Pediatric Gynecology

Ambiguous genitalia look for adrenogenital syndrome and congenital adrenal hyperplasia, which usually are due to 21-hydroxylase deficiency 90 of cases . Patients are female males with this disease show precocious sexual development. Patients with 21-hydroxylase deficiency have salt-wasting low sodium levels , hyperkalemia, hypotension, and elevated 17-hy-droxyprogesterone. Treat with steroids and IV fluids immediately to prevent death. No patient with ambiguous genitalia should be assigned, a...

Streptococcal Infection

Streptococcus pyogenes strep A causes multiple important infections 1. Pharyngitis look for sore throat with fever, tonsillar exudate, enlarged tender cervical nodes, and leukocytosis. Streptococcal throat culture confirms the diagnosis. Elevated an tistreptolysin O ASO and anti-DNase titers also are used retrospectively when needed rheumatic fever, post-streptococcal glomerulonephritis .Treat with penicillin to avoid rheumatic fever and scarlet fever. Rheumatic fever diagnosis is made by...

Immunology

Types of hypersensitivity reactions 1. Type I anaphylactic due to preformed IgE antibodies, which cause release of vasoactive amines e.g., histamine, leukotrienes from mast cells and basophils. Examples are anaphylaxis bee stings, food allergy especially peanuts and shellfish , medications especially penicillin and sulfa drugs , rubber glove allergy , atopy, hay fever, urticaria, allergic rhinitis, and some forms of asthma. With chronic type I hypersensitivity atopy, some asthma, allergic...

Metabolic derangements that accompany liver failure

Coagulopathy prolonged prothrombin time in severe cases, partial thromboplastin time may be prolonged. Because the damaged liver cannot use vitamin K, patients must be treated with fresh frozen plasma. 2. Jaundice hyperbilirubinemia elevated conjugated and unconjugated bilirubin with hepatic damage vs. biliary tract disease . 3. Hypoalhuminemia liver synthesizes albumin. 4. Ascites due to portal hypertension and or hypoalhuminemia. Ascites can be detected on physical exam by shifting...