Forum Replies Created
-
Posts
-
Yes. I was referring to poor renal function and hypoxia. I would say just take my word for it and spend your time on more high-yield information.
Here’s the updated section.
DIGOXIN TOXICITY
Digoxin toxicity leads to anorexia, weakness, n/v, poor appetite, V-tach. Increased chance of dig toxicity if LOW K+, Mg, poor renal function or hypoxia. Treat with BB, Digibind if life threatening correction of electrolytes.
I think your other resource is incorrect. By virtue of the mechanism, discussed in the description (“There is a defect of phosphate reabsorption in the proximal tubule AND a defect of the kidney to convert 25-Vitamin D to 1,25 Vitamin D “) there has to be a LOW 1,25 level.
What’s the other resource?
Shoot! You’re right. It’s correct everywhere else, including the diagram, but I did say PV at the beginning. Thanks so much for the catch… Keep em coming!
Corrected version below:
TRANSPOSITION OF THE GREAT ARTERIES (TGA/TOGA)
The “great arteries” are the AORTA and the PULMONARY ARTERY. In Transposition Of The Great Arteries, the LV leads to the PA and the RV leads to the Aorta. Most common cardiac cause for cyanosis on DOL 1, and usually presents within hours. EKG shows RVH. The two circuits do not connect and are “running in parallel” (see image). Mixing needs to occur in order to support life. Often a VSD is present, but if not, then a septal “defect” needs to be created. To treat, create an ASD to allow mixing. Mixing at the PDA also helps (though not as much) so create the presence of BOTH (ASD and the PDA) by also giving PGE. The ASD (or existing VSD) allows a RIGHT to LEFT shunt (deoxygenated circuit to oxygenated circuit) to be created. CXR shows an EGG SHAPED and vascular congestion (due to blood flow from the LV to the PA). There is no associated murmur. In the image below, note the circuits running in parallel. Treatment is an ASD (represented by the crossed arrows).
PEARL: If you suspect a cardiac cause for cyanosis on DOL 1, this is probably your answer!
Hey therm,
Thanks for the question. It’s a confusing and low-yield topic so please don’t spend too much time on it. You’re partially correct so thank you for bringing my attention to it. The updated version is below:
ALPHA THALASSEMIA
Alpha thalassemia refers to a mutation in an alpha chain allele. Because of the defect, other types of hemoglobin persist. You will find elevated levels of fetal hemoglobin (hgb F) as well as elevated levels of “minor adult hemoglobin” (hgb A2). There will only be low levels of A1. Patients with alpha thalassemia do fairly well and only have a mild microcytosis.
PEARL: The only thing you probably need to know for the exam is that alpha thalassemia can cause a microcytic anemia and cannot be diagnosed by hemoglobin electrophoresis.
MNEMONIC: Be familiar with, but do not memorize this. It’s doubtful that you will be asked to name the types of alpha thalassemia on the exam, but if you are, try this – “silent… trait (or minor)… barts… DEAD!” If one allele is mutated the patient is said to be a “silent carrier”, if 2 = trait or minor, 3 = Hemoglobin H disease (or Barts) and 4 = Major (or hydrops fetalis)! Four defective alleles are not compatible with life since ALL types of hemoglobin have alpha chains. Hgb A1 = alpha-beta, Hgb S = alpha-beta (but with a defective beta due to glu-val), Hgb A2 = alpha-delta and Hgb F = alpha-gamma.
Hi Therm,
Either can be given, but you’re right. IM is better and has a faster onset of action and is more reliable. Updated section below. Thanks for the help and correction!
FOOD ALLERGIES
Early introduction of solids results in an increased chance of food allergies and may predispose children to obesity later in life. ABDOMINAL PAIN may be the only sign of impending anaphylaxis. If the patient has a history of a food allergy, GIVE IM EPINEPHRINE.
Hi Laz,
I looked it up. You’re correct and THANK YOU so much for the reference. That really makes it easier for me to verify and clarify!
Another PBR member also pointed it out and gave me an AAP reference ( http://www2.aap.org/breastfeeding/policyOnBreastfeedingAndUseOfHumanMilk.html). You are both correct. The next version of the book will have this correction with Hepatitis B omitted, and also a CMV correction. Here’s the most updated version:
BREAST MILK
Breast milk contains arachidonic acid, DHA, whey, casein, colostrum, hind milk, etc. It’s a lot to remember, so memorize the following and move on!
* ARACHIDONIC ACID (AA) & DOCOSAHEXAENOIC ACID (DHA): Help with neurologic development. Greatest in COLOSTRUM. Not as much in mature milk.
* WHEY: The primary protein in breast MILK.
* CASEIN: The primary protein in FORMULA.
* COLOSTRUM: The milk produced at the end of pregnancy and early after delivery. Only small amounts are expressed in the first few days until the more mature milk finally comes in.
- Yellow color is from carotene.
- Stimulates passage of meconium.
- High in PROTEIN (immunoglobulins, especially IgA).
* HIND MILK: Last bit of milk expressed during breast-feeding. It is highest in CALORIES and FAT.
* FROZEN BREAST MILK: Good for 3-6 months. Once thawed, use within 48 hours.
* CONTRAINDICATIONS TO BREAST-FEEDING: Mother with herpes simplex virus (HSV), HIV, tuberculosis (TB), on chemotherapy, on HYPERthyroid medications, on metronidazole, on sulfa drugs or on Tetracycline. Breast-feeding is also usually contraindicated if the baby has an INBORN ERROR OF METABOLISM. An inverted nipple may be a contraindication depending on the degree of inversion. Breast shells may be needed.
PEARL: Candidiasis, mastitis and fibrocystic disease are NOT contraindications.
PEARL: Breastfeeding is NOT a contraindication for Hepatitis B. For mothers who are CMV carriers (not recent converters), they may also breastfeed.
MNEMONICS:
- COLOSTRUM: Although it is supplied to babies very EARLY in life, it has tremendous LONG-TERM protective benefits/ingredients (AA, DHA, IG’s/IgA aka protein).
- MATURE MILK is the regular, everyday milk that provides the regular, everyday ingredients to a baby (fat, lactose, “energy,” etc.).
- HIND MILK: HIND milk has a high FAT and CALORIC content, like the unusually oversized beHIND of an appropriately overweight/fat new mom. (Sorry for the un-PC mnemonic. Hopefully it helps).
- WHEY: A BREAST full of milk WEIGHS much more than in a can of powdered formula.
For once in dermatology, it’s not steroids
Updated section below:MOLLUSCUM CONTAGIOSUM
Molluscum contagiosum results in flesh-colored, pearly papules that are dome-shaped and umbilicated. Caused by the POX virus. NO treatment is needed, but sometimes cryotherapy or topical Cantharidin, Podophyllotoxin, Imiquimod or Potassium hydroxide.
- When barium passes through the poorly canalized esophagus, there is a “jet” of propelled barium distal to the initial point of constriction. When looking at a barium swallow, it’s the thin area of barium seen. When that area is tortuous, it can resemble a TE fistula. When it’s linear, it does not. New description is below
ESOPHAGEAL WEB
An esophageal web can cause reflux-like symptoms, esophageal impaction and chest pain. It results from the failure of the esophagus to re-canalize in utero. The web then acts as an obstruction to the passage of a food bolus. Liquids, however, pass through more easily. Treatment requires dilation of the esophageal web.
IMAGES: http://bit.ly/ngX7zN and http://bit.ly/oF2ryU
PEARL: The “jet phenomenon” refers to the thin area of barium seen when looking at a barium swallow. It starts at initial point of constriction. When that area is tortuous (http://bit.ly/oF2ryU), it can resemble a TE fistula. When it’s linear it does not (http://www.ajronline.org/content/129/4/747.full.pdf – page 1 – see it and move on!).
Sorry about that. I must’ve passed out due to exhaustion
Here’s the updated section:
CARDIOPULMONARY RESUSCITATION (CPR)
Cardiopulmonary Resuscitation (CPR) is a low-yield topic because guidelines are always changing.
* SINGLE RESCUER CPR FOR BABIES: Provide compressions and breaths at a ratio of 30:2 to minimize transition times. Also, COMPRESSIONS are more important than breaths.
* DOUBLE RESCUER CPR FOR BABIES: Provide compressions and breaths at a ratio of 15:1 (15 compressions for every breath).
* ADOLESCENTS: 30:2 regardless of the number of rescuers.
* PEARL: Guidelines have changed, but the key is to remember that it’s becoming more and more important to focus on high quality chest compressions to get the blood flowing rather than focusing on breaths.
-
This reply was modified 11 years, 7 months ago by
ashish.
Regarding agammaglobinemia… I was talking about the fact that it’s a B-cell def. So titers for tetanus and diphtheria will be low even after immunization. ABP likes for you to know that fact and can test around that information in many different ways. Here’s the updated section:
TITERS
If you suspect a B-cell (aka Humoral) deficiency, test for it by obtaining antiBody TITERS for something the child was already immunized against, such as TETANUS (testing for tetanus titers in patients with Agammaglobulinemia, a B-cell deficiency, is a an ABP favorite way of testing your knowledge). Could also test for titers against Diphtheria and Streptococcus/Pneumococcus. Do not get confused with getting SKIN TESTING for tetanus/Candida/Mumps/PPD which all test for T-cell mediated (aka cellular) immunity.
PEARLS:
* Infections related to B-cell deficiencies rarely occur before 6 months of age because of presence of maternal antibodies.
* ANTIBODY SUBCLASSES: If IgG levels are in the normal range but you still have a high suspicion for a B-cell/Humoral defect, consider checking for the presence of Ig subclasses for Tetanus, Pneumococcus, etc.
Regarding the epi pens, doses are typically not tested, though epinephrine could be one of the few places you’re tested on it. If you were, though, I’d think it would in more of a code type of situation. It wouldn’t hurt to know it, but I’d write it in the margin and consider tying to memorize it on my 4th or 5th pass through the material.
This is usually a tough topic, but I’ve tried to provide a methodical way of approaching the questions. What specifically are you struggling with?
