Clinic Flashcards
How to differentiate E. tox from herpes rash
Well appearance…(vesicles w/ rash)
E.tox- comes and goes
Herpes- consistent and more clustered
2 treatments for tumor lysis syndrome
Give allopurinol to prevent uric acid production => prevent uric acid crystalization in the kidneys to prevent AKI
Acutely give calcium to stabilize cardiac myocytes to prevent arrhythmias (due to hyperkalemia)
Indication for Keflex
Keflex = Cephalexin = 1st gen cephalosporin
Covers MSSA, Strep, GNR
-first line for cellulitis since covers strep and staph
-used for UTI (covers E. coli) and soft tissue infections (that aren’t MRSA)
‘Sunken chest’
= Pectus Excavatum- some of the ribs + sternum grow abnormally
- usually sporadic, but associated w/ connective tissue d/o (Marfans and Ehler Danlos)
- typically present as cosmetic concern
4 electrolyte/lab abnormalities seen in tumor lysis syndrome
Tumor lysis syndrome
- hyperkalemia: K+ released from inside of cells
- hypocalcemia: K+ released from inside cells, but then binds to phosphorus and unbound Ca2+ isnt measurable
- elevated uric acid
- elevated phosphorus: bound phosphorus can be measured
Why are the electrolyte abnormalities seen in tumor lysis syndrome dangerous?
Tumor lysis syndrome
Hyperkalemia => arrhythmia
Calcium phosphate and uric acid crystalize in the kidney => AKI
Port wine stain
Sturge-Weber syndrome = rare neurocutaneous (nerve and skin) d/o present at birth
After what age is thrush worrisome
After about 1 yoa- if you see thrush (white that doesnt rub off), start concern for immunodeficiency
Coverage of 3rd vs. 4th gen cephalosporin
Both cover MSSA, Strep, GNR
-then 4th gen (Cefepime) and one specific 3rd gen (Cefazidime) cover pseudomonas
Features of Sturge-Weber syndrome
- port wine stain
- seizures
- glaucoma
- MR
- cerebral malformation and tumors
Which TORCH infxn do you think of if newborn fails the BAERs test?
Failing newborn hearing test- think of congenital CMV = most common cause of nonhereditary sensorineural hearing loss
3 main side effects of Penicillins
Penicillins
- hypersensitivity: rash, hives
- diarrhea
- neutropenia (especially PenG and Nafcillin)
2 most common places of ALL recurrence
Two places where cancer cells can hide: immunoprivaledged sites specifically gonads and CNS
Abx indicated for sinus and ear infections
Most common bugs for sinus and ear infxns (otitis media) = moraxella, untypable H. flu, strep pneumo
-all 3 covered by 2nd gen cephalosporins = Cefotetan, Cefoxitin
Differentiate Penicillin vs. Nafcillin coverage
Well Penicillin is PO and Nafcillin/Oxacillin are IV
- penicillin covers strep
- nafcillin covers staph, specifically MSSA
1st line tx for community acquired pneumonia
Amoxicillin
Single most common cause of bacterial sinus infections
Strep pneumo 30%
-then Moraxella and non-typbale H. flu 20% each
Hallmark feature of juvenile dermatomyositis
Muscle weakness- symmetric and proximal
Then also
- characteristic rashes: Gottron’s papules (erythematous eruption over knuckles), heliotrope rash (red/purple upper eyelid discoloration), nailfold capillary change
- calcinosis
Ancef
Ancef = Cefazolin = 1st gen cephalosporin
-covers staph and strep, E. coli, Klensiella => used in post -op kids
Major indication = surgery prophylaxis
Differentiate signs of gonorrhea vs. chlamydia conjunctivitis
(a) Tx
Gonorrhea conjunctivitis is purulent
Chlamydia conjunctivitis is mucopurulent
(a) Azithromycin can be used against both gonorrhea and chlamydia
Adverse rxn of bata-lactamase inhibitors
Similar to penicillins
- hypersensitivity: rash, hives
- diarrhea
- possibly neutropenia
Abx for GBS prophylaxis
PenG
Triad for congenital toxoplasmosis
Congenital toxoplasmosis
- chorioretinitis (most common late finding)
- hydrocephalus
- intracranial calcification => intellectual disability
4 factors dictating prognosis of ALL (risk stratification)
Risk stratification of ALL
- age: best prognosis 1-10 yoa
- presenting white count: better if lower
- response to initial therapy
- cell markers: cytometry
Management of juvenile dermatomyositis
Combo high dose glucocorticoids + MTX
Abx for osteomyelitis
Nafcillin/Oxacillin = narrow spectrum penicillin
Acrocyanosis
= benign peripheral cyanosis in newborns
Most common idiopathic inflammatory myopathy of childhood
Juvenile Dermatomyositis = rare autoimmune myopathy in children where there is an autoimmune rxn in the small blood vessels and/or muscle tissue
Tx for neonatal sepsis
Ampicillin (covers strep, staph, E. coli, Listeria) + Gentamicin (aminoglycoside)
Gentamicin expands go cover all G(-): enterobacter, proteus, pseudomonas, serratia
2 indications for vanco
- MRSA
2. PO for C. dif
Blueberry muffin baby
Blueberry muffin baby = congenital rubella b/c of purpura + hyperbilirubinemia
What would be found on scrape of E. tox rash
Tons of eosinophils
Which abx do you need to monitor for potential risk of C. dif?
Cephalosporins
Coverage of 2nd gen cephalosporins
Strep,staph, anaerobes, H. flu, moraxella, E. coli and Klebsiella
Differentiate two types of cyanosis detected by looking at newborn’s lips
Peri-oral cyanosis = blue around the mouth, but NOT the lips
- benign
- due to venous drainage around mouth
Central cyansois- blue lips
-this is worrisome
Differentiate Unasyn vs. Zosyn coverage
Unasyn (Amp/Sulbactam) and Zosyn (Piperacillin/Tazobactam) both cover MSSA, Strep, E. Coli, GNR, and anaerobes
-then in addition Zosyn covers Pseudomonas (Piperacillin covers Pseudomonas)
Why do we obtain LHD in pts w/ potential neoplastic process?
Lactate dehydrogenase as a marker of cell turnover
Classic description of fungal diaper rash
Candida (fungal) diaper rash: beefy red, most at places where skin overly (creases) w/ satellite lesions
-NOT tender to palpation
Differentiate penicillin vs. amoxicillin coverage
PenG: susceptible to beta-lactamases- covers GAS, GBS, Neisseria, syphillis
-but not strep pneumo anymore
Amox: Strep (not Staph), E. Coli, GNR (Salmonella, Shigella, Enterobacter)
Distinguish pathologic vs. physiologic lymphadenopathy
Signs that an enlarged LN is worrisome = rubbery, painless, immobile (cancer latches down to underlying tissue)
So good signs if a LN is painful to the touch and mobile
Side effect of meropenem
Almost all given Meropenem/imipenem go into AKI
Which TORCH infxn correlates w/ newborn presenting w/
(a) chorioretinitis
(b) hydrops fetalis
TORCH infxns
(a) Chorioretinitis- toxoplasmosis and CMV
(b) Hydrops fetalis- congenital syphilis and rubella
What abx is used after a pt remains febrile after a course of Cefepime + Vanco
Cefepime (4th gen cephalo) covers G+ and G- both well, then Vanco covers MRSA
-Biggest gun left = Meropenem/Imipenem to add anaerobic coverage
Tx for syphilis
PenG
Why do you want to avoid giving bactrum to ppl in liver failure?
Bactrum = trimethoprim/sulfa, sulfa displaces bilirubin from plasma proteins => increases risk for kernicterus
8 yo’s brother has pertussis, so he is started on prophylactic abx, he starts acutely vomiting (non-bileous)
(a) Which prophylactic abx was he put on
(b) Cause of vomiting
Pertussis prophylaxis- can use Erythromycin (macrolide)
(a) Erythromycin
(b) Erythromycin can cause pyloric stenosis
How to differentiate peripheral vs. central Bell’s Palsy
It’s all in the forehead
Peripheral Bell’s palsy- can’t raise forehead
Central Bell’s palsy- can raise forehead
-so actually a good sign wen can’t move the forehead
Transient neonatal pustular melanosis
Benign, idiopathic, skin condition of newborns
- only in skin of color
- present at birth: pustules rupture easily and resolve w/in 48 hrs, leaving brown macules that may persist for months
