Current essentials: pediatrics by Judith Sondheimer

By Judith Sondheimer

Use present necessities: Pediatrics as a brief reference at the wards and within the hospital! This concise, alphabetically-organized reference offers synoptic info for greater than four hundred universal or vital ailments and syndromes visible in teenagers, from start via infancy and formative years. "Nutshell" details at the analysis and therapy of greater than four hundred clinical problems One Pearl and one ailment consistent with web page Covers ambulatory and inpatient medication contains all key specialties in pediatrics convenient skinny trim measurement slips simply into lab coat pocket Use as a significant other to present prognosis and therapy in Pediatrics (McGraw-Hill, nineteenth variation, 2007)!

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American Heart Association updated the indications and drug recommendations in 2007 Pearl The most common agent of bacterial endocarditis in IV drug users is S aureus.

Chapter 2 Cardiovascular Disorders 37 Rheumatic Fever ■ Essentials of Diagnosis • • • • • • • • ■ Differential Diagnosis • • • • • ■ Other polyarthritis/arthralgia—juvenile rheumatoid arthritis, systemic lupus erythematosus, and other autoimmune disorders Pyogenic arthritis—Haemophilus influenza type B, Neisseria gonorrhoeae, Staphylococcus aureus, Streptococcus pyogenes, Kingella kingae Dystonia from medications, brain tumor Other myocarditis—Kawasaki disease, adenovirus, coxsackie A and B, echovirus, cytomegalovirus, parvovirus, influenza A virus, human immunodeficiency virus Mitral and aortic insufficiency due to bacterial endocarditis Treatment • • • • • • ■ Group A β-hemolytic streptococcus (GAS) infection causes B lymphocytes to make anti-GAS antibodies Carditis—immune complexes cross-react with cardiac sarcolemma causing carditis, mitral and aortic insufficiency, and congestive heart failure Polyarthritis—large joints are swollen, red, and extremely tender Chorea—emotional lability, involuntary movements, ataxia, slurred speech, and weakness; sometimes onset is after acute stage of disease Subcutaneous nodules—nontender, moveable, present in severe disease Major Jones criteria—carditis, polyarthritis, Sydenham chorea, erythema marginatum, subcutaneous nodules Minor Jones criteria—previous rheumatic fever, polyarthralgia, fever, high sedimentation rate, prolonged PR interval suggestive of carditis Diagnosis requires 2 major or 1 major and 2 minor Jones criteria plus evidence of GAS infection (antistreptolysin O, positive throat culture) Treat GAS infection with penicillin and arthritis with aspirin Treat heart failure with diuretics, angiotensin-converting enzyme inhibitors Treat carditis with aspirin or corticosteroid until acute phase inflammatory tests resolve Prevent future GAS with monthly intramuscular benzathine penicillin.

Culture may be required to differentiate Lymphadenitis, lymphoma Lung tumor Fungal infection Sarcoid Metastatic TB infection may present as isolated bacterial meningitis, osteomyelitis, enteritis, peritonitis, nephritis, otitis, dermatitis, adrenal insufficiency, sepsis, and multiorgan failure Spontaneous healing is the usual course of primary infection in normal children Isoniazid is drug of choice for newly positive TB skin test Isoniazid plus rifampin for 6 months with pyrazinamide for first 2 months used for primary pulmonary infection Corticosteroids used for mediastinal lymphadenopathy compressing the airways, massive pleural effusion with mediastinal shift and miliary TB Increasingly, multiple drug-resistant strains require changes in antibiotic regimens.

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