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Absolute rest while the Antibiotics are often not indicated in the first 2 weeks patient is symptomatic is critical to avoid prolonged since most cases are viral safe 80 mg super cialis. SORE THROAT Antibiotic treatment should primarily target Bordetella species (Gilbert, Moellering and Sande, 2002). The Common infectious causes of acute pharyngitis include first line choice is erythromycin estolate (500 mg qid viral URIs, group A beta-hemolytic strep (GABHS), for 14 days). Second line choices include trimethoprim- infectious mononucleosis (IM), and enterovirus infec- sulfamethoxazole-DS (1 bid for 14 days) or clari- tions, like coxsackievirus, which have been linked to thromycin (500 mg bid for 7 days). These can trig- On examination look for tonsillar erythema and exu- ger bronchospasm and impede training. The clinician dates, asymmetric tonsillar swelling, ulcerations, palatal must provide considerable reassurance as complete petichiae, fever, cervical adenopathy, and splenomegaly. Management relies on avoiding irritant stimuli Symptomatic treatment with warm salt water gargles, and using bronchodilators such as albuterol (1–2 puffs humidified air, throat lozenges, and analgesics is often q 4–6 h). If negative, then a throat culture should be bid-qid) may be useful too (McDonald, 1997). Second line choices include Chest X-rays often show localized or diffuse infiltrates, azithromycin (500 mg qd for 1 day and then 250 mg but may not early in the course of disease. Sputum a day for 4 days) or erythromycin (250 mg qid for gram stain and culture may provide clues to the 10 days) (Perkins, 1997). Antibiotics hasten recovery, causative organism (Masters and Weitekemp, 1998). Proper rest, hydration, and IM, caused by Ebstein-Barr virus (EBV), occurs most nutrition are critical, as well as antibiotics to cover the commonly between ages 15 and 24 and affects 1–3% common bacterial pathogens (Streptococcus pneumo- of college students each year (Maki and Reich, 1982). One may also malaise are often present for longer, and can lengthen consider a flouroquinolone with increased S. There is no correlation Diagnostic studies include a lymphocytosis of >50%, between the severity of the illness and the susceptibil- >10% atypical lymphocytes on a peripheral smear, and ity to splenic rupture. Left upper quadrant pain that a positive heterophil antibody (monospot) test.

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US has the potential to assess cal syndromes of spina bifida discount 80mg super cialis with amex, myelomeningocele tethering and limitation of motion. There is now a Congenital and Developmental Disorders 11 considerable expertise in the prenatal diagnosis of Techniques that are available are: these lesions by US and this subject is dealt with in detail in many texts. As a result there is the Plain films: option of termination of pregnancy with a reduc- ¼ Show vertebral defects tion in the number of children born with these – Hemivertebrae (Fig. The management is often surgical with repair changes in projection or release of tethered structures and instrumenta- ¼ Rotational deformities are difficult to measure tion and osteotomy for the bony deformity. US has significant advan- – Limits repeat examination tages in accuracy over MRI, although both may be ¼ Films taken bending will show correctable (sec- required in borderline or complex cases [50–52]. For ondary) curves open neural tube defects, closed myelomeningocele and cranial abnormalities MRI is the technique of choice. There are a number of disorders where the neural tube is intact but the bony architecture of the spine is abnormal. Children and adolescents who pres- ent with a lordoscoliosis or a kyphoscoliosis may be divided into those who have a congenital lesion (Fig. Some ado- lescents may show endplate abnormalities that were not present in infancy; these include Scheuermann’s disease and several skeletal dysplasias. To identify vertebral defects that might lead to progressive deformity 2. To identify neural tissue lesions that may damage the spinal cord function as the child matures 3. To follow the progress of the disease and judge response to treatment 5.

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