CDC Developmental Milestones
By this stage, most children are able to reach and grab for toys they want and are able to recognize familiar people's faces.
What is 6 months?
This organ performs the first hydroxylation step, converting cholecalciferol into 25-hydroxyvitamin D (calcidiol).
What is the liver?
This is the single most dangerous adverse effect of isotretinoin, driving strict pregnancy-prevention requirements.
What is teratogenicity?
This foundation, tied to a board that certifies internal medicine physicians, created the Choosing Wisely campaign.
What is the ABIM Foundation?
At their previous visit, Dr. Myers had noted Jenny had this particular characteristic, finding it strange for someone Jenny's age to have.
What are freckles?
This is the age by which most children combine two words into phrases and follow two-step instructions.
What is 2 years?
This is the primary reason Dr. Otey prescribes cholecalciferol for Jenny.
What is preventing vitamin D deficiency due to sun avoidance?
This US risk-mitigation program requires all isotretinoin patients, prescribers, and pharmacies to register.
What is iPLEDGE?
This is the first of the five Choosing Wisely questions, asking whether a test or procedure is truly necessary.
What is "Do I really need this test or procedure?"
This characteristic that Jenny had helped Dr. Otey rule out the related disease, trichiodystrophy.
What is normal-appearing hair?
Clue: By this age, most children walk alone, say several single words, and drink from a cup without a lid.
What is 18 months?
This nuclear receptor is bound by active calcitriol to increase intestinal calcium and phosphate absorption.
What is the vitamin D receptor (VDR)?
This is the reason Dr. Otey gives for hesitating to prescribe isotretinoin to Jenny, even though it could lower her skin cancer risk.
What is concern about the drug's side effects?
Patients are encouraged to ask this question about a treatment's potential dangers and unwanted effects.
What are the risks / What are the side effects?
Kathy describes her hometown, Jonestown, in this way, noting that it is also a farming-based community.
What is an isolated community?
By this age, most children pull to stand, wave "bye-bye," and say "mama" or "dada" specifically.
What is 12 months (1 year)?
This electrolyte disturbance is the hallmark of cholecalciferol toxicity, causing nausea, constipation, and kidney stones.
What is hypercalcemia?
Isotretinoin is a synthetic derivative of this vitamin.
What is vitamin A?
This Choosing Wisely question asks what would happen if the patient chose not to pursue the test or treatment right away.
What happens if I don't do anything?
This is the global rate of consanguineous marriage.
What is ~10.4%
By this age, most children speak in three-word sentences, pedal a tricycle, and engage in imaginative/pretend play.
What is 3 years?
This granulomatous disease is a relative contraindication to vitamin D supplementation, because granulomas contain their own 1-alpha-hydroxylase.
What is sarcoidosis?
This class of antibiotics, when combined with isotretinoin, significantly raises the risk of pseudotumor cerebri.
What are tetracyclines?
These two questions, numbers 3 and 5 on the Choosing Wisely campaign program, put into consideration not only safer treatment options but also much, much simpler options.
What is "Are there simpler, safer options? / How much does it cost?"
These two DNA repair pathway mechanisms are still functional in Jenny, allowing her to have an X-Ray scan done.
What are homologous recombination (HR) and non-homologous end joining (NHEJ)?