Pediatric Rotation Review

I conducted Pediatrics core rotation at Jackson Park Hospital with Dr. Hughes in the summer; this is a 6 weeks rotation. Dr. Hughes is a very energetic and nice pediatrician at the hospital.

There is one set of schedule during the summer and another different schedule during the school year. I had 4 days of clinic every week with 4 hours of rotations. Every other Friday I had to go to a clinic in a rural area, in Harvey, IL. Rotations are conducted in the MOB clinic on the 3rd floor. She serves as a physician at a local high school in South Side but since it was the summer time, I didn’t have to go to the high school.

Dr. Hughes does a great job in teaching about pediatrics. She will help you in understanding the vaccination schedules and more. She will teach you with hands-on learning with pediatric patients to understand pediatric concepts. All the patients you will see will be outpatients so you will not see any inpatients.

For the rotation you are to do one power point presentation on a system on 3 or more pediatric illnesses and one full pediatric history & physical.

Where to Get your Car’s Emission Test Done in Illinois

If you come from a US State where your car must pass the emission test in order to renew your vehicle registration then you should read this post.  On your license plate, on the top right, you need a new sticker every year, which represents passing the emission test.

If you have family or anyone else who can take care of your vehicle’s registration from your home state then you can do your emission test here in Illinois and send the paperwork back home to get the sticker for your license plate.

For Illinois registered cars, the emission test is free but for out-of-state registered vehicles, the price is $20 in cash. Make sure you have cash because they do not accept any other forms of payment.

I went to the testing station at:
1850 Webster Ave.
Chicago , IL 60614

I went in the main office and asked for a volunteer emission test for an out-of-state vehicle, and paid $20 in cash. They went out to get my car’s license plate number and the car’s VIN (vehicle identification number). Then they got the rest of the information such as my house address and other minor information in my home state and gave me a voucher. Then I took my car to the opposite side of the office and gave my voucher to the person who conducts the test and got my car’s emission tested; and passed.

You can find other testing locations at the Air Team Illinois website.

Types of Systemic Fungal Infections

The following fungal infections (mycoses) can cause pneumonia (lung infection) and the infection can disseminate (spread). In immunocompromised people (ex. cancer treated patients, HIV patients, etc.), fungal infection will lead to systemic disease. Systemic mycosis infection can mimic tuberculosis symptoms like fever, chills, nights sweats, and weight loss.
In immunocompetent people (people with normal immunity), the fungal infection will lead to just lung disease (local infection).

These fungi are di-morphic, which means they can be in the form of mold or yeast. They are mold in the cold (20°C) and yeast in the heat (37°C). The exception is coccidioidomycosis, which is a spherule and not at yeast.

Histoplasmosis
Histiocyte (macrophage) filled with Histoplasma.It’s most common in the southeastern, mid-Atlantic, and central United States; such as the Mississippi and Ohio river valleys. It can cause an acute pneumonia, which presents as cough, fever, and malaise. Chest X-ray will show hilar adnopathy and may demonstrate areas of pneumonia. Disseminated histoplasmosis are more common in HIV patients.
Labs: Microscopy will show macrophage filled with Histoplasma. Can present as coin lesions that is calcified on chest x-ray.

Key Scenario: Found in soil and droppings of birds bats so, cave exploration and cleaning bird coups is associated with the fungus. Also, doing activities that disrupt soil.

Blastomycosis
Broad-based budding with thick double refractice walls.
It’s endemic in the south-central and north-central United States. It affects the lungs, skin, bnes, joints, and protaste. Infection in immunocompromised hosts is uncommon. Primary pulmonary infection may be asymptomatic or present with flu-like symptoms. Forms granulomatous nodules.
Labs: Microscopy will show broad-based budding; same size as RBCs. Diagnosis is made by use of potassium hydroxide (KOH) prep to reveal big broad-based budding in sputum and tissues. The organism will show thick double refractive walls around it. 
Coccidioidomycosis
Spherules filled with endospores.It’s endemic in the southwestern United States, as well Central America and South America. Primary pulmonary infection has a non-speicif features, such as fever, fatigue, dry cough, weight loss, and pleuritic chest pain. It can spread to bones as skin; cutaneous findings, such as erythema multiforme and erythema nodosum, as well as arthlagias, are common.
Labs: Microscopy will show spherules filled with endospores.
Key Scenario: Patient gets infected after and earthquake, because the spherules in dust are thrown up in the air. 

Image Source: Medscape

Rx: Treated with fluconazole or ketoconazole for local infections. Amphotericin B for systemic infections.