Tuesday, October 6, 2009

Development of Language Skills

This is a pediatric board favorite, and for good cause. Language development is a better gauge of cognitive function than gross motor development. Mental retardation can be diagnosed earlier if language development is followed closely.

It is important to note that much of the first year of life is devoted to physical growth and the development of gross motor skills. Fine motor, language, and social skills are the focus after the first year of life.

Let's review the basic tenets of language development. And let's find a way to make them easier to committ to memory.

Monday, October 5, 2009

DDAVP and Hemophilia

I forgot when I did this, but I remember memorizing that DDAVP can be used as a treatment for hemophilia. In my current state of trying to understand what I've memorized, I've learned something new.

Desmopressine acetate (DDAVP) is known to increase the plasma concentration of factor VIII and von Willebrand factor. It has therefore been successfully used as a treatment for mild to moderate hemophilia A. DDAVP will only increase factor VIII about 2-6 times above baseline, and vWF about 2-4 times above baseline. Thus, it is usually possible to increase the factor VIII to hemostatic levels in moderate hemophilia A.

DDAVP has minimal effect on factor IX and so is not used as treatment for hemophilia B. Recent trials have shown that there may be enough of a factor IX increase to warrant DDAVP's use in patients with mild hemophilia B, but this has not been adopted yet.

So, in summary - DDAVP is effective for hemophilia A, not for hemophilia B.

Thursday, October 1, 2009

Pediatric Nephrology Questions

1. A 3-year-old girl presents with mild periorbital and 1+ pretibial edema. Her blood pressure is 126/85, BUN 30mg/dl, Cr 1.2 mg/dl, and albumin 1.6 mg/dl. The most likely diagnosis is
    • focal segmental glomerulosclerosis
    • acute postinfectious glomerulonephritis
    • lupus nephritis
    • minimal change disease
    • cirrhosis

Don't Compliment Someone with PMS

Here's a good way to remember the most common conditions that lead to hypocomplimentemia

Poststreptococcal glomerulonephritis
Membranoproliferative glomerulonephritis
Systemic lupus erythematosus

Hyperpigmentation in acanthosis nigricans versus that in Addison's disease

I was looking at this picture and recognized the hyperpigmentation of acanthosis nigricans, which is commonly associated with type II diabetes millitus. However, I remembered that hyperpigmentation can also be cause by Addison's disease. Should I, based on this picture alone, be able distinguish the two?

The answer is yes ... (maybe)

Wednesday, September 30, 2009

Approach to the Infant with Ambiguous Genitalia

We all have subjects that are difficult to learn. And since difficulty sometimes breeds resentment, some of us tend to spend a little less time reading subjects we don't like. This propagates the difficulty.

For me, the whole issue of ambiguous genitalia was difficult to understand. Until now ...

McCune-Albright Syndrome

I've always tried to memorize the features of this board-favorite syndrome, but it's hard to memorize features that don't (at first glance) appear to "fit together". Until now ...