Questions and Answers
What tests should be conducted for a patient with chronic urticaria (>6 wk)?
What is the first line treatment for urticaria?
H1 antihistamines
What are the two categories of hemolytic uremic syndrome?
Diarrhea-positive and diarrhea-negative
What characterizes Grade 1 - 3 ankle sprains?
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What are the Ottawa ankle criteria for ordering radiographs?
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What is the initial treatment for GAS pharyngitis?
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What is indicated for Na < 120 mEq/L?
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What are the indications for renal replacement therapy in renal failure?
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What triggers paradoxical vocal fold dysfunction (PVFD)?
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What indicates insulin management in newly diagnosed T2 diabetics?
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What are the maternal quadruple screening results associated with Trisomy 21?
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What are the indications for CT after a closed head injury?
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What symptoms indicate the need for observation vs CT after a closed head injury?
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Who should receive passive immunoprophylaxis after exposure to VZV?
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What is a common reason for frequent bacterial infections in young children?
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What is the treatment for perichondritis of the ear?
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What does low urine sodium concentration indicate in a patient with low effective circulatory volume?
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Study Notes
Chronic Urticaria Testing
- Testing includes CBC, ESR/CRP, and TSH to rule out autoimmune conditions and thyroid diseases.
- Food allergies are rarely linked to chronic urticaria lasting over six weeks.
Treatment for Urticaria
- First line of treatment: H1 antihistamines.
- Second line includes H2 antihistamines and leukotriene modifiers.
- Third line treatment consists of systemic steroids.
Hemolytic Uremic Syndrome (HUS) Categories
- Diarrhea-positive HUS often caused by STEC (EHEC O157:H7).
- Diarrhea-negative HUS associated with worse outcomes due to malignancy, medications, SLE, pregnancy, or genetic factors.
Sprains Classification and Common Ligaments
- Grade 1: ligament is stretched.
- Grade 2: partial ligament tear.
- Grade 3: complete ligament tear.
- Most affected ligaments in ankle sprains are the anterior talofibular and calcaneofibular ligaments.
Ottawa Ankle Criteria for Radiographs
- Patients unable to bear weight on the affected ankle require radiographic imaging.
- Tenderness at the tip or posterior aspect of ankle malleoli indicates the need for further evaluation.
GAS Pharyngitis Treatment
- Initial treatment options include oral PCN V or oral amoxicillin for ten days, IM benzathine PCN G as a single dose, or cephalosporins if PCN allergic.
- For recurrent cases or PCN anaphylaxis, prescribed oral clindamycin for ten days.
Indications for IV Hypertonic Saline
- Recommended when sodium levels are below 120 mEq/L.
- Presence of neurological symptoms such as headaches, seizures, or coma strengthens the indication for administration.
Renal Replacement Therapy Indications
- Volume overload with complications.
- Severe hyperkalemia.
- Uremia characterized by BUN exceeding 100 mg/dL or significant acidosis.
Paradoxical Vocal Fold Dysfunction (PVFD)
- Exercise is a common trigger.
- Diagnosis possible through direct laryngoscopy showing vocal cord adduction with a posterior chinklike opening.
- Managed with laryngeal control therapy focusing on diaphragmatic breathing and relaxation techniques.
Insulin Management in Newly Diagnosed T2 Diabetes
- Initiated when plasma glucose levels exceed 250 mg/dL.
- Also indicated if hemoglobin A1c is greater than 9%.
Maternal Quadruple Screening for Trisomy 21
- Results indicate low AFP and estriol levels combined with high hCG and inhibin A levels.
CT Indications After Closed Head Injury
- Glasgow coma scale score of 14 or lower.
- Presence of alteration in mental status, palpable skull fracture, or signs of basilar fracture warrants a CT scan.
Observation vs. CT After Closed Head Injury
- Patients with isolated loss of consciousness, headaches, or vomiting may be observed for 6-8 hours.
- CT is necessary if symptoms worsen or do not improve.
Passive Immunoprophylaxis After VZV Exposure
- Recommended for individuals with congenital or acquired T-lymphocyte immunodeficiency, certain neoplasms, post-HSCT, or immunosuppressive therapy.
- Pregnant women are also eligible for this prophylaxis, which can be administered within 10 days of exposure.
Frequent Bacterial Infections in Young Children
- Suggests an innate immune system dysfunction, such as Chronic Granulomatous Disease (CGD) from CYBB mutations or leukocyte adhesion deficiencies (LAD).
Treatment of Perichondritis of the Ear
- IV antibiotics effective against pseudomonas, specifically ciprofloxacin, are the treatment of choice.
Urine Sodium Concentration in Low Effective Circulatory Volume
- A low urine sodium concentration is indicative in cases of dehydration, nephrotic syndrome, cirrhosis, or congestive heart failure.
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Description
Prepare for the AAP exam with these flashcards focusing on chronic urticaria, treatment options, and hemolytic uremic syndrome. Each card provides crucial information to help clarify definitions and management strategies in pediatric care.
