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168 Cards in this Set
- Front
- Back
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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 |
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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 |
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Sore throat differential
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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) |
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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 |
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Workup of a malignant breast mass
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Fine needle aspiration
& if non-diagnostic do biopsy then Remove it. |
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Types of unilateral Bloody nipple discharge
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Intraductal papilloma: Cytology fluid & then GG resection
Intraductal carcinoma: Skin is dimpled and mass present.LN involvement -Must remove. |
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Fibroadenoma
S/S Tx |
Painless rubbery-firm, mobile mass.
If patient stable follow them through several cycles. If not stable do FNA. |
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Malignant breast mass description
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-Upper outer quadrant
-Painless(except intraductual) -Fixed -Microcalcified(coarse=fat necrosis) -Peau d orange=inflammatory -Lymph node involvement |
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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 |
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OCD
-#1 Type -Pathophysiology -Tx |
-Main type is contamination
-Defect in serotonin -SSRI(to increase Serotonin): Fluvoxamine |
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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 |
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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 |
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Temporal lobe encephalitis
S/S Dx Tx |
Hallucinate & seize
Do PCR of CSF Acyclovir |
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Twin risk in pregnancy
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Increases risk of HTN
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Drugs CI in pregnancy
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Neuro: Benzo,amphetamine,ETOH
Abx: Tetra, Quinolones Hyper Thyroid: PTU, Methimazole Hypertensives but not hydralazine, methyldopa & labetolol Glucocorticoids Theophylline Coumadin but not heparin |
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Cohort study
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Prospective study that looks at healthy people who have been exposed to a potential risk factor.
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Cross sectional study
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Looks at a group at a specific point in time
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Case control Study
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Looks at those who have disease(Case) & those who do not(control) and how they were exposed to a risk factor.
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Crossover study
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One group gets placebo then later they get the drug
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POSTERIOR DISLOCATION OF THE SHOULDER
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Cannot externally rotate and must get tangential(transcapular) view x-ray or you will not see it.
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Infant w/ cyanotic LE but pink UE
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PDA w/ coarctation
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Dissociative identity disorder
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Associated with sexual abuse as a child
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P<.05 definition
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Probability events occured by chance alone or by random variation
If P<.05 then results are statistically signifigant(not clinically) |
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Fragile X association
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Big balls, big ears and retarded/autistic
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Cyanotic heart diseases
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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 |
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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 |
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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) |
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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 |
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Galeazzi Fracure
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Radial shaft fracture w/ dislocation of the radio-ulnar joint
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Monteggia Fracture
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Ulnar fx c/ radial head dislocation
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Humerus Fx
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Wrist drop(radial n. damage) & may have a dislocated shoulder
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Supracondylar fracture
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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. |
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Nursemaid elbow
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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. |
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Anterior dislocation of shoulder
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Can rotate but cannot feel over lateral deltoid(axillary N.).
Check lateral forearm for paresthesia also(mucocutaneous n.) |
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Regression
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Start to act like a child/tantrum when in a difficult situatuion
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Projection
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Talk about something you do not like about yourself in reference to other. DL is a liar.
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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. |
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Methotrexate
-Pharm |
Works at S-phase and inhibits DHFR.
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Bleomyacin
-Pharm -AE |
-Works in G2 phase and creates free radicals for cytotoxicity
-Pulmonary fibrosis |
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Paclitaxel
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M-Phase: does not let mitotic spindle disassemble.
-Peripheral neuropathy, thrombocytopenia, Neutropenia |
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Vinblastine
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M-phase. binds tubulin to inhibit spindle formation.
Hematotoxic: thrombocytopenia & neutropenia (Blasts the bone marow) |
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Hodgkins lymphoma drug cocktail
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Doxorubicin-Arrythmia, pericardiitis, cardiomyopathy
Dacarbazine Bleomyacin-Pulm fibrosis Vinblastine-thromb,neutropenia |
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M phase anti-neoplastic drugs
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Vinblastine:Bind tubulin so spindle can't form
-Neutro-thrombocytopenia Paclitaxel: does not let tubule dissociate -neurotoxic,neutro-thrombocytopeniapenia |
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S-Phase drug
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Methotrexate: inhibits DHFR
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Bleomyacin
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causes pulmonary fibrosis
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Seperation anxiety d/o
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Kids>6mo who have tantrum, fake sick to stay w/ mom/dad. If <6mo think of stranger anxiety.
Get panic D/O as adults |
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Oppositional defiant D/O
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Has friends but defiant to authority(teacher,mom & dad)
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Conduct D/O
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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.
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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) |
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Degrees of retardation w/ IQ
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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 |
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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 |
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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 |
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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 |
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Phobia Tx
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Systematic desensitization>SSRI
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Drugs to avoid in G6PD patient and the reasons why.
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Anti-malarials & Sulfa drugs because the erythrocyte membrane cannot handle the excess oxidation and the cells hemolyse
Chloroquine/Primaquine INH Nitrofurantoins SMZ-TMP |
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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 |
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DOC for sleep terror & Sleep walking
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Diazepam b/c it decreases the time spent in stage 4 sleep which is when these disorders occur.
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Narcolepsy
S/S Tx |
Decreased REM latency
Cataplexy Hallucinations Alpha methyphenidate Dextroamphetamine |
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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 |
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Signs of thyroid malignancy
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Solitary nodule >4cm in man or child
Hx of irradiation Adenopathy FNA then remove |
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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 |
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Urgency incontinence
S/S Causes |
Frequency, Urgency, Nocturia
Can be 1)Interstitial cystitis: Fever & UTI 2)Detrusor irritability (no fever or UTI). |
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Overflow incontinence
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Diabetic who leaks w/ full bladder secondary to peripheral neuropathy.
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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. |
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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 |
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Pleomorphic Adenoma
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#1 tumor of the salivary glands
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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 |
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Optic neuritis
Culprit S/S Tx |
Syphillus, TB, Lyme disease, ethambutol
sudden & painful unilateral vision loss w/ pain on EOM movement Steroids |
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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) |
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Hypocalcemia changes
Dx Tx |
Prolonged QT interval, facial N. tetany, carpal spasm w/ BP cuff.
Must give Mg when giving Ca |
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Adult conjunctivitis
Culprits S/S Tx |
staph/strep/H.Aegypti(pink eye)
D/C w/ mild photophobia Polymyxin B, Neomyacin ,bacitracin |
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Strabismus in child
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Lazy eye
Patch the good eye b/c visual system develops until 7-8years of age and may go blind otherwise. |
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Opthamologic Herpes Zoster
S/S Tx |
Look for dermatomal pattern of rash @ medial eyelid & tip of nose
Acyclovir |
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Herpes simplex keratitis
S/S D/x T/x |
Conjunctivitis after vessicular lid eruption.
Flourescin stain Idoxuridine/Trifluridine topicals |
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Stye
S/S Tx |
Painful lump next to lid margin
Warm compressesthen I&D if they do not work |
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Presbyopia
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Need glasses to read b/c lens cannot accomadate. Normal not pathological and occurs at about 40-50.
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Uveitis
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Seen in kids w/ JRA (mimics RA) and must do serial slit lamp exams
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Sudden b/l vision loss
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Methanol toxicity in alcoholic (drinkin hairspray)
UV light exposure(welder or skier) conversion disorder Tx: Patch eyes and topical antibiotic |
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Pleomorphic Adenoma
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#1 tumor of the salivary glands
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Cystic teratoma
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Any pelvic mass with calcifications. take it out
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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 |
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Sudden unilateral painless loss of vision
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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 |
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Sudden unilateral painful loss of vision
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1)Trauma
2)Optic Neuritis 3)Closed angle glaucoma 4)Migraine |
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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 |
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Opthamolgic changes in diabetes
Dx Tx |
Neovascularization
Microaneurysms Dot blot hemmhorrhages Tx: Pan retinal photocoagulation(laser) |
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Papilledema
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See swelling of optic disk and blurring of the margins on fundoscopic exam
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Macular degeneration
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#1 cause of blindness
-Yellow/white deposits on retinal pigment epithelium(Drusen) No Tx. |
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Toxic Shock syndrome
Culprit S/S |
Staph Aureus toxin
Palm & sole desquaminating rash, fever, hypotention in a woman who uses tampons |
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LSD intoxication
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Visual hallucinations and have flashbacks/nightmares
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PCP intoxication
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Get angry and have vertical and horizontal nyastagmus
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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. |
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Crohns Disease
S/S Dx Tx |
All over GI tract
-Skip lesion,fistula,stricture -Bowel wall thickened & Cobblestoned Dx: Colonoscopy & biopsy Tx: Steroids |
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Ulcerative Colitis
S/S Dx Tx |
Bloody diarrhea
Only colon & rectum Pseudopolyps, Ulcerated & friable mucosa, Thin bowel wall. +pANCA Colonoscopy & biopsy Steroids & Sulfadiazine |
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Benzodiazepine OD management
Benzodiazepine WD management |
Flumazenil
-Get seizure & anxiety. May be fatal so must taper with long acting benzo |
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Cocaine Use symptoms
-OD -WD |
HTN, Sweating,Paranoid, Formication(somatic sensation of ants crawling on your skin
-Stroke & Arrythmia -Hypersomnia, Hyperphagia |
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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. |
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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) |
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Anti-Ribonucleoprotein Ab
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Mixed CT disease
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Avoidant personality disorder
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Loner who wants to be part of the group but is afraid to
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Schizoid personality
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Loner and ok w/ being alone
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Schizotypal
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Loner with weird thoughts
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Cyclothymia vs. Dysthymia
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Cyclo: 2 years of depression-hypomania
Dysthymia: Two years of mild depression only |
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Monozygotic vs. Dizygotic
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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 |
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Hyperemesis gravadum
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1st trimester w/ alot of social stressors constant vomiting.
-Have high Hct, ketonemia & weight loss -Hypokalemic,hypochloremic met alkalosis so correct it. |
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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. |
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Alport syndrome
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Deaf kid w/ Nephritis
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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 |
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vaccine that causes seizures and how to manage.
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Pertussis. Stop giving it but do give diptheria and tetanus at the appropriate intervals.
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#1 complication of carotid endarectomy
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MI
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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 |
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MAOI
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Phenelizine/Tranylcypromine
AE: wine & cheese: HT crisis SSRI: serotonin syndrome (Fever, rigidity, Autonomic hyperactivity) Meperidine: Coma |
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Normal Grief reaction
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1 year and may hallucinate about lost one but realize it is fake
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Trazodone AE
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Priaprasm
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SSRI
-Name -AE |
Fluoxetine, Fluvoxamine
Anorexia, insomnia, sexual dysfunction |
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TCA
-Names -AE -OD |
Amitryptilene/Nortriptylene
Arrythmia & orthostatic hypotention(poor choice in elderly) NaHCo3 |
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Dissociative fugue
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Move away get a new identity
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Generalized anxiety disorder
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Anxious about many things
Buspirone or benzo(sedating) |
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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) |
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Learning D/o
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Poor in only 1 subject but rest is fine
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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 |
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delusion Subtypes
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Paranoid: Gonna get me
Reference: Personal sig to neutral events Bizarre: Absract thinking Grandiose: I have a mission |
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Toxoplasmosis
S/S RF Tx |
-Chorioretinitis w/ intracranial calcifications
Microencepahly and Hydrocephalus Raw meat or cat exposure Pryramethamine-sulfadiazine |
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Parvo B-19
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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 |
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Pagets disease
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Scaly rash that involves the nipple and means you have cancer
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Cystosarcoma Phylloides
-Describe -Tx |
-Type of malignant fibroadenoma(stromal tumor) that is a huge bulky mass.
Resect it |
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Breast cancer screening
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> 20 annual exam (monthly self) always 5 days after menses so breast is not swollen
> 40 annual mamo |
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Inflammatory Cx of the breast
S/S Tx |
Hot,red, swollen with peau d orange(plugged up dermal lymphatics)
-Metastasizes alot. -HRT, Chemo, Radiation |
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Breast abscess association
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Breast feeding
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Lead poisoning Adult vs Child
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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 |
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Klein-Levin syndrome
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Hypersomnia & hyperphagia
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Drug induced renal diseases
S/S Causes |
Interstitial nephritis(Type 4 HS): Eosinophiluria, eosinophilia, oliguria
methicillin/cephalosporin IC glomerulonephritis: Nephrotic syndrome |
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panniculitis
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Kid with swollen parotid gland from eating popsicles
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lobular Cx in Situ of breast
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-Tends to affect both breasts but will not metastasize for 10-15 years
-Does not affect chest wall -Est & progest receptor + |
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Female Orgasm
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Excitation(parasympathetic):Tenting, excess mucus, vascular engorgement, Head & neck rash
Orgasm(sympathetic): levator sling contraction |
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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. |
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Esophogeal Cx
S/S D/x |
Long hx of gerd with weight loss and dysphagia.
Endoscopy & biopsy |
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Hematemesis DDX
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Varices(bright red)
Ulcer(duodenal>Gastric: Coffee ground) |
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Anti-mitochondrial Ab
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Primary biliary cirrhosis(AI destruction of the intrahepatic bile ducts.)
-Itch alot b/c have increased bile salts & jaundiced. -Middle aged female. predominance |
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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 |
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Cu deficiency
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Kinky hair
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Zinc deficiency
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Poor taste & smell. Rash around mouth and eyes.
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Mg deficiency
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Hypocalcemia & tetany
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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. |
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Newborn with bloody stools
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APT test first to see if it is moms blood
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Sonogram dating
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Earliest is most acurate
1st trimester: CRL 2nd trimester: Femur,AC,HC,BPD |
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Tinea capitus
Culprits S/S Dx |
Allopecia & pruritis
Microsporum(lights up w/ wood lamp) & tricophyton |
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Ergophony
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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. |
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Rocky mountain spotted fever
culprit S/S |
Ricky Rickettsiae Tick
Extremity rash then on whole body-palm & sole Fever+headache+hepatosplenomegaly |
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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 |
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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 |
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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 |
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Normocytic anemia in kids
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all are red cell aplasias(low Hb & retic count)
-aplastic-post viral/med/rads transient -erythroblasthenia-viral -anemia of premie |
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Sheehan syndrome
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Ant pit infarction post hemmhorrhage.
Prolactin i most affected hormone |
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Ruptured Spleen
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LUQ pain post trauma or in kid w/ EBV that radiates to shoulder.
Stable=CT Unstable=OR |
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Organophosphate poisoning
S/S Tx |
SLUDS(Ach excess)
-Give pralidoxime(stim AchE) & Atropine(Ach blocker) |
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B-blocker OD
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Glucagon
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Gold OD
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Dimercaptol
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PE
dx Tx |
V/Q scan or helical CT
-Widened A-a gradient -New onset RBBB -Hx of DVT Heparin |
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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 |
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TORCH
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Toxo
Rubella CMV HIV |
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IUGR
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Symmetric HC=AC(TORCH/Renal Agenesis)
Asymmetric: Maternal HTN |
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Renal Casts
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Waxy: ESRD
RBC: PSGN or SLE GN WBC: Pyelo(CV angle tender) Fatty: MCD(Nephrotic) Renal tubular: ATN Hyaline: No Sig |
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Minimal change disease
S/S |
GBM loses -ve charge so nephrotic syndrome then periorbital edema & fatty casts
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Drugs causing Lupus
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Hydralazine(lower BP in severe pre-eclampsia)
INH: Neurotoxic give B6(pyridoxine) Procainamide(Vtach prolongs PR interval) |
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Jogger w/ pain in foot
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metatarsal Fx & need bone scan to see
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Large fall onto feet
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Lumbar fx,calcaneous fx, compartment syndrome
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Achilles vs Gastrocnemius tear
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Achilles:
-no tiptoe walking -No calf compression pain Gastrocnemius -Tiptoe Ok -Calf compression pain |
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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 |
