.1.2.4. immunization: 2 and 4 months
2.1.2.5. changed to S26ar anti reflux
2.1.2.6. at 3 months developed nappy rash, changed fomula from pharmacist
2.1.2.7. went back to the anti reflux
2.1.2.8. at 5 months
2.1.2.8.1. changed formula again
2.1.2.8.2. with apple juice
2.1.3. Drug history / allergy
2.1.3.1. none
2.1.4. peri natal history
2.1.4.1. at term 40 weeks
2.1.4.2. vaginal
2.1.4.3. 3.15 KG
2.1.4.4. 49 cm
2.1.4.5. 35 head circumference
2.1.4.6. ABGAR score 8 and 9
2.1.4.7. pregnancy complicated with unreported bleeding
2.1.4.8. missed number of appointments
2.1.4.9. HBv immunized
2.1.4.10. discharged on day 4
2.1.5. Family history
2.1.5.1. NOT significant
2.1.6. Social / occupational history
2.1.6.1. father
2.1.6.1.1. husband busy
2.1.6.1.2. long working hours including weekends
2.1.6.2. brother and sister
2.1.6.3. mother
2.1.6.3.1. feels tiered and stressed
2.1.6.3.2. 24
2.1.6.3.3. did high school
2.1.6.4. ant
2.1.6.4.1. talk on the phone
2.1.6.4.2. offer advice
2.1.6.5. grandmother
2.1.6.5.1. lives away and gives visits
2.1.6.5.2. 44 yo
2.1.7. development
2.1.7.1. rolled over at 5 months
2.1.7.2. can sit without support
2.1.7.3. grasp objects
2.1.8. Systemic review
2.1.9. Physical examination
2.1.9.1. vitals
2.1.9.1.1. temp 38
2.1.9.1.2. pulse 130
2.1.9.1.3. BP 85/60
2.1.9.1.4. rr 40
2.1.9.1.5. central capillary refill less than 2 seconds
2.1.9.2. chart
2.1.9.2.1. lenght 25th percintile
2.1.9.2.2. HC 25-50 percintile
2.1.9.2.3. wight less than 3rd percintle
2.1.9.3. inspection
2.1.9.3.1. thin lying in mother's arm
2.1.9.3.2. dry mouth and cool periphery
2.1.9.3.3. skin folds visibile on inner thighs
2.1.9.3.4. sitting supported
2.1.9.4. palpation
2.1.9.4.1. palpable liver
2.1.9.4.2. rash on the hand
2.1.9.4.3. scratch marks on hands and trunk
2.1.9.5. ear normal
2.1.10. tests results
2.1.10.1. urine
2.1.10.1.1. RBC less than 10
2.1.10.1.2. no protein
2.1.10.1.3. WBC 10^100
2.1.10.1.4. culture mixed growth
2.1.10.2. hematology
2.1.10.2.1. HB 90
2.1.10.2.2. microcitosis
2.1.10.3. biochem
2.1.10.3.1. K reduced
2.1.10.3.2. urea increased
2.1.10.3.3. Na increased
2.1.10.3.4. creatining increased
2.1.10.3.5. bicard reduced
2.1.10.4. blood culture
2.1.10.4.1. no growth
2.1.10.5. stool
2.1.10.5.1. detected rotavirus
2.1.10.5.2. no bacterial pathogen
2.2. 50 minutes
3. Step 6
3.1. Review session 1
3.2. Report new knowledge
3.2.1. Failure to thrive
3.2.1.1. evaluation
3.2.1.2. causes
3.2.1.2.1. malnutrition
3.2.1.2.2. malabsorbtion
3.2.2. diarrhea and vomiting in infants
3.2.2.1. infection
3.2.2.2. other causes