Primary acute angle-closure glaucoma occurs only with closure of a preexisting narrow anterior chamber angle found in older age groups, hyperopes, inuites, and Asians. Angle closure may be precipitated by pupillary dilation and thus can occur from sitting in a darkened room, at times of stress or, rarely, from pharmacologic mydriasis. The symptoms given are classic for acute angle-closure glaucoma (older age group, Asian, rapid onset of severe pain and profound visual loss with halos around light, red eye, steamy cornea, dilated pupil, hard eye to palpation). A Clostridial tetani infection is a vaccine-preventable disease that results in approximately 50 cases/yr in the United States. Even with modern medical resources, one of four or one of five patients with generalized tetanus dies. Almost all cases occur in individuals who are not properly immunized. Sixty percent of cases occur in older adults for whom immunity has waned. Tetanus presents in different forms including generalized, localized, cephalad, and neonatal. Generalized is the most common and symptoms include mood changes, trismus, diaphoresis, dysphagia, and drooling. Later symptoms include painful flexion and adduction of the arms and pain with extension of the legs. Convulsions and spasms are possible, along with a variety of autonomic symptoms. Treatment includes airway protection, benzodiazepines for muscle spasm, tetanus immune globulin immediately, and three doses of tetanus toxoid given by the standard schedule. Metronidazole has been demonstrated to be the most effective antimicrobial. Labetalol may be used for catecholamine-induced hypertension but the patient must also be monitored for hypotension and bradycardia. A Cytomegalovirus (CMV) is one of the congenital neonatal TORCH infections (toxoplasmosis, other [syphilis, varicella-zoster, and parvovirus in this list], rubella, cytomegalovirus, and herpes simplex/hepatitis/HIV). CMV is the most common congenital infection. The disease-specific manifestations for CMV include microcephaly with periventricular calcifications, neonatal jaundice with direct hyperbilirubinemia, and hepatosplenomegaly. Other associated manifestations include intrauterine growth retardation, thrombocytopenia, and purpura. Disease-specific manifestations for herpes simplex virus include skin/eye/mouth vesicles, encephalitis, respiratory distress, and sepsis. Disease-specific manifestations of rubella include congenital heart lesions (patent ductus arteriosus, pulmonary artery stenosis, aortic stenosis, ventricular defects), thrombocytopenic purpura characterized by purple macular lesions ("blueberry muffin" appearance), cataracts, retinopathy, and sensorineural deafness. A 5-year-old male child presents to the office for his kindergarten physical examination. Assuming that the patient's immunizations have been up to date, which of the following are the immunizations that the patient should receive at the end of today's visit?
hepatitis B, inactivated poliovirus (IPV), diphtheria, tetanus, acellular pertussis (DTaP), measles, mumps, rubella (MMR), varicella
IPV, DTaP, MMR, pneumococcal (PCV)
IPV, DTaP, MMR, Haemophilus influenzae type B (Hib)
DTaP, IPV, MMR, varicella