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The Pediatric Glasgow Coma score. #Surgery #Pediatrics

The Blantyre coma scale is a modification of the Pediatric Glasgow Coma Scale, designed to assess malarial coma in children. #Infectious

Severe malaria is an infection with Plasmodium falciparum with any of the following complications: - Impaired consciousness (GCS < 11 in adults, Blantyre score < 3 in children) - Multiple convulsions (>2 in 24 hrs) - Generalized weakness - Acidosis (bicarb < 15 mmol/L or lactate ≥ 5 mmol/L) - Hypoglycemia (<40 mg/dL in ages >5 or <54 mg/dL if <5 yrs old) - Severe anemia (Hgb < 7 in adults and ≤5 in children <12 yrs) - Jaundice (>3g/dL) - Renal impairment (Cr > 3mg/dL) - Pulmonary edema - Significant bleeding - Shock - Hyperparasitemia #Infectious

Give diabetic patients ≥ 40 years old with a 10-year ASCVD risk of >10% statins regardless of the LDL level. #Endocrinology

Glucose control in type 2 diabetes does not lower the risk of macrovascular disease like MI and stroke but does lower the risk of microvascular complications like nephropathy and retinopathy. Glucose control in type 1 diabetes reduces the risk of both macrovascular and microvascular complications. #Endocrinology

Myxedema coma is treated with IV combine therapy with levothyroxine and liothyronine + stress-dose glucocorticoids (IV hydrocortisone 100 mg q8hr) We give exogenous steroids because the body is less responsive to cortisol in hypothyroidism. Patients may also require mechanical ventilation and IV fluids. #Endocrinology

Latent TB is diagnosed with a positive tuberculin test + negative chest CXR The old standard therapy for TB was 9 months of daily Isoniazid (INH) The current preferred treatment are Rifamycin-based regimens such as - Rifampin daily for 4 months - INH and Rifampin daily for 3 months - INH and Rifapentine weekly for 3 months #Infectious

Developmental milestones in premature infants are delayed. Correct the age by: Actual age - weeks premature( before 40) A 6-month-old infant born 8 weeks earlier (2 months) should have the milestones of a 4 month old. #Pediatrics

Neonatal respiratory distress syndrome is more common in preterm infants. CXR shows white-out appearance. Persistent pulmonary hypertension of the newborn is more common in term infants. CXR shows clear lungs. Meconium aspiration syndrome is more common in babies born after 40 weeks. CXR shows hyperinflation and diffuse patchy infiltrates. #Pediatrics

Explaining the Answer This patient has Systemic Juvenile Idiopathic Arthritis. -The ESR is often elevated but nonspecific. The diagnosis is made clinically. - Treatment is with NSAIDs and Glucocorticoids, not IVIG. - ANA antibodies are negative in the systemic form of this disease. - Patients have a 50% chance of developing severe, erosive arthritis.

A 3-year-old girl is brought to your office by her parents, who report that she has had 2 months of intermittent high-spiking fevers with temperature up to 39'C (103'F), which occur nightly and return quickly to normal. The parents report that their daughter's activity and appetite are diminished. She is often reluctant to walk because of swelling of her ankles and knees. Six months ago her weight was at the 50th percentile, and now her weight is at the 25th percentile for age. On examination, you note a temperature of 39.2'C (102.6'F) and a salmon-colored maculopapular rash on the trunk. Diffuse lymphadenopathy is present, and the liver is palpable 4 cm below the right costal margin. Which of the following statements regarding this patient's likely diagnosis is most accurate?

Blount disease is an abnormal development of the growth plates near medial tibia which leads to a genu varum deformity of the lower limbs. It is treated with bracing or surgery. #Orthopedics #Pediatrics

Pioglitazone is a diabetes drug that is contraindicated in those with active bladder cancer because this drug causes a slight increase in bladder cancer risk. #Endocrinology #Pharmacology

The definitive treatments for Grave's disease are radioiodine ablation and thyroidectomy. Radioiodine ablation increases thyroid-stimulating immunoglobulins and worsens orbitopathy. Thyroidectomy lowers the antibodies and does not effect the orbitopathy. #Endocrinology

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Know how to interpret a tuberculin skin test Note: only the indurated area is measured, not the surrounding erythema #Infectious

Adam's forward bend can be used to screen for functional and structural scoliosis. Note: Structural scoliosis is when the patient's spine actually has a physical curve. Functional scoliosis is when the spine appears to be curved, but the apparent curvature is actually the result of an irregularity elsewhere in the body (e.g. different leg lengths) #Orthopedics #Pediatrics

Scoliosis can develops in patients > 10 years of age. Treatment is based on Cobb's angle and skeletal maturity. If the angle is < 20°, observe. If an angle is >50°, perform surgical correction. #Orthopedics #Pediatrics

Q: When should you order a CT scan before performing a lumbar puncture? A: - Immunocompromised - History of mass lesion - New onset seizures - Papilledema - Abnormal level of consciousness - Focal neurologic deficits Why? To exclude mass or ↑ ICP