Shelf Questions From the CLIPP Cases

2 diseases with strawberry tongue? Time to development of coronary artery aneurysms in Kawasaki disease? Risk of long term aspirin treatment for Kawasaki disease? Risk of coronary artery aneurysm after Kawasaki disease and change in risk w Aspirin vs IVIG treatment in Kawasaki?

What happens to the ESR after the fever in Kawasaki disappears?

Complications of Kawasaki's?

Diseases associated with diffuse adenopathy? Palm/sole rash?

Rashes that start on trunk?

Fever in Erythema infectiosum (B19) vs Measles?

Rashes that follow fever?

Triad of RMSF?

Rash of SJS? Diagnosis criteria of Kawasaki?

Who to suspect bacterial cervical adenitis in?

Appearance of someone with mycobacterial lymphadenitis?

Coughs that are worse at night? Dry coughs?

Barking cough?

Paroxysmal coughs?

Brassy/honking cough? Change in voice implies what? Radiology findings in TB?

Who uses inhaled steroids?

Who gets methacholine, histamine, or exercise challenge? Abx to treat sinusitis? Timing of sinus development? Complications of sinusitis?

Cause of rhonchi?

Cause of cobblestoning of posterior pharynx?

Stages of asthma exacerbation?

Cerebellar hemispheric vs deep cerebellar nuclei lesions?

Most common childhood brain tumors?

Classic vs common migraine?

Triad of ICP signs?

Complication of pseudutumor cerebri? Causes of pseudotumor cerebri?

Location of germ cell tumors in brain? Presentation of supratentorial vs infratentorial tumor?

Male predominance of what types of brain tumors? Two peaks of incidence of brain tumors? Ages where supra or infratentorial tumors are more common?

Who does post–infectious cerebellitis appear in?

Infectious cerebellitis can be caused by what?

Examples of toxins that can cause sudden ataxia?

Age of neuroblastoma/opsoclonus–myoclonus? Initial workup for CHF?

Murmurs associated with CHF?

When is a VSD first heard? EKG changes with VSD?

When are ASD and Coarctation detected? Most common murmur in kids? What does Still's murmur sound like?

Digoxin and Lasix treat what?

Most common hip disorder in adolescents?

Complications of Legg–Calve–Perthes disease?

How long after and after what types of infections does reactive arthritis occu What action is impaired with a SCFE? How is pain from transient synovitis and septic arthritis relieved? Key way to distinguish transient synovitis vs septic arthritis? What worsens pain with osteomyelitis?

Time of ESR vs CRP elevation?

3 reasons kids are at higher risk of dehydration?

Diagnosis of DKA?

Dx of diabetes?

Most common cause of diabetes–associated death in children? Replacement complications of hyponatremia and hypernatremia?

Cause of iso/hypo/hyper tonic/natremic dehydration?

Risk factors for cerebral edema?

Other Abs to check in DM workup?

Sodium concentration in oral rehydration solution? Where's the blood in malrotation (+/– volvulus)? Current jelly stools?

Electrolyte changes in vomiting from pyloric stenosis? Time of presentation of pyloric stenosis? Order of exam in child?

Most important characteristics of ear exam?

Appearance of TM in AOM? Bacterial causes of AOM?

Who do we treat AOM with amoxicillin–clavulanate with (as opposed to just am Alternative treatments for AOM?

Use of conventional vs visual reinforcement audiometry (VRA)?

Which hearing test is used in newborn assessments?

Findings associated with otitis external?

Who to use abx vs no abx for AOM?

Who should get a hearing test?

Test for 0–6yo that reports percent of children who successfully perform each Complications of untreated chronic OME?

Cause of RUQ pain in PID? What should you ask the child to do during a rectal exam? Presentation of hernia?

Use of CT for abd pain? Use of US in abd pain? Use of barium study in abd pain?

Use of KUB in abd pain?

What causes Fitz–Hugh–Curtis? Immediate treatment of hypoglycemia?

What can be given to inhibit insulin release with sulfonylurea overdose? EKG findings with TCA overdose?

2 causes of hypotension with TCA overdose?

2 types of breath holding spells?

Time period of colic?

Time of SIDS vs ALTE (apparent life threatening event)?

Other names for Mongolian spots?

Fracture that can be confused for abuse? Posterior rib fractures can result from what? What's the fattest baby" age?" When is the physiologic nadir for Hgb?

What can cause false positive sweat test results? Screening vs confirmatory test for CF?

What percent of CF pts present with pancreatic insufficiency?

Pain scales by age?

Most common cause of abd pain in kids? First signs of chronic GI illness?

What percent of pts with HSP have guiac positive stool? 2 problems with barium enema?

Are crypt abscesses are more common with UC or CD? 2 studies to distinguish UC vs CD? 2 characteristics of Crohn's on barium enema? Does UC or CD have a stronger inheritable component? Treatments for IBD?

When do you stop using prematurity corrected charts?

Most variable component of development? When does the AAP recommend developmental screening? What causes pigeon–toe–ing? How long does it take the pedal arch to develop? When does child gait look like an adult? When do you screen for autism? 3 realms of changes in autism?

Which types of diseases will cause regression of milestones? Description of cerebral palsy?

Risk factors for cerebral palsy?

Sequence of events in retinopathy of prematurity?

Complication associated with IVH? Complications of kernicterus? 2 surgeries common in sickle cell patients? Cause of gallstones in sickle cell? Which sickle cell pts get abx prophylaxis? PCV23 is given to who and when?

2 things that can worsen anemia with sickle cell pts? Who gets transcranial doppler (TCD) and why? Causes of impaired height and weight in sickle cell?

What happens to the spleen of sickle cell pts?

Baseline Hgb in sickle cell? Treatment of painful crises in sickle cell? Peak time of lymphoid tissue growth? Most common infection with steroid use for nephrotic syndrome? Management of nephrotic syndrome?

What are pts with nephrotic syndrome predisposed to?

4 categories of MCD?

PID and TOA are best detected with which type of imaging? Chronic abd pain is best assessed with which type of imaging? Who needs to be seen immediately for a fever? What is the worst measure of circulatory status? What do the D and E stand for in the ABCDEs of assessment?

What's a practical problem with vasoconstriction in shock? Next line of management if you can't get a peripheral IV in for a pt in shock?

Prophylaxis for meningococcus? Complications of meningococcal meningitis?

Problem with penicillin treatment of meningococcus?

Contraindications to IO line?

Complications of IO line?

Actions of TCAs?

Sympathomimetic toxidrome?

Opioid toxidrome?

Sedative–hypnotic toxidrome?

Anticholinergic toxidrome?

Cholinergic toxidrome?

What is given with activated charcoal in poisoning cases?

Series of events in anorexia?

Best tests for dx of von Willebrand's disease?

Genetics of vWD?

Meds to treat vWD?

Most common hereditary bleeding disorder? When does fever after a vaccine usually present?

3 clinical tests/findings in meningitis?

Most common organism in occult bacteremia? How common is occult bacteremia in kids with fever? Indications for LP?

Who doesn't needed to be cultured for strep throat?

Treatment options for UTI?

Who should get a VCUG? Who should get a renal technetium scan? How prevalent is VUR? Management of grade 1–2 VUR?

Benefit of radionuclide cystogram?

What percent of pts with HSV gingivostomatitis are symptomatic?

Sequelae of bronchopulmonary dysplasia?

What is grunting a sign of? Signs and cause of paradoxical breathing?

Sounds with narrowing of airways above vs below thoracic inlet?

Sounds from secretions causing airway narrowing? Cause of fine vs coarse crackles?

What should you get before getting a bronchoscopy? Dynamic eval over several breaths to see foreign body? Two manifestations of foreign body and findings on imaging?

Most consistent finding with Down syndrome? Findings on US with Down syndrome?

Standard karyotype test? Purpose of annual CBC in pts with Down syndrome?

Which vaccines are first given at adolescence? Methods of calculating BMI?

Characterization of chest pain in precordial catch syndrome?

Tanner stage with increased penis length AND circumference? Tanner stage with small amount of pubic hair but still childlike phallus? Tanner stage with moderate curly pubic hair and phallus of increased length? Differentiation of costochondritis pain with precordial catch syndrome? Symptoms of hypoglycemic syncope?

Erythema multiforme progression?

Common time of onset and treatment of candidal rash?

Selenium sulfide is used to treat what? Treatment of tinea capitis? Zinc oxide is used to treat what? What can help distinguish it from other ras

Strength of steroids? Location of staph folliculitis vs nodular/cystic acne? Pseudofolliculitis appearance? Radiographic appearance of intussusception? Most common manifestations of HSP?

What is small for gestational age (SGA) most often due to? 3 risks for babies with SGA?

Presentation of polycythemia in infants? Respiratory distress Poor feeding Hypoglycemia Sluggish blood flow"

Symmetric vs asymmetric IUGR?

5 basics of newborn resuscitation?

What percent of newborn and 12mo olds have palpable spleens?

Most common presentation of congenital CMV?

5 types of treatments for eczema?

2 things to prevent dental caries?

2 metabolic causes of hyperbili?

Severe manifestations of kernicterus?

Signs of kernicterus in those who survive? When and how does biliary atresia usually present?

How does jaundice progress?

Optimal time for newborn exam?

Time of breast feeding vs breast milk jaundice?

Is PE common in neonates? Is prematurity a risk factor for TTN?

Are APGAR scores predictive of neurologic outcome?

Small, appropriate, and large for gestational age percentiles?

Complications of LGA?

What is Transient Tachypnea of the Newborn (TTN) due to and what is it also Causes of persistent pulmonary HTN of the newborn (PPHN)?

Which cardiac anomaly is associated with maternal diabetes? Best indicator of fetal malformations in moms with diabetes?

Relationship of respiratory rate and feedings? Hypoglycemic glucose values that require intervention?

What can happen after giving a hyperinsulinemic infant glucose water? When are electrolyte values indicative of the infant's status?

What are the risk factors for DDH?

What is an MSK concern for pts with Down syndrome?

Distinguish neonatal seizures from jitteriness? Risks of home deliveries?

Definition of polycythemia in term newborn? When does OTC deficiency present?

Causes of large anterior fontanelle?

Causes of premature closure of anterior fontanelle?

Later symptoms of congenital hypothyroidism?

Most common time and presentation of botulism? Risk of adulthood obesity with childhood obesity? Psychiatric condition with the highest comorbidity with ADHD? When to start vision and hearing screening?

Sequelae of obesity?

When to suspect secondary causes of HTN?

Who and how to screen for type 2 DM?

Car seat rules?

Causes of absent red reflex?

Times of administration of Hep B?

Times of administration of Rotavirus?

Times of administration of Hep A? Times of administration of Varicella?

Times of administration of MMR?

Times of administration of IPV?

Times of administration of PCV?

Times of administration of Hib?

Times of administration of DTaP?

Strep pharyngitis_x000D_ Kawasaki disease 4 weeks_x000D_ (follow up with Cardiology within 2 weeks) Reye syndrome if you get the flu_x000D_ (make sure they get flu shots!) 20%_x000D_ down to 2–4% Aspirin reduces febrile course of illness (DON'T use Ibuprofen)_x000D_ _x000D_ IVIG reduces risk of coronary artery aneurysm Stays elevated!_x000D_ _x000D_ (Platelets are also elevated) CNS (90%)_x000D_ Coronary artery aneurysm (20–25%)_x000D_ Liver dysfunction (40%)_x000D_ Arthritis (30%)_x000D_ Hydrops gallbladder (10%)

EBV, CMV, HIV, Histo, Toxo, Mycobacteria, Measles, Lymphoma, Leukemia, Neuroblastoma, Rhabdomy Enterovirus (coxsackie)_x000D_ Syphilis_x000D_ RMSF_x000D_ Kawasaki Varicella (mild fever after)_x000D_ _x000D_ Roseola (fever first) (in kids < 2) B19: temp of 100–101_x000D_ _x000D_ Measles: T > 101 B19: rash follows fever 7–10d later_x000D_ _x000D_ Roseola: rash 3–4d after fever Fever_x000D_ Headache_x000D_ Rash

Blistering, purpuric macules on face/trunk, erythema multiforme, severe mucosal changes (stomatitis High fever > 5 d_x000D_ Changes in oral mucosa_x000D_ Extremity changes (red/swell)_x000D_ Rash_x000D_ Conjunctivitis_x000D_ Cervical adenopathy

1–5 yo with recurrent URI, strep, or staph_x000D_ _x000D_ Pt has high fever, toxic appearance, sometimes cellulitis or fluctuance Often appear well_x000D_ _x000D_ Nodes can rupture through skin though ––> tx with surgical excision Asthma_x000D_ Sinusitis Environmental irritant_x000D_ Fungal infection_x000D_ Asthma Croup_x000D_ Subglottic disease_x000D_ Foreign body Pertussis_x000D_ Chlamydia_x000D_ Mycoplasma_x000D_ Foreign body Habitual cough_x000D_ Tracheitis Laryngeal irritation (can be from rhinitis, GERD, etc) Primary complex (large hilar adenopathy with initial lung focus)_x000D_ Focal hyperinflation_x000D_ Atelectasis_x000D_ Small local pleural effusions All pts with persistent asthma_x000D_ _x000D_ Need to monitor BP, glucose, growth delay, cataracts When asthma is suspected but spirometry is normal Cefuroxime_x000D_ Amoxicillin–clavulanate Ethmoid and maxillary at birth_x000D_ Frontal start around 6–8 yr Orbital sinusitis_x000D_ Cavernous sinus thrombosis_x000D_ Meningitis_x000D_ Epidural abscess Mucus/secretions in airways_x000D_ _x000D_ Continuous, low pitched, polyphonic Lymphoid hyperplasia_x000D_ – from chronic post nasal drip and with chronic nasal allergies

Early asthmatic reaction: 1 hr, PGs/LTs, permeability, hypersecretion, bronchoconstriction_x000D_ _x000D_ Late: 2–3 hrs later, epithelial destruction, fibrotic remodeling, hyperplasia of bronchial smooth muscle_x000D_ _x000D_ Airway hyperresponsiveness can persist for days to weeks Hemispheric: limb abnormalities, nystagmus, tremor, dysmetria (spares speech)_x000D_ _x000D_ Deep nuclei: resting tremor, myoclonus, opsoclonus (neuroblastoma) Medulloblastoma (20%)_x000D_ _x000D_ Juvenile pilocytic astrocytoma (20%) Classic has aura_x000D_ _x000D_ Common: no aura, more common HTN_x000D_ Bradycardia_x000D_ Irregular respiration Blindness from elevated pressure around optic nerve sheath Obesity_x000D_ Meds (Vit A, tetracycline, OCPs, steroids)_x000D_ Metabolic disorders (galactosemia, hypo–PTH)_x000D_ Infection (sinusitis, OM) Pineal gland or suprasellar region Infratentorial: cerebellar signs, signs of raised ICP_x000D_ _x000D_ Supratentorial: focal motor and sensory abnl on opposite side of lesion Medulloblastoma_x000D_ Ependymoma First decade_x000D_ 8th decade Supra < 2yo_x000D_ Infa in kids_x000D_ Supra in adolescents/adults 1–3 yo_x000D_ Several wks after viral infection (varicella, coxsackie)_x000D_ CSF w/ pleocytosis, high prot Mumps_x000D_ Enterovirus_x000D_ EBV_x000D_ Bacterial meningitis pathogens

Alcohol_x000D_ Anti–convulsants_x000D_ _x000D_ Often get dysmetria and nystagmus also 6mo to 3yo CXR_x000D_ EKG_x000D_ (save echo for later) Aortic stenosis_x000D_ Coarctation_x000D_ PDA_x000D_ VSD Days to weeks of age_x000D_ – occurs as pulmonary resistance decreases Large: RVH and upright T wave in V1_x000D_ Moderate: LVH_x000D_ Small: nl Preschool age Innocent murmur_x000D_ 3–7 yo Musical/vibratory_x000D_ Best heard LLSB, supine_x000D_ 3–7 yo Symptoms of CHF_x000D_ _x000D_ – Digoxin: not good for VSD SCFE_x000D_ _x000D_ – posterior displacement of capital femoral epiphysis from femoral neck through cartilage growth plate Femoral head deformity_x000D_ Degenerative arthritis_x000D_ _x000D_ often in boys 4–10 yo 2–4 wks after GI or GU infection Internal rotation By opening the hip capsule (hold hip in flexion and external rotation) Elevated ESR, CRP in septic arthritis (can wait for lab values before doing joint tap if low suspicion) Weight bearing_x000D_ _x000D_ Pain is NOT position dependent (like in septic arthritis or transient synovitis)

ESR: remains elevated for weeks after improvement_x000D_ _x000D_ CRP: elevated 4–6 hrs after initial insult, peaks at 36–50 hrs, and returns to normal after 3–7 days 1. Higher SA to body mass ratio_x000D_ 2. Higher basal metabolic rate_x000D_ 3. Higher percentage of body weight that's water 1. Random BS > 200_x000D_ 2. pH < 7.3 or HCO3 < 15_x000D_ 3. Mod–lg ketonuria or ketonemia 1. 2. 3. 4.

Sx and random glucose > 200_x000D_ Fasting > 126_x000D_ 2–hr GTT > 200_x000D_ HbA1c > 6.5

Cerebral edema Hyponatremia: replacement can cause central pontine myelinolysis_x000D_ _x000D_ Hypernatremia: replacement can cause cerebral edema Iso: AGE, diarrhea_x000D_ Hypo: adrenal insufficiency_x000D_ Hyper: breastfeeding failure, DI, inappropriate rehydration solutions High BUN_x000D_ Acidosis with hypocapnia_x000D_ Attenuated rise in Na+ with treatment_x000D_ Admin of bicarb Anti–pancreatic (Anti insulin, GAD, IA2)_x000D_ Autoimmune thyroiditis and celiac_x000D_ _x000D_ DON'T check TFTs (can be elevated due to non–thyroidal illness) 45–50 mEq/L Blood in stool but not in vomit Intussusception_x000D_ _x000D_ – also bilious emesis, crampy abd pain, and sausage mass on exam Hypochloremic, hypokalemic metabolic alkalosis 3–12 weeks 1. General obs_x000D_ 2. Eyes_x000D_ 3. CV/Lungs/Abd_x000D_ 4. Ears/oral cavity

Mobility and Position_x000D_ _x000D_ – Also color, translucency, and other Bulging, yellow, poorly mobile 1/2. S. pneumo/Non–typeable H. inf_x000D_ 3. M. catarrhalis_x000D_ 4. S. pyogenes Kid with fever > 39C or moderate to severe otalgia Azithromycin_x000D_ Erythromycin_x000D_ Clindamycin VRA: good 6 mo to 2.5 yo, not ear specific_x000D_ _x000D_ Conventional: > 4yo, frequency–specific Otoacoustic emissions (OAE)_x000D_ _x000D_ – measure cochlear fxn in response to presentation of stimulus Bullous myringitis_x000D_ Radial vascular dilation (bicycle–spoke distribution)_x000D_ Marked erythema with cobblestone" appearance of TM" Abx: < 6mo, 6mo to 2 yr: if certain dx or severe disease, >2 yo with severe illness_x000D_ _x000D_ No abx: 6mo to 2yr with uncertain dx, > 2yo without severe illness Effusion > 3mo_x000D_ If nl, follow q3–6mo_x000D_ If not, consider bilateral myringotomy with tube placement Denver II Permanent sensory neural hearing loss (SNHL)_x000D_ Tympanosclerosis_x000D_ Adhesive otitis media_x000D_ Cholesteatoma_x000D_ TM perforation_x000D_ Mastoiditis, Labyrinthitis, Meningitis_x000D_ Epidural/brain abscess Fitz–Hugh–Curtis Bear down as you enter the rectum to relax the external sphincter 5 nights/week_x000D_ _x000D_ Age: > 2 wks, peaks at 6 wks, lessens by 3–4 mo SIDS: most are midnight to 6am_x000D_ _x000D_ ALTE: most are 8am–8pm Congenital dermal melanocytoses_x000D_ _x000D_ Slate gray patches Toddler's fracture: fracture of tibia in walking children Squeezing baby's thorax (shaken baby syndrome) 4mo: 25% of weight is fat Around 7–9 weeks_x000D_ Hgb 11_x000D_ Then starts to rise after Adrenal insufficiency_x000D_ Hypothyroidism Screening (newborn): detects immunoreactive trypsinogen in blood_x000D_ _x000D_ Confirmatory = genotyping for specific mutations

85–90%_x000D_ aka 10–15% don't have it (they have normal weight gain, normal stools) FLACC (face, legs, activity, cry, consolability) for non–verbal kids_x000D_ _x000D_ FACES: for 3–8 yo_x000D_ _x000D_ 0–10 scale: > 8 yo Functional abdominal pain Slowing of weight gain (or especially weight loss)_x000D_ _x000D_ Change in height velocity suggests more long standing illness 50% are guiac positive 1. Contrast delays potential colonoscopy_x000D_ _x000D_ 2. Increased risk of toxic megacolon with UC UC Upper GI study_x000D_ Colonoscopy 1. Cobblestoning_x000D_ 2. Separation from nearby loops (bowel wall thickening) CD 1st line: aminosalicylates (mesalamine)_x000D_ ––> Corticosteroids, abx (cipro, metro), immunomodulators (6–MP, MTX), anti–TNF age 2_x000D_ _x000D_ premature infants should catch up by then Language 9, 18, and 30 months Internal tibial torsion_x000D_ – common in childhood, resolves with growth 8 yrs_x000D_ – can have flat feet until then 3 yo_x000D_ – heel strike present 18 and 24 months 1. Social interaction_x000D_ 2. Communication_x000D_ 3. Restricted repetitive and stereotyped patterns Neurodegenerative disease_x000D_ Psychosocial Heterogeneous group of non–progressive disorders_x000D_ – motor and postural dysfunction

Perinatal asphyxia (10%)_x000D_ Intrauterine infection (28%)_x000D_ Prematurity (78%)_x000D_ IUGR (34%) Extraretinal fibrovascular proliferation_x000D_ Detachment_x000D_ Blindness/visual impairment_x000D_ _x000D_ – risk: BW < 1500g Periventricular Leukomalacia (PVL)_x000D_ – damage from hypoxia, ischemia, inflammation Abnl motor development (choreoathetoid cerebral palsy)_x000D_ Sensorineural hearing loss Tonsillectomy_x000D_ Cholecystectomy Hemolytic anemia ––> bilirubin gallstones ––> cholelithiasis ––> cholecystitis Age 2 mo to 5–6 yrs_x000D_ – oral penicillin BID Pts with sickle cell get PCV23_x000D_ _x000D_ – 2yo and then repeat 3–5 yr later_x000D_ – same schedule for meningococcal 1. Myelosuppression by viruses (parvovirus)_x000D_ 2. Hypersplenism (spleen enlarges and traps RBCs) Sickle cell pts between 2–15 yo_x000D_ – determine risk of stroke (10% risk by 15 yo) Chronic anemia_x000D_ Poor nutrition_x000D_ Painful crises_x000D_ Endocrine dysfunction_x000D_ Poor pulmonary function Becomes progressively fibrotic and no longer palpable by age 4–6_x000D_ _x000D_ Hgb SC or S–beta–thal can have splenic enlargement into adolescence 6–9 IVF and IV narcotics Age 4–6 yo_x000D_ – tonsils can be mildly enlarged during this time Spontaneous peritonitis_x000D_ – often S. pneumo or GNRs 1. 2. 3. 4.

Albumin infusion_x000D_ IV furosemide_x000D_ Corticosteroids (taper over wks)_x000D_ Sodium restriction (1500–2000 mg/d)

Venous thrombosis_x000D_ – urinary loss of anti–coagulants, lipids destabilize platelets, inc fibrinogen, inc blood viscosity (high Hct) Steroid responsive_x000D_ Relapsing_x000D_ Steroid–dependent_x000D_ Resistant (––> bx) Ultrasound Barium study Kids younger than 6–8 wks Cold extremities_x000D_ (pt can be cold with adequate circulation) D: disability (quick neuro assessment – ICP, toxidromes, etc) and dextrose (check for hypoglycemia)_x000D_ _x000D_ E: exposure/environment (expose all parts of pt, keep pt warm) Vasoconstriction can make it difficult to get a good pulse ox measurement Intraosseus line_x000D_ – if peripheral IV can't be placed in 90 seconds_x000D_ – central line also acceptable in older kid or adult Rifampin, cipro, or ceftriaxone 11–19% get complications:_x000D_ – hearing loss_x000D_ – neuro disability_x000D_ – digit/limb amputations_x000D_ – skin scar Doesn't eliminate carrier state._x000D_ – Need rifampin (kids, young adults) or cipro (adults) or 5–7 d ceftriaxone to eliminate carrier state Osteogenesis imperfecta_x000D_ Fracture_x000D_ Recently used site_x000D_ Infection Fracture_x000D_ Fluid into subQ (––> compartment syndrome)_x000D_ Osteomyelitis_x000D_ Microscopic fat, BM emboli Inhibit reuptake of NE_x000D_ Antagonize ACh (––> hypotension), Na+ channels (––> dysrhythmias), and GABA (––> seizure)

Mydriasis_x000D_ Fever_x000D_ Diaphoresis_x000D_ Tachycardia_x000D_ Agitation_x000D_ SZ Miosis_x000D_ Resp depression_x000D_ Hypotension_x000D_ Bradycardia_x000D_ Hypothermia_x000D_ AMS Miosis OR mydriasis_x000D_ Hypotension_x000D_ Bradycardia_x000D_ Hypothermia_x000D_ Sedation Mydriasis_x000D_ Dry skin_x000D_ Flushing_x000D_ Tachycardia_x000D_ Ileus_x000D_ Urinary retention_x000D_ Fever_x000D_ Delirium, SZ Miosis_x000D_ n/v/d_x000D_ Tears_x000D_ Sweating_x000D_ Urinating_x000D_ Bronchorrhea_x000D_ Bronchospasm_x000D_ Muscle twitch_x000D_ Bradycardia_x000D_ SZ, coma Cathartics_x000D_ – charcoal helps absorb the toxins and cathartics accelerate defecation Amenorrhea_x000D_ Bradycardia_x000D_ Postural hypotension_x000D_ Electrolyte abnormalities_x000D_ Continued deficiency of Ca, Mg_x000D_ Neuro changes, increased reflex tone, compromised cardiac function

Platelet function tests_x000D_ Factor VIII activity_x000D_ vWf antigen and activity (Ristocetin)_x000D_ aPTT (but can be normal, other tests are better) Autosomal dominant with variable penetrance: Type 1 and 2_x000D_ _x000D_ Autosomal recessive: Type 3 Intranasal or IV desmopressin_x000D_ vWF_x000D_ OCPs/levonorgestrel IUD (for menorrhagia) von Willebrand's disease_x000D_ – 1% of population Usually 24–72 hours after_x000D_ _x000D_ MMR and Varicella: can be 7–10d after 1. Kernig's: resist knee extension_x000D_ 2. Brudzinski's: flex hip/knee in response to neck flexion_x000D_ 3. Opisthotonos: hyperextension of neck and spine_x000D_ _x000D_ – often NOT positive in infants