Board Vitals Flashcards
infection often occurs after the ingestion of dirt contaminated with dog feces; the stool contains eggs produced by adult worms
Affects GI tracts, lungs, eyes
Can see crackles on lung exam, Hepatomegaly
Seen with little kid and new pet
Toxocara canis
is a condition that usually involves the 2nd costochondral cartilage on either side and is always associated with visible swelling and, in many cases, with erythema and warmth.
Tietze syndrome
Tx NSAIDs
Swelling makes different from costocondritis
Pts that require prophylaxis for SBE
patients with a prosthetic heart valve (including homografts and transcatheter implanted valves), a history of previous endocarditis, a history of complex unrepaired cyanotic congenital heart disease, or a systemic-to-pulmonary artery shunt or conduit. patients who have undergone repair of a congenital heart defect with prosthetic material within the previous 6 months or who have residual defects in close proximity to prosthetic material (i.e., patch) following repair of a congenital heart lesion. Patients who have undergone heart transplantation and have valve dysfunction require SBE prophylaxis.
What procedures require SBE prophylaxis
All dental procedures that involve manipulation of gingival tissue or perforation of the oral mucosa require SBE prophylaxis. SBE prophylaxis is also recommended for respiratory procedures that involve incision or biopsy of the respiratory mucosa including: tonsillectomy, adenoidectomy, or bronchoscopy with biopsy.
Describe Kostmann syndrome
Kostmann syndrome, children have myeloid arrest. Their myeloid stem cells are insensitive to G-CSF and fail to mature. They have no reserves, similar to a post-bone marrow transplant recipient, and are therefore extremely vulnerable to their own bacterial flora.
Cause of death from direct contact to chest
Sudden cardiac death secondary to ventricular fibrillation following direct precordial trauma—from, for example, a fist, baseball, lacrosse stick, or hockey puck—is known as commotio cordis
is an arrhythmic event (ventricular fibrillation) that occurs when a nonpenetrating blow to the chest causes a sudden increase in intracardiac pressure. If the trauma occurs during a narrow window of the cardiac cycle, a 10- to 20-ms interval during repolarization just prior to the peak of the T wave, then ventricular fibrillation may result.
Commotio cordis
Risk with ingestion of caustic agents
Management?
patient is at risk for necrosis of the esophageal and gastric wall due to the ingestion of sulfuric acid and should undergo endoscopy 12–24 hours after ingestion. Caustic ingestions can be acid or alkali. Caustic ingestions may be associated with dysphagia, burns in the mouth and throat, swelling of the throat, drooling, vomiting, esophagitis, and gastritis;
Endoscopy, NPo Iv fluids, obs
Patients ____have recurrent episodes of angioedema, especially of the skin, GI tract, and upper airway. is an ____ disorder caused by a low or non-functional C1 esterase inhibitor
Patients with hereditary angiodema an autosomal dominant disorder caused by a low or non-functional C1 esterase inhibitor
causes susceptibility to recurrent neisserial infections.
C8 deficiency (terminal complement deficiency) causes susceptibility to recurrent neisserial infections.
When does immunocompromised patient get varcilla immunoglobulin?
what is tx for active infection in this individual?
IG in patient exposed to varicella w/o symptoms, goal w/in 96 hours
Tx for active infection is IV acyclovir
Patient with scattered flat hyperpigented lesions on body, headache and scattered dark spots in eyes. concerning for?
NF 1, loss of function mutation; have cafe au lait, axillary freckling, Lisch nodues
Patient with seizures, intellectual disability and intracranial calcifications with scattered cutaneous lesions
Tuberous sclerosis
Patient with bilatearal acoustic schwannoma, early onset cataracts and meningioma or ependymomoma
NF2
What is the danger of using inhalants?
Tx?
Peak 7th to 9th grade, most are hydrocarbons or NO = CNS depressants.
Complications are N/V, ataxia, risk of pulmonary aspiration and can have cardiac dysrhythmia
Manage with supportive cares
Tx for pinworms
Who should get treated?
Tx albendazole, mebendazole and wash all bedding and clothes
Tx the family of index patient
What is the incubation period for varicella?
When are you most contagious?
MC complication?
Incubation: 10-21 days
Contagious 48 hrs prior to onset of rash until all lesions crust over; attack rate >90%
secondary skin infection MC complication
MCC of seizures in term newborn?
hypoxia, likely from intrapartum or antepartum asphyxia
Infant can sit without support, pull to stand, has 3 finger pincer grasp, bangs blocks, makes 2 syllable sounds and imitates speech sounds, says mama, dada
9 months
Child can stand alone, walk, put block in cup, imitate others, say mama, dada intentionally, 1-2 words and follow simple instructions, sip from cup
12 months
Can run well, walk backwards, walk up steps with one hand held, kick a ball, stack 4 blocks, use a spoon and fork, engage in pretend play and vocabulary of 10-25 words
18 months
Child can kick ball, throw ball overhead, jump and walk up down stairs one step at a time, stack 6 block, copy a line, point to pictures and follow 2 step command and put 2 words with vocab of 50 words
24 months
what is the triad of sturge weber sydrome?
facial port-wine stain, ipsilateral meningeal capillary malformations, ipsiliateral cerebral cortical capillary malformations
Define bulimia and the treatment
binge eating and inappropriate compensatory behavior to prevent gain: vomitting, laxatives, diuretics or fasting/exercising.
Tx: CBT and fluoxetine (if no concern for bipolar)
Child with devo delay, micropenis and BL cryptorchidism, issues feeding at birth and low tone with FTT. Few years later, insatiable appetite and obese with small hands and feet.
Inheritance?
Prader willi
Dele 15q11 from paternally derived chromosome
Patient with delayed motor milestones, low tone, macrocephaly and large testicles
Dx and inheritance?
Fragile X
X linked from expansion of CGG in FMR1 gene
Child with small penis and testis, normal tone, normal devo.
Klinefelter syndrome
XXY with male phenotype
Slow growth, high pitch cry in infancy, mental deficiency and microcephaly. Most with IUGR, low BW and hypotonia with downslanting palpebral fissures
Cri du Chat
partial del of chrom 5
What does EKG with hyperK look like?
What treatments are given and why?
Tall peaked T waves, widening of QRS complex
Goal shift K from serum –> intracellular
Insulin is tx; this does that… glucose given to prevent hypoglycemia with insulin
Calcium gluconate to stabilize cardiac membrane and inhaled Beta-2 (albuterol) to drive K into skeletal muscles
May need dialysis
What is nursemaids elbow?
Classic presentation?
How to treat it?
Subluxation of the radial head or annular ligament displacement. seen 6mo to 5yo
Pt refuses to move arm, holds in flexed and pronated position
Tx: do not need imaging, apply pressure to radial head while supinating the forearm
patient with family history of CAD early onset, has lesions on extensor surfaces of elbows, knees and has LDL >500.
Dx?
Genetics?
Tx?
Familial homozygous hypercholesterolemia
disorder of lipoprotein metabolism = elevated serum LDL = increased risk for CAD
Dx clinically plus FHx and genetics; worse corse if homozygous
Tx with aggressive cholesterol reduction
ORder of events in male puberty
Testicular/scrotal enlargement Pubic hair/Axillary hair Enlargement of penis 6mo later Growth spurt 1-2 years later Facial hair, voice changes at end
Causes atypical PNA as well as formation of cross-reacting IgM antiB against RBC membrane–> leads to agglutination in cold areas of body (ear, hands, toes,nose) and potential erythrocyte hemolysis in liver and spleen
Mycoplasma PNA
Patient is 5 mo old, presents with fever, dehydration and hypoxia to 90%, CXR with diffuse pulmonary infiltates.
Labs with elevated IgM and decreased IgA and IgG
Dx?
Cause?
Genetics?
CD40 ligand deficiency–> leads to humoral immunodeficiency with elevated IgM, low other Igs from imparied interaction btwn T cells and other cells expressiong CD40; can do isoform switch from IgM to other classes
X linked, male predominance
B cell count usually unaffected
Pt with CD40 deficiency present with what illnesses? Why?
recurrent respiratory with encapsulated bactrial: s.pna, h.influenza and opportunistics like histo of PCP
see elevated IgM, low G and A bc can’t class switch from M to other Ig’s
See GI and pancrease malignancies later in life
form of humoarl immunodeficiency with decreased levels of 2 or more immunoglobulins
CVID or common variable
What are signs of pulmonary arterial hypertension?
What medications should we put patients on?
See elevated BNP from RA dilatation from elevated RV pressures. Hear a single or loud S2 with hepatomegaly
Tx with phosphodiesteraese-5 inhibitor; Tadalafil
What is the danger with a sulfonylurea ingestion?
What is the treatment?
‘one pill can kill’
inhibit ATP-sensitive K channels in pancreatic beta cell= increase in insulin release
1/2 life of 10 hours with peak at 2-6 hrs
Tx with 2 to 4mL per kg of D25W OR 5 to 10ml/kg of D10W
~ 0.5 to 1.0g per kg of dextrose
admit for overnight observation
When and why do pregnant women get Tdap vaccine?
Get during 3rd trimester
For neonatal immunity; pass along antiB to neonate
Pt with 2 our of 4 genes abormal in alpha thal.
What is disease and are there symptoms?
2/4 is alpha thal MINOR
Sx are mild microcytic anemia
Pt with 3/4 genes mutated controlling alpha chain.
Disease?
Hemoglobin H
have microcytic anemia and mild hemolysis
6yo Pt presents with frothy urine, + proteinuria and casts. Recent skin infection. Bx shows effacement foot processes
Disease?
Changes to kidney?
Minimal change
no change to glomeruli
What do you see on kidney bx in patient with IgA nephropathy?
When do patients have flaires?
NephRITIC syndrome
see episodic hematuria w/in 1-2 days of URI
See mesangial proliferation
What is the most serious form of renal issues in patient with lupus?
Diffuse proliferative glomerulonephritis = Nephritic
get immune complexes all over==> thickened capillary wall and see ‘wire looping’ on microscopy with subendothelial immune complexes
