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181 Cards in this Set

  • Front
  • Back
Describe SHOCK Distributive
Distributive(Anaphylaxis: Type I HS, IgE mediated; Sepsis: Endotoxemia activates Complement C3a & C5a= vasodilation and increases neutrophil adhesion=neutropenia). CO increases, PVR decreases, CVP decreases.
Describe SHOCK Cardiogenic
(PE,MI,Tension Pneumo)low CO, high PVR,high CVP.
Describe SHOCK Hypovolemic
Low CO, High PVR, Low CVP.
What are good prognosis factors in Schizo? Poor?
Good: Sudden onset or late onset, Family supprt, positive symptoms

Bad: Slow or early onset, Social WD, MRI changes
Differentiate Hyperthyroidism based on morphology of gland and T3 uptake?
-What is the tx for these conditions?
1)Graves=increased uptake
-TSH receptor stimulating immunoglobulins
-Pretibial myxedema(red, swollen, shiny skin)

Tx: PTU or Methimazole unless:
<20 or pregnant=surgery
>40= RAI

2)Thyroiditis=Decreased uptake
(Transient Hyper- hypo state)

Tx: B-Blocker

b)Subacute(post viral): Painful w/ fever
Tx: Give NSAID

HYPERTHYROID w/ Multinodular:
1)Plummer(toxic nodular): Nodules have increased uptake but the rest is decreased.
Nasal Angiofibroma
Nasal mass with Epistaxis
Stroke management
Lower the risk
Noncontrast CT to R/o bleed.
Age & HTN are RF
Give ASA to lower the risk
-Age & sex of primary pulmonary HTN.
-Murmur of Pulmonary HTN
-What is differential?
-30+ female.
-Accentuation of P2 w/ parasternal heave
-Dyspnea(low LV volume), JVD,RVH.
-High EPO

Tx: Heart lung transplant and ca channel blockers while waiting for it.

Polcthemia Vera is differential & has low EPO.
Mastitis Tx
Keep feeding off breast & give PO dicloxacillin to cover MRSA
Breast feed CI
HIV,Hep B(dsDNA), Active herpes, TB, Varicella, Syphillus,Galactossemia,sepsis,malaria
Case Fatalaty rate
#of deaths in new cases in year x
# new cases in year x
Boerrhaves Syndrome
Inferior tear of esophogus secondary to wretching by alcoholics and bullimics.
-Painful inspiration and pain after eating
-D/X with barium swallow as endoscope will perforate.
Acoustic Neuroma
-Most Common
-N:V, tinnitus, vertigo, unilateral hearing loss.
-Neurofibromatosis type II(AD:chromosome 22) has b/l AN's
Lung Cx
-How to differentiate the two types
-Dx via sputum cytology
1)Squamous=eosinophillic & hyperchromatic
2) Small cell: basophyllic & lymphocyte sized

Tx; All small cell get chemo only b/c metastasize alot. Every other non-small cell type gets chemo/radiation/resection.
Emphysema S/S
Flat diaphram, increased A-P diameter, Distant Heart sound
Bronchitis S/S
Productive cough, Coarse Rhonchi & wheezes
Lower the FN rate or narrow the reference interval= higher sens
100% sensitivity has no FN
Lower the FP rate= higher Spec
100% spec has no FP
Top 3 tumors that metastasize to bone. Result?
Follicular Cx of thyroid, Breast
Small cell lung
Result is they increase osteoclast factors and get high Ca+, low Po4+ with low PTH.
Nagles Rule
LMP-3mo+7days based on 28 day cycle
Conversion disorder
Stressor then motor or sensory loss w/ le belle indifference. The symptoms are real!!
Labor Phases
Labor must have contractions and dilation as contractions alone is braxton hicks(pseudo)

a) Latent:<3cm dilation
b) Active: >3cm dilation

II: full dilation to baby
III: Baby to placenta
Multiple Sclerosis
-multifocal periventricular demyelination of white matter

-Symptoms are intermittant:
1)Diplopia(optic neuritis or intranuclear opthalmyoplegia)

2) Urinary frequency & urgncy

3) Flex neck and shoot pain down leg.

4)Trigeminal Neuralgia: pain from ear to mouth

MRI w/ contrast then CSF to see: High protein & lymphocytes
-increased IgG
-Kappa light chains
-Oligoclonal bands.

Placenta Previa
Vasa Previa
Placental Abruption
Uterine rupture
PP(At OS): Painless bleed diagnosed with transabdominal sono as TV is CI.

VP: Fetal bleed, HR will fall

PA: Painful bleed with hyperactive uterine tone secondary to HTN & Cocaine

UR: painful w/ immediate hypotention.
Prevalence vs. Incidence
Prevalence=Total # of cases
Incidence=# new cases
Head of the Pancreas Cx
-palpable GB, Pain w/ eating, Clay colored stools, Hyperbilrubinemia

-Pancreatic enzymes & low fat diet
+ve B-Hcg w/ HTN & Proteinuria
<20 weeks= molar pregnancy(snowstorm on sono,pass grapes, complete=46XX, Partial=69XXY-Triploid)

>20 weeks= Pre-eclampsia
(Headache, Diplopia, Edema)
1) Mild: BP<160/110, Pro<3
-Preterm=steroid and bedrest
-Term: MgSo4 & deliver

2) Severe: BP>160/110,Pro>3+
-Preterm: steroids,hydralazine, MgSO4
-Term: MgSo4 & Deliver
Hypercalcemia causes
All cause high Ca+ and low PO4
1) PTH Adenoma: PTH high
2) Malignancy(high osteoclast activity): PTH low
Perinatal mortality rate
#perinatal death(<28 days)+Still Births
Normal & Stll births
Bells Palsy

Unilateral: Facial paralysis w/ taste loss(chorda tympani) & loss of orbicularis oculi(CN III). May get tinnitus or hyperacusis if stapedius muscle paralyzed.

Bilateral: Think MS or Lymes disease

-How do they work?
-Give Examples of each
I: IgE mediated like anaphylaxis or allergy. Will see eosinophilia

II: Ab mediated
-AI hemolytic anemia(methyldopa)
-Blood transfusion reaction
-Goodpasture(Linear IF pattern)
-Pemphigus(Fishnet/lacelike IF pattern)
-Hyperacute transplant(sec-min)

III: IC mediated

IV: CD4 T-cell mediated -contact dermatitis
-PPD intradermal
**4 decreased in HIV**
Pott fracture
b/l medial malleoli fx secondary to eversion
Supracondylar fx
See anterior fat pad displaced on x-ray

Get median Nerve and brachial artery damage and then Volkmans ischemic contracture and then possile compartment syndrome(pain w/ passive extention of fingers).

Mean vs Median vs Mode
Median=In the middle
Mode= Most frequent
Colles Fracture
FOOSH fx of radialsuprastyloid & ulnar styloid LEADING TO DINNER FORK DEFORMITY.

Closed reduction and cast
Mesenteric angina
-Stomach pain after eating and will lose weight.'
-Secondary to ischemia of mesenteric Arteries from atherosclerosis.
-Colonoscopy, CT abdomen & Guiac will be negative so do angiography.
-Tx=modify Atherosclerosis RF's.
Hep B
-Differentiate b/w
1) Acute infection
2)Chronic Infection
3)Resolved infection & immunized
-Give IFN alpha
1) Acute: HbSAg
2) Chronic: Anti Hbc Ab
3) Resolved or immune: Anti Hbs Ab
Odds Ratio
-When is it used
-What is the formula
-What does it tell you
Used in retrospective case-control studies to see if a RF contributes to disease.
-Tells you odds of becoming diseased if exposed to the RF.
Why do neonatal menses occur?
Maternal estrogen falls
Hemophilia A & B
-High PTT only
A= low factor 8
B= Low 9
-Tend to get hemarthroses of the joints
-Give factor to Tx.
-Describe V-tach
-Tx of Vtach
-No p-wave & notching
-Amiodarone or Lidocaine/Procainamide(post MI)
Tx of SVT
Carotid massage
stable use adenosine
Unstable use cardioversion
-Virus type
-Fever w/ cough, conjunctivitis, coryza then head to foot morbilliform rash & buccal mucosa Koplik spots.
-Sequelae is Otitis media
-Tx= Vit A
Loop Dieuretics
-Area of Action
-Electrolyte changes
-Furosemide, Bemetimide, Erythrocrynic acid(non-sulfa)
-Work at thick ascending limb
-lower K+ & Ca+ in serum
-Ototoxic especially with aminoglycosides
-Sulfa allergy CI(Not EA)
-SIADH if Na+ <120, Hypercalcemia states, CHF
Thiazide Dieuretics
-Action area
-Electrloyte changes
-Hydrochlorothiazide, metalozone
-Distal tubule
-Lower K+ & Na but raise Ca+ glucose, uric acid(ppt gout attacks), lipids in serum.
-HTN(1st choice), Nephro DI(after failing to [] urine post desmopressin administration, CHF,Calcium stones
-sulfa drug so CI in allergy.
-Toxic with lithium
Aldosterone Antagonists
-Spirolactone & Amiloride
-Inhibits aldosterone so no Na/K or Na/H exchange.K+ spared.
-Spirolactone causes gyno & impotence in men
-Use for Hyperaldosteronism whether primary: renin low or secondary: renin high ie edematous states.
Iron OD
Lead OD
Dimercaptol or Ca EDTA
Torsades Des Pointes
Amiodarone & Quinidine
Wilson Disease
AR on chromosome 13.
Copper accumulates b/c cerruplasmin is deficient.

Get Hepatolenticular degeneration(hypodense basal ganglia ie Globus pallidus & putamen) causing spasticity, psychosis, Kaysner fleischner, and liver failure.

-Dx via high urinary copper excretion and LOW cerruplasmin levels.

-Tx: Chelate the copper
1 mo milestone
Follow object to midline
2 mo milestone
Follow object 180 degrees
,coo,social smile
Lift head when prone 45 degrees
4 mo milestone
Roll from prone to supine
Restrictive Lung Disease
Sarcoidosis & fibrosis
- Poor compliance (can't fill so all Lung volumes decreased)
-Great recoil(FEV1/FVC is about 100% or increased compared to the normal value of 80%)
-PaCO2 is normal

**NOTE: FEV1 & FVC are both decreased overall***
Obstructive Lung disease
-Great compliance so fill well
-Poor recoil so can't get air out(increased PaC02, increased RV & increased TLC)
-Everything else is decreased:
Elderly changes
-Glucose intolerance
-High alk phos
-Make more autoantibodies
-Decreased Hgb & Clearance of creatinine
How do you decide whether to treat abnormal lipids:

What is the LDL Calculation?
1) Get fasting lipid profile
2) Asess risk factors for CAD
(Smoke,HTN,Family Hx,Age,DM)
3) Get cholesterol level

No RF & cholesterol>240 order LDL
*LDL<190=lifestyle mod

2 RF and cholesterol>200 order LDL

What are the top 3 cancers in women and top 3 cancer COD?
Cause: Breast>lung>colon

Death: Lung>breast>colon
Otitis Externa
Otitis Media & sinusitus
Bugs and Tx are the same:
S. Pneumoniae, H. Influenzae, M. Cattarrhalis.

-Tx= 10 days amoxicillin
Neonatal Sepsis
GBS>E.coli>Listeria(unless galactosemia which has a high E.Coli sepsis rate)
-If mom got ABx for being GBS+ then cultures can be falsely negative so do latex aggluttination test
Variant Angina
-Random Angina during sleep or with exercise
-Nifedipine(Ca channel blocker) and Sublingual Nitro
Clozapine AE
Get a CBC b/c may cause agranulocytosis. if patient gets lethargic and infection stop this drug immediately.
Color(Pink=2, Pink & Blue=1)
Grimace(Active=2, slight=1,0)
Measles Exposure in HIV +
Give immunoglobulin unless kid has gotten it <3weeks ago.
-What is it?
Describe the disease it is associated with?
EEG of infantile spasm(tonic clonic seizure clusters) seen in Tuberous sclerosis(AD disease seen at 1 year old).
-Other features of TS are ASH leaf hypopigmented macules & cortical Tubers on CT of the brain

Treat with ACTH
3 second spike and wave pattern
EEG of Absence seizure. Give ethosuximide or valproic acid.
Centrotemporal Spike
EEG of benign partial epilepsy
6 second spike & wave
EEG of juvenile myoclonic epilepsy(Have muscle spasms). Tx is valproic acid.
Best Ulcer surgical option if meds dont work
Parietal cell vagotomy b/c minimizes the risk of dumping syndrome(flushing,hypotention secondary to reactive hypoglycemia) like in Bilroth II.
Universal donor & recipient
-Blood transfusion Rxn HS?
Donor=O negative(no Ag for A/B Ab to attack: Type 2 HS reaction Ab attacking antigens).

What to do in transfusion reaction

When do you give a transfusion?

What is the first sign of hemmhorrhage?
Stop tranfusion and flush with normal saline and osmotic/Loop dieuretics.

Give packed RBC's when:
TRAUMA: >1500ml lost or if patient has been given 2L NS and still hypotensive

Non-Trauma: Hct<30, Met acidosis, tacypnea-tachycardia for unknown reason

Lowered CVP, and HB/Hct doesnot change for 1-3 days
Indications for pneumococcal vaccine?
>2 years of age and have:
-HIV, Nephrotic syndrome, Sickle cell, Functional asplenia.
-Which inhalational anesthetics are the fastest acting and quickest to be turned off?

-What is minimum alveolar[]?
Those with the smallest blood -gas partition coefficients.

-% alveloli needed to be penetrated to get the effect of the inhaled anesthetic. The lower the MAC the more potent the inhaled gas.
3 year old milestones
Tricycle, Copy circle & cross
4 year old milestones
Dress themself & hop on one foot.
5 year old milestones
Copy triangle
Wheezing especially expiratory post URI.
-See air trapping/atelectasis on x-ray but CBC normal
- Increases risk of asthma in future
-Bronchodilators and Ribavirin.
-RSV or Parainfluenza
-Runny nose then barking/brassy cough
-See Subepiglottic narrowing on x-ray(steeple sign)
-Racemic epinephrine or Steroids
-H. Influenzae
-Suddenly drool, lean forward
-Thumb sign on x-ray
-Intubate immediately and give cefotaxime before x-ray.
Cardinal movements of delivery
Descennt, flexion, IR,Extention,ER
Osmotic dieuretic so lose free water and may get hypernatremic. Great to immediately lower ICP with bed head elevation
Cardinal movements of delivery
Descennt, flexion, IR,Extention,ER
Macrocytic Anemias
-Types & associations
-Way to differentiate
Either Megaloblastic(Hypersegmented neutrophils, Howell Jowell bodies) or Non-Megaloblastic

B-12: D. latum, Vegan, Pernicious Anemia(No I-factor & atrophic glossitis)

Folate: Alcohol or Phenytoin/phenobarbitol

-B-12 will have neurological sequelae(babinski or mental changes). Folate will not.

-Dx via looking at blood cyanocobalmin & folate levels.
Make sure B-12 is not pernicious with the schilling test which looks for I-factor.

-Treatment is supplementation

1) Diamond Blackfan: 1 year old Red cell aplasia w/ webbed neck, cleft palate triphalangeal thumb

2) Fanconi: 8 year old pancytopenia w/ Neck & interdigital cafe Au lait and
small eyes-head & no thumbs
Neonatal conjuctivitis
0-24 hours=chemical via AgNo3
-No treatment

2-5 days=Gonnorrhea
-erythromyacin topical
-IV ceftriaxone

5-7 days= Chlamydia(Use erythromyacin topical & oral)
Lacrimal duct Obstruction
Seen first few weeks of life and tends to be unilateral.
Types of breech Presentations
Frank: \/
Complete: \/\
Double footling: Two Feet down
Partial:One foot down
Transverse lie:-
Name all Tocolytics
1) B2 agonists: Ritodrine, Terbutaline(increases glucose)

2) Ca blockers: Nifedipine

3) MgSo4

4) NSAID: Indomethicin
Adrenal insufficiency

1)Addisons(AG dysfunc=Primary)
-Hypoten w/ low Na+, High K+
-GI distress
-Skin Pigmentation

Dx: Give ACTH(Cosyntropin)
Addison= High renin-Low Aldosterone

**Give Prednisone/Flucortisone

2)Pituitary tumor or long term steroid user who stops
-Same symptoms as addison but no Pigmentation changes.

**Give steroids immediately

3)Adrenal insufficiency w/ hirsuitism(Gonadal tumor or Adrenal Tumor)

-Get Test & DHEA levels
-High DHEA means get 17-OH Progesterone to r/o CAH(21 hydroxylase deficiency).
Adrenal Excess
Hypertention w/ Hopokalemia
Striae, extremity wasting
Moon face, Hyperglycemia

1)Pituitary tumor(Cushing)
2)Ectopic ACTH(small cell Cx)
3) Exogenous Steroids

1) 24 hour urine cortisol or low dose dex.
2) Get ACTH, if low then exogenous steroid admin
3) High dose dex and if ACTH falls then cushing.

MRI to find and remove adenoma

(small cell cx)
Neonatal Palsies
Diaphram paralysis(C4)
Erb(C5-C6): waiter tip
Klumpke(C7-T1): Total arm paralysis w/ horner syndrome
Todds Paralysis
Post ictial paralysis
Hernia types
Femoral: Female and strangulates
Direct: Through Hesselbach triangle
Indirect: In internal, out external into scrotum(Bassini repair)
Pantalloon: Indirect & direct
-Drugs that cause it
-Serum Osm >Urine Osm

1)Restrict water and see if urine Osm increases
-No change=Central or Nephro

2) Give Vasopressin
No change=Nephro

Tx: Central need vasopressin
Nephro need Thiazide

Lithium causes nephrogenic type
-Drugs/conditions that cause it
-Urine Osm>Serum Osm
-All serum electolytes diluted
but treatment basedon Na+ level.

Na+: >120= restrict water
Na+<120= NS & furosemide

Symptomatic(mental changes) Hypertonic saline & furosemide.

-Post Surgery
Hypertention w/ Hypokalemia

Primary=Adrenal adenoma/BAH
(Renin will be low)

Secondary=Edema states
(Renin will be high)
-Nephrotic syndrome

Tx: Aldosterone antagonists
Spirolactone(AE on men-gyno-impotence)
Typical Antipsychotics
-Type of symptoms treated
-Names of drugs
-AE of drugs
-Use to treat +ve symptoms only(hallucinations, delusions, agitation)
-Great for treating a violent patient.
-May cause galactohhrea, low libido and Amenhorrhea b/c block dopamine(R/O pit tumor with MRI)

(High Potency & alot of EPS)

(Low Potency & alot of Anti-choliergic symptoms ie dry & sedated)

1) Chlorpromazine: Photsensitivity & jaundice

2)Thorazine: retinal pigment deposition
-time of onset
4 hours get dystonia:
-Muscle spasm, twist neck, roll eyes

4 days get Akinesia/Parkinson
-cogwheel rigidity,shuffling gait, masklike facies.

Tx: Both get:

4 weeks get akathisia
-can't sit still

Tx: Benzo's

4mo get tardive dyskinesia
-Lip smaking, tongue writhing, choreaform

Tx: Give atypical b/c irreversible
Atypical antipsychotics
Treat + & -ve symptoms
-Cause weight gain & diabetes


Risperidone: Elevates prolactin(MRI to r/o pit tumor)

Clozapine:Agranulocytosis(get CBC)
Neuroleptic malignant Syndrome
-Drugs causing it
Typical and atypical antipsychotics may cause it

High fever(107+) with muscle spasm and increased CPK, myoglobinuria.

Tx: Stop drug, fluids, dantrolene.
Microcytic Anemias
-Lab differential

-High Fe,High Ferritin, N TIBC
-Extramedullary hematopoesis (wide bones & HS-megaly)
Alpha=Asian(Normal Hb electro but can cause spontaneous abortions)
Beta=Mediterranean(High HBA2 & HbF in Hb electrophoresis)

*Iron deficiency
Low ferritin & Iron, High TIBC

-Lead, Pyridoxine def, INH, ETOH
-High Fe/Ferritin/Transferritn
-Ringed Sideroblasts on smear
-Basophillic strippling & epiphyseal deposits on bone in lead

Tx: Pyridoxine/remove agent
Normocytic Anemia
Classified based on marrow response

No reticulcytosis:
1) Aplastic anemia(pancytopenia:Low RBC, WBC, Platelets)

2) CRF (Deficient EPO)

Have Reticulocytosis "GASS"
High LDH, low haptoglobulin.
a) AI=+ve Coombs Test, give steroids.

b) Spherocytosis= No cental pallor, Dx w/ osmotic fragility test. Take out spleen.

c)Sickle cell=Sickles w/ high HbS. Dx on electrophoresis, watch out for crises w/ parvo B-19. Give O2, Morphine,Fluid.

d)G6PD(XLR): Seen post sulfa or quinidine drugs. Diagnosis via Heinz bodies and enzyme deficient
Thrombocytopenia post viral illness
Post streptococcal Glomerular Nephritis
Sore throat or Skin infection
HTN, Hematuria(coca cola),Edema(pre-orbital)

-Proteinuria lasts 1 year
-Hematuria lasts 6mo.
-C3 & CH50 are low b/c C3 deposits in
"humps" along GBM w/ IgG
- High ASO titer indicates strep infection

Tx: Treating strep will not resolve it
Von Wildebrand Disease
Autosomal dominant. Increased PTT & Bleeding time. b/c VWF is needed to store factor 8
Polycthemia rubra Vera
-Diagnostic criterion
Bone marrow working OT:
-High Hct, WBC count, B-12 level,Pao2>92%, low EPO

Tx: Phlebotomy
-Hypothyroid(low T4/Low TSH)
-Low Test/Est(Low FSH/LH

Tx: Supplement the Test/Est/Levothyroxine
GH Adenoma
-Large Tongue, headache, bone Pain, Hirsuitism

Dx: IGF-1
Tx: Bromocriptine
Treatment of Graves disease if not preganant.
-Causes Agranulocytosis(so if patient gets fever or sore throat d/c)
Diabetic Nephropathy
-Ways to slow the Nephropathy
-Screen w/ 24 hour urine albumin-creatinine ratio
-Slow nephropathy by lowering protein & ACE inhibitors.
Conditions with low AFP
Trisomies & baby who is younger than thought.
Conditions with high AFP
NT defects
-Spinal bifida
-CNS Anomalies


Conditions with High B-Hcg
Turner & Twin
Sacrococcygeal Teratoma
Gallstone Illeus
-Large radiopaque Gallstone that lodges in the Small bowel. Air seen in GB b/c fistula created with SB.

-Presents like Cholycystitis (colicky RUQ pain, billous n-v) but bowel loops are dilated and BS are decreased(illeus)

-Do laparotomy to remove stone & cholycystectomy.
Opiod Addiction
-How long does it last
-Addicts social tendencies
-Is addiction common in patients
-Do they develop psychosis
-Usually lasts less than 10 years
-Addicts are social and socially deviant
-Uncommon to get addicted
-Opiods do not cause psychosis
Congeital Syphillus
Symptoms are early(0-2 years) & Late(2+)

Early: Fever,anemia, maculopapularrash,snuffles, hepatomegaly, failure to thrive

Late: Sqaddle nose, Saber shin, Hutchinson teeth, Perioral fissure(Rhagades)
Breakthrough seizure management in patient on meds that have worked for a long period of time
-Stabilize patient: airway then diazepam.
-Check the dilantin level
-If low or in lower end of therapeutic range then raise the dose of dilantin
What to do when placing a Subclavian Vein Catheder.
-Reverse trndelemburg to prevent air embolism (tachypnea,hypotention,continuous murmur)

-CXR to check placement & R/o pneumothorax
Describe a normally distributed curve
Mean +/- 1 SD=65%
Mean +/- 2 SD=95%
Born with bowel outside stomach and covered in a membrane.

Associated with heart and kidney problems

1) Wrap bowel in sterile gauze
2) IV fluid & Antibiotics
3) Decompress w/ OG tube
4) Surgery to close abdominal wall
Turner Syndrome
-45XO 04 46XY
-Short, wide nips,pectus excavatum, webbed neck, primary amenhorrhea(ovarian failure-streaked on U/S)

-Coarctation of Aorta(UE HTN,Wide PP,Radio femoral delay, rib notching on x-ray: Tx w/ balloon angioplasty or surgical end to end repair)

-Dx via buccal smear(no barr bodies)

-46xy get b/l gonadectomy to prevent gonadoblastoma), if <5th percentile give GH.
Down syndrome
-Triple scren results
-Hischprung, endocardial cushion defect,duodenal atresia, ALL leukemia, Alzheimers

-UE3 & AFP low, Hcg high
P's: pounding headache, Perspiration,Pressure changes

MEN II, Neurofibromatosis, Von Hippel Lindau

Urine/serum VMA & Metanephrines to screen and if positive to CT to locate

Phenoxybenzamine (alpha & beta blocker) then resect.
Raynaud Phenomenon
Associations & their descriptions
Cold weather makes vessels spasm & thicken(white digit then red).

Associated with:
1)CREST(Anti centromere Ab): Calcinosis,Raynaud,Esophogus dysmotility,Sclerodactyly,Telangiectasias

2)Sys sclerosis(Anti Scl Ab):
-Facial skin is taught, esophogeal acahlasia, renal dysfunction(vessels onion skin), arthritis
Tx: Penicillamine

3)Thromboangitis obliterans(Breugers disease): Inflammatory disease causing Digital vessel thrombosis in male smokers
-Psychotic associations
-W/D duration
-Use alcohol
-Get psychotic so use haloperidol to control agitation and psychosis
-W/D will last many weeks
-Deficient enzyme
Low phenalalanine hydroxylase
so phenalalanie accumulates
causing brain damage

Musty/Mousy odor, fair skinned-blue eyes-blond hair, badly behaved b/c retarded,eczematous rash.

High phenalalanine and urinary phenylacetic acid

Mom keep Phe intake<10
Post op causes of fever and ways to tx/prevent
Wind-Atelectasis in 1st 24 hours(Prevent w/ spirometry)

Water-UTI in >2days

Wound- 5-10 days(Just drain no antibiotics)
What are normal values for
In pregnancy wht electrolytes increase
no change
All changes occur in the second trimester!!!!!

-Alk phos
-Lipid level
-Tidal volume


No Change
Inhibits Aldehyde dehydrogenase fo get alot of acetylaldehyde to build up.

Get hot & flushed/n-v/ pounding headache/hypotention.
Management of Hepatic encephalopathy
Goal is to reduce NH3(ammonia)
1) Stop protein intake
2) Lactulose: Gut uses it to make H+ ions that bind NH3 and create NH4.
3) Neomyacin to kill gut flora
that make ammonia
Somatization Disorder
Not doing it on purpose. Multiple organ systems w/ extensive medical workups.

Tx: Psychotherapy
Feel like have same disease though workup continues to be negative.

Tx: Get Psychotherapy to look into life experiences & stressors. Relieve the stressor nd relieve the condition
Somatoform vs factitious vs malingering.
Somatoform: Not faking symptoms intentionally

Factitious: Fake symptoms to become a patient & have procedures done

Malingering: Fake to get something(money.attention,off work)
Sub Arachnoid hemmhorrhage
Blood between arachnoid and pia matter usually due to trauma or ruptured berry aneurysm(PCKD)

Worst headache of my life then stiff neck then poor consciousness.

Non-contrast CT head and if retinal examination is negative(looking for ICP elevation) do Tap to look for bloody CSF
Lower GI bleed in elderly

Hemmhorroids should be seen on rectal exam

Angiodysplasia seen on colonoscopy

Diverticulosis seen on barium enema

If bleed is active then do schintography

Tx is diathermy
Meckels Diverticulum
Painless melena
Petinecinate scan
Decreased relaxation of LES

Associated wiith glandular metaplasia(barrets:squamos to columnar) and possible adenocarcinoma
24 hour PH monitoring

-Diet modification and PPI/H2 blocker
Ovarian Cx
Pelvic mass w/ ascites`
Epidural vs. subdural hematoma
Evacuate all if high ICP

Epidural: out-up-out
-temporal bone skull fracture that tears the middle meningeal artery
-Lens shaped
-Ipsi Blown pupil(means elevated ICP)

Subdural: Sickle shaped
Just out or hit head a long time ago.
15-24 COD
exept in african american where homicide is #1
Hypoglycemic infant
Premie=poor fat & glycogen stores

Macrosomic(DB mom): Baby making too much insulin

Von Gierke(low glu-6-phosphatase): doll, large liver & kidney
Medullary Cx thyroid
-TSH & T4 normal

Parathyroid Adenoma
-High ca, Low PO4, High PTH

-Headache, palpitation, pressure changes

Dx: Get calcitonin level to screen as C-Cells in thyroid Cx make it.

Tx: Resect
Cardiac Tamponade
JVD, Hypotention, Pulsus paradoxus(decrease BP w/ inspiration), normal BS.

Echo if stable
Pericardiocentesis if unstable
Asherman syndrome
Secondary amenhorrhea in a woman with normal prolactin/TSH levels and +ve progesterone challenge who is a non-hirsuit. Occurs due to uterine scarring post D&C.
-How would the secondary amennhorrhea workup look
-Obese teen w/ hirsuitism & irregular periods. Dx is clinical

-High DHEA and DHEA response exaggerated to ACTH stim test
-High Testosterone.

-Give OCP to regulate periods & prevent endometrial hyperplasia(test converts to est= hyperplasia)

-Do Oral GTT & if >140 give:
Metformin-Do not want babies

Clomiphene-Want Babies b/c stimulates ovulation

secondary amenhorrhea w/ normal TSH & prolactin & progesterone challenge who has hirsuitism.
Secondary amenhorrhea
3 missed periods

1) Get Prolactin/TSH

High Pro, High TSH

-Correct hypothyroid and repeat(high TSH will cause high prolactin)

High Prolactin, norm TSH

-R/O prolactinoma w/ MRI
(galactorrhea,headache, blurry vision)

-R/O meds that inhibit dopamine (MAOI/TCA/SSRI/Psychotics)

Normal TSH, Normal Prolactin
-Do Progesterone challenge(stimulates est release and if est present pt will W/D bleed)

W/D bleed
Hirsuit: PCOS or Ovarian tumor
Non-Hirsuit: Asherman or hypothalmic dys

No W/d bleed
-Get FSH
High=Ovarian failure
Low=Hypothalmic dysfunction
Solitary thyroid nodule workup
Fine needle aspirate and if malignant remove.
Granulosa Theca tumor
Produce Estrogen & inhibin so get:
-Secondary amenhorrhea or irregular menses
-Precocious puberty
-Post menopausal bleeds
-Endometrial hyperplasia & cancer

Must sample endometrium

Unilateral Salpingo-oophorectomy
Sertoli Leydig Tumor
Produces Testosterone so get big clit, small reasts, deep voice & acne

B/L salpingo-oophorectomy
Benzo W/D
Anxiety, Psychosis, Seizure
Opiod W/D
Pseudomembraneous colitis
-How diarrhea looks

Ampicillin or clindamyacin allow colonization and bug makes enterotoxin that damages mucosa causing white plaques.

Profuse & watery

Metronidazole then vancomyacin
Traveler diarrhea
No fever. Watery and not bloody or involving any leukocytes.

E.Coli enterotoxin stimulates cAMP causing secretory diarrhea

WBC in stool of Diarrhea
-Test to dx
Use methylene blue test

-ulcerated & friable mucosa
Excessive fluid infusion
Post op patient w/ S3,JVD, Edema & rales.

Stop fluid & give furosemide
Benign Rolandic Epilepsy
Kid who is fully cognisant but has facial twitching and cannot speak when he is drowsy or wakes up in the night.
Fat embolism
Break large bone and get tacypnea-tacycardia,low grade fever and petachiae in the axillary region.
Hyperthyroidism Arrythmias
A-fib & Sinus Tach
Cardiac Enzymes
Up in 2hrs
peaks in 24hrs
Lasts 2 days

Troponin(most sensitive)
-Up in 6 hours
-Peaks in 24 hours
-Lasts 7 days
Fibrinogen & All factors low.
PT & D-dimer (says lots of fibrin clots)are increased.
Duodenal Atresia
-Newborn w/ bilous vomiting & nondistended. Double bubble x-ray
Ruptured papillary Muscle
Seen 4 days pot RCA infarction and pressents with Mitral insufficiency murmur( systolic and radiating to axilla)
Pyloric stenosis
6 weeker w/ non-billous vomiting, palpateable olive that pulsates.

Dx via barium swallow

Rehydrate & treat hypochloremic hypokalemic metabolic alkalosis first then do pyloromyotomy
MRI changes in schizophrenia
-Best way to rehabilitate a schizophrenic
-decreased prefrontal metabolic activity

-large lateral ventricles

-small corpus collosum

Drugs early and a home environment with minimal stress improves outcomes
Burn % calculation
Burn fluid equation
Burn infection cause
Burn Tx
Burn Types
Burn Surface Area Calculation (only count 2nd & 3rd degree):
Leg =9,9(front,back)
Front Torso=9,9
Rear Torso=9,9

Carbon Monoxide poisoning (someone in a fire): Always give 100% O2 by mask.

Burn Management: O2 by mouth to prevent CO poisoning, IV fluids to prevent hypovolemia (4ml *KG * %Body SA involved: Give ½ in first 8hours and rest over next 16 hours).

Pseudomonas Infection is the #1 cause of death so give topical Silver Sulfadiazine antimicrobial & tetanus toxoid. Excise all partial and full thickness burns so grafting can occur rapidly. Use petrolatum based gauze.

1st degree: Red
2nd degree: Very swollen and Blisters
3rd degree: Charred
Scald: Liquid Burn
Hemmhorrhagic disease of the newborn
Vitamin K deficiency

High PT & PTT but low factors 8
-10 and low protein C&S
If you can't get an IV line do what
Go interosseous
Reye Syndrome
-Best way to prevent
ASA after viral illnes & get elevated LFT & NH3 and elevated ICP(Lethargy)
-Lower ICP

Best way to prevent in a kid that must take ASA is to give them the influenza A vaccine
Ankylosing Spondylitis
Young male w/ decreased anterior spinal flexion(Schober test) & stiff back in the morning.
-Lab shows -ve ANA,RF but +ve HLA B-27)
-X-ray shows bamboo spine secondary to vertebrae fusion
6mo milestone
sit up, pass object hand to hand, babble
9mo milestone
pincer grasp
Foreign Body Aspiration
Repeated RLL pneumonia
Cystic fibrosis
-Tx –
Failure to pass meconium, b/l nasal polyps, repeated pseudomonas lung infections, clubbing,steatthorrhea.
-Sweat Cl- test
-Gent w/ Carbe/Piper/ticar for lung infections and pancreatic enzymes for malabsorption
-Age & inheritance
-S/S –
7-10 year old & x-linked
-Posterior demyelination of white matter
-Apraxia, dysphagia, dysarthria, aphasia with mental deterioration.
Hirschprung disease
-Tx –
Associated with down's & T.Cruzi(Chagas disease)
-No ganglion cells in myenteric or auerbach plexi
-No passage of meconium, constipation w/o stool in rectal vault, abd distention & pain.
-May rupture causing necrotizing enterocolitis
-Dx via KUB and Barium, confirm w/ rectal mucosa biopsy
--Tx is surgical decompression w/ temporary colostomy then reattach.
-How to Dx each type
2 types both AD: I=17, II=22
Type I: must have 2 of:
1)>6 Cafe Au lait
2) Inguinal-axiallary freckles
3) Hemartoma on iris
4) Neurofibroma

Type II= B/L acoustic neuroma
-S/S –
AI IgA deposition vasculitis related to strep & penicillin
-LE rash, arthritis, abd pain, hematuria, guiac +ve.
Congenital spherocytosis
-Tx –
Extravascular hemolysis causing splenomegaly
-Cholycystitis(Ca bilrubinate stones) & elev conj bili.
-Normocytic anemia w/ Reticulocytosis. Smear showing lack of central pallor
-Dx w/ osmotic fragility test.
-Tx= Splenectomy
When does moro reflex begin/end?
-What does asymmetric moro indicate?
-What reflexes are at birth? –
Begins at birth and ends at 6mo
-Indicates fractured clavicle(feel crepitus) or peripheral nerve injury(ERB=C5-C6: Klumpke=C7-C8).
-Moro, Rooting, Grasping.
When do kids get cows milk? solid food? Juices?
-What if it is given before then?
-What is the nutrient difference in cow vs. mom milk?
-When should iron be supplemented in a kids diet –
1 year.
-Get Renal failure from excess protein(lethargic).
-Mom= high Vit C, Cow=High Vit K and protein.
-Give iron at 6mo or will get ID anemia