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151

Congenital rubella findings

Deafness and cataracts as well as numerous purpuric skin lesions, (“blueberry muffin” baby).

Congenital rubella syndrome occurs when the mother contracts rubella early on in her pregnancy – the risk of congenital rubella syndrome is very low after 20 weeks. Since the MMR vaccine contains a live attenuated virus, there is at least a theoretical risk of causing congenital rubella syndrome, and for this reason the vaccine is avoided in pregnant women.

152

Most common causes of hypercalcemia

Malignancy and hyperparathyroidism

CHIMPANZEES
-calcium supplementation
-hyperparathyroidism
-immobility // iatrogenic (from thiazide diuretics)
-milk alkali syndrome
-Paget's disease
-Acromegaly // Addison's disease
-Neoplasm
-Zollinger-Ellison syndrome (when associated w/ MEN-1)
-Excess vitamin D
-Excess vitamin A
-Sarcoidosis

153

Signs of hypercalcemia

Bones, stones, abdominal groans, psychiatric overtones

bone fractures, kidney stones, vomiting and constipation, and weakness, fatigue, and altered mental status

154

Hypercalcemic crisis

MEDICAL EMERGENCY d/t heart conduction abnormalities

Calcium > 14 or severe symptoms

Check EKG and begin IV fluids and furosemide (lose Ca++)

155

Charcot's triad

of acute cholecystitis

RUQ pain, jaundice, and fever/chills

156

Reynold's pentad

of acute cholecystitis

Charcot's triad (RUQ pain, jaundice, and fever/chills) plus shock and mental status changes

157

Treatment of isolated chlamydia infection

Azithromycin (single dose) or doxycycline (1 wk)

(1 wk of erythromycin also reasonable but causes GI upset)

(Fluoroquinolones like ofloxacin and levofloxacin are more expensive alternatives)

(Pregnant: azithromycin or erythromycin)

158

Treatment of acute dystonia

Benztropine or diphenhydramine

159

What is leukoria and what does it signify?

Leukoria is a white pupillary reflex (as opposed to the normal red reflex).

It can indicate
-disorders of the lens (e.g., cataracts)
-disorders of the vitreous (e.g., hemorrhage)
-disorders of the retina (e.g., retinoblastoma)

160

Isolated elevated opening pressure

Cryptococcal meningitis

also see lymphocytosis in CSF

161

Treatment of cryptococcal meningitis

amphotericin B and flucytosine

162

If early pregnancy loss, think:

cytogenetic abnormalities (abnormalities of chromosome number or structure)

163

Elevated BUN/Cr ratio

Pre-renal azotemia

164

Causes of late pregnancy loss

-cervical incompetence
-uterine anomalies
-leiomyoma
-intrauterine synechiae

165

PANDAS

pediatric autoimmune neuropsychiatric disorder associated with group A streptococci

-pediatric onset
-presence of obsessive compulsive disorder and/or a tic disorder
-abrupt onset with episodic symptom course
-associated with group A strep infections
- association with neurological abnormalities like motoric hyperactivity, choreiform movements and tics

166

Superficial thrombophlebitis treatment

rest, elevation, NSAIDs, heat

NO NEED FOR ANTICOAGULATION

167

SVT vs. DVT

Palpable cords: superficial vs. deep

Both cause swelling, pain, and warmth

Only DVT can cause PE

The saphenous vein is a superficial vein; the femoral (and superficial femoral) and popliteal veins are deep veins!

168

What antibodies are found in primary biliary cholangitis?

Anti-mitochondrial

169

What antibodies are found in celiac sprue?

Anti-TTG (most SN + SP), anti-gliadin, anti-endomysial

170

What is leukoria and what does it signify?

Leukoria is a white pupillary reflex (as opposed to the normal red reflex).

It can indicate
-disorders of the lens (e.g., cataracts)
-disorders of the vitreous (e.g., hemorrhage)
-disorders of the retina (e.g., retinoblastoma)

171

Treatment of mild comedonal acne

topical retinoid and/or other topical agents such as salicylic acid, azelaic acid, glycolic acid, and benzoyl peroxide

172

Test for primary adrenal insufficiency (Addison's disease)

Cosyntropin (synthetic ACTH) stimulation test, along with a measurement of plasma cortisol

If adrenals are functioning: cortisol should rise upon stimulation

173

Symptoms of Addison's disease

fatigue, weight loss, hypotension, hyponatremia, and hypoglycemia

174

Elevated BUN/Cr ratio

Pre-renal azotemia

175

Otitis media antibiotic guidelines

The American Academy of Pediatrics (AAP) recommends antibiotic therapy for children 6 months of age
or older with severe signs and symptoms of acute otitis media (AOM), including moderate or severe otalgia
or otalgia for more than 48 hours, or a temperature ³39°C (102°F), whether the AOM is unilateral or
bilateral (SOR B). Children younger than 24 months without severe symptoms should receive antibiotic
therapy for bilateral AOM, whereas older children or those with unilateral AOM can be offered the option
of observation and follow-up.

The usual treatment for AOM is amoxicillin, but an antibiotic with additional beta-lactamase coverage, such
as amoxicillin/clavulanate, should be given if the child has received amoxicillin within the past 30 days,
has concurrent purulent conjunctivitis, or has a history of AOM unresponsive to amoxicillin (SOR C).
Penicillin-allergic patients should be treated with an alternative antibiotic such as cefdinir, cefuroxime,
cefpodoxime, or ceftriaxone.

176

Treatment of salmonella infection

NOTHING

The recommended management for patients who have non-severe Salmonella infection and are otherwise
healthy is no treatment. Patients with high-risk conditions that predispose to bacteremia, and those with
severe diarrhea, fever, and systemic toxicity or positive blood cultures should be treated with levofloxacin,
500 mg once daily for 7–10 days (or another fluoroquinolone in an equivalent dosage), or with a slow
intravenous infusion of ceftriaxone, 1–2 g once daily for 7–10 days (14 days in patients with
immunosuppression).

177

Treatment of cervical lymphadenitis

Systemic symptoms, unilateral lymphadenopathy,
skin erythema, node tenderness, and a node that is 2–3 cm in size. The most common organisms associated
with lymphadenitis are Staphylococcus aureus and group A Streptococcus. Empiric antibiotic therapy with
observation for 4 weeks is acceptable for children with presumed reactive lymphadenopathy (SOR C). If
symptoms do not resolve, or if the mass increases in size during antibiotic treatment, further evaluation
is appropriate.

178

What needs to be tested before beginning PrEP w/ Truvada (emtricitabine/tenofovir disoproxil )

HIV antibody test

Need to make sure they're HIV negative since Truvada is insufficient for treating HIV

179

What is recommended in all patients w/ croup, even with mild disease?

Single dose of po dexamethasone

180

Most common cause of toxic megacolon

IBD (esp. UC)