Irreversible effects of inhalant toxicity with chronic use
- Hearing loss: spray paints, glues, dry cleaning chemical, correction fluid
- Peripheral neuropathies or limb spasms: glues, gasoline, shipped cream dispenser, gas cylinders
- CNS or brain damage: spray paints, glues, dewaxers
- Bone marrow suppression
3 locations to place the scoliometer for Adams Forward Bend Test
- Thoracic
- Thoracolumbar
- Lumbar levels
What constitutes scoliosis?
More than 10 degrees on scoliometer is abnormal.
Definition of pediatric hypertension
An average systolic BP and/or diastolic BP that is over or equal to the 95th percentile for gender, age, and height on 3 or more occasions
Pharmacological management of depression in children/adolescents
SSRI’s: fluoxetine (Prozac) and citalopram yielded statistically significant higher response rates than did other SSRI’s.
- Fluoxetine is the only drug that is approved by the US FDA for treating MDA among youth
Iron requirement for pregnancy <21 yo.
27 mg/day
Vitamin A deficiency
- Nyctalopia (night blindness)
- Corneal xerosis (aka drying)
- Keratomalacia (ulcerations)
- Blindness once ulcerations occur
- Failure to thrive and depressed immune function
- Increased risk of diarrhea disease
Vitamin B1 (Thiamine) deficiency
- Wernicke-Korsakoff syndrome: irritability, peripheral neuritis, decresed tendon reflexes, ataxia, loss of vibriation sense, aseptic meningitis
- Beriberi: cardiac failure, loud piercing cry, vomiting
Vitamin B2 (Riboflavin) deficiency
- Cheilosis: abnormal condition of the lips characterized by scaling of the surface and by the formation of fissures in the corners of the mouth
- Glossitis: smooth tongue, lack of papillae
- Keratitis
- Photophobia
- Seborrheic dermatitis
- Sore throat, hyperemia of the mucosal surfaces,
- Normocytic anemia
Vitamin B3 (Niacin) deficiency
[Milk and egg]
- Diarrhea
- Dementia
- Dermatitis
Vitamin B6 (Pyridoxine) deficiency
[Yeast, rice polishing, cereals]
- Diarrhea
- taking INH needs supplementation
- Exclusively breastfed infants need supplementation if mother is deficient
Vitamin B12 (Cyanocobalamin) deficiency
[Absorbed in terminal ileum]
- In young children symptoms include poor growth and development, with difficulties with movement
- Older children and adolescent = neurological + hematologic
- Neuro: developmental delay, parasthesia, impaired vibratory, proprioceptive sense, hypotonic, seizures, ataxia, memory loss, depression, weakness, poor school performance
- Heme: macrocytic anemia, thrombocytopenia, leukopenia, pancytopenia
Diagnosis of Vitamin B12 deficiency
- Methylmalonic acid (MMA): elevated in 90-98% of patients. Sensitive but not specific.
- Homocysteine levels: Elevated homocysteine levels denote vitamin B12 OR folate deficiency, so again not specific
- B12 level: directly measure B12 level
Vitamin C deficiency
- Scurvy or Barlow disease occurs after 1-3 months of deficiency
- Newborns are protected since human milk and formula contains Vitamin C
- Signs: bleeding, osteopenia, gingival disease, pseudoparalysis, irritability, holding legs in front position, decreased appetite, fatigue, follicular keratosis on buttocks and legs
Folic acid or Folate
- Prevents megaloblastic anemia
- Adequate intake:
(1-3 y.) 150 mcg
(4-8 y.) 200 mcg
(9-13 y.) 300 mcg
(14-21 y.) 400 mcg
Vitamin D deficiency (infants)
[Fortified foods and sun]
- Failure to thrive
- Seizures and Tetany due to Calcium deficiency
- Widened cranial sutures
- Frontal bossing
- Hypotonic
Vitamin D deficiency (children)
[Fortified foods and sun]
- Bony changes
- Delayed tooth eruption
- Bowed legs
- Kyphosis
- Pelvic abnormalities
- Pot belly
Vitamin E deficiency
[Found in a variety of foods]
- Freidereich’s ataxia
- Serum alpha tocopherol level <5mg
Bacterial Vaginosis characteristics
- Symptom: Odor, itch, discharge
- Discharge: Adherent, thin, homogenous, milky white, foul, fishy
- pH: >4.5
- KOH Whiff Test: (+)
- NaCl Wet Mount: >20% clue cells
Candida Vaginitis characteristics
- Symptom: Itch, discomfort, dysuria, thick discharge
- Discharge: White, thick cheesy, clumpy cottage cheese
- Exam findings: Inflammation, erythematous
- pH: usually less than 4.5
- NaCl Wet Mount: Few WBX (?)
T. vaginalis (Trichomonas) characteristics
- Symptom: Itch, discharge (50% asymptomatic)
- Discharge: Frothy, grey, yellow green, malodorous
- Exam findings: Cervical petechial lesion, strawberry cervix
- pH: >4.5
- KOH Whiff Test: (+)
- NaCl wet mount: Mobile flagellated protozoa
Treatment of VVC
- Intravaginal antifungal cream (“azoles”), OR
- Oral tablet (fluconazole 150 mg, single dose)
Amsel Criteria for Bacterial Vaginosis
- Vaginal pH >4.5
- Presence of clue cells on wet mount exam.
- Positive amine, “whiff” test
- Homogenous, non-viscous, milky-white discharge adherent to vaginal walls
Recommended regimen to treat Bacterial Vaginosis
- Metronidazole 500 mg orally 2x/day for 7 days
- Metronidazole gel 0.75%, one full applicator, intravaginally, 1x/day for 5 days
- Clindamycin cream 2%, one full applicatory, intravaginally at bedtime for 7 days
