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CONTENTS
COMMENTARY
87 The Importance of Amy Lynn
Vincent J. Menna
ARTICLES
89 Cocaine: A Review
John Wootton and Sheldon I. Miller
93 Point-Counterpoint: Otitis Media
94 Migraine Headaches in Children
Harvey S. Singer
102 Hematuria
Douglas S. Fitzwater and Robert J. Wyatt
110 Scabies
James E. Rasmussen
115 Consultation with the Specialist:
Hearing Loss in the Absence of Otitis Media
John F. Kveton
117 Index of Suspicion
Najla N. Falaki, Michael Shannon, and
Anthony M. Policastro
ABSTRACTS
87 Labial Adhesions
88 Congenital Nasolacrimal Duct Obstruction
120 Myocarditis
121 Foreign Body Aspiration
122 Common Red Cell Transfusion Reactions
COVER
“Le Gourmet,” painted in 1901 by Picasso (1881.1973) during his “BluePeriod,” demonstrates the natural appetite of the small child, who appearswell nourished and even is eating standing up. Eating problems in children
are not inherent in their stage of development but are their response toadverse environments. The blue color, however, suggests a threat to this
healthy state. Child health professionals must balance this innate healthy
aspect of childhood against the environmental threats to their well-beingand be advocates for the healthy development of children. (This painting isfrom the National Gallery of Art’s Chester Dale collection and is
reproduced with permission.)
ANSWER KEY
1. A; 2. A; 3. E; 4. D; 5. D; 6. C; 7. E; 8. B; 9. C; 10. C; 11. C; 12. D;13. D; 14. E; 15. C; 16. D; 17. A; 18. E; 19. A; 20. D; 21. B; 22. C
Printed in the USA
Pediatrics in Review
Vol 15 No 3March 1994
EDITORRobert J. HaggertyUniversity of RochesterSchool of Medicine and DentistryRochester, NY
Editorial Office:Department of PediatricsUniversity of RochesterSchool of Medicine and Dentistry601 ElmwoodAve, Box 777Rochester, NY 14642
ASSOCIATE EDITORLawrence F. NazarianPanorama Pediatnc GroupRochester, NY
CONSULTING EDITOREvan Charney, Worcester, MA
ABSTRACTS EDITORSteven P. Shelov, Bronx, NY
MANAGING EDITORJo Largent, Elk Grove Village, IL
EDITORIAL CONSULTANTVictor C. Vaughan, III, Stanford, CA
EDITORIAL BOARDMoris A. Angulo, Mineola, NYRussell W. Chesney, Memphis, TNPeggy Copple, Tucson, AZRichard B. Goldbloom, Halifax, NSJohn L. Green, Rochester, NYRobert L Johnson, Newark, NJKathi Kemper, Seattle, WAAlan M. Lake, Glen Arm, MDFrederick H. Lovejoy, Jr, Boston, MAJohn T. McBride, Rochester, NYVincent J. Menna, Doylestown, PALawrence C. Pakula, Timonium, MDJohn M. Pascoe, Madison, WIRonald L Poland, Hershey, PAJames E. Rasmussen, Ann Arbor, MIJames S. Seidel, Torrance, CARichard H. Sills, Newark, NJLaurie J. Smith, Washington, DCWilliam B. Strong, Augusta, GAJon Tingelstad, Greenville, NCVernon T. Tolo, Los Angeles, CARobert J. Touloukian, New Haven, CTTerry Yamauchi, Little Rock, ARMoritz M. Ziegler, Cincinnati, OH
EDITORIAL ASSISTANTSydney Sutherland
PUBLISHERAmerican Academy of PediatricsErrol R. Alden, Director
Department of EducationJean Dow, Director
Division of PREP/PEDIATRICSDeborah Kuhlman, Copy Editor
PEDIATRICS IN REVIEW (ISSN 0191.9601) is ownedand controlled by the American Academy ofPediatrics. It is published monthly by the AmericanAcademy of Pediatrics, 141 Northwest Point Blvd.P0 Box 927, Elk Grove Village, IL 60009-0927.
Statements and opinions expressed in Pediatricsin Review are those of the authors and not necessaniythose of the American Academy of Pediatrics or its
Committees. Recommendations included in thispublication do not indicate an exclusive course oftreatment or serve as a standard of medical care.
Subscription price for 1994: AAP Fellow $100; AAPCandidate Fellow $75; AAFP $125; Allied Health orResident $70; Nonmember or Institution $130. Currentsingle price is $10. Subscription claims will be honoredup to 12 months from the publication date.
Second-class postage paid at ARLINGTONHEIGHTS, ILLINOIS 60009-0927 and at additionalmailing offices.
�AMERICAN ACADEMY OF PEDIATRICS, 1994.All rights reserved. Printed in USA. No part may beduplicated or reproduced without permission of theAmerican Academy of Pediatrics. POSTMASTER:Send address changes to PEDIATRICS IN REVIEW,American Academy of Pediatrics, P0 Box 927, ElkGrove Village, IL 60009-0927. _____________
The printing and productionof Pediatrics in Review ismade possible, in part, by ROBBan educational grant from I SUPPORTINGRoss Products Division,Abbott Laboratories. -.
92 Pediatrics in Review VoL 15 No. 3 March 1994
SUBSTANCE ABUSECocaine
treatment of suspected life-threaten-ing cocaine overdose in the infant issupportive.
TreatmentSeizures are best treated with diaze-pam. Imbalances in pH must be cor-
rected and the patient monitored andtreated for cardiac arrhythmias. Other
previously noted medical complica-tions are treated supportively.
Patients who present acutely intox-
icated require stimulation to be keptto a minimum until the immediate“high’ ‘ abates. Benzodiazepines may
help in the face of psychomotor agi-
tation. If psychosis is present, halo-peridol is the drug of choice.
However, neuroleptics should beused in the lowest possible dose be-cause they may lower the seizure
threshold.As noted previously, there is a
rather long period of withdrawal
from cocaine marked by depressionand anhedonia. This is a particularlyvulnerable period for the addict at-
tempting to maintain abstinence andcan last up to 3 months. Numerousdrugs have been tried to decreasecraving and reverse withdrawalsymptoms, with equivocal results.Amantadine, bromocriptine, and tn-cyclic antidepressants have been usedat standard therapeutic doses bymany and are thought to be helpfulby some. Whether these beneficialeffects derive from therapeutic ac-tions or as a placebo response tothese drugs is unclear.
The previously noted treatmentsare important. However, in addic-tion, the only acceptable goal oftreatment is a lifelong abstinencefrom all addicting psychoactive
agents, with particular emphasis onthe drug of choice. Very rarely is
this achieved through pharmacologicintervention or one-on-one psycho-logic intervention alone. The
achievement of this goal usually de-
pends on the patient’s participation ina structured intensive drug treatmentprogram. Most of these treatmentscan occur on an outpatient basis,with only a small percentage requir-ing inpatient care, and they are en-hanced greatly by the patient’sinvolvement in a 12-step self-helpgroup.
SUGGESTED READINGAdams EH, Blanken AJ, Ferguson LD,
Kopstein A. Overview of Selected Drug
Trends. Rockville, MD: National Institute
on Drug Abuse; 1989; publication NIDA
RPO-73 1
American Psychiatric Association. Diagnostic
and Statistical Manual of Mental Disorders.
3rd ed. Washington, DC: 1987
Brown ER, Zuckerman B. The infant of the
drug-abusing mother. Pediatr Ann.
1991 ;10:555-563
Chasnoff IJ, Griffith DR. MacGregor 5, et al.
Temporal patterns of cocaine use in
pregnancy. JAMA. 1989;261:1741-1744
Chasnoff IJ, Schnoll SH. Consequences of
cocaine and other drug use in pregnancy. In:Washton A, Gold MS. eds. Cocaine: A
Clinician ‘s Handbook. New York, NY: The
Guilford Press; 1987:241-251
Cregler LL, Mark H. Medical complications of
cocaine abuse. NEnglJMed. 1986;315:
1495-1500
Frances Ri, Miller SI. Clinical Textbook of
Addictive Disorders. New York, NY: The
Guilford Press; 1991
Gawn FH, Kleber HD. Abstinence symptoma-
tology and psychiatric diagnosis in cocaine
abusers: clinical observations. Arch Gen
Psychiatry. 1986;43:107-1 13.Hadeed AJ, Siegel SR. Maternal cocaine use
during pregnancy: effect on the newborn
infant. Pediatrics. 1989;84:205-210
Karan LD, HaIler DL, Schnoll SH. Cocaine.
In: Frances Ri, Miller SI, eds. Clinical
Textbook of Addictive Disorders. New York,
NY: The Guilford Press; 1991:121-145Lowenstein DH, Massa DM, Rowbotham MC,
et al. Acute neurologic and psychiatric
complications associated with cocaine abuse.
Am J Med. 1987;83:841-846
Mule SJ. The pharmacodynamics of cocaine
abuse. Psychiatr Ann. 1984;14:724-727
National Institute on Drug Abuse (NIDA).
Drug abuse warning network (DAWN)
(Data File). Rockville, MD; 1989
Ryan L, Ehlich 5, Finnegan L. Cocaine abuse
in pregnancy: effects on the fetus and
newborn. Neurotoxicol Teratol. 1987;9:295-
299
PIR QUIZI . A 1 7-year-old male Hispanic patient
acknowledges during a physical cx-
amination that he was offered crack
cocaine at a party recently. He
states that he has never used cocaine
before. He asks your help in decid-
ing whether to accept the opportu-
nity if offered again. Of the
following statements, the most ap-
propriate information for use in
counseling your patient is that:
A. He runs the risk of becoming a
compulsive user.
B. Hispanic adolescents use cocaine
less frequently than do non-
Hispanic adolescents.
C. Nearly all who try cocaine be-
come regularusers.D. The risk of a cocaine user being
admitted to an emergency room
has dropped dramatically during
the past decade.E. The streetcost of cocaine has
risen substantially during the
past decade.
2. During attending rounds, you arepresented a 17-year-old female pa-
tient admitted the previous night
having pelvic inflammatory disease,who reported that she began snort-
ing cocaine with her boyfriend 2weeks ago. You are asked by your
residents to review the pharmacol-
ogy and mode of action of cocaine
to explain why the method of
administration may vary among
users over time. The most appropri-
ate statement regarding repeated co-
caine use isthat:A. Of the three most common
methods of administration, free-
basing (smoking) produces themost rapid onset of action.
B. Regardless of how administered,
the amount of drug required to
achieve desired results is con-
stant over time.
C. Snorting is the most efficientway to deliver cocaine to the
brain
D. The duration of the “rush” gen-
erated by free-basing is greater
than that generated by snorting.
E. The intensity of the cocaine“rush” produced by snorting is
greaterthan thatproduced byfree-basing.
3. During an annual physical examina-
tion, a 17-year-old female patient
asks about the risks of cocaine use.
Among the medical complications
produced directly by cocaine use,you would most appropriately iden-
tify:A. Hemolytic anemia.
B. Hypoparathyroidism.
C. Malignant obesity.
D. Pathologic fracture.
E. Ventricular tachycardia.
4. An agitated, periodically violent 16-
year-old girl manifesting paranoid
ideation is admitted to the intensive
care unit following repeated intrave-
nous cocaine use at a party. You are
aware that multiple drug use is in-
creasingly common and that cocaine
frequently is cut with a variety of
substances. Aside from cocaine it-
self, which of the following sub-
stances is most likelyto beexacerbating the girl’s symptoms?
A. Ethyl alcohol.
B. Heroin.C. Lidocaine.
D. Phencyclidine.
E. Talc.
5. A homeless 19-year-old girl has de-
livered an infant weighing 2500 g.She has no history of prenatal care.She admits to use of cocaine
throughout the pregnancy, and her
urine screen is positive for benzoy-
lecgonine. Which of the following
conditions in the infant is most
likely to demand special attention in
the first 12 hours after birth?
A. Cocaine withdrawal syndrome.
B. HIV infection.
C. Hypovolemic shock.
D. Intrauterine growth retardation.
E. Respiratory distress syndrome
(hyaline membrane disease).
Pediatrics in Review Vol. 15 No. 3 March 1994 93
LII1�±�I�1 POINT-COUNTERPOINT ______
Otitis Media
A reader questioned Dr. Howie’s an-tide on otitis media (PIR 1993;14:320-323) on three counts:1. His recommendation not to use
amoxicillin as first-line treatment
for acute otitis media;2. His discussion of otitis media
with perforation; and3. His recommendation to place tym-
panostomy tubes in “any young-ster who has otitis media witheffusion that persists for 6 to 12weeks.”
Dr. Howie responds:“I share with you the frustration
of the ever-present challenge of otitismedia with effusion (OME), whether
acute, recurrent acute, or persistent,in the pediatric population that weserve. The ‘relapsogenic nature’ ofaminopenicillins (eg, ampicillin andamoxicillin) seems to be part andparcel of the problem. This observa-
tion of mine has not been confirmedor refuted by other pediatricians inclinical studies. It is based on my ob-servation of a randomized trial of103 infants, with 48 infants fallinginto the treatment group getting am-picillin for their initial and up tothird episode of OME and 55 infantsgetting either erythromycin estolateor penicillin V-K mixed with triplesulfonamide in the other group. Four-teen patients in the ampicillin groupwent on to have six or more attacksof OME requiring antibiotics,whereas only three of the ‘mixture’-
treated group had six or more epi-sodes of OME. More recently, I haveobserved that one third of patients
treated with amoxicillin-clavulanicacid who grow H influenzae or pneu-mococcus from their ears relapsewithin 72 hours after a 10-day courseof antibiotic. This ‘lighting relapse’does not seem to happen with otherantibiotics, such as cephalosporins or
mixtures of sulfonamides with eryth-
romycin or penicillin V-K or pro-caine penicillin-bicillin IM.” (In hisarticle, he recommends penicillinwith a sulfonamide or any therapy
“that misses less than 10% of thehuman principal pathogens is most
desirable.”)“Your observation that very few
patients in these United States end upwith a chronic persistent perforationis very true in my experience, too.Most of these, I note, are in the
medically underserved or third-worldcountries. The persistent perforationsthat we see most often in Texas and
the adjacent states are those deliber-ately placed to ventilate fluid-filled
middle ears by medical means, forexample, pressure-equalization tubes.I have served on international com-mittees that tried to reach a consen-sus on exactly when (afterappropriate antibiotic therapy) the
ventilation tubes should be placed.The usual decision of these commit-tees has been 60 to 90 days if expert
surgeons are available to do the job.Admittedly, corticosteroids some-times will clear the fluid-filled ears,
but not as regularly or as penma-nently as ventilation tubes. It hasbeen my experience that in largermetropolitan areas, one can find askilled pediatrician or ENT surgeonwilling to place these tubes without
general anesthesia in a hospital. Icertainly try to teach pediatric resi-dents this procedure.
“This procedure can be performedon an outpatient basis under localiontophoretic anesthesia with moder-
ate sedation with mepenidine on the
‘cocktail’ of your choice. I havenever paid anything extra for mal-
practice coverage to perform this pro-cedure in states from Alabama toCalifornia and would not expect oth-ers to, unless they use general anes-thesia.”
This One
I��I�III�I�OIIII�I�III��IIUI1III�I11111I�I8YX5-9JG-JD7N
Pediatrics in Review Vol. 15 No. 3 March 1994 101
NEUROLOGYHeadaches
Igarashi M, May WN, Golden GS.Pharmacologic treatment of childhood
migraine. ] Pediatr. 1992;120:653-657
Illingworth RS. Common Symptoms of Disease
in Children. 5th ed. Oxford, UK: Blackwell
Scientific Publishers; 1975Mathew NT. Drug-induced headache. Neurol
Clipi. 1990;8:903-912
Olness KN, MacDonald iT. Recurrent head-
aches in children: diagnosis and treatment.
Pediatrics in Review. 1987;8:307-311
Peroutka Si. Developments in 5-hydroxy-
triptamine receptor pharmacology in
migraine. Neurol Cliii. 1990;8:829-839
Prensky AL. Differentiating and treating
pediatric headaches. Contemp Pediatr.
1984;!: 12-45
Prensky AL, Sommer D. Diagnosis and
treatment of migraine in children.
Neurology. 1979;29:506-5 10
Raskin NH. Modern pharmacotherapy of
migraine. Neurol Clin. 1990;8:857-865
Shinnar S. An approach to the child with
headaches. mt Pediatr. 1991;6:140-148
Silberstein SD. Advances in understanding the
pathophysiology of headache. Neurology.
1992;42(suppl 2):6-10
Singer HS, Rowe S. Chronic recurrentheadaches in children. Pediatr Ann.
1992;21 :369-373
Stang PE, Yanagihara T, Swanson JW, et al.
Incidence of migraine headache: a
population-based study in Olmsted County,
Minnesota. Neurology 1992;42: 1657-1662
Stewart WF, Lipton RB, Celentano DD, Reed
ML. Prevalence of migraine headache in the
United States. JAM.4. 1992;267:64-69Waranch HR, Keenan DM. Behavioral
treatment of children with recurrent
headaches. J Behav T/zer &p Psychiat.
1985; 16:31-38
Yuill GM, Swinburn WR, Liversedge LA. A
double-blind crossover trial of isometheptene
mucate compound and ergotamine inmigraine. BrJ Clipi Pract. 1972;26:76-79
PIR QUIZ6. Which of the following most clearly
sets the stage for the occurrence of
migraine in a child or adolescent?
A. Food intolerances.
B. Head trauma.
C. History of migraine in a parent.
D. History of seizure disorder.
E. Stress.
7. Current views of the pathophysiol-
ogy of migraine:
A. Ascribe the condition to a disor-
der of neurotransmitters.
B. Ascribe the condition to arterial
inflammation.
C. Ascribe the condition to arterial
spasm.
D. Ascribe the condition to venous
dilatation.
E. Have not reached a consensus.
8. An 8-year-old girl had the onset 2
hours ago of a mild left hemiplegia
with sensory deficit, followed in 1
hour by a severe right-sided head-
ache. She appears anxious, but is
lucid and complaining of headache.
Neurologic examination discloses a
mild left hemiplegia and left hemi-
anopsia. The optic fundus is normal.
The patient has had no previous
similar episode. Her mother reports
herself as having had two similar
episodes as a child. Among the fol-lowing diagnostic studies, you
would give highest priority at this
time to:
A. EEG.
B. MRI.
C. Measurement of cerebral blood
flow.
D. Radiography of the head.
E. Ultrasonography of the head.
9. A diagnosis of migraine is made in
the 8-year-old child described previ-
ously. The symptoms subside in
several hours. In the prevention of
further such attacks of migraine in
this child, first priority among the
following should be given to:
A. Prophylactic use of anticonvul-
sant medication.B. Prophylactic use of ergotamine.
C. Prophylactic use of propranolol.
D. Trialof behavior modificationtherapy.
E. Investigation of triggering mech-
anisms.
Pediatrics in Review Vol. 15 No. 3 March 1994 109
PIR QUIZ
RENAL DISORDERSHematurla
10. The finding most consistent with
the definition of hematuria is:A. A positive perioxidase test for
hemoglobin in the urine.B. Greater than 100 000 RBCs in
a 24-hour urine collection.
C. Greater than 2 RBCs/high-
power field of centrifuged urine
sediment.
D. Greater than 12 RBCs/0.9 mm2of unspun urine in a countingchamber.
1 1 . Among the following, the findingmost definitive for confirming thepresence of a glomerular lesion asthe cause of hematuria is:
A. A greater intensity of blood in
the last phase of voiding than
in the initial flow.
B. A positive nitrite test on a firstmorning voided urine.
C. Presence of casts containingRBCS in the urine.
D. Presence of crenated (serrated)RBCs in fresh urinary sedi-
ment.E. Presence of fresh clots of blood
in the urine.
12. A 7-year-old Caucasian girl pre-
sents with a 2-day history of sud-
den onset of painless, gross
hematuria. Her history is unre-
markable; family history is positivefor nephrolithiasis (a maternal Un-dc). Physical examination is unre-markable. The urine is positive forblood but negative for protein.
Culture is negative; renal ultrason-ography is normal. The most ap-
propnate next diagnostic study is:A. Assay for serum ANA.B. Cytoscopic examination.C. Determination of serum electro-
lytes with BUN.
D. Determination of urine calcium!
creatinine ratio.E. Measurement of serum C3 con-
centration.
13. A 5-year-old Caucasian boy hashad microscopic hematuria for 8months. He is asymptomatic. Noincrease of hematuria occurs with
intercurrent respiratory infections.
Two brothers, ages 12 and 19
years, are healthy. Repeated physi-cal examinations are normal. Dys-
morphic RBCs are present in the
urine but proteinuria is absent.
Cultures are negative. Serum elec-
trolytes, BUN, sedimentation rate,
and streptozyme are normal. Of the
following, the findings are most
consistent with the diagnosis of:A. Henoch Schoenlein purpura.
B. Hypercalciuria.
C. Membranoproliferativeglomerulonephritis.
D. Thin basement membrane
disease.
14. An 8-year-old boy presents havinga history of painless, gross hema-tuna occurring for several days
during a recent acute viral respira-tory illness. Past history is noncon-tributory. Physical examination is
unremarkable. On urinalysis, thereis microscopic hematuria. On a 12-
hour urine study, protein excretionexceeds 20 mg/M2 per hour.Serum electrolytes, BUN, strepto-
zyme, C3 concentration, and im-mune globulins are normal. Onreevaluation in 2 months, physicalexamination is normal. Micro-scopic hematuria and proteinuriapersist in the same quantities aswere found initially. The most ap-propriate next diagnostic step is to:
A. Measure 24-hour creatinineclearance.
B. Measure serum circulating IgA-containing immune complexes.
C. Obtain an ultrasonographicstudy of kidneys and bladder.
D. Refer for an audiometric exam-ination.
E. Refer to a pediatric nephrolo-
gist.
15. In children who have asymptomaticmicroscopic hematuria, the most
correct statement is:
A. An association with nondrug-
related allergic disease oftencan be documented.
B. An unsuspected coagulationdisorder often is present.
C. The majority do not have sig-nificant glomerular disease.
D. The prevalence is less than 1 ina 1000.
E. Tuberculosis of the kidneys fre-quently becomes evident inseveralyears.
114 Pediatrics in Review VoL 15 No. 3 March 1994
DERMATOLOGYScables
also consider it to be mildly antiprur-itic, although this has not been myexperience.
SULFUR
Five percent sulfur cneme on ointmentis the oldest known remedy for the
treatment of scabies. Its efficacy andtoxicity have never been studied in amodern, controlled trial. Neventhe-less, many physicians still consider5% sulfur cream to be the treatment
of choice for infants, young children,and pregnant women. No studieshave established the safety of thisdrug in the treatment of pregnancy,and experience with its use is sub-
stantially less than that of the other
major agents.
PERMETHRIN
Five percent permethnin has beenmarketed in the US for approxi-mately the past 4 years. It is aproven effective medication with asingle application, which cleanly setsit apart from the other active drugs.Penmethnin also is used as a popularantipediculocide, which is sold oventhe counter. This synthetic pynethninis a neurotoxin, producing paralysisand death of a wide variety of ecto-parasites, such as lice, ticks, fleas,mites, and other anthropods. Thedrug is in pregnancy category B. It isindicated for use in patients of anyage.
Postscabetic Syndrome
Most patients will continue to havevisible lesions and pnunitus for daysto weeks following the use of any ofthe above-mentioned scabicides. It isimportant to relay this information topatients at the time of therapy so thatthey do not continue to reuse thedrug inappropriately. I treat thepostscabetic syndrome with mild-to-moderate potency topical steroids(hydnocontisone 1%, tniamcinolone
0.1% to 0.025%).
Nodular lesions of scabies may
take weeks to months to resolve. Aspreviously mentioned, these lesionsare most notable on the male geni-talia, the upper back, and the anteriorand posterior axillary fold. If theseare present at the initial evaluation,their slow progress should be pointedout carefully to the parents. This typeof patient should be seen in the of-fice after 2 to 4 weeks; moderate-to-high potency steroids, coal tan, on in-tralesional steroids should be consid-ened.
A few patients will continue to de-velop vesicles without burrows onthe hands and feet. In some situa-tions, these patients look as thoughthey have infantile acropustulosis, acondition seen primarily but not cx-elusively in African-American chil-dren less than 2 years old. Thesymptomatic lesions appearing on thepalms and soles after scabies shouldnot be retreated with scabicides un-less the scrapings remain positive.These vesicular lesions usually re-solve very slowly, and if severe, mayneed moderate-to-potent topical ster-
oids on even the occasional use ofparentenal corticostenoids.
SUGGESTED READINGArlian LG, Estes A, Vyszenski-Moher D.
Prevalences of Sarcoptes scabiei in the
homes and nursing homes of scabetic
patients. J Am Acad Dermatol.1988;19:806-81 I
Ginsburg CM, Lowry W, Reisch JS.
Absorption of lindane (gamma benzene
hexachloride) in infants and children. JPediatr. 1977;91 :998-1000
Konstantinov D, Stanoeva L. Crotamiton
cream and lotion in the treatment of infants
and young children with scabies. J Int Med
Res. 1979;7:443-448Rasmussen JE. The problem of lindane. J Am
Acad DermatoL 1981 ;5:507-516
Taplin D, Arrue C, Walker JG, et al.
Eradication of scabies with a single
treatment schedule. J Am Acad Dermatol.1983;9:546-550
Taplin D, Meinking TL, Chen JA, et al.
Comparison of crotamiton 10% cream(Eurax) and permethrin 5% cream (Elimite)
for the treatment of scabies in children. PedDermatol. 1990;7:67-73
PIR QUIZ16. The following statements about
scabies all are correct except:
A. All lesions, whether or not vis-ibly infected, should be treated.
B. Effective scabicides require twoapplications separated by I
week.C. If a diagnosis of scabies is
made, all exposed individuals,not only the symptomatic ones,need to be treated.
D. Itching symptoms cease as
soon as all the mites are killed.
17. The following statements about the
clinical presentation of scabies all
are correct except:A. African-Americans frequently
are infected with scabies.
B. Burrows can be found in 90%
to 95% of all patients.C. Infants, children, and adults are
equally susceptible to scabies.D. Secondary lesions are more
numerous and prominent thanburrows.
E. The burrow is the only charac-teristic lesion.
18. The following statements about thediagnosis of scabies all are true
except:
A. Animal scabies (mange) are not
the source of human scabiesepidemics.
B. Any patient who itches should
be suspected of having scabies.
C. Good light with appropriate
magnification is necessary for
examination of the web spaces.
D. Hands and feet yield the mostpositive results for scabies
scraping.
E. Only specialistsor speciallytrained individuals should at-tempt scabies scraping.
Match the treatment (19-22) with theappropriate statement (A-D).19. Lindane A. Contraindicated
in premature in-20. Crotamiton fants less than 2
months of age.21. 5% Sulfur
22. Permethrin
B. Efficacy and tox-icity never havebeen studied.
C. Indicatedin pa-tients of any age.
D. Must be used
daily for 5 con-secutive days.
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