First Aid Pediatrics

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Most common viral cause of conjunctivitis
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Adenovirus
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pharyngitis, fever, conjunctivitis
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Pharyngoconjunctival fever, adenovirus
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Conjunctivitis with lymph nodes
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viral
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Fair hair and skin, blue eyes, mousy odor
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Phenylketonuria (PKU), Give tyrosine
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Ectopia lentis/ subluxation
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Homocystinuria/ Homocytinemia
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Odor of maple syrup in urine, sweat, cerumen, poor feeding
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MSUD, Maple Syrup Urine Disease, leucine, isoleucine, valine/ IV amino acids
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Lethargy, anorexia, anemia, rashes, diarrhea
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tyrosine deficiency
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cherry red macula, HSM, jaundice
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Neimann-Pick, Sphingomyelinase, AutoRec, Ashkenazi Jews
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Pancytopenia, fractures, crinkled paper cells in bone
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Gaucher, Def of Beta-glucosidase infant: neurodegenerative
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Angiokeratomas, telangiectasia, limb pain, cloudy cornea
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Fabry disease, ceramide or galactosidase kidney failure, hepatomegaly, cardiac
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CNS degen, optic atrophy, clear cornea
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Krabbe disease, galactosyl ceramide stem cell transplant
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nodules on joints, hoarseness, mental retardation
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Farber disease, ceramidase
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cherry red macula, hyperacusis, frog position
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Tay Sachs, jews, hexosaminidase A If HSM-> Sandhoff dz
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mental retardation, heart disease, corneal clouding, organomegaly, coarse facies, large tongue
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Hurler syndrome, lysosomal storage dz
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Corneal clouding, stiff joints, aortic regurgitation
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Scheie syndrome, lysosomal storage dz
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MR, organomegaly, coarse facies, clear cornea (retinitis/ papilledema)
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Hunter syndrome, lysosomal storage dz
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Von Gierke disease
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G6PD
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FTT, hypoglycemia, hepatomegaly, lipemia, metabolic acidosis
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G6PD, von gierke dz, accumulates liver, kidney, intestine
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Temporary weakness and cramping of skeletal muscles
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McArdle dz, muscle glycogen phosphorylase
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cardiomegaly, macroglossia, hypotonia, hepatomegaly
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Pompe dz, alpha-1,4 glucosidase, death from respiratory failure
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Jaundice, hepatomegaly, pos urinary reducing substance, nl urine odor
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Galactosemia, inc risk of E. Coli sepsis, liver failure, renal tubular dysfunction, cataract
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FTT, hypoglycemia, lactic acidosis, vomiting, seizures
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fructose intolerance, aldolase B def,
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self-mutilation, choreoathetosis, MR
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Lesch-Nyhan syndrome, HGPRT, uric acid crystals
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Eczema, eosinophilia, lax joints, staph infections, coarse features
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Job syndrome (Hyper-IgE), sinusitis, otitis media
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Partial albinism, progressive neuropathy, HSM
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Chediak-Higashi, abnormal chemotaxis and fusion of granules, skin and pneumonia
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Gingivitis, seborrheic dermatitis, retinitis pigmentosa, abscesses
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Chronic granulomatous disease, pyruvate deficiency, S. aureus
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Recurrent meningococcal meningitis
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complement deficiency C5-C9, Neisseria
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Recurrent pneumococcal infxns
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C2 deficiency
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Fever, purpura, rapid progression
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Meningococcemia
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Lymphadenopathy, HSM, oral thrush, FTT
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HIV, commonly present PCP infant or ITP in child
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low grade fever before rash, shower
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Rubella, suboccipital lymph nodes
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Coryza, Cough, Conjunctivitis
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Koplik spots, Rubeola (Measles), paramyxovirus
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High fever then rash
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Roseola (HHV 6) exanthem subitum, febrile seizures, red eardrums, suboccipital lymph nodes
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Fever with sore throat, pastia lines, sandpaper rash
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Scarlet fever, Erythrotoxin of group A Strep, circumoral pallor, ASO
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Rash in diff stages, with fever red with vesicles
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varicella
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fever, rash, URI, GI sx, macules, papules, vesicles, palms and soles
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Hand-foot-Mouth, coxsackievirus A16
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erythema migrans, Bell’s palsy, heart block
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Lyme dz, Borrelia burgdorferi, Amoxicillin, Doxycycline >8yo
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high fever, myalgia, HA, rash on palms and soles spreads to trunk
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RMSF, rickettsia rickettsii, Doxycycline, dermacentor
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VACTERL
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Vertebral Anorectal Cardiac Tracheal Esophageal Renal Limb anomalies
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Cure H. pylori
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PPI + 2 antibiotics – amoxicillin, clarithromycin
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Treat enterobius vermicularis (pinworm)
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Albendazole or Mebendazole or Pyrantel pamoate
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Treat Strongyloides stercoralis
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Ivermectin
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Pigmented freckles on lips, bleeding and crampy abdominal pain
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Peutz-Jeghers syndrome: multiple GI hamartomas, low malignancy
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Dental changes, pigmented ocular fundus, intestinal polyps
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Gardner syndrome: tumors of soft tissue and bone, high malignancy
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Tumors of enterochromaffin cells in intestine (usually appendix)
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Carcinoid tumors: Inc serotonin, vasomotor, bronchoconstriction if metastatic to liver
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Alagille syndrome
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Absence or reduction in bile ducts, unusual facies, ocular, CV abnormalities, nephropathy
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Progressive degeneration of liver and kidneys
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Zellweger syndrome, hypotonia, abnormal facies, hepatomegaly, renal cortical cysts, ocular abnormalities, diaphragmatic hernia
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Hypotonia, abnormal facies, hepatomegaly, renal cortical cysts, ocular abnormalities, diaphragmatic hernia
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Zellweger syndrome: Progressive degeneration of liver and kidneys
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Absence or reduction in bile ducts, unusual facies, ocular, CV abnormalities, nephropathy
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Alagille syndrome
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Hepatoblastoma is assoc with
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Beckwith-Wiedemann
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Large asymptomatic liver mass
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hepatoblastoma
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Reye syndrome is assoc with
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Aspirin plus influenza or varicella
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Influenza is an
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Orthomyxovirus
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Barking cough, steeple sign
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Croup, Parainfluenza virus
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Tripod position, thumb sign, stridor
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Epiglottitis, S pneumoniae, H influenzae type B
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Rapidly progressive respiratory infxn, stridor and distress despite treatment
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Tracheitis, S aureus, H influenzae type B
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Paroxysmal wheezing
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Bronchiolitis, RSV
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Productive cough for 2 months
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Bronchitis, viral
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Sore throat, tonsillar involvement
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Pharyngitis, viral, group A strep
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Productive cough, lobar consolidation
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Bacterial pneumonia, S pneumoniae
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Cavity with air-fluid level
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Pulmonary abscess, S aureus
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Give corticosteroids to febrile child with stridor for:
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Croup, Epiglottitis, Retropharyngeal abscess, Bacterial tracheitis
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Drooling, dysphagia, distress, “hot potato” voice
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Epiglottis
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Erosive rhinitis, Tonsillopharyngeal, Tachycardia out of proportion to fever
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Diptheria, Corynebacterium diptheriae
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False positive sweat test
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Nephrogenic DI, Myxedema, Mucopolysaccharidosis, Adrenal insufficiency, Ectodermal dysplasia
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Effects of fat soluble vitamin deficiencies
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A: night blindness, D: Dec bone density, E: neurologic dysfunction, K: bleeding
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Prolonged PR
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myocarditis, digitalis, hyperkalemia, ischemia, Inc vagal tone, hyperthyroidism
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Short PR
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Ectopic atrial pacemaker, preexcitation syndromes (WPW, Lown-Ganong-Levine), glycogen storage disease
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Prolonged QRS
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RBBB, LBBB, WPW, PVCs, mechanical pacemakers
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QT- Congenital syndromes
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WIDTH: WPW, Ischemic heart dz, Drugs, Torsades, Hypokalemia, Hypomagnesemia, Hypocalcemia
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boot shaped heart
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Tetralogy of Fallot
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egg shaped heart
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Transposition of the Great arteries
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Jones criteria
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Rheumatic fever: JONES, Joints, Carditis, Nodules (subcu), Erythema marginatum, Sydenham’s chorea Minor: Arthralgia, Fever, ESR, CRP, Long PR & ASO titer
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Causes of endorcarditis
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alpha hemolytic Strep, Strep viridans,
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Myocarditis is caused by
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Coxsackievirus, echovirus, adenovirus
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Causes of anion gap metabolic acidosis
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MUDPILES: Methanol, Uremia, DKA, Paraldehyde, Isoniazid, Lactate, Ethylene glycol, Salicylates
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ABG parts
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pH/pCO2/pO2/ Calc HCO3/ Calc SaO2
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Normal anion gap
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8-16 mEq/L Na – (Cl + HCO3)
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Winter’s formula
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Expected pCO2 = 1.5*HCO3 +8 +/- 2
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Type 4 RTA
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mineralocorticoid deficiency, Aldosterone deficiency or resistance, (Addison dz, CAH, Primary hypoaldosteronism)
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Treat chlamydia
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1 dose Azithromycin, doxycycline, erythromycin, levofloxacin or ofloxacin
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Treat gonorrhea
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IM Ceftriaxone or oral Cefixime, Ciprofloxacin, Ofloxacin
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Treat Candida
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Topical azoles
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Treat epididymitis
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Trimethroprim- sulfamethoxazole (TMP-SMX)
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Treat PID
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Doxycycline for 2 weeks
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Treat HSV
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Acyclovir
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Microcytic anemia
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Iron def, Thalessemia, Lead toxicity, Neoplastic
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Normocytic anemia
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Blood loss, Hemolytic, Anemia of chronic dz, Hemoglobinopathy, Renal dz
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Macrocytic anemia
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Hemolytic (autoimmune), Alcohol, Liver dz, Aplastic anemia, Hypothyroidism, Drugs, Myelodysplasia
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Megaloblastic anemia
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Folate and B12 def
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Spherocyte
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Hereditary spherocytosis, Autoimmune hemolytic anemia
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Target cell
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Liver dz, Hemoglobinopathies, Postsplenectomy, Thalessemia
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Echinocyte (Burr cells)
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Liver dz, Post splenectomy, Azotemia/ uremia, Gastric carcinoma
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Howell-Jolly Body
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Hemolytic anemia, Megaloblastic anemia, Hyposplenism, Postsplenectomy
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Schistocyte
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“bite cell”, G6PD, DIC, HUS, vaculitis
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Basophilic stippling
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Sideroblastic anemia, Myelodysplastic syndrome, Heavy metal poisoning
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Diamond-Blackfan
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pure red cell aplasia
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Iron deficiency
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Dec ferritin, Dec iron Inc TIBC
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Most common cause of fatal sepsis in SCD
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Step pneumo
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cardiomyopathy, cirrhosis, diabetes
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Hemosiderosis
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Drugs causing hemolysis in G6PD
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Aspirin, Sulfonamides, Ciprofloxacin, Antimalarials
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hemolysis, Inc retic count, family history, splenomegaly, gallstones
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Hereditary spherocytosis
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TTP
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FAT RN Fever Anemia Thrombocytopenia Renal dysfunction Neurologic abnormality
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Fever Anemia Thrombocytopenia Renal dysfunction Neurologic abnormality
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TTP
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Hemolytic anemia, thrombocytopenia, uremia
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HUS Hemolytic Uremic syndrome

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