Idiopathic Thrombocytopenic Purpura (ITP) – Kaufman

ITP is an acquired disorder of platelets:  consider as either increased destruction or decreased production. Classified as primary (a dx of exclusion) vs secondary. Etiology:  Caused by anti-platelet IgG directed against membrane proteins of the platelets. Inciting events:  infection vs immune alteration.. Incidence:  highest in children, and increased incidence with increased age in adult. DDx:… Continue reading Idiopathic Thrombocytopenic Purpura (ITP) – Kaufman

Some Indications for Tonsillectomy

Obstructive sleep apnea / sleep disordered breathing Tonsillitis  Paradise Criteria:  7 strep infections in a year (see the AAO/HNS 2011 guidelines for details: http://www.aafp.org/afp/2011/0901/p566.html) or 5 infections / 2 years or 3 infections / 3 years. Post-op pain usu lasts 7-14 days - can be controlled with NSAIDs/APAP and cold foods.  Caution with opioids, esp… Continue reading Some Indications for Tonsillectomy

Long-Acting Reversible Contraception (LARC)

Adapted from NEJM 2/2/2017 review article, "Long-Acting Reversible Contraception": THE PROBLEM: Unintended pregnancies are common in the US, though decreasing from 2008 to 2011:  45% of US pregnancies are unintended (compared to 35% in W Europe).  54/1000 in 2008 down to 45/1000 in 2011. From 2011-13, only 62% of women 15-44 yo were using contraception;… Continue reading Long-Acting Reversible Contraception (LARC)

Inhaled Steroids of Minimal Benefit in Mild Asthma

Lancet 2016 Nov 29 - the START study. Researchers examined benefit of low-dose inhaled budesonide given within 2 years of mild asthma diagnosis in children and adults. n = 4098 patients with symptoms ≤3 days weekly randomized to budesonide or placebo Doses:  400 mcg in adults, 200 mcg in children Budesonide recipients had fewer severe asthma-related… Continue reading Inhaled Steroids of Minimal Benefit in Mild Asthma

Pediatric Headaches – Turner

Majority of children are diagnosed with viral illness or migraine in the ED/UC setting. DDx: Infection:  viral meningitis, bacterial meningitis, orbital or cerebral abscess. Tumor:  isolated headache is a rare manifestation of a brain tumor. Intracranial hemorrhage:  non-traumatic (not typically HA alone) Carbon monoxide poisoning Hypertension:  essential, pheo Common secondary causes: fever viral meningitis pharyngitis… Continue reading Pediatric Headaches – Turner