- A 24-year old woman delivers a healthy baby but begins experiencing significant bleeding from her cervix after delivery. On examination, her uterus feels boggy on palpation.
- Postpartum hemorrhage is a leading cause of maternal mortality and is defined as blood loss over 500mL after vaginal delivery or 1000mL after c-section. The most common cause is uterine atony.
- Oxytocin is the first-line treatment for postpartum hemorrhage caused by uterine atony, as it stimulates uterine contractions. 10IU should be administered intramuscularly to help the uterus contract and decrease bleeding.
Leprosy & pregnancy , treatment, control programs Harsha Yaramati
The document discusses leprosy and pregnancy. Some key points:
- Cell-mediated immunity is depressed during pregnancy, worsening leprosy symptoms for many patients. Reversal reactions frequently occur during pregnancy and shortly after delivery.
- Leprosy symptoms can first appear or worsen during pregnancy due to immunosuppression. Increased bacillary loads can also occur.
- Babies born to mothers with lepromatous leprosy tend to have lower birth weights. Infants may have increased respiratory problems.
- Most drugs used to treat leprosy are considered safe during pregnancy, though dapsone, rifampicin, and corticosteroids carry some risks and should be
Case presentation on toxic epidermal necrolysisRumana Hameed
Here are the potential acute and chronic complications of toxic epidermal necrolysis (TEN):
Acute complications:
- Similar to burns, depends on extent of involvement
- Massive fluid and electrolyte loss
- Prerenal failure
- Hypercatabolism
- Mucous membrane involvement
- Bacterial infection, sepsis
Chronic complications:
- Ocular complications (up to 30%), including conjunctivitis, ectropion, entropion, corneal scarring
- Wound infection
- Nail dystrophy
- Scarring alopecia
- Esophageal stricture
This presentation provides an overview of Hirschsprung's disease, including:
1) It is a congenital disorder where ganglion cells are absent from parts of the colon, preventing normal movement of stool.
2) Risk factors include being male and having Down syndrome. Symptoms include failure to pass meconium in newborns and chronic constipation in older children.
3) Diagnosis involves examinations, x-rays, and biopsy to identify the aganglionic segment. Treatment is surgical resection of that segment. Prognosis is generally good after surgery but some complications can occur.
Stevens-Johnson syndrome is a severe mucocutaneous reaction typically caused by drugs involving skin and mucous membranes. It begins with flu-like symptoms followed by distinctive target lesions. Complications can include blindness, infections, and death. Treatment focuses on stopping the causative agent, supportive care, corticosteroids, IVIG, and antibiotics for secondary infections.
This document provides guidelines for the management of Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) from an Indian perspective. It summarizes 104 sources on managing SJS/TEN and makes recommendations. Key points include promptly withdrawing the culprit drug, providing supportive care, and initiating moderate to high doses of oral or parenteral corticosteroids or cyclosporine within 72 hours. A multidisciplinary approach is recommended due to the systemic nature of SJS/TEN.
Meningitis is an inflammation of the meninges, or protective membranes covering the brain and spinal cord. In pediatric patients, the most common causative organisms are Haemophilus influenzae, Streptococcus pneumoniae, and Neisseria meningitidis. Clinical presentation in infants includes irritability, high pitched crying, fever, lethargy, refusal to eat, and vomiting. In older children, the classic triad of symptoms is headache, fever, and neck stiffness. Treatment involves supportive care, antibiotics targeted against the suspected organism, and treatment of any complications. Prophylactic antibiotics are given to close contacts, and vaccination against H. influenzae, N. meningitidis, and S. pneumonia
This case presentation describes a 25-year-old male who presented with fever, body aches, and lymphocytosis. His symptoms began after trekking in an endemic area. Scrub typhus was suspected based on his symptoms and history. Diagnosis was confirmed with a positive IgM ELISA test for Orientia tsutsugamushi. Doxycycline is the treatment of choice for scrub typhus. Symptoms typically resolve within a week of doxycycline treatment. Prevention involves public education, rodent control, and chemoprophylaxis with antibiotics in endemic areas.
Lyell's syndrome or Toxic epidermal necrolysisSharon Jessy
Toxic epidermal necrolysis (TEN), also known as Lyell's syndrome, is a rare, life-threatening skin condition usually caused by an adverse drug reaction. It causes the top layer of skin to detach from the lower layers all over the body, leaving the body susceptible to severe infection. TEN progresses from a rash and blisters to large areas of skin sloughing off and can involve mucous membranes. It has overall mortality rate of around 30% and treatment aims to discontinue the causative drug and provide supportive care to protect the skin and monitor fluid and electrolyte balance.
Leprosy & pregnancy , treatment, control programs Harsha Yaramati
The document discusses leprosy and pregnancy. Some key points:
- Cell-mediated immunity is depressed during pregnancy, worsening leprosy symptoms for many patients. Reversal reactions frequently occur during pregnancy and shortly after delivery.
- Leprosy symptoms can first appear or worsen during pregnancy due to immunosuppression. Increased bacillary loads can also occur.
- Babies born to mothers with lepromatous leprosy tend to have lower birth weights. Infants may have increased respiratory problems.
- Most drugs used to treat leprosy are considered safe during pregnancy, though dapsone, rifampicin, and corticosteroids carry some risks and should be
Case presentation on toxic epidermal necrolysisRumana Hameed
Here are the potential acute and chronic complications of toxic epidermal necrolysis (TEN):
Acute complications:
- Similar to burns, depends on extent of involvement
- Massive fluid and electrolyte loss
- Prerenal failure
- Hypercatabolism
- Mucous membrane involvement
- Bacterial infection, sepsis
Chronic complications:
- Ocular complications (up to 30%), including conjunctivitis, ectropion, entropion, corneal scarring
- Wound infection
- Nail dystrophy
- Scarring alopecia
- Esophageal stricture
This presentation provides an overview of Hirschsprung's disease, including:
1) It is a congenital disorder where ganglion cells are absent from parts of the colon, preventing normal movement of stool.
2) Risk factors include being male and having Down syndrome. Symptoms include failure to pass meconium in newborns and chronic constipation in older children.
3) Diagnosis involves examinations, x-rays, and biopsy to identify the aganglionic segment. Treatment is surgical resection of that segment. Prognosis is generally good after surgery but some complications can occur.
Stevens-Johnson syndrome is a severe mucocutaneous reaction typically caused by drugs involving skin and mucous membranes. It begins with flu-like symptoms followed by distinctive target lesions. Complications can include blindness, infections, and death. Treatment focuses on stopping the causative agent, supportive care, corticosteroids, IVIG, and antibiotics for secondary infections.
This document provides guidelines for the management of Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) from an Indian perspective. It summarizes 104 sources on managing SJS/TEN and makes recommendations. Key points include promptly withdrawing the culprit drug, providing supportive care, and initiating moderate to high doses of oral or parenteral corticosteroids or cyclosporine within 72 hours. A multidisciplinary approach is recommended due to the systemic nature of SJS/TEN.
Meningitis is an inflammation of the meninges, or protective membranes covering the brain and spinal cord. In pediatric patients, the most common causative organisms are Haemophilus influenzae, Streptococcus pneumoniae, and Neisseria meningitidis. Clinical presentation in infants includes irritability, high pitched crying, fever, lethargy, refusal to eat, and vomiting. In older children, the classic triad of symptoms is headache, fever, and neck stiffness. Treatment involves supportive care, antibiotics targeted against the suspected organism, and treatment of any complications. Prophylactic antibiotics are given to close contacts, and vaccination against H. influenzae, N. meningitidis, and S. pneumonia
This case presentation describes a 25-year-old male who presented with fever, body aches, and lymphocytosis. His symptoms began after trekking in an endemic area. Scrub typhus was suspected based on his symptoms and history. Diagnosis was confirmed with a positive IgM ELISA test for Orientia tsutsugamushi. Doxycycline is the treatment of choice for scrub typhus. Symptoms typically resolve within a week of doxycycline treatment. Prevention involves public education, rodent control, and chemoprophylaxis with antibiotics in endemic areas.
Lyell's syndrome or Toxic epidermal necrolysisSharon Jessy
Toxic epidermal necrolysis (TEN), also known as Lyell's syndrome, is a rare, life-threatening skin condition usually caused by an adverse drug reaction. It causes the top layer of skin to detach from the lower layers all over the body, leaving the body susceptible to severe infection. TEN progresses from a rash and blisters to large areas of skin sloughing off and can involve mucous membranes. It has overall mortality rate of around 30% and treatment aims to discontinue the causative drug and provide supportive care to protect the skin and monitor fluid and electrolyte balance.
- Toxic epidermal necrolysis (TEN) and Stevens-Johnson syndrome (SJS) are acute life-threatening skin reactions caused by extensive necrosis and epidermal detachment. They are considered severity variants of the same process that differ only in the extent of body surface area involved.
- Common causes are certain medications, especially allopurinol, sulfonamides, and carbamazepine. A genetic predisposition also contributes to risk.
- The disease begins with flu-like symptoms followed by painful blistering of the skin and mucous membranes. Prognosis depends on factors like age, comorbidities, and surface area of involvement. Complications can include infection, respiratory failure
This document provides an overview of meningitis including:
- It is an inflammation of the meninges that can be caused by bacteria, viruses, fungi or tuberculosis. Common bacterial causes are Neisseria meningitidis, Streptococcus pneumoniae, and Haemophilus influenzae type b.
- An outbreak in Nigeria from 2016-2017 saw over 1,400 suspected cases mostly in children ages 5-14 in certain states. Risk factors include young age, close contacts, crowding and poverty.
- Symptoms can include fever, headache, nausea, and signs of meningeal irritation like neck stiffness. Diagnosis involves CSF and blood tests. Treatment depends on the suspected cause but may include
Stevens-Johnson syndrome is a life-threatening skin condition characterized by extensive necrosis and separation of the epidermis from the dermis. It exists on a spectrum of severity from Steven Johnson Syndrome (<10% body surface area involvement) to Stevens Johnson Syndrome-Toxic Epidermal Necrolysis (10-30% involvement) and Toxic Epidermal Necrolysis (>30% involvement). It is typically caused by hypersensitivity drug reactions or infections and presents with painful erosions and blistering of the skin and mucous membranes that can lead to vision loss, respiratory failure, or death in severe cases. Treatment focuses on stopping the offending agent, supportive care in intensive care units, wound care of d
This document discusses neurotuberculosis, specifically tuberculous meningitis. It begins by classifying neurotuberculosis and describing the pathogenesis of tuberculous meningitis. It then covers the clinical features and stages of tuberculous meningitis, diagnostic criteria, complications, management including treatment with antitubercular drugs and corticosteroids, and differential diagnosis. Imaging and diagnostic tests for tuberculous meningitis like CSF analysis are also summarized.
Steven-Johnson syndrome (SJS) is a severe skin reaction typically caused by drug reactions. It is characterized by painful sores and blisters in the mouth, eyes, and other mucus membranes. SJS progresses to toxic epidermal necrolysis (TEN) when over 30% of the skin is affected and shows widespread damage. Both SJS and TEN can cause blindness, infection, and death if not properly treated with fluid replacement, antibiotics, steroids, and stopping the causative drug. Prompt diagnosis and management are important to prevent complications and improve prognosis of these potentially life-threatening conditions.
Now a days TBM is super most disease in Indian children.
Tuberculous meningitis (TBM) is difficult to diagnose, and a high index of suspicion is needed to make an early diagnosis.
This document summarizes a presentation on Stevens-Johnson syndrome and toxic epidermal necrolysis (SJS/TEN). The presentation covers the ocular and systemic features of SJS/TEN as well as treatment approaches. It notes that SJS/TEN is a severe drug reaction involving skin and mucous membrane blistering. Ocular features include conjunctivitis, keratitis, pseudomembranes and late complications like symblepharon. Systemically, patients experience flu-like symptoms and skin lesions. Treatment involves removing the precipitating drug, supportive care, and managing ocular complications with lubricants and surgery if needed.
Drug induced steven johnson syndrome sjsmartinshaji
This is an article about Drug induced steven johnson syndrome sjs / toxic epidermal necrolysis (TEN) , this is a life threatening immune complex activated hypersensitivity reaction.
pictures , a case , treatment options , side effects , references , journals are also mentioned in this slide share
Agranulocytosis, also known as neutropenia, is a condition defined by an abnormally low level of neutrophils in the blood. It can be caused by decreased production, ineffective cell development, or decreased survival of neutrophils. Common causes include drug reactions, cancers, infections, and autoimmune disorders. Symptoms range from none with mild disease to severe bacterial infections that can be life-threatening. Diagnosis involves medical history, physical exam, and blood tests showing low neutrophil counts. Treatment focuses on removing the cause, monitoring blood counts, promptly treating any infections, and providing supportive care.
This document provides information on meningitis, including:
- Meningitis is an inflammation of the meninges (membranes covering the brain and spinal cord) that can be caused by bacteria, viruses, fungi, or other causes.
- Common symptoms include fever, headache, and neck stiffness.
- Bacterial meningitis requires immediate treatment with antibiotics to prevent disability or death. Viral meningitis is generally less severe but still requires supportive care.
- Complications can include hearing loss, seizures, learning difficulties, and even death if not properly treated.
Myasthenia Gravis is an autoimmune disorder that causes muscle weakness. It occurs when antibodies block or destroy acetylcholine receptors, interrupting communication between nerves and muscles. Symptoms include varying muscle weakness that worsens with activity. It commonly first affects eye muscles. Diagnosis involves tests showing improvement of symptoms with acetylcholinesterase inhibitors and presence of acetylcholine receptor antibodies. Treatment focuses on anticholinesterase medications, immunosuppressants, plasmapheresis, IVIG, and sometimes thymectomy. Patients require education on medication management and prevention of crisis.
EPIDEMIOLOGY, CONTROL & MANAGEMENT OF MENINGITISRashmi Singhal
Meningitis is an infection of the meninges that cover the brain and spinal cord. It can be caused by bacteria, viruses, or fungi. Bacterial meningitis is the most severe form and can be life-threatening if not treated promptly with antibiotics. Symptoms include fever, headache, and neck stiffness. Complications can include brain damage, hearing loss, and learning disabilities. Treatment involves intravenous antibiotics and corticosteroids. Vaccines exist to help prevent certain types of bacterial meningitis. Prognosis depends on the causative organism and how quickly treatment is initiated.
1. Leprosy is a chronic infectious disease caused by Mycobacterium leprae bacteria. It primarily affects the skin and nerves, causing disfiguring skin sores and nerve damage. There is no vaccine for leprosy. While leprosy is not highly contagious, it can be treated with multidrug regimens. Left untreated, it can cause blindness, disfigurement, and other complications.
2. Acne vulgaris is a common skin condition typically affecting adolescents and young adults. It is characterized by whiteheads, blackheads, pimples, and pustules on the face, chest, and back. Acne is caused by changes in hormone levels and blocked hair
Diseases of the central nervous system.pptxEndex Tam
This document provides information on meningitis and epilepsy in children. It discusses:
1. Meningitis is an inflammation of the meninges that can be caused by bacteria or viruses. Bacterial meningitis is more serious, especially in infants and young children. Symptoms include fever, headache, and neck stiffness. Diagnosis involves lumbar puncture and CSF analysis. Treatment involves antibiotics and supportive care.
2. Epilepsy is a neurological condition characterized by recurrent seizures. It affects around 1% of children. Seizures have various causes like infections, brain injuries, or genetic factors. Generalized tonic-clonic seizures involve loss of consciousness and muscle contractions. Diagnosis is based on clinical history
1. Acute flaccid paralysis (AFP) is defined as sudden onset of weakness or paralysis over 15 days in patients under 15 years old. It suggests involvement of the lower motor neuron complex.
2. Common causes of AFP include poliomyelitis, Guillain-Barré syndrome, transverse myelitis, botulism, and non-polio enteroviruses. Clinical features and investigations can help differentiate between these causes.
3. Treatment depends on the underlying etiology but may include supportive care, IV immunoglobulin, plasmapheresis, and corticosteroids. Prognosis ranges from full recovery to residual deficits or death, depending on the cause and extent of
1. Acute flaccid paralysis (AFP) is defined as sudden onset of weakness or paralysis over 15 days in patients under 15 years old. It suggests involvement of the lower motor neuron complex.
2. Common causes of AFP include poliomyelitis, Guillain-Barré syndrome, transverse myelitis, botulism, and non-polio enteroviruses. Clinical features and investigations can help differentiate between these causes.
3. Treatment depends on the underlying etiology but may include supportive care, IV immunoglobulin, plasmapheresis, and corticosteroids. Prognosis ranges from full recovery to residual deficits or death, depending on the cause and extent of
- Toxic epidermal necrolysis (TEN) and Stevens-Johnson syndrome (SJS) are acute life-threatening skin reactions caused by extensive necrosis and epidermal detachment. They are considered severity variants of the same process that differ only in the extent of body surface area involved.
- Common causes are certain medications, especially allopurinol, sulfonamides, and carbamazepine. A genetic predisposition also contributes to risk.
- The disease begins with flu-like symptoms followed by painful blistering of the skin and mucous membranes. Prognosis depends on factors like age, comorbidities, and surface area of involvement. Complications can include infection, respiratory failure
This document provides an overview of meningitis including:
- It is an inflammation of the meninges that can be caused by bacteria, viruses, fungi or tuberculosis. Common bacterial causes are Neisseria meningitidis, Streptococcus pneumoniae, and Haemophilus influenzae type b.
- An outbreak in Nigeria from 2016-2017 saw over 1,400 suspected cases mostly in children ages 5-14 in certain states. Risk factors include young age, close contacts, crowding and poverty.
- Symptoms can include fever, headache, nausea, and signs of meningeal irritation like neck stiffness. Diagnosis involves CSF and blood tests. Treatment depends on the suspected cause but may include
Stevens-Johnson syndrome is a life-threatening skin condition characterized by extensive necrosis and separation of the epidermis from the dermis. It exists on a spectrum of severity from Steven Johnson Syndrome (<10% body surface area involvement) to Stevens Johnson Syndrome-Toxic Epidermal Necrolysis (10-30% involvement) and Toxic Epidermal Necrolysis (>30% involvement). It is typically caused by hypersensitivity drug reactions or infections and presents with painful erosions and blistering of the skin and mucous membranes that can lead to vision loss, respiratory failure, or death in severe cases. Treatment focuses on stopping the offending agent, supportive care in intensive care units, wound care of d
This document discusses neurotuberculosis, specifically tuberculous meningitis. It begins by classifying neurotuberculosis and describing the pathogenesis of tuberculous meningitis. It then covers the clinical features and stages of tuberculous meningitis, diagnostic criteria, complications, management including treatment with antitubercular drugs and corticosteroids, and differential diagnosis. Imaging and diagnostic tests for tuberculous meningitis like CSF analysis are also summarized.
Steven-Johnson syndrome (SJS) is a severe skin reaction typically caused by drug reactions. It is characterized by painful sores and blisters in the mouth, eyes, and other mucus membranes. SJS progresses to toxic epidermal necrolysis (TEN) when over 30% of the skin is affected and shows widespread damage. Both SJS and TEN can cause blindness, infection, and death if not properly treated with fluid replacement, antibiotics, steroids, and stopping the causative drug. Prompt diagnosis and management are important to prevent complications and improve prognosis of these potentially life-threatening conditions.
Now a days TBM is super most disease in Indian children.
Tuberculous meningitis (TBM) is difficult to diagnose, and a high index of suspicion is needed to make an early diagnosis.
This document summarizes a presentation on Stevens-Johnson syndrome and toxic epidermal necrolysis (SJS/TEN). The presentation covers the ocular and systemic features of SJS/TEN as well as treatment approaches. It notes that SJS/TEN is a severe drug reaction involving skin and mucous membrane blistering. Ocular features include conjunctivitis, keratitis, pseudomembranes and late complications like symblepharon. Systemically, patients experience flu-like symptoms and skin lesions. Treatment involves removing the precipitating drug, supportive care, and managing ocular complications with lubricants and surgery if needed.
Drug induced steven johnson syndrome sjsmartinshaji
This is an article about Drug induced steven johnson syndrome sjs / toxic epidermal necrolysis (TEN) , this is a life threatening immune complex activated hypersensitivity reaction.
pictures , a case , treatment options , side effects , references , journals are also mentioned in this slide share
Agranulocytosis, also known as neutropenia, is a condition defined by an abnormally low level of neutrophils in the blood. It can be caused by decreased production, ineffective cell development, or decreased survival of neutrophils. Common causes include drug reactions, cancers, infections, and autoimmune disorders. Symptoms range from none with mild disease to severe bacterial infections that can be life-threatening. Diagnosis involves medical history, physical exam, and blood tests showing low neutrophil counts. Treatment focuses on removing the cause, monitoring blood counts, promptly treating any infections, and providing supportive care.
This document provides information on meningitis, including:
- Meningitis is an inflammation of the meninges (membranes covering the brain and spinal cord) that can be caused by bacteria, viruses, fungi, or other causes.
- Common symptoms include fever, headache, and neck stiffness.
- Bacterial meningitis requires immediate treatment with antibiotics to prevent disability or death. Viral meningitis is generally less severe but still requires supportive care.
- Complications can include hearing loss, seizures, learning difficulties, and even death if not properly treated.
Myasthenia Gravis is an autoimmune disorder that causes muscle weakness. It occurs when antibodies block or destroy acetylcholine receptors, interrupting communication between nerves and muscles. Symptoms include varying muscle weakness that worsens with activity. It commonly first affects eye muscles. Diagnosis involves tests showing improvement of symptoms with acetylcholinesterase inhibitors and presence of acetylcholine receptor antibodies. Treatment focuses on anticholinesterase medications, immunosuppressants, plasmapheresis, IVIG, and sometimes thymectomy. Patients require education on medication management and prevention of crisis.
EPIDEMIOLOGY, CONTROL & MANAGEMENT OF MENINGITISRashmi Singhal
Meningitis is an infection of the meninges that cover the brain and spinal cord. It can be caused by bacteria, viruses, or fungi. Bacterial meningitis is the most severe form and can be life-threatening if not treated promptly with antibiotics. Symptoms include fever, headache, and neck stiffness. Complications can include brain damage, hearing loss, and learning disabilities. Treatment involves intravenous antibiotics and corticosteroids. Vaccines exist to help prevent certain types of bacterial meningitis. Prognosis depends on the causative organism and how quickly treatment is initiated.
1. Leprosy is a chronic infectious disease caused by Mycobacterium leprae bacteria. It primarily affects the skin and nerves, causing disfiguring skin sores and nerve damage. There is no vaccine for leprosy. While leprosy is not highly contagious, it can be treated with multidrug regimens. Left untreated, it can cause blindness, disfigurement, and other complications.
2. Acne vulgaris is a common skin condition typically affecting adolescents and young adults. It is characterized by whiteheads, blackheads, pimples, and pustules on the face, chest, and back. Acne is caused by changes in hormone levels and blocked hair
Diseases of the central nervous system.pptxEndex Tam
This document provides information on meningitis and epilepsy in children. It discusses:
1. Meningitis is an inflammation of the meninges that can be caused by bacteria or viruses. Bacterial meningitis is more serious, especially in infants and young children. Symptoms include fever, headache, and neck stiffness. Diagnosis involves lumbar puncture and CSF analysis. Treatment involves antibiotics and supportive care.
2. Epilepsy is a neurological condition characterized by recurrent seizures. It affects around 1% of children. Seizures have various causes like infections, brain injuries, or genetic factors. Generalized tonic-clonic seizures involve loss of consciousness and muscle contractions. Diagnosis is based on clinical history
1. Acute flaccid paralysis (AFP) is defined as sudden onset of weakness or paralysis over 15 days in patients under 15 years old. It suggests involvement of the lower motor neuron complex.
2. Common causes of AFP include poliomyelitis, Guillain-Barré syndrome, transverse myelitis, botulism, and non-polio enteroviruses. Clinical features and investigations can help differentiate between these causes.
3. Treatment depends on the underlying etiology but may include supportive care, IV immunoglobulin, plasmapheresis, and corticosteroids. Prognosis ranges from full recovery to residual deficits or death, depending on the cause and extent of
1. Acute flaccid paralysis (AFP) is defined as sudden onset of weakness or paralysis over 15 days in patients under 15 years old. It suggests involvement of the lower motor neuron complex.
2. Common causes of AFP include poliomyelitis, Guillain-Barré syndrome, transverse myelitis, botulism, and non-polio enteroviruses. Clinical features and investigations can help differentiate between these causes.
3. Treatment depends on the underlying etiology but may include supportive care, IV immunoglobulin, plasmapheresis, and corticosteroids. Prognosis ranges from full recovery to residual deficits or death, depending on the cause and extent of
Epilepsy in pregnancy By Dr Muhammad Akram KHan Qaim KhaniMuhammad Akram
This document discusses epilepsy in pregnancy, including its classification, effects on pregnancy, and management. It defines epilepsy as recurring spontaneous seizures due to excessive electrical discharge in the brain. During pregnancy, a woman's seizure frequency may increase, decrease, or remain unchanged. Having epilepsy can increase risks for the fetus like intrauterine growth restriction. Management involves preconception counseling, monotherapy with the lowest effective antiepileptic drug dose, folic acid supplementation, and seizure treatment if one occurs during labor. The risks of seizures and effects of antiepileptic drugs on the fetus require close monitoring throughout pregnancy.
Systemic corticosteroids are synthetic derivatives of cortisol that can be taken orally or via injection. They are used to treat various autoimmune and inflammatory conditions. Common side effects include increased risk of infection, skin thinning, acne, osteoporosis, diabetes, and psychiatric issues. Risks are higher with longer term or high dose use. Monitoring of blood pressure, weight, and blood sugar is recommended during treatment. Measures like calcium/vitamin D supplementation and bone density scans can help prevent side effects like osteoporosis. Some conditions like active tuberculosis or severe psychiatric disease are contraindications for steroid use due to risk of worsening.
Neutropenia is a decrease in circulating neutrophils below the normal range. It can be caused by decreased neutrophil production or increased neutrophil destruction. Symptoms include fever and infections of the mouth, skin, lungs, or other organs. Diagnosis involves blood tests to measure white blood cell and neutrophil counts. Treatment focuses on managing any underlying causes, treating infections with antibiotics, and using growth factors to boost neutrophil production. Nurses focus on careful infection prevention and monitoring for early signs of infection in patients with neutropenia.
This document discusses various topics related to ophthalmic drugs including antibiotics, steroids, and drugs used to treat glaucoma. It provides details on the mechanisms of action, indications, and side effects of different drug classes. It describes commonly used antibiotics like aminoglycosides, macrolides, and quinolones. It also outlines steroid drugs and their anti-inflammatory mechanisms and ocular uses. The document discusses various agents used to lower intraocular pressure in glaucoma including parasympathomimetics, sympathomimetics, alpha-agonists, and beta-blockers.
This document provides information on myasthenia gravis (MG), including:
- MG is an autoimmune neuromuscular junction disorder causing muscle weakness.
- Treatment involves immunomodulation with pyridostigmine, corticosteroids, immunosuppressants like azathioprine and mycophenolate, IVIG, or plasma exchange.
- Diagnosis is based on symptoms, serologic testing for acetylcholine receptor (AChR) or muscle-specific kinase (MuSK) antibodies, and electrodiagnostic testing showing decremental response on repetitive nerve stimulation.
Mucormycosis is a serious fungal infection caused by exposure to mucor mold spores, usually through inhalation. It most often affects people who have health problems that weaken the immune system, such as diabetes, cancer, or those taking immunosuppressive drugs. The infection can cause sinus, lung, or brain infections and is life-threatening without prompt treatment with antifungal drugs and sometimes surgery. Managing any underlying health conditions contributing to a weakened immune system is also important for treatment. Prognosis depends on early diagnosis and treatment as well as the patient's overall health status.
Seizures during pregnancy can cause: Slowing of the fetal heart rate. Decreased oxygen to the fetus. Fetal injury, premature separation of the placenta from the uterus (placental abruption) or miscarriage due to trauma, such as a fall, during a seizure
The document discusses the management of meningitis in children. It defines meningitis and describes the common causes as bacteria, viruses, fungi and parasites. It then covers the clinical presentation of symptoms in young infants and older children. Laboratory investigations and treatment approaches are outlined for bacterial meningitis, including specific antibiotic regimens. The document concludes with details on supportive care and nursing management of children with meningitis.
This document provides guidelines for antibiotic treatment of common infections in general practice. It lists respiratory infections, ear, nose and throat infections, and gastrointestinal and genitourinary infections. For each condition, it summarizes the management, common pathogens, and first-choice and alternative antibiotic treatments. The guidelines aim to promote prudent antibiotic use and recommend first choosing effective first-line antibiotics, reserving broad-spectrum antibiotics only for indicated conditions.
1. 61) A 23-year-old woman complains of headaches and arthralgias for the past 3
days. She presents to urgent care because of a painful rash on her face that
has progressed into multiple vesicles. This rash is characterized by
erythematous macules with dark purple centers with multiple vesicles in
different stages. On physical exam there is also mucosal edema within the
oral cavity. She recently completed an antibiotic course for a urinary tract
infection. What is the most likely diagnosis?
A) Erythema multiforme
B) Staphylcoccal scalded skin syndrome
C) Stevens–Johnson syndrome
D) Toxic epidermal necrolysis
Answer C. Stevens-Johnson syndrome is an immune-complex–mediated
hypersensitivity complex that typically involves the skin and the mucous
membranes. After one to three weeks of exposure to the causative agent, a
prodrome of fever, malaise, headache, cough, and conjunctivitis develops.
Skin lesions appear one to three days after this prodrome. The lesions
initially appear as erythematous macules with dark purpuric centers, then
form atypical target lesions with central dusky purpura or a central bulla,
with surrounding macular erythema. Mucosal involvement occurs in
almost all affected patients. By definition, Stevens-Johnson syndrome
affects less than 10% of the body surface area. Approximately 50% of cases
of Stevens-Johnson syndrome are drug induced. Common causative agents
include sulfa drugs, antiepileptic drugs, antibiotics, and nonsteroidal anti-
inflammatory drugs. Steven-Johnson syndrome is a clinical diagnosis. The
causative drug and any unnecessary medications should be discontinued.
Aggressive management should include fluid resuscitation, nutritional
supplementation, and wound care. Antibiotics should be used only if there
is evidence of infection. Intravenous immune globulin has been
incorporated into some treatment protocols. Complications include
hypotension, renal failure, corneal ulcerations, anterior uveitis, erosive
vulvovaginitis, respiratory failure, seizures, and coma.
2. Staphylococcal scalded skin syndrome (B) most commonly occurs in
infants and in young children, faint, orange-red, macular erythema with
cutaneous tenderness. Periorificial and flexural accentuation may be
observed. Characteristic tissue paper–like wrinkling of the epidermis is
followed by the appearance of large, flaccid bullae in the axillae, in the
groin, and around the body orifices. Toxic epidermal necrolysis (D) is a
potentially life-threatening dermatologic disorder characterized by
widespread erythema, necrosis, and bullous detachment of the epidermis
and mucous membranes, resulting in exfoliation. By definition, toxic
epidermal necrolysis affects more than 30 percent of the body surface area.
Erythema multiforme minor (A) represents a localized eruption of the
skin with minimal or no mucosal involvement. The papules evolve into
pathognomonic target lesions that appear within a 72-hour period and
begin on the extremities. Lesions remain in a fixed location for at least 7
days and then begin to heal.
OSF
Q) What is the definition of Stevens-Johnson/toxic epidermis necrolysis?
A) When the body surface area involved in 15-30%.
Ref:
Sandy, Natasha, MD, University of Texas Health Science Center School of
Medicine, San Antonio, Texas Am Fam Physician. 2010 Oct 1;82(7):773-780.
62) A 32-year-old woman complains of a band-like pressure around her forehead
that radiates down to the back of her neck. These headaches occur twice a
week on average and last for approximately 1 hour in duration. Her
3. neurological exam is within normal limits and she has no other associated
symptoms. What is the best initial abortive treatment?
A) Amitriptyline
B) Caffeine
C) Ibuprofen
D) Promethazine
Answer C. Tension-type headaches cause pain that is mild or moderately
intense and is described as tightness, pressure, or a dull ache. The pain is
usually experienced as a band extending bilaterally back from the forehead
across the sides of the head to the occiput. Patients often report that this
tension radiates from the occiput to the posterior neck muscles. In its most
extensive form, the pain distribution is “cape like,” radiating along the medial
and lateral trapezius muscles covering the shoulders. Tension-type
headaches can last from 30 minutes to several days and can be continuous in
severe cases. In addition to its characteristic distribution and intermittent
nature, the history obtained from patients with tension-type headache
discloses an absence of signs of any serious underlying condition. Patients
with tension-type headache do not typically report any visual disturbance,
fever, stiff neck or recent trauma. Treatment goals for patients with tension-
type headache should include recommending effective over the counter
analgesic agents and discovering and ameliorating any circumstances that
may be triggering the headaches. Research confirms that NSAIDs, such as
Ibuprofen, and acetaminophen are effective in reducing headache
symptoms. Patients with chronic tension-type headache should limit their
use of analgesics to two times weekly to prevent the development of chronic
daily headache. Repeated use of analgesics, especially ones containing
caffeine or butalbital, can lead to “rebound” headaches as each dose wears off
and patients then take another round of medication. Common features of
chronic daily headache associated with frequent analgesic use are early
morning awakening with headache, poor appetite, nausea, restlessness,
irritability, memory or concentration problems, and depression. If the patient
requires analgesic medication more frequently, adjunctive headache
medications can be initiated. Smoking cessation is an important issue to
address in patients with chronic tension-type headache. The number of
cigarettes smoked has been “significantly related” to the headache index
score and to the number of days with headache each week.
4. Analgesics can be augmented with a sedating antihistamine, such as
promethazine (D) and diphenhydramine or an antiemetic, such as
metoclopramide and prochlorperazine. If this regimen is inadequate, the
patient can try acetaminophen or aspirin combined with caffeine (B) and
butalbital. A wide variety of prophylactic agents have been researched in the
management of chronic tension-type headache. Amitriptyline (A) is the
most researched of the prophylactic agents for chronic tension-type
headache. It is typically used in doses of 10 to 75 mg, one to two hours before
bedtime to minimize grogginess on awakening.
OSF
Q) What is the first-line abortive therapy for moderate to severe migraine
headaches?
A) Triptans.
Ref:
Boride, Jonathon, M.D. Medical College of Wisconsin, Milwaukee, Wisconsin
Am Fam Physician. 2002 Sep 1;66(5):797-805.
63) A 24-year old primigravida delivers a healthy full-term baby boy. After the
third stage of labor there is significant bright red blood coming from the
cervix. On physical exam there are no vaginal or cervical lacerations and no
retained products are visualized. On fundal massage the uterus is boggy.
What pharmacological agent should be started immediately?
A) Carboprost tromethamine
B) Methylergonovine
C) Misoprostol
D) Oxytocin
Answer D. Postpartum hemorrhage (PPH) is the leading cause of maternal
mortality. Postpartum hemorrhage, defined as blood loss of more than 500
5. mL following vaginal delivery or more than 1000 mL following cesarean
delivery, occurs in up to 18% of births. Risk factors for postpartum
hemorrhage include a prolonged third stage of labor, multiple delivery,
episiotomy, fetal macrosomia, and history of postpartum hemorrhage.
However, postpartum hemorrhage also occurs in women with no risk factors,
so physicians must be prepared to manage this condition at every delivery.
The diagnosis of postpartum hemorrhage begins with recognition of
excessive bleeding and methodic examination to determine its cause. The
“Four Ts” mnemonic (Tone, Trauma, Tissue, and Thrombin) can be used to
detect specific causes. Uterine atony is the most common cause of
postpartum hemorrhage. Because hemostasis associated with placental
separation depends on myometrial contraction, atony is treated initially by
bimanual uterine compression and massage, followed by drugs that promote
uterine contraction. Uterotonic agents include oxytocin, ergot alkaloids, and
prostaglandins. Oxytocin stimulates the upper segment of the myometrium
to contract rhythmically, which constricts spiral arteries and decreases blood
flow through the uterus. Oxytocin is an effective first-line treatment for
postpartum hemorrhage; 10 international units (IU) should be injected
intramuscularly, or 20 IU in 1 L of saline may be infused at a rate of 250 mL
per hour. As much as 500 mL can be infused over 10 minutes without
complications
Other second and third-line medications are given in the event of postpartum
hemorrhage after the initiation of Oxytocin. Methylergonovine (B) is an
alkaloid that cause generalized smooth muscle contraction in which the
upper and lower segments of the uterus contract tetanically. A typical dose of
methylergonovine, 0.2 mg administered intramuscularly, may be repeated as
required at intervals of two to four hours. Because ergot alkaloid agents raise
blood pressure, they are contraindicated in women with preclampsia or
hypertension. Prostaglandins enhance uterine contractility and cause
vasoconstriction. The prostaglandins most commonly used are carboprost
and misoprostol. Carboprost (A) can be administered intramyometrially or
intramuscularly in a dose of 0.25 mg; this dose can be repeated every 15
minutes for a total dose of 2 mg. Hypersensitivity is the only absolute
6. contraindication, but carboprost should be used with caution in patients with
asthma or hypertension. Misoprostol (D) is another prostaglandin that
increases uterine tone and decreases postpartum bleeding. Misoprostol is
effective in the treatment of postpartum hemorrhage, but side effects may
limit its use.
OSF
Q) What is the definitive treatment for postpartum hemorrhage in women
with severe intractable bleeding?
A) Hysterectomy.
Ref:
Etches, Duncan, M.D., M.CL.SC., University of British Columbia Faculty of
Medicine, Vancouver, British Columbia Am Fam
Physician. 2007 Mar 15;75(6):875-882.
64) A 26-year old woman presents to urgent care with a fever of 101.4°F, dysuria
and nausea for the past 24 hours. On physical exam, exquisite pain is elicited
on palpation of the right flank. She does not appear toxic. She is able to eat
and drink, despite her nausea. Her pregnancy test is negative and her
urinalysis is pending. What is the best management and treatment for this
patient?
A) Inpatient management with intravenous ceftriaxone
B) Inpatient management with intravenous vancomycin
C) Outpatient management with oral ciprofloxacin
D) Outpatient management with oral nitrofurantoin
Answer C. Acute pyelonephritis is a common bacterial infection of the renal
pelvis and kidney most often seen in young adult women. Most patients have
fever, although it may be absent early in the illness. Flank pain is nearly
universal, and its absence should raise suspicion of an alternative diagnosis.
Risk factors for acute pyelonephritis in nonpregnant women include sexual
intercourse three or more times per week during the previous 30 days,
urinary tract infections in the previous 12 months, diabetes, stress
incontinence in the previous 30 days, a new sex partner in the previous year,
recent spermicide use, and a history of urinary tract infections in the
patient's mother. A positive urinalysis confirms the diagnosis in patients with
a compatible history and physical examination. Urine culture should be
obtained in all patients to guide antibiotic therapy if the patient does not
respond to initial empiric antibiotic regimens. Escherichia coli is the most
common pathogen in acute pyelonephritis, and in the past decade, there has
been an increasing rate of E. coli resistance to extended-spectrum beta-
lactam antibiotics. Uncomplicated acute pyelonephritis typically occurs in
healthy, young women without structural or functional urinary tract
abnormalities and without relevant comorbidities. Complicated acute
pyelonephritis occurs in patients with a structurally or functionally abnormal
7. genitourinary tract, or a predisposing medical condition. Most cases of
uncomplicated acute pyelonephritis can be managed in the outpatient
setting. However, patients who appear ill may have severe pyelonephritis or
a complication of acute pyelonephritis and should be considered for
hospitalization and further evaluation. For uncomplicated pyelonephritis,
outpatient treatment with fluoroquinolones is the preferred empiric
antimicrobial class in communities where the local prevalence of resistance
of community-acquired E. coli is 10 percent or less. If the prevalence of
fluoroquinolone resistance among relevant organisms does not exceed 10
percent, patients not requiring hospitalization can be treated with oral
ciprofloxacin (500 mg twice per day for seven days), or a once-daily oral
fluoroquinolone, such as ciprofloxacin (1,000 mg, extended-release, for seven
days) or levofloxacin (750 mg for five days). If the resistance rate exceeds 10
percent, an initial intravenous dose of ceftriaxone or gentamicin should be
given, followed by an oral fluoroquinolone regimen.
Outpatient management with oral nitrofurantoin(D) is not recommended
for pyelonephritis, however it is commonly used for treatment in acute
cystitis. For women with complicated acute pyelonephritis, inpatient
therapy with intravenous ceftriaxone (A) is recommended. Other options
for inpatient management with intravenous antibiotics include a
fluoroquinolone, an aminoglycoside, an extended-spectrum penicillin, or a
carbapenem. Inpatient treatment with intravenous vancomycin (B) is not
recommended because this antibiotic does not have gram-negative coverage.
OSF
Q) What is the management and treatment for pyelonephritis in pregnancy?
A) Inpatient management with an intravenous second- or third-generation
cephalosporin.
Ref:
Johnson, James, MD, University of Minnesota, Minneapolis, Minnesota Am
8. Fam Physician. 2011 Sep 1;84(5):519-526.
65) A 46-year-old man with papulopustular rosacea sees you for follow-up. You
have been treating his condition with topical azelaic acid, and although his
condition is improved he is not satisfied with the results. You suggest adding
which one of the following oral medications?
A) Clindamycin
B) Doxycycline
C) Erythromycin
D) Metronidazole
Answer B. Rosacea is a common condition characterized by symptoms of
facial flushing and a spectrum of clinical signs, including erythema,
telangiectasia, coarseness of skin, and an inflammatory papulopustular
eruption resembling acne. In most patients, the central area of the face is
affected, such as the nose, forehead, chin, and perioral areas. The diagnosis of
rosacea is made clinically. Patients with rosacea should avoid sun exposure
and use a broad-spectrum sunscreen daily that has a sun protection factor of
at least 15. Avoidance of common triggers such as hot baths, alcohol, spicy
foods, emotional stress is important to prevent outbreaks. Topical regimens
are first-line therapies for mild papulopustular rosacea because there is less
risk of adverse events, drug interactions, and antibiotic resistance. Topical
metronidazole is generally well tolerated with few local skin adverse
reactions, and it is the recommended topical therapy for rosacea. Topical
azelaic acid, sulfacetamide products, and topical acne medications are also
commonly used. Oral tetracyclines, most commonly doxycycline, tetracycline,
and minocycline have been used to treat papulopustular rosacea for more
than four decades. Doxycycline is the only drug approved by the FDA to
specifically treat papulopustular rosacea. Three to four weeks of therapy
with a tetracycline is required before substantial improvement occurs;
typical duration of therapy ranges from six to 12 weeks.
9. Macroclides such as erythromycin (C), clarithromycin and azithromycin
have been studied in patients with rosacea, but study quality is poor. Oral
metronidazole (D) is a problematic option for patients with rosacea
because of rare adverse effects such as neuropathy, seizures and its
disulfiram-like properties. Clindamycin (A) is not used to treat roasacea.
OSF
Q) What is the only herbal therapy studied in clinical trials to treat rosacea?
A) Licorice.
Ref:
May D, Kelsberg G, Safranek S: What is the most effective treatment for acne
rosacea? J Fam Pract 2011;60(2):108a-100c.
66) A previously healthy 16-year old boy presents to your office after having a
syncopal episode at the start of track practice. An ECG reveals a QTc of 520
ms. This is confirmed on a subsequent ECG. This finding is associated with
which one of the following rhythm abnormalities?
A) Paroxysmal supraventricular tachycardia
B) Polymorphic ventricular tachycardia
C) Sinus arrest
D) Third degree atrioventricular block
Answer B. Patients with repeated ECGs showing a QTc interval > 480 ms with
a syncopal episode, or > 500 ms in the absence of symptoms, are diagnosed
with long QT syndrome if no secondary cause such as medication use is
10. present. In addition to a prolonged QT interval, which occurs in some but not
all persons with long QT syndrome. Prolong QT interval is associated with
polymorphic ventricular tachycardia, including torsades de pointes, and
sudden cardiac death. Most cardiac events are precipitated by vigorous
exercise or emotional stress, but they also can occur during sleep. Long QT
syndrome is usually diagnosed after a person has a cardiac event such as
syncope or cardiac arrest. In some situations, this condition is diagnosed
after a family member suddenly dies. It may be treated with beta-blockers
and implanted cardioverter defibrillators. Patients with long QT
syndrome should avoid participation in competitive sports, strenuous
exercise, and stress-related emotions. Epinephrine adrenaline for local
anesthesia and asthma medication should be avoided in patients with long
QT syndrome. Other medications that should be avoided include certain
antibiotics, antifungals, antihistamines, antiarrythmics and psychotropic
medications which prolong the QT interval.
11. Third-degree atrioventricular block (D) results from various pathologic
states causing infiltration, fibrosis, or loss of connection in portions of the
healthy conduction system. Third-degree atrioventricular block can be either
congenital or acquired. Paroxysmal supraventricular tachycardia (A) is a
narrow-complex tachycardia that has a regular, rapid rhythm and is
triggered by a reentry mechanism. This may be induced by premature atrial
or ventricular ectopic beats. Other triggers include hyperthyroidism and
stimulants, including caffeine, drugs, and alcohol. Paroxysmal
supraventricular tachycardia is observed not only in healthy individuals; it is
also common in patients with previous myocardial infarction, mitral valve
12. prolapse, rheumatic heart disease, pericarditis, pneumonia, chronic lung
disease, and current alcohol intoxication. Sinoatrial arrest is when the
sinoatrial node of the heart transiently ceases to generate the electrical
impulses that normally stimulate the myocardial tissues to contract. It is
defined as lasting from 2.0 seconds to several minutes. None of the above are
associated with long QT syndrome.
OSF
Q) Which electrolyte abnormalities can cause long QT syndrome?
A) Hypokalemia and hypomagnesemia.
Ref:
Longo DL, Fauci AS, Kasper DL, et al (eds): Harrison’s Principles of Internal
Medicine, ed 18. McGraw-Hill, 2012, pp 1897-1900.
67) A 61-year-old woman presents to your office with a sudden painless loss of
vision in her right eye. Her past medical history includes both hypertension
and type 2 diabetes mellitus. Which one of the following would make you
suspect retinal vein occlusion as the cause of her sudden visual loss?
A) An afferent pupillary defect in the contralateral eye
B) Macular drusen on funduscopic examination
C) Right eye scleral injection
D) Tortuous retinal veins on funduscopic examination
Answer D. Central retinal vein occlusion (CRVO) is a common vascular
disorder of the retina and one of the most common causes of vision loss
worldwide. Specifically, it is the second most common cause of blindness
from retinal vascular disease after diabetic retinopathy. The signs of retinal
vein occlusion typically include sudden painless loss of vision, distortion of
vision or dense central scotoma. In some cases, this loss of vision is subtle in
character, with intermittent episodes of blurred vision. In other cases, it may
be sudden and dramatic. The nonischemic type is often the more subtle of the
two, while the ischemic type is prone to the more acute clinical
presentations. Tortuous and dilated retinal veins are the most common
finding on funduscopic examination. Diabetes mellitus and hypertension
are both risk factors for retinal vein occlusion, increasing the likelihood in
this patient.
13. Patients also often have multiple macula drusen (B) commonly known as
cotton-wool spots, although these are not specific to retinal vein occlusion.
Eye redness (C) is not typical and should cause the clinician to suspect an
alternate diagnosis. An afferent pupillary defect (A) often occurs on the
ipsilateral side.
OSF
Q) What are two complications of retinal vein occlusion?
A) Macular edema and neovascularization.
Ref:
Tran KT, Qualm AS, Shannon MA: Retinal changes and visual impairment. Am
Fam Physician 2010;81(1):73.
68) A 58-year-old man with diabetes mellitus and hypertension presents with a
6-month history of generalized pruritus. He reports that he scratches
frequently. On examination his skin is dry and scaly. He has multiple linear
excoriations and thickened skin on his forearms, legs, and neck.
Which one of the following is the most likely cause of his pruritus?
A) Contact dermatitis
B) Chronic urticaria
14. C) Lichen simplex chronicus
D) Scabies
Answer C. This patient has lichen simplex chronicus, consisting of
lichenified plaques and excoriations that result from excessive scratching.
On physical exam, one or more slightly erythematous, scaly, well-
demarcated, lichenified, firm, rough plaques with exaggerated skin lines are
noted. Atopic dermatitis results in a higher probability of developing lichen
simplex chronicus. Psychological factors appear to play a role in the
development or exacerbation of lichen simplex chronicus. Anxiety has been
reported to be more prevalent in patients with lichen simplex chronicus.
Insect bites, scars, postherpetic zoster, xerosis, venous insufficiency and
asteatotic eczema are common factors. An elevated serum immunoglobulin E
level occasionally supports the diagnosis of an underlying atopic diathesis.
Perform potassium hydroxide examination and fungal cultures to exclude
tinea cruris or candidiasis in patients with genital lichen simplex chronicus.
Treatment is aimed at reducing pruritus and minimizing existing lesions
because rubbing and scratching cause lichen simplex chronicus. Location,
lesion morphology, and extent of the lesions influence treatment. For
example, a thick psoriasiform plaque of lichen simplex chronicus on a limb is
commonly treated with a highly potent topical corticosteroid or intralesional
corticosteroids, whereas vulvar lesions are more commonly treated with a
mild topical corticosteroid or a topical calcineurin inhibitor. Widespread
lesions are more likely to require systemic treatment or total body
phototherapy.
Contact dermatitis (A) is usually associated with direct skin exposure to an
allergen or irritant and is typically localized to the area of exposure. Chronic
urticaria (B) causes a typical circumscribed, raised, erythematous lesion
15. with central pallor. Scabies (D) lesions are small, erythematous papules that
are frequently excoriated.
OSF
Q) What common nueuromuscular blockade can be used to treat severe
lichen simplex chronicus?
A) Botulism toxin injections.
Ref:
Moses S: Pruritus. Am Fam Physician 2003;68(6):1135-1142. 2) Habif TP:
Clinical Dermatology: A Color Guide to Diagnosis and Therapy, ed 5. Mosby
Elsevier, 2010, pp 115-118.
69) A 21-year old woman sees you because of a depressed mood since the birth
of her son 2 months ago. She is breastfeeding, and her baby is doing well. She
denies any suicidal or homicidal ideation and has never had thoughts about
hurting the baby. She has a history of depression 2 years ago that was
associated with starting college. She began taking sertraline , changed her
schedule, and spent more time exercising. Within 6 months her depression
resolved and she stopped the medication. She reports this current
depression feels worse than her previous depression. Which one of the
following would be the most appropriate medication for this patient?
A) Amitriptyline
B) Diazepam
C) Phenytoin
D) Sertraline
Answer D. Selective serotonin reuptake inhibitors such as sertraline (D) are
the most commonly used medications for postpartum depression. They have
fewer side effects and are considered safer than tricyclic antidepressants,
especially in depressed women who may be at increased risk for medication
overdose. In one study, infant serum levels of sertraline and paroxetine were
undetectable. It is also recommended that a woman with postpartum
depression be started on a medication that she had taken previously with a
good response, unless there is evidence of potential harm to her infant.
Tricyclic antidepressants such as amitriptyline (A) are excreted into breast
milk and there is some concern regarding potential toxicity to the newborn.
Phenytoin (C) and diazepam (B) are not antidepressants. Phenytoin and
diazepam are Category D for use in pregnant women. Diazepam is potentially
toxic to infants and can accumulate in breastfed infants, and it is not
recommended for lactating women.
OSF
16. Q) What is the strongest risk factor for post partum depression?
A) Postpartum depression in a previous pregnancy.
Ref:
ACOG Committee on Practice Bulletins—Obstetrics: ACOG Practice Bulletin:
Clinical management guidelines for obstetrician-gynecologists number 92,
April 2008 (replaces practice bulletin number 87, November 2007). Use of
psychiatric medications during pregnancy and lactation. Obstet Gynecol
2008;111(4):1001-1020.
70) A 25-year old man presents to your office after recently being diagnosed with
HIV infection at the health department. You obtain blood work and note that
his CD4+ count is 180. This patient should receive prophylaxis against which
one of the following opportunistic infections?
A) Histoplasma capsulatum
B) Mycobacterium avium-intracellulare complex
C) Pneumocystis jirovecci
D) Toxoplasma gondii
Answer C. Patients with HIV infection and severe immunodeficiency are at
risk for certain opportunistic infections. Susceptibility to opportunistic
infections can be measured by CD4+ T lymphocyte counts. Patients with a
CD4+ count < 200 should receive trimethoprim/sulfamethoxazole for
prevention of Pneumocystis jirovecci pneumonia (PCP pneumonia).
Pneumocystis jiroveci pneumonia remains relatively common in patients with
HIV infection, and may be the presenting manifestation of HIV in patients
who have not yet been diagnosed. Patients with P. jiroveci pneumonia
classically present with fever, progressive exertional dyspnea, and
nonproductive cough. Although there are a wide variety of radiologic
findings, chest radiography typically shows bilateral interstitial infiltrates.
17. Toxoplasma-seropositive patients who have a CD4+ T-lymphocyte count of
less than 100 should be administered prophylaxis against Toxoplasma
gondii (D) encephalitis. The daily double-strength tablet of
trimethoprim/sulfamethoxazole is recommended, as the preferred regimen
for Pneumocystis prophylaxis appears to be effective against toxoplasmic
encephalitis as well and is therefore recommended. Adults and adolescents
who have HIV infection should receive chemoprophylaxis against
disseminated Mycobacterium avium-complex (B) disease if they have a
CD4+ T-lymphocyte count of less than 50.Preferred prophylaxis is
clarithromycin or azithromycin.. Prophylaxis with itraconazole may be
considered for Histoplasma capsulatum (A) in patients with CD4+ T-
lymphocyte counts less than 100 who are at especially high risk because of
occupational exposure or who live in a community with a hyperendemic rate
of histoplasmosis (10 or more cases per 100 patient-years).
OSF
Q) What is the treatment for the opportunistic infection, Cryptococcus?
A) Amphotericen B combined with flucytosine.
Ref:
Goldman L, Schafer AI (eds): Goldman’s Cecil Medicine, ed 24. Elsevier
Saunders, 2011, pp 2190-2194.