URx Flashcards
Simple febrile seizures are managed with ___.
temperature control with antipyretics.
How can beta-blocker toxicity be differentiated from muscarinic toxicity (e.g. OP poisoning) clinically?
β-Blocker toxicity ≈ muscarinic toxicity common s/s: broncho-constriction -> wheezing, low SpO2
Other predominant s/s in β-blocker toxicity: low BP, low Bl. glucose, and seizures.
predominant s/s in muscarinic agent toxicity: lacrimation, nausea, vomiting, and diarrhea.
True/False?
In accordance with the shared decision-making approach, physicians should obtain information directly from minor patients and discuss treatment options with them, provided they are able to understand their medical history and articulate their wishes.
True
Shared medical decision-making typically begins with ___ and ______.
begins with the patient and physician.
*When the patient is a minor, a parent or guardian may also be involved.
A ______ presents at birth or within first few weeks of birth as a deeply hyperpigmented lesion that is minimally elevated (ie, a thin plaque) and has a texture that differs from that of the surrounding normal skin.
congenital melanocytic naevus (CMN);
aka giant hairy naevus/nevi (based on size and hair growth).
*CMNs develop in utero between ____ weeks GA d/t mostly sporadic localized genetic abnormalities esp. N-Ras mutation.
between 5-24 weeks GA
True/False?
When compared to acquired nevi, CMNs more commonly extend deeper into the dermis or subcutaneous fat layer.
True
Congenital melanocytic naevus (CMN) is usually seen in children of ____ age.
present at birth or develop within the first few weeks after birth (mostly);
may develop within 6 months of birth.
Approx. _____ % of newborns may present with or develop within first few weeks of birth, a congenital melanocytic naevus (CMN).
~1%
Small (<1.5 cm) and medium (1.5-20 cm) CMN have a lifetime risk of malignant melanoma of ____ %; the risk of malignant transformation in rarely occurring large (>20-40 cm) or “giant” (>40 cm) CMN, is about _____%.
risk of malignant transformation in
small/medium CMN is < 1%;
large/giant CMN is < 5%
True/False?
Coarse hair or texture on a CMN may increase the risk of transformation to a malignant melanoma.
False
A melanocytic nevus located in the epidermis is called a _____nevus; if in the dermis, it is called ____ nevus; and if present in both locations, it is called a _____ nevus.
epidermis: junctional nevus,
dermis: intradermal nevus, and
in both locations: compound nevus.
The differential diagnosis of a CMN include ______ conditions.
-café-au-lait macules (lack textural changes as seen in CMN),
-ephelides aka freckles (not congenital; lack textural changes as seen in CMN),
-junctional melanocytic nevi (not congenital; lack textural changes as seen in CMN), and
-lentigines (not congenital; lack textural change seen in CMN).
Ephelides aka ____ are non-congenital, very small (<3 mm), light brown macules located in sun-exposed areas, such as the face, upper chest, or back, which become darker with sun exposure and fade during cold weather months (when there is less sun exposure).
freckles;
A junctional melanocytic nevus can be clinically or histopathologically distinguished from a congenital melanocytic nevus based on ____ characteristics.
junctional melanocytic nevus:
-not congenital (unlike CMN)
-appear during childhood (unlike CMN).
-in the epidermis (CMNs are deep).
-usually light brown, and
-lack surface textural change.
The classic triad of c/p in infectious mononucleosis includes ___, ___, and _____ in addition to fever, myalgia, malaise, and fatigue.
- exudative pharyngitis
- lymphadenopathy (commonly cervical with mild tenderness),
- splenomegaly.
*Other s/s
-Hepatomegaly and/or jaundice in 5% to 10% of cases.
-Morbilliform skin rash in ~ 5% of patients (esp. if t/t with ampicillin for pharyngitis).
Blood smear showing _____ is a characteristic early lab finding of infectious mononucleosis in the presence of suggestive symptoms.
-lymphocytosis (>50% of total WBCs) with
-atypical lymphocytes (>10% of total lymphocytes).
The most feasible and widely used screening test for infectious mononucleosis (EBV infection) is the _____ test, which is positive in more than 90% of tested cases.
heterophile antibody (monospot) test.
*detects IgM to EBV by using horse, sheep, or bovine erythrocytes.
When are serologic tests (e.g. IgM antibodies to viral capsid antigen) indicated for the diagnosis of acute EBV infection?
-in heterophile antibody-negative cases, or
-in those with atypical presentations.
____ is the most common cause of osteomyelitis in patients with sickle cell disease in the US and Europe.
Salmonella
True/False?
A physician can provide confidential care to an adolescent for specific situations after discussing their reasons for not wanting to share the information with their parents, and then based on their response, encourage them to disclose the information to their family. However, it should be made clear that this is not necessary for him to receive care.
true.
Adolescents are considered minors and must rely on their parents for consent in almost all medical situations. Exceptions for which adolescents may receive confidential care include _____ situations.
STI testing and treatment, pregnancy testing, prenatal care, pregnancy termination and adoption, mental health services, and substance use treatment.
The differential diagnosis of hidradenitis suppurativa (HS) includes ____ conditions.
-Acne vulgaris (does not involve axillae),
-Extraintestinal Crohn’s disease (vulvar & perianal areas involved, +ve h/o intestinal Crohn’s disease),
-Folliculitis (superficial pustules), and
-Furuncles (usually transient, not recurrent or chronic).
*HS aka acne inversus, is chronic, inflammatory, and involves deep-seated nodules and abscesses, draining tracts, and fibrotic scars most commonly occur in intertriginous areas and areas rich in apocrine glands.
Intrapartum t/t for GBS is warranted for all patients with a positive GBS during pregnancy to avoid the risk of ______ d/t ____ reason.
to avoid the risk of GBS neonatal meningitis;
as antenatal t/t does not ensure eradication of GBS, and there is also a risk of recolonization after t/t.
____ is a common cutaneous fungal infection that causes itching, scaling, maceration, and fissuring of the interdigital spaces (e.g. toe webs).
Tinea pedis
*Less frequently, patients p/w
-scaling of the plantar and lateral surfaces of the foot (“moccasin” distribution), or
-vesicles or bullae on the instep of the foot (inflammatory tinea pedis).
Tinea pedis is common in ___ age group (s), and is often acquired from the decks surrounding swimming pools or from public showers.
preadolescents and teenagers;
The differential diagnosis of tinea pedis includes ____ conditions.
- Allergic contact dermatitis: erythema & scaling on the dorsum of the foot.
- Juvenile plantar dermatosis: 3-14 year old with fissures, redness & scaling of the plantar forefoot esp. great toe; a/w hyperhidrosis f/by quick drying (see attached image).
- Pitted keratolysis (aka ringed keratolysis): superficial bacterial infection p/with pitting & shallow erosions of the plantar foot (palms rare) with foot malodor (see attached image).
*none of the above involve interdigital spaces involved.
**Also, check 4th- 5th webspace for erythrasma in Tenia Pedis.
https://dermnetnz.org/topics/juvenile-plantar-dermatosis-images
Apnea of prematurity is defined as ____.
In an infant younger than 37 weeks of gestation, cessation of breathing for >20 seconds, or shorter if it involves bradycardia and/or desaturation.
Most episodes of apnea in preterm infants are ____, or _____.
(? central, obstructive, mixed).
central (physiologic immaturity of the respiratory drive),
or
mixed (both central and obstructive).
______ on clinical exam is suggestive of central apnea of prematurity.
absent inspiratory effort (d/t physiologically immature respiratory drive);
*whereas, in obstructive apnea, inspiratory efforts persist, but are ineffective in the presence of upper airway obstruction.
Apnea of prematurity occurs in approximately ___% of infants born between 33 and 34 6/7 weeks of gestation, and in virtually ____ % of infants <28 weeks GA.
~50% of infants born between 33 and 34 6/7 weeks GA, and
-in virtually all infants <28 weeks GA.
In comparison to apnea of prematurity, the incidence of apnea in term infants is very low, and is usually suggestive of an underlying ____ condition.
pathologic condition
A 2-day-old newborn p/with yellow skin, yellow sclera, elevated unconjugated bilirubin (UCB), a normal CBC, and normal liver enzymes. What is the most likely diagnosis?
Crigler-Najjar syndrome (liver cannot conjugate UCB d/t enzyme deficiency).
normal CBC rules out hemolysis, and normal liver enzymes rule out infective or inflammatory liver disease as cause of UCB hyperbilirubinemia.
Crigler-Najjar syndrome type I (more severe) can be distinguished from type II via _____ administration.
phenobarbital-> reduces sr. bilirubin in Crigler-Najjar syndrome type II;
-> no reduction in sr. bilirubin in Crigler-Najjar syndrome type I (more severe).
The differential diagnosis of unconjugated hyperbilirubinemia in the FIRST FEW DAYS of life includes ____ etiologies.
-breastfeeding jaundice (> common than Criggler-Najjar);
-hemolytic anemias (> common than Criggler-Najjar).
-hemolysis caused by maternal-fetal blood type incompatibility.
-Criggler-Najjar syndrome (liver cannot conjugate UCB).
A child presenting with a subdural hematoma and no h/o major trauma (eg, fall from a large height or motor vehicle accident) should be evaluated for ____.
non-accidental trauma.
Aside from accidental or non-accidental trauma, alternative diagnoses for life threatening intracranial bleeding in toddlers include _____ etiologies.
-AVM rupture (no subdural bleeding).
-hematologic: ITP, hemophilia, SCD (no subdural bleeding).
-malignancy (less chance of subdural hematoma).
*accidental or non-accidental trauma may present more commonly with a subdural hematoma.
____ is still a relevant and most common cause of epiglottitis in under- or unvaccinated children.
Hib
Acute epiglottitis, primarily caused by infection can lead to life-threatening airway obstruction; a lateral x-ray of the neck demonstrates the pathognomonic “______ sign.”
“thumb-print sign.”
Noninfectious causes of epiglottitis include ____ cause (s).
-thermal injury,
-direct trauma, or
-caustic ingestion.
The differential diagnosis of acute epiglottitis includes conditions such as ________.
- Croup: barking cough (unlike epiglottitis); distention of the hypopharynx on lateral X-ray neck (no thumb-print sign of epiglottitis).
- Peritonsillar or retropharyngeal infections: p/with drooling and neck extension.
- Foreign bodies: p/with drooling and respiratory distress.
- Diphtheria: s/s progress is typically more gradual with sore-throat, malaise, and low-grade fever with gray, sharply demarcated membranes.
A 5-year-old boy with no significant past medical history p/with fever, malaise, and a rash for 3 days that appeared on his hands and feet. On CE, vitals are all normal except for several shallow ulcers in the posterior pharynx, mild non-tender submandibular lymphadenopathy; and elliptical/oval vesicular rash on the palms, soles, and buttocks. What is the most likely diagnosis?
HFMD;
mc cause: Coxsackie virus A16;
*atypical HFMD is caused primarily by coxsackievirus A6.
Mediterranean ancestry and the presence of target cells (see attached image) in a patient with microcytic hypochromic anemia who is unresponsive to iron therapy should raise suspicion _____.
Thalassemia
_____ can also reveal “Target cells” on the peripheral smear (see attached image for target cells).
Liver disease.
Superficial infantile hemangioma (IH) formerly known as _____ typically appears around ___ age as a solitary, painless lesion on skin/mucus membrane, and has the potential to proliferate.
fka strawberry hemangioma (see attached image).
typically appear before 4 weeks of age.
