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168 Cards in this Set

  • Front
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Kawasaki syndrome
S/S
Tx
B/l conjunctivitis
Perioral fissuring
Cervical adenopathy.
Fever>104 for 4 days

Tx: Do Echo to r/o aneurysm and give NSAID & Immunoglobins
Rheumatic Fever
-S/S
-How to diagnose
-Culprit
-Tx
Rheumatic fever (2 major or 1 major & 2 minor Jones criterion):

Group A strep

Treatment is Penicillin G.

Get sore throat 1st and then get:

Major criterion: “ACCNE”
Arthritis-Migratory
Carditis-Friction Rub/ Long PR interval
Chorea
Nodules subcutaneous
Erythema Marginatum

Minor criterion
Arthralgia (not arthritis)
Fever
Previous Rheumatic fever
Sore throat differential
1) Herpangina(hand-foot-mouth): High fever and vesicles on palate/pharynx/palms/soles. Kid may not want to drink and get dehydrated. Rehydrate.

2) EBV: Exudative with Lymphadenopathy and lymphocytosis (atypical lymphocytes).

Ampicillin/Amoxicillin causes a rash. No contact sports as spleen may be enlarged

3) Strep: Exudative +/- sandpaper rash (Scarlet fever)
Autism vs. Deafness
-S/S
-Tx

Disease causing autism
Deaf have good social skills though language is impaired and they need speech therapy.

Autistics have poor language & social skills and are treated with behavior therapy
(no drugs)

Rubella and associated w/ fragile x syndrome
Workup of a malignant breast mass
Fine needle aspiration
& if non-diagnostic do biopsy then Remove it.
Types of unilateral Bloody nipple discharge
Intraductal papilloma: Cytology fluid & then GG resection

Intraductal carcinoma: Skin is dimpled and mass present.LN involvement
-Must remove.
Fibroadenoma
S/S
Tx
Painless rubbery-firm, mobile mass.

If patient stable follow them through several cycles. If not stable do FNA.
Malignant breast mass description
-Upper outer quadrant
-Painless(except intraductual)
-Fixed
-Microcalcified(coarse=fat necrosis)
-Peau d orange=inflammatory
-Lymph node involvement
FCC
-S/S
-Dx
-Tx
-Painful
-Increase in size with menses
-Multiple or B/l w/ diffuse nodularity
-Mobile & soft

Dx with U/S(tells if cystic or solid) and drain.

Give OCP's for pain
OCD
-#1 Type
-Pathophysiology
-Tx
-Main type is contamination
-Defect in serotonin
-SSRI(to increase Serotonin): Fluvoxamine
Meningitis
s/s(adult vs. child)
Dx
Tx
Adult: Fever,stiff neck, headache,photophobia

Child: Signs of high ICP(bulging fontanelle, papilledema, lethargy)

Dx via CSF analysis

1) Viral(aseptic)
-lymphocytes, high protein, Normal glucose

2) Bacterial:
-PMN predominance
-Very High protein>100
-Glucose low

Tx: IV cefotaxime-CT to r/o bleed then do LP
Nissira Meningitis
S/S
Tx
Meningtis + petachiae and hemodynamically unstable (secondary to b/l adrenal hemmhorrhage)

Give everyone ciprofloxacin or rifampin prophylaxis(orange urine) that was exposed
Temporal lobe encephalitis
S/S
Dx
Tx
Hallucinate & seize

Do PCR of CSF

Acyclovir
Twin risk in pregnancy
Increases risk of HTN
Drugs CI in pregnancy
Neuro: Benzo,amphetamine,ETOH

Abx: Tetra, Quinolones

Hyper Thyroid: PTU,
Methimazole

Hypertensives but not hydralazine, methyldopa & labetolol

Glucocorticoids

Theophylline

Coumadin but not heparin
Cohort study
Prospective study that looks at healthy people who have been exposed to a potential risk factor.
Cross sectional study
Looks at a group at a specific point in time
Case control Study
Looks at those who have disease(Case) & those who do not(control) and how they were exposed to a risk factor.
Crossover study
One group gets placebo then later they get the drug
POSTERIOR DISLOCATION OF THE SHOULDER
Cannot externally rotate and must get tangential(transcapular) view x-ray or you will not see it.
Infant w/ cyanotic LE but pink UE
PDA w/ coarctation
Dissociative identity disorder
Associated with sexual abuse as a child
P<.05 definition
Probability events occured by chance alone or by random variation

If P<.05 then results are statistically signifigant(not clinically)
Fragile X association
Big balls, big ears and retarded/autistic
Cyanotic heart diseases
All are R to L shunts and begin with T

1) Truncus arteriosus
2) Teratology of Fallot
3) Tricuspid Atresia
4) Transposition of the GV
Occular Nerve Palsies
S/S
CN 3: Down & out w/ ptosis
-See in diabetic w/ HTN
-If pupil blown get MRI or cerebral angiogram b/c compressive & emergency
(aneurysm or tumor)
-If pupil not blown then leave alone b/c will resolve

CN 6(LR): Can't move eye laterally

CN 4(SO): Can't look down on medial gaze

CN 5 & 7: no corneal reflex so cornea may dry out
Anorexia
S/S
Medical complications
Tx
-Do not eat anything & have control issues with parents

-Secondary amenhorrhea
-Look for electrolyte disturbances that may cause arrythmia

-Cyproheptadine(Anti-Ch to stimulate appetite)
Asthmatic
-Acute Treatment
-Chronic Tx
-When is pt in trouble
ACUTE
-Nebulized Albuterol & steroids
------------------------------
CHRONIC

Stop bronchial hyperactivity
1) Leukotriene inhibitors:
Zarleukast

2)Lipooxygenase inhibitor: Zileutin

3) Mast cell stabilizers: Cromolyn
**Give especially in kid w/ allergies or eczema
------------------------------
If patient does not hyperventilate or seems fatigued and Pco2 is elevating then intubate b/c they are crashing
Galeazzi Fracure
Radial shaft fracture w/ dislocation of the radio-ulnar joint
Monteggia Fracture
Ulnar fx c/ radial head dislocation
Humerus Fx
Wrist drop(radial n. damage) & may have a dislocated shoulder
Supracondylar fracture
Fall onto elbow and elbow is swollen.

Damage to brachial A. & median nerve may lead to Volkman ischemic contacture-compartment syndrome and will see sail sign(anterior fat pad dislocation).

Make sure to palpate radial pulse during reduction.
Nursemaid elbow
Yank kid by the arm and will hold arm in pronation w/o elbow swelling

Radial head displaced through annular ligament and to fix must supinate the arm.
Anterior dislocation of shoulder
Can rotate but cannot feel over lateral deltoid(axillary N.).

Check lateral forearm for paresthesia also(mucocutaneous n.)
Regression
Start to act like a child/tantrum when in a difficult situatuion
Projection
Talk about something you do not like about yourself in reference to other. DL is a liar.
cyclophosphamide
-Uses
-Pharm
-AE
-Lymphoma & breast cancer

-activated by cyt P-450 so do not give it with P-450 inhibitors.

-May cause hemmhorrhagic cystitis or bladder cx long term b/c produces acrolein. Give Mercaptoethane sulfate to prevent this.
Methotrexate
-Pharm
Works at S-phase and inhibits DHFR.
Bleomyacin
-Pharm
-AE
-Works in G2 phase and creates free radicals for cytotoxicity

-Pulmonary fibrosis
Paclitaxel
M-Phase: does not let mitotic spindle disassemble.

-Peripheral neuropathy, thrombocytopenia, Neutropenia
Vinblastine
M-phase. binds tubulin to inhibit spindle formation.

Hematotoxic: thrombocytopenia & neutropenia
(Blasts the bone marow)
Hodgkins lymphoma drug cocktail
Doxorubicin-Arrythmia, pericardiitis, cardiomyopathy
Dacarbazine
Bleomyacin-Pulm fibrosis
Vinblastine-thromb,neutropenia
M phase anti-neoplastic drugs
Vinblastine:Bind tubulin so spindle can't form
-Neutro-thrombocytopenia

Paclitaxel: does not let tubule dissociate
-neurotoxic,neutro-thrombocytopeniapenia
S-Phase drug
Methotrexate: inhibits DHFR
Bleomyacin
causes pulmonary fibrosis
Seperation anxiety d/o
Kids>6mo who have tantrum, fake sick to stay w/ mom/dad. If <6mo think of stranger anxiety.

Get panic D/O as adults
Oppositional defiant D/O
Has friends but defiant to authority(teacher,mom & dad)
Conduct D/O
Hurts animals and commits crimes. May develop Anti social personality D/O later in life. A diagnosis of conduct is a must for ASPD diagnosis.
Panic disorder
S/S
Sequelae
Tx
Have unexpected physical symptoms(heart racing, sweating) and fear of doom. Need at least one attack and have been thinking about that attack for >1mo.

May get agoraphobia b/c afraid will get attack and no one will help them and this frustrates them. Usually have seperation anxiety disorder as children

During attack use Benzo's and for prophylaxis use ANTI-D's(SSRI,TCA,MAOI)
Degrees of retardation w/ IQ
Profound<20: Need FT help

Severe: 20-35: Cannot work but can communicate.
-Down or FAS

Moderate: 35-55: Sheltered workshop job
-Down or FAS

Mild: 55-70: Normal life and may have problems w/ impulse control
-Not down's or FAS

70+= Normal
ADHD
-S/S
-Tx
Problem in a min of 2 situations ie @ home and school.

Dextroamphetamine
Alpha methyphenidate
-AM May cause GH suppression so take kid off in summer
Tourette's Disorder
S/S
Tx
-Have a tic that repeats
-Then make repetitive noises: Grunt, clear throat
-Then swear out loud

**All Tics remit w/ activity & sleep**

Tx: Haloperidol
Bullimia
S/S
Tx
Normal body weight but binge and vomit(most specific sign of vomiting are erosions on fingers, enlarged parotid or Mallory Weiss tears)

Psychotherapy 1st then SSRI
Phobia Tx
Systematic desensitization>SSRI
Drugs to avoid in G6PD patient and the reasons why.
Anti-malarials & Sulfa drugs because the erythrocyte membrane cannot handle the excess oxidation and the cells hemolyse

Chloroquine/Primaquine
INH
Nitrofurantoins
SMZ-TMP
Best drugs for a UTI?
Best drugs for UTI in pregnancy & why?
Usually E.coli
SMZ-TMP
Ciprofloxacin
Nitrofurantoin

If pregnant can't give quinolones b/c cause cartilage damage so use AMOXICILLIN
DOC for sleep terror & Sleep walking
Diazepam b/c it decreases the time spent in stage 4 sleep which is when these disorders occur.
Narcolepsy
S/S
Tx
Decreased REM latency
Cataplexy
Hallucinations

Alpha methyphenidate
Dextroamphetamine
Sleep Apnea
S/S
Complications
Tx
Obese male that snores then long pause w/o breathing. Anoxia may wake up and then patient gets chronically tired.

Arrythmia & pulmonary HTN

CPAP w/ weight loss
Signs of thyroid malignancy
Solitary nodule >4cm in man or child
Hx of irradiation
Adenopathy

FNA then remove
Stress incontinence
S/S
RF
Exam
Lose urine w/ things that increase IA pressure(sneeze, cough) secondary to weakness of the muscles in the pelvic floor

Multiparity(weakens the floor)

Cystocoele or uterine prolapse
Urgency incontinence
S/S
Causes
Frequency, Urgency, Nocturia

Can be
1)Interstitial cystitis: Fever & UTI

2)Detrusor irritability (no fever or UTI).
Overflow incontinence
Diabetic who leaks w/ full bladder secondary to peripheral neuropathy.
IgA deficiency
S/S
Things to note
Recurrent sinus infections, allergies, diarrhea(Giardia).
(B-cells do not differentiate)

May get anaphylactic reaction if they get blood transfusion so if blood needed get it from someone IgA deficient.
AV fistula
S/S

Causes

Dx
Large pulsatile mass w/ dilation of the Artery & Veins proximal to the mass. Distal pulses are faint and the murmur is continuos and machinelike.

Trauma(penetrating#1>blunt)
Congenital defect
Eroded prior graft

Dx via angiography or MRI
Pleomorphic Adenoma
#1 tumor of the salivary glands
AAA
ss
dx
tx
Pulsatile mass w/ bruit in abdomen as a result of vessel wall weakening from atherosclerosis.

Dx via Abdominal CT w/ IV contrast.

Tx: Repair if >5mm or enlarging or emergency.

If <5mm follow w/ serial TA ultrasounds
Optic neuritis
Culprit
S/S
Tx
Syphillus, TB, Lyme disease, ethambutol

sudden & painful unilateral vision loss w/ pain on EOM movement

Steroids
Central Retinal A. Occlusion
S/S
Exam
Relationships
Sudden painless loss of vision

Pale fundus w/ cherry red spot on macula

Temporal arteritis(start steroids immediately) or polymyalgia rhumatica(stiff 7 painful achy muscles w/ proximal muscle weakness)
Hypocalcemia changes
Dx
Tx
Prolonged QT interval, facial N. tetany, carpal spasm w/ BP cuff.

Must give Mg when giving Ca
Adult conjunctivitis
Culprits
S/S
Tx
staph/strep/H.Aegypti(pink eye)

D/C w/ mild photophobia

Polymyxin B, Neomyacin ,bacitracin
Strabismus in child
Lazy eye

Patch the good eye b/c visual system develops until 7-8years of age and may go blind otherwise.
Opthamologic Herpes Zoster
S/S
Tx
Look for dermatomal pattern of rash @ medial eyelid & tip of nose

Acyclovir
Herpes simplex keratitis
S/S
D/x
T/x
Conjunctivitis after vessicular lid eruption.

Flourescin stain

Idoxuridine/Trifluridine topicals
Stye
S/S
Tx
Painful lump next to lid margin

Warm compressesthen I&D if they do not work
Presbyopia
Need glasses to read b/c lens cannot accomadate. Normal not pathological and occurs at about 40-50.
Uveitis
Seen in kids w/ JRA (mimics RA) and must do serial slit lamp exams
Sudden b/l vision loss
Methanol toxicity in alcoholic (drinkin hairspray)

UV light exposure(welder or skier)

conversion disorder

Tx: Patch eyes and topical antibiotic
Pleomorphic Adenoma
#1 tumor of the salivary glands
Cystic teratoma
Any pelvic mass with calcifications. take it out
Glaucoma
-RF
-Drugs that may precipitate attacks
-Open vs closed
*S/S
*D/x
*T/x
Black(#1 Cause of blindness), >40, Family Hx

Anticholinergics or steroids may precipitate closed angle attacks only!!
---------------------------------------------------------------------------------------------------------------------
Open
-Painless
-IOP elevated 20-30, cup to disk ratio increased
-Give B-blocker actazolamide, pilocorpine
-If they fail do surgery.

Closed
-Painful c/ N-V and pupil is mid-dilated and fixed. Vision decreases
-IOP>30
-Give "Close the GAP"
Glycerin, acetazolamide, pilocporpine or peripheral iridectomy
Sudden unilateral painless loss of vision
1) C. retinal A occlusion

2) C. retinal V occlusion

3) Retinal detachment
-See floaters
-Refer to opthamologist for immediate surgery

4) Stroke/TIA
-Peripheral signs
Sudden unilateral painful loss of vision
1)Trauma
2)Optic Neuritis
3)Closed angle glaucoma
4)Migraine
Cataracts(adult vs. Child)
S/S
Dx
Adult: progressive painless loss of vision w/ absent red reflex and looking through dirty windshield or problems with driving at night

Tx: surgery

Kid: TORCH or Galactossemia
Opthamolgic changes in diabetes
Dx
Tx
Neovascularization
Microaneurysms
Dot blot hemmhorrhages

Tx: Pan retinal photocoagulation(laser)
Papilledema
See swelling of optic disk and blurring of the margins on fundoscopic exam
Macular degeneration
#1 cause of blindness
-Yellow/white deposits on retinal pigment epithelium(Drusen)

No Tx.
Toxic Shock syndrome
Culprit
S/S
Staph Aureus toxin

Palm & sole desquaminating rash, fever, hypotention in a woman who uses tampons
LSD intoxication
Visual hallucinations and have flashbacks/nightmares
PCP intoxication
Get angry and have vertical and horizontal nyastagmus
Bile Salts
-Area made
-Route in body
-Diseases that decrease
-Drugs that decrease
Made in liver from cholesterol and allow fatty acids to be absorbed in the small intestine. Recycled at the terminal illeum unless gut bacteria conjugate them.

Cirrhosis, Crohns, SB disease

Cholystyramine: lose salts so liver is forced to use cholesterol to make more.
Crohns Disease
S/S
Dx
Tx
All over GI tract
-Skip lesion,fistula,stricture
-Bowel wall thickened & Cobblestoned

Dx: Colonoscopy & biopsy

Tx: Steroids
Ulcerative Colitis
S/S
Dx
Tx
Bloody diarrhea

Only colon & rectum

Pseudopolyps, Ulcerated & friable mucosa, Thin bowel wall.

+pANCA

Colonoscopy & biopsy

Steroids & Sulfadiazine
Benzodiazepine OD management
Benzodiazepine WD management
Flumazenil

-Get seizure & anxiety. May be fatal so must taper with long acting benzo
Cocaine Use symptoms
-OD
-WD
HTN, Sweating,Paranoid, Formication(somatic sensation of ants crawling on your skin

-Stroke & Arrythmia
-Hypersomnia, Hyperphagia
SLE
S/S
Screen
Confirm
Congenital problems
Tests that are false positive
Malar rash, arthralgia, weight loss, fatigue, female

Screen w/ ANA(best for SLE & all CT diseases)

Confirm w/ Anti-smith, Anti DsDNA unless drug induced(Hydralazine,INH, Procainamide) then use Anti histone Ab.

Congenital heart block

FP=RPR & VDRL for syphillus but not FTA.
Sjorgen Syndrome
S/S
Screen
Confirm
Tx
Sequelae
Dry Eyes(Keratoconjunctivitis) , Dry mouth(Xerostomia)& enlarge salivary glands(secondary to lymphcytic infiltration).

Screen via ANA

Confirm via Anti SSA & Anti SSB, also HLA DR3 +ve

Good oral hygiene & artificial tears.

Watch out for Non-Hodgkins lymphoma(40x increase)
Anti-Ribonucleoprotein Ab
Mixed CT disease
Avoidant personality disorder
Loner who wants to be part of the group but is afraid to
Schizoid personality
Loner and ok w/ being alone
Schizotypal
Loner with weird thoughts
Cyclothymia vs. Dysthymia
Cyclo: 2 years of depression-hypomania

Dysthymia: Two years of mild depression only
Monozygotic vs. Dizygotic
All twins have elevated AFP, BHcG, HPL


Dizygotic: 2 ova so not identical, 2 chorion, 2 amnions

Monozygotic: 1 ova that splits so identical

1) Dichorion-Diamnion

2) Diamnion-monochorion
-chance of twin transfusion reaction(1 large & polycthemic and 1 small and anemic)

3) Monochorion-monoamnion: Chance of cord entanglement
Hyperemesis gravadum
1st trimester w/ alot of social stressors constant vomiting.
-Have high Hct, ketonemia & weight loss
-Hypokalemic,hypochloremic met alkalosis so correct it.
Renovascular HTN
-Causes
-S/S
-Dx
Male: atherosclerosis
Young Female: Fibromuscular hyperplasia of the renal vessels

-Retinopathy, PVD, Bruits
-1 small kidney whose renal fxn worsens with captopril
-Drug refractory HTN
-Good kidney has low renin output because of already high fluid volume from excess aldosterone & renin.

Give captopril and radioisotope uptake and excretion will decrease or do arteriogram.
Alport syndrome
Deaf kid w/ Nephritis
Flank mass in kid
-How to dx
B/l=PCKD

Unilateral
1) Neuroblastoma(NC cell tumor of adrenal gland):
<3 & not palpateable but crosses midline
-High Urine HMA VMA
-Calcified AG on x-ray

2) Wilms tumor of metanephros
>3, palpateable and does not cross midline
-Have aniridia & hemihypertrophy of body

Tx: Nephrectomy
vaccine that causes seizures and how to manage.
Pertussis. Stop giving it but do give diptheria and tetanus at the appropriate intervals.
#1 complication of carotid endarectomy
MI
Zollinger Ellison Syndrome
Pathophys
S/S
Dx
Tx
Malignant Islet cell tumor that releases gastrin & presents with PUD and GERD symptoms

-Do baseline Acid output first
(Should be elevated)
-Do secretin challenge test and gastrin will be very high.
(High acid should have low gastrin)

Omeprazole & Resect
MAOI
Phenelizine/Tranylcypromine

AE:

wine & cheese: HT crisis

SSRI: serotonin syndrome (Fever, rigidity, Autonomic hyperactivity)

Meperidine: Coma
Normal Grief reaction
1 year and may hallucinate about lost one but realize it is fake
Trazodone AE
Priaprasm
SSRI
-Name
-AE
Fluoxetine, Fluvoxamine

Anorexia, insomnia, sexual dysfunction
TCA
-Names
-AE
-OD
Amitryptilene/Nortriptylene

Arrythmia & orthostatic hypotention(poor choice in elderly)


NaHCo3
Dissociative fugue
Move away get a new identity
Generalized anxiety disorder
Anxious about many things

Buspirone or benzo(sedating)
Encoporesis/Eneuresis
-Age ok until
-First step
-Tx
4(enco), 5(eneur)
-R/O hischprung(enco) or UTI(enerur)

-Behavior modification/ alarms and imipramine if they do not work(eneuresis only)
Learning D/o
Poor in only 1 subject but rest is fine
Suicide RF
-deficient NT
-what if they won't comply
45, male, previous attempt-psychotic problems-hx of violence

-serotonin low in the CSF

-hospitalize against will
delusion Subtypes
Paranoid: Gonna get me

Reference: Personal sig to neutral events

Bizarre: Absract thinking

Grandiose: I have a mission
Toxoplasmosis
S/S
RF
Tx
-Chorioretinitis w/ intracranial calcifications

Microencepahly and Hydrocephalus

Raw meat or cat exposure

Pryramethamine-sulfadiazine
Parvo B-19
Aplastic crises in sickler

Erythema infectiosum in kids
-slapped cheek rash that moves to arms legs & torso and worse w/ sunlight exposure & temperature changes

Hydrops faetalis in utero
Pagets disease
Scaly rash that involves the nipple and means you have cancer
Cystosarcoma Phylloides
-Describe
-Tx
-Type of malignant fibroadenoma(stromal tumor) that is a huge bulky mass.

Resect it
Breast cancer screening
> 20 annual exam (monthly self) always 5 days after menses so breast is not swollen

> 40 annual mamo
Inflammatory Cx of the breast
S/S
Tx
Hot,red, swollen with peau d orange(plugged up dermal lymphatics)

-Metastasizes alot.

-HRT, Chemo, Radiation
Breast abscess association
Breast feeding
Lead poisoning Adult vs Child
Both have microcytic anemia with basophillic strippling

Child: encephalopathy w/ epiphyseal deposits on x-ray

Adult: Wrist drop

Dx: Urine screen for heavy metals

Tx: Dimercapol, EDTA
Klein-Levin syndrome
Hypersomnia & hyperphagia
Drug induced renal diseases
S/S
Causes
Interstitial nephritis(Type 4 HS): Eosinophiluria, eosinophilia, oliguria

methicillin/cephalosporin

IC glomerulonephritis: Nephrotic syndrome
panniculitis
Kid with swollen parotid gland from eating popsicles
lobular Cx in Situ of breast
-Tends to affect both breasts but will not metastasize for 10-15 years
-Does not affect chest wall
-Est & progest receptor +
Female Orgasm
Excitation(parasympathetic):Tenting, excess mucus, vascular engorgement, Head & neck rash

Orgasm(sympathetic): levator sling contraction
Esophogeal varices
S/S
Dx
Tx
Hematemesis in alcoholic with portal HTN (abd distention, ascites-shifting dullness)

Dx via endoscopy(r/o PUD bleed)

Sclerotherapy/band/ vasopressin w/ scope.

Next balloon tamponade.

If horrible do portocaval shunt.
Esophogeal Cx
S/S
D/x
Long hx of gerd with weight loss and dysphagia.

Endoscopy & biopsy
Hematemesis DDX
Varices(bright red)
Ulcer(duodenal>Gastric: Coffee ground)
Anti-mitochondrial Ab
Primary biliary cirrhosis(AI destruction of the intrahepatic bile ducts.)
-Itch alot b/c have increased bile salts & jaundiced.
-Middle aged female. predominance
Bipolar disorder
Types
Tx & AE
I: Mania+/-Depression
-lithium (Nephro DI, hypothyroid, poisonous w/ thiazide).

-Valproic Acid(Hepatotoxic)

-Carbamazepine(Agranulocytosis)

-ECT last resort

II: Hypomania w/ depression
Cu deficiency
Kinky hair
Zinc deficiency
Poor taste & smell. Rash around mouth and eyes.
Mg deficiency
Hypocalcemia & tetany
Intusseption
S/S
Dx
Tx
2 year old w/ colicky abd pain, RUQ cock mass, currant jelly stools.

Barium enema(Dx & Tx) if stable or surgery if unstable.
Newborn with bloody stools
APT test first to see if it is moms blood
Sonogram dating
Earliest is most acurate

1st trimester: CRL
2nd trimester: Femur,AC,HC,BPD
Tinea capitus
Culprits
S/S
Dx
Allopecia & pruritis

Microsporum(lights up w/ wood lamp) & tricophyton
Ergophony
Seen in consolidated lung states
(S.pneumoniae pneumonia)e sounds like a. Also will have dullness to percussion. Must do thoracocentesis to look at the fluid in the lung.
Rocky mountain spotted fever
culprit
S/S
Ricky Rickettsiae Tick

Extremity rash then on whole body-palm & sole

Fever+headache+hepatosplenomegaly
DIC
S/S
Causes
Labs
Tx
Bleeding from multiple sites post trauma or malignancy.

Low platelets-factors-fibrinogen PT & PTT & D-dimer are elevated

Tx: Cryoprecipitate
TTP
S/S
DDx
Thrombocytopenia with neurologic changes, fever, microangiopathic hemolytic anemia & ARF secondary to diffuse emboli/thrombi in brain

DDx is HUS from e.coli but this has diarrhea prodrome

No Tx unless platelets<30 then give IV IG and steroids
Rheumatoid Arthritis
S/S
Labs
Pathophys
Tx
Ulnar deviation, rheumatoid nodules on forearm, morning stiffness better w/ exercise

High RF titer, polyclonal gammopathy, IC deposition at synovial tissue creating pannus

Nsaid then gold,methotrexate, penicillamine
Normocytic anemia in kids
all are red cell aplasias(low Hb & retic count)

-aplastic-post viral/med/rads
transient -erythroblasthenia-viral
-anemia of premie
Sheehan syndrome
Ant pit infarction post hemmhorrhage.

Prolactin i most affected hormone
Ruptured Spleen
LUQ pain post trauma or in kid w/ EBV that radiates to shoulder.
Stable=CT
Unstable=OR
Organophosphate poisoning
S/S
Tx
SLUDS(Ach excess)
-Give pralidoxime(stim AchE) & Atropine(Ach blocker)
B-blocker OD
Glucagon
Gold OD
Dimercaptol
PE
dx
Tx
V/Q scan or helical CT
-Widened A-a gradient
-New onset RBBB
-Hx of DVT

Heparin
Temporal arteritis
S/S
Pathophys
Association
Tx
Jaw cludication, Headache, ELEVATED ESR.

May get CRA occlusion and go blind

Associated w/ Polymyalgia rheumatica(high CRP/ESR, normal myelogram and NCV tests, pain & stiffness in neck and shoulders)

Give corticosteroids immediately then biopsy
TORCH
Toxo
Rubella
CMV
HIV
IUGR
Symmetric HC=AC(TORCH/Renal Agenesis)

Asymmetric: Maternal HTN
Renal Casts
Waxy: ESRD
RBC: PSGN or SLE GN
WBC: Pyelo(CV angle tender)
Fatty: MCD(Nephrotic)
Renal tubular: ATN
Hyaline: No Sig
Minimal change disease
S/S
GBM loses -ve charge so nephrotic syndrome then periorbital edema & fatty casts
Drugs causing Lupus
Hydralazine(lower BP in severe pre-eclampsia)

INH: Neurotoxic give B6(pyridoxine)

Procainamide(Vtach prolongs PR interval)
Jogger w/ pain in foot
metatarsal Fx & need bone scan to see
Large fall onto feet
Lumbar fx,calcaneous fx, compartment syndrome
Achilles vs Gastrocnemius tear
Achilles:
-no tiptoe walking
-No calf compression pain

Gastrocnemius
-Tiptoe Ok
-Calf compression pain
Gout
S/S
Dx
Tx
Awake at night with pain at big toe in guy with hyperuriemia & alcohol/red meat consumption or on thiazide(causes hyperuricemia)

-ve birefringent needle shaped crystals in synovial fluid(urate deposition)

Attack: NSAID(indomethicin)/Steroid/Colcichine

Non-Attack:Allopurinol, probenacid