New-Onset Seizure Evaluation in Children – Matelich

HISTORY Talk to witnesses and the patient.  Knowing events surrounding the seizure is key! Mime or description of observed physical actions during the seizure. Brief, focal symptoms prior to the dramatic event can be easily missed on a cursory history. Developmental, family and past medical histories should be covered - inherited seizure disorders, plateaus in… Continue reading New-Onset Seizure Evaluation in Children – Matelich

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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