Random Flashcards
Refeeding syndrome
Hypokalemia
Hypophosphatemia (hallmark)
Hypomagnesemia
Active antirabies vaccine dose, route, days administered
0.5ml IM days 0, 3, 7, 14, 28
Passive rabies vaccine
HRIG 20 U/kg 1/2 IM, 1/2 infiltrated around the wound
ERIG 40 U/kg (skin test needed)
Rabies Immunization
CAT II
Immunologically naive vs Previously immunized
2 sites ID day 0,3,7
Or
1 site IM day 0,3,7 and between 14-28
Or
2 sites IM day 0 and 1 site IM day 7,21
—————
1 site ID day 0,3
Or
4 sites ID day 0
Or
1 site IM day 0,3
Rabies Immunization
CAT III
Immunologically naive vs previously immunized
CAT II management plus RIG
to be infiltrated as much as possible to wound area, no need to give remaining via IM
———————
Same as CAT II
No RIG
Tetanus prophylaxis
Clean minor wound
Uncertain or <3 doses
Give TDAP or TD
No need for TIG
Tetanus prophylaxis
Clean minor wound
3 or more doses given
No need for TDAP OR TD (Except if 10 or more years)
No need for TIG
Tetanus prophylaxis
All other wounds (Dirty etc)
3 or more doses given
No need for TDAP or TD (Except if 5 years or more)
No need for TIG
Tetanus prophylaxis
All other wounds (dirty etc)
Uncertain or <3 doses
Give TDAP or TD
Give TIG
Iron supplementation
LBW 15/0.6 0.3ml PO OD at 2 mos until 6 mos
6-11 mos 30/0.6ml 0.6ml OD x 3 mos
1-5 y/o 30/5ml 5ml OD x 3 mos
Adol 60mg iron/400mcg FA OD
Deworming
Albendazole
12 mos to 23 mos 200mg single dose q6 mos
14 mos and up 400mg single dose q6 mos
Mebendazole
12 mos and up 500 ng single dose q6 mos
Ideal body weight computation
<6 months - age in months x 600 + BW
>6 months - age in months x 500 + BW
1-6 age in years x 2 + 8
Expected length and height during the 1st yr
0-3 mos 9 cm
4-6 mos 8 cm
6-9 mos 5 cm
10-12 mos 3cm
Ave gain during 1st yr 25 cm
Estimated length or height computation
Cms - age in years x 5 + 80
Inches - age in years x 2 + 32
Quick sheet in anthropometrics
BW doubled at 4 mos
BW tripled at 1 year
1/2 mature height for boys at 2
3 ft tall at 3
2x birth length at 4
3x birth length at 13
Attained 90% adult head size at 2
Approximates adult head size at 6
Abd pain, vomiting, +/- distention
Cant pass NG tube, severe pain, emesis, coffee or omega sign
Volvulus
Abd pain, vomiting, +/- distention
Bloody currant jelly stools, sausage shaped RUQ mass on UTZ, absent bowel sounds on RLQ, coiled spring sign
Intussusception
Abd pain, vomiting, +/- distention
Post prandial vomiting, nonbilious, down’s syndrome, olive shaped mass, barium studies: shoulder sign, double tract
Pyloric stenosis
Abd pain, vomiting, +/- distention
Normal
Hx or recurrent obstructive symptoms
Painless rectal bleeding
Intermittent pain
Technetium 99m pertechnetate Scintigraphy scan to detect gastric tissue
Meckel Diverticulum
Meckel Diverticulum Rule of 2
2% of population
2x more males than females
2 y/o
2 inches long
2 ft from ileocecal valve
2 types of tissue gastric and pancreatic
Osmotic vs Secretory Diarrhea
Osmotic
<200 ml/day
Stops with fasting
<70 meq/l Na
Reducing substances (+)
Stool ph <5
First clinical evidence of HBV infection
ALT elevation at 6-7 weeks after exposure
Most valuable single serologic marker of acute HBV infection
Anti HBc Ag
Marker of active viral replication, identification of infected people at risk of transmitting HBV
HBe Ag
First serologic marker to appear, coincides with the onset of symptoms
HBs Ag
Identification if people who have resolved infection, immunity after immunization
Anti HBs
Identification of infected people with lower risk of transmitting HBV
Anti HBe
Identification of people with acute, resolved, or chronic HBV
Anti HBc
Identification of people with acute or recent HBV including HBs Ag neg during window period
IgM anti HBc
Nephritic
(HOHA)
Hypertension
Oliguria
Hematuria
Azotemia
Nephrotic
(PALE)
Proteinuria (nephrotic range)
Albumin low
Lipids high
Edema
Cafe au lait that spares the face, axillary or inguinal freckling, lisch nodules, optic glioma, CT scan or MRI, genetic counseling and early detection of treatable complications
Neurofibromatosis
Von Recklinghausen
Multisystemic, siezures, mental retardation, tubers in cerebrum (candle dripping), ash leaf, shagreen patch, CT/MRI of brain, heart, abdomen, 2d echo, renal utz
Seizure control, multidisciplinary approach
Tuberous sclerosis
Upper respi obstructive symptoms
Patchy infiltrates and ragged tracheal column
Bacterial tracheitis
Tx: clinda/metro + 3rd gen ceph
Upper respi obstructive symptoms
Thumbs sign or leaf sign
Acute Epiglottitis
If vaccinated: staph aureus
If unvaccinated: Hib
Tx: 3rd gen cepha + ampisul/clinda
Thrombocytopenia
Infections
Eczema
WASP mutation
Wiskott Aldrich Sydrome
Di George Syndrome
TCATCH-22
T cell d/o
Cardiac defect (TOF)
Abnormal facies
Thymic aplasia
Cleft palate
Hypocalcemia (seizure)
22q11.2 chromosomal deletion
No antibody production
Lacks of B cells
Bacterial infections and esp enteroviruses
Small to absent tonsils
No palpable lymph nodes
XLA or Bruton agammaglobulinemia
Tx Gammaglobulin IM once a month
Low igg with normal b cells, later age of onset, normal nodes and tonsils, inc risk of granuloma
CVID
Low or absent IgA
Respi and GI (giardia) infections
Urogenital tract infections
Selective IgA deficiency
Failure to produce IGG IGA IGE
Normal or inc IGM
Symptomatic during 1at or 2nd yr of life
Recurrent pyogenic infections
Profoundly neutropenic
P. Jiroveci pneumonia
Hyper IgM syndrome
Low Ig, lack of anti EBNA and long lived T cell immunity
Inadequate immune response to EBV
Healthy males until they acquire EBV
Fatal infectious mononucleosis, lymphomas, acquired hypogammaglobulinemia
X linked lymphoproliferative disease or Duncan disease
Low number of T cells and impaired t cell function
CATCH 22
Susceptible to fungi, viruses, P jiroveci
Thymic hypoplasia or Digeorge Syndrome
Poor response to candida antigen
Chronic and severe candida skin and mucous membrane infections in the 1st month if until 2nd decade of life
Chronic mucocutaneous candidiasis
Absence of T and B cell
Poor Ab production to polysaccharides
1st mo of life recurrent and persistent diarrhea, penumonia, OM, sepsis, skin infection with opportunistic agents
Unable to reject foreign tissue
SCID
Coarse facies, coronary artery anuerysm, mortality in adulthood, pathologic fractures
Recurrent bacterial infection (S. Aureus, pneumococcus, H influenzae)
Aspergillus, mucocutaneous candidiasis
Hyper IgE syndrome (AD or sporadic or Job syndrome)
Decreased chemotaxis, degranulation and bactericidal activity
Impaired NK function
Recurrent pyogenic infection
Bleeding diathesis
Albinism
Peripheral neuropathy
Prolonged BT with normal platelet
Neutropenia, hepatosplenomegaly
Chediak Higashi Syndrome
Impaired neutrophil adhesion and platelet activation
Dec binding of c3bi to neutrophils
Neutrophilia, lack of pus formation, delayed umbilical cord separation, slow healing, S aureus, e coli, candida, aspergillus
Leukocyte adhesion deficiency
AR
Failure to activate neutrophil respiratory burst leasing to failure to kill catalase positive microbes
Recurrent pyogenic inf w catalase positive microorg
S aureus, serratia, B cepacia, candida, pneumonia, osteomyelitis, skin inf
Hallmark: granuloma formation and inflammatory process
Chronic Granulomatous Disease
Classification of DKA
Mild
Ph <7.3 hco3 <15
Oriented alert but fatigued
Moderate
<7.2, <10
Kussmaul, oriented but sleepy
Severe
<7.1, <5
Kussmaul or depressed respi, depressed sensorium/coma
SIADH
Serum Na low
UO N or low
Urine Na high
Intravascular volume N or high
Serum uric acid low
Vasopressin level high
CSW
Serum Na low
UO high
Urine Na very high
Intravascular volume low
Serum uric acid N or high
Vasopressin low
Central DI
Serum Na high
UO high
Urine Na low
Intravascular vol low
Serum uric acid high
Vasopressin low
Normal linear growth velocity for age
Bone age consistent with chronological
Normal age of onset of puberty
Familiar short stature
Delayed growth in one parent but average final stature
Normal birth hx and growth for first few mos
Chronologic age is greater than bone age
Constitutional short stature
Coryza, cough, conjunctivitis
High grade fever
Rashes at peak of fever, cephalocaudal
Koplik spot
4 day before and 4 days after communicability
Measles (Rubeola)
Low grade fever
Cephalocaudal rash
Posterior auricular LN
Forchheimer spots
7 days before and 7 days after communicability
Ribella (German measles)
Fever 3-5 days
Fussiness
Seizures
Rash appears when fever abates
Nagayama spots
Roseola Infantum
Exanthem Subitum or 6th Disease
Fever, malaise 1-2 days before rash
Different stages of rash at time of presentation
Trunk first (like Roseola)
1-2 days before rash to 7 days after rash or til all lesions have crusted
Varicella
Ulcers in tongue, buccal mucosa
Tender ulcers on hands and feet
HFMD
Coxsackie Virus A16
Slapped cheek
Spread to trunk
Spares palms and soles
Complication: Aplastic crisis
Erythema infectiosum
5th disease
Parvovirus B19
Hbs Ag (+)
Hbe Ag (+)
Anti HBS, Anti HBC (-)
Incubation period
Hbs Ag (+)
Anti Hbs (-)
Igm Anti Hbc (+)
Hbe Ag (+)
Acute Infection
Anti Hbc IgM (+)
Hbs ag, anti hbs, hbe ag (-)
Window period
Anti Hbc IgM (+)
Hbs ag, anti hbs, hbe ag (-)
Window period
Anti hbc igg (+)
Anti hbs (+)
Hbs Ag (-)
Hbe Ag (-)
Complete recovery
Anti hbc igg (+)
HbsAg (+)
Anti Hbs (-)
Hbe ag (-)
Chronic carrier
Anti hbc igg (+)
HbsAg (+)
Anti Hbs (-)
Hbe ag (+)
Chronic active
Anti hbc (-)
HbsAg (-)
Anti Hbs (+)
Hbe ag (-)
Vaccinated
- Handedness
- Bedwetting
- Ties shoes
- Language explosion
- Interest in basic sexuality
- 3 y/o
- Upto 4 y/o in girls, upto 5 y/o in boys
- 6 y/o
- 2 y/o (20-50 words by end of 2nd yr)
- 4-5 y/o
Management of Sporotrichosis
Itraconazole
Amphotericin B for the severely Ill
Empiric treatment for Lymphogranuloma Venereum
Doxycycline 100 mg orally BID x 21 days
Drug of choice of Syphilis
Single dose of Benzathine Penicillin G 2.4 M U IM
DOC for W. Bancrofti
DEC (contraindicated in onchocerciasis) + Doxycycline 200 mg/day 4-6 weeks
DOC for Mycobacterium marinum
Clarithromycin and Ethambutol + Rifampicin if with deeper organ involvement such as osteomyelitis
DOC for Actinomyces
High dose IV Penicillin 18-24 million U daily for 2-6 weeks followed by oral Penicillin or Amoxicillin for 6-12 mos.
DOC for Nocardiosis
TMP-SMZ but if with sulfa allergy, Imipenem, Ceftriaxone, and Linezolid are options
DOC for Bacillus anthracis (anthrax)
Ciprofloxacin 30mkday q8 (max 400) + Clindamycin 40 mkday q8 (max 900)
DOC for Borrelia Burgdorferi
Doxycycline 2.2mg/kg BID X 10-14 days (best CNS penetration), Amoxicillin, Cefuroxime
DOC for Pasteurella Multocida
Co-amoxiclav
DOC for Bartonella Henselae
Most cases are self-limited
May Give Azithromycin
DOC for rickettsia (Rocky Mountain Spotted Fever)
Doxycycline
PEP for measles
Measles IG for prevention and attenuation within 6 days of exposure
Measles active vaccine for susceptible children >1 y/o within 72 hours, if <6 mos, pregnant, and immunocompromised - give IG
PEP for Rubella
Active vaccine within 72 hours
Use of IG not routinely done except if termination of pregnancy is not an option (0.55ml/kg IM)
A chronic progressive infection developing usually on a distal location on the limbs
Mycetoma caused by Nocardia
PID with liver involvement
Fitz-Hugh-Curtis
Disseminated Gonococcal Infection characterized by fever, chills, skin lesions, polyarthralgia (wrists and hands), negative synovial culture
Tenosynovitis-dermatitis syndrome
Delirium with mumbling speech, tachycardia, dry, flushed skin, dilated pupils, myoclonus, slightly elevated temperature,
urinary retention, and decreased bowel sounds. Seizures and dysrhythmias may occur in severe cases
Anticholinergic Toxicity
- Antihistamines, antiparkinsonian medication, atropine, scopolamine, amantadine, antipsychotic agents, antidepressant
agents, antispasmodic agents, mydriatic agents, skeletal muscle relaxants, and many plants (notably jimsonweed and
Amanita muscaria).
Delusions, paranoia, tachycardia (or bradycardia if the drug is a pure α-adrenergic agonist), hypertension, hyperpyrexia,
diaphoresis, piloerection, mydriasis, and hyperreflexia. Seizures, hypotension, and dysrhythmias may occur in severe cases.
Sympathomimetic Toxicity
- Cocaine, amphetamine, methamphetamine (and its derivatives 3,4-methylenedioxyamphetamine, 3,4-methylenedioxymethamphetamine,
3,4-methylenedioxyethamphetamine, and 2,5-dimethoxy-4-bromoamphetamine), some synthetic marijuana,
and OTC decongestants (phenylpropanolamine, ephedrine, and pseudoephedrine). In caffeine and theophylline
overdoses, similar findings, except for the organic psychiatric signs, result from catecholamine release.
Coma, respiratory depression, miosis, hypotension, bradycardia, hypothermia, pulmonary edema, decreased bowel sounds,
hyporeflexia, and needle marks. Seizures may occur after overdoses of some narcotics, notably propoxyphene.
Opiate, Sedative, Ethanol Intoxication
- Narcotics, barbiturates, benzodiazepines, ethchlorvynol, glutethimide, methyprylon, methaqualone, meprobamate, ethanol,
clonidine, and guanabenz.
Confusion, central nervous system depression, weakness, salivation, lacrimation, urinary and fecal incontinence,
gastrointestinal cramping, emesis, diaphoresis, muscle fasciculations, pulmonary edema, miosis, bradycardia or
tachycardia, and seizures.
Cholinergic Toxicity
- Organophosphate and carbamate insecticides, physostigmine, edrophonium, and some mushrooms.
Normal size and weight at birth
Apnea, cyanosis, severe hypoglycemia, with or without seizures
Round and the face is short, broad, prominent frontal bone, depressed nose bridge and saddle shaped, nose is small, mandible and chin underdeveloped, teeth late eruption, high pitched voice, small genitals, delayed puberty
Congenital hypopituitarism
