• Fever of ≥5 days' duration plus 4 of:
  
• Bilateral nonsuppurative conjunctivitis
• One or more changes of the mucous membranes of the upper respiratory tract
• Pharyngeal injection, dry fissured lips, injected lips, "strawberry" tongue
• One or more changes of the extremities
• Peripheral erythema, peripheral edema, periungual desquamation, generalized desquamation
• Polymorphous rash
• Pimarily truncal
• Cervical lymphadenopathy
  
• >1.5 cm in diameter
• Need echocardiogram to exclude coronary artery aneurysm
  

• Macules are small, flat discolored spots
• Papules are small, raised bumps

Mefenamic acid overdose

• Convulsions, nausea, emesis, haematemesis, bradypnea, coma
• Renal failure
  
• Onset of symptoms is usually between 30 minutes and 4 hours, but signs of renal failure may appear several days after an overdose
• Lethal dose can be as low as 2.5 g
• Conservative management; Can manage acidosis with bicarb

Sylvian fissure

• AKA lateral sulcus
  
• Divides the frontal lobe and parietal lobe above from the temporal lobe below
• Longer in the left hemisphere in most people
• Dot sign = MCA embolus

Methemoglobinemia

• PathPhys
  
• Higher than normal level of methemoglobin (metHb, i.e., ferric [Fe³⁺] rather than ferrous [Fe²⁺] haemoglobin) in the blood
• Methemoglobin has a decreased ability to bind oxygen, but allosterically raises affinity for the other 3 ferrous haemoglobins
• => Shifts dissociation curve to left => Tissue hypoxia
  
• Elevated levels of methemoglobin in the blood are caused when the mechanisms that defend against oxidative stress within the red blood cell are overwhelmed
  
• => Oxidation of ferrous iron
• Can give the blood a bluish or chocolate-brown color
• Causes
  
• Congenital methemoglobinemia
• Autosomal recessive - due to a deficiency of the enzyme diaphorase I (NADH methemoglobin reductase)
• May also be seen in patients with abnormal hemoglobin variants such as hemoglobin M (HbM), or hemoglobin H (HbH)
• Not amenable to reduction despite intact enzyme systems
• Can also arise in patients with pyruvate kinase deficiency due to impaired production of NADH
• Patients with Glucose-6-phosphate dehydrogenase (G6PD) deficiency may have impaired production of NADPH
• Acquired
  
• Exposure to exogenous oxidizing drugs and their metabolites (benzocaine, dapsone, nitrates)
• e.g. Nitrates from farms in drinking water
  
• Other classical drug causes:
• Antibiotics (trimethoprim, sulfonamides, dapsone)
• Local anesthetics (especially articaine and prilocaine)
• Aniline dyes, metoclopramide, chlorates, bromates
• Management
• Supplemental oxygen and methylene blue 1% solution (10 mg/ml) 1 to 2 mg/kg slow IV
• Restores the iron in hemoglobin to its normal (reduced) oxygen-carrying state

Notes

• Erythromycin for gastric stasis
• AmBisome = Amphotericin B
  
• IV antifungal
  
• Formoterol = LABA
• Clonidine
• Centrally acting α2 adrenergic agonist
• For HTN. ADHA, anxiety/panic disorder, pain
•