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92 Cards in this Set
- Front
- Back
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PALPITATIONS
-cardiac cause -a. fib -Ventricular Premature beats -exercise arrhythmia Mother with hyperthyroid |
C: male, "irregular heartbeat", personal hx of heart dz, event >5mins
Afib: flutter sensation only (hyperthyroid would have other symptoms) Vent: "flip-flopping" sensation Exer: stress test Mom: lead to heart failure of infant (thyrotoxicosis) |
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Pneumonia Severity Index
Types -pneumonitis -CAP -atypical -HAP -PCP |
PneumoniaSevereityIndex: age, comorbid, specific exam, labs;
High RF: neoplastic, liver, renal dz, chf, diabetes. 3-4 hospitalized -Pneumonitis: chemicals, blood, radiation, autoimmune -CAP: s. pneumoniae, h. Influenza, moraxella catarrhalis--- rust color, lobar focal infiltrate -Atypical: mycoplasma, chlamydia, legionella (diarrhea)--- bilateral, diffuse; tx erythromycin -HAP: pseudomonas, klebsiella, acinetobacter, s. auerus (postinfluenza pneumoniae)-- d/t intubation, ng tube, peexisting lung dz, multisystem failure -PCP/pneumocystitis jiroveci: ground glass; tx TMP-SMX/bactrim |
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HCOM
Endocarditis |
HCOM: AD, Continuous HoloSystolic murmur 3/6. murmur inc w/stand/valsalva, dec w/squat (opp to aortic stenosis). Worsen with exertion, boot shape heart. Marfans. Asymptomatic. Diastolic. Tx. B-blocker, Sx mymectomy or pacemaker placement
E: FROM JANE; heart murmur, petechiae, mild splenomegaly; tx antibiotic prophylaxis for dental procedure |
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Guidelines for Adolescent Preventive Services (GAPS)
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3 PE's
- 11-14, 15-17, 18-21 y/o HEEAADDSS: Home, Education, Eating, Activity, Abuse, Drugs (no routine tox screen), Depression, Suicide, Sex Htn, eating disorder/obesity ONLY Screen lipid and TB If sexually active, cervical sample females and leukocyte esterase for males |
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Acute otitis media Rfs
Hearing impairment Hearing impairment RFs Effusions TMJ OM, vaccine College athlete/swimmer |
RFs: 6-7mos, NA, eskimos, cleft palate, down syndrome, daycare, smoking parents
H: OM, eustachian tube, tinnitus, vertigo, OE, barotrauma HRF: fhx, craniofacial abnL, <1500g, neonatal hyperbilirubinemia, asphyxia, bacterial meningitis, congenital infections, ototoxic meds, mechanical ventilation >10d E: reassurance, not OM T: nsaids, bite guard O: vaccine only reduces by 10% C: OE, topical antibiotics |
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CHILDREN wheezing
Acute Viral infection Asthma Bronchiolitis Pneumonia Congenital Heart Dz Idiopathic Apnea Harlequin syndrome GERD Diaphragmatic Hernia |
AV: 50% of wheezing episodes<2y/o
Asth:recurrent episodes of wheezing. B&P: wheezing, not recurrent. CHD: full-term infant; dyspnea and even cyanosis with exertion, no wheezes; BNP>80 IA: like CHD but premature infants HS: transient skin color change of asymptomatic newborn (usually preterm) which dependent body side turns red GERD: 24hr pH DH: resp distress; scaphoid ab; no breath sounds on L side; no improvement w/immediate intubation; bowel sounds in chest; tx mechanical ventilation or extracorporeal membrane oxygenation |
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Acure wheezing Children
-FBAO -Bronchiolitis -Croup -Epiglottis -Tracheitis -Retrooharyngeal Abscess -Peritonsillar Abscess -Cystic Fibrosis -Toxocara Non-wheeze Lung Abscess |
#1 is acute viral infection
FBAO: nonvisibile object=heimlich maneuver; no soft pillows B: expiratory wheeze (like asthma), viral infection (RSV, parainfluenza, adenovirus, mycoplasma, metapneumonvirus), wheezing+om, irritability, variable cxr, nL cbc, only hospitalized if serious other findings, ONLY supplemental O2+care, RSV or nebulized Epi IVIG/palicizumnab for high risk C: viral (parainfluenza, adeno, rsv), SEAL-BARK COUGH, STEEPLE sign, closely monitor if major symptoms or just keep child away from stimulant factors, Supportive care, E: h. Infleunzae, h. Parainfluenza, s. pneumoniae, s. aureus, B-hemolytic strep, DROOLING; THUMB sign, leukocytosis, neutrophilia, bandemia, tx oxacillin nafacillin cefazolin, clindamycin AIRWAY management T:severe s. aureus, SUBGLOTTIC narrowing; bark cough; tx intubation+antibiotics R: 2-4y/o penetrate instrument fb; fever, DROOL, dysphagia, stridor, resp DISTRESS, tender enlarged lymphadenopathy, cervical spine ROM limitation, stridor, wheeze, LATERAL neck films, d/tS. AUREUS, s. pyogenes, oral anaerobes tx. I&D; ceph/pcn P: TEENS, muffled voice, TRISMUS, neck pain, cervical adenopathy, deviated uvula, CT, s PYOGENES, s aureus, anaerobes, tx PCN or Ampicillin-sulbactam, i&d, aw obstruction, septicemia, aspirationm jvd CF: Cl>60meq/L; several pneumonitis, tx inhalation therapy, chest physiocal therapy aggressive antibiotic administration, bronchodilators, o2, nutrition support, amiloride, purified human plasma a-antitrypsin, recombinant DNAase, gene therapy; heart-lung transplants -Tox: ELISA for dx d/t pica; larvae penetrate intestine and migrate to liver, lung, brain NON LA: cough, fever; CXR=round density, air-fluid level, opaque rim; anaerobic organisms; tx ampicillin w/b-lactamase inhibitor |
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Rcurrent sinusitis
-clinical rhinosinusitis -most common -#1 bug -nasal decongestant Maxillary, Ethmoid Frontal Sphenoid |
RC: persistence greater than 7-10days
MC: allergic rhinitis #1: s. pneumoniae or h. Influenzae; chronic=polymicrobial and tx w/fluroquinolone/augmentin for 2-3wks N: topical nasal steroids M, E: large enough harbor infections from infancy F: harbor until 6-10y/o S: large until 3-5y/o; pus drain superior meatus (also posterior ethmoid); CT for more complicated cases; tx oral antibiotics 10-14d |
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CYANOSIS
Breath holding spell Choanal atresia Asphyxia Apneic episodes Periodic Breathing Transient Tachypnea of Newborn tension pneumothorax Meconium Aspiration Hyaline Membrane Dz Bronchopulmonary Dysplasia |
5g of unoxygenated Hgb in skin capillaries; dificult w/dark skin+poor lighting
BHS: (1)cyanotic spells; 6mos-5y/os (2)pallid breath-holding d/t painful experience; both spontaneously go away and do not reinforce habit CA: block nasal passage; worst when eating/sleeping but IMPROVE when CRYING; lethal if unrecognized & untreated; tx/dx= nose catheter; other txoropharyngeal airways, positioning, tongue fixation, endotracheal intubation, sx Asp: low apgar scores, meconium stain, respiratory distress, high pulm arterial pressure leading to persistent R-to-L systemic bp fall across a PDA or foramen ovale Apn: >20s w/bradycardia, cyanosis 2ndary to undeveloped resp centers Per: pattern of respiration in low birth wt babies w/recurrent pauses of 3-10s TTN: tachpnea, retractions, grunting, cyanosis, prominent pulm vas marking w/FLUID in FISSURES, flat diaphragms; supportive therapy w/resolution in 1st 3days; STARBURST patterns TP: mediastinal shift AWAY; cardiovascular compromise; d/t staph pneumonia tx emergent needle aspiration, then chest tube MA: under perinatal stress; PATCHY INFILTRATES BILATERALLY; meconium stained umbilical cord/skin HMD: infants<34wks; SGA BPD: chornic lung dz in preme infants require persistent O2; airway hyperresponsiveness; pulmonary edema (tx diuretics) |
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Undigested food w/ N/V
-meds -psychogenic vomit -viral gastroenteritis -V before eating -Vestibular -Gastroparesis -Pancreatitis -Pyloric Stenosis -Necrotizing Enterocolitis |
M: metoclopramide (causes extrapyramidal rxns)
Pysch: social stress or past hx of psychiatric disorder Vir: resolve w/in 5 days V before eat: pregnancy, uremia, alcohol w/drawal, inc ICP (d/t malignancy) Vest: not w/meals or time of day G: delayed >59mins after eating; nonbilious & undigestd food Pan: pain+nausea after meals Pyl: before 7wks of age (never breast milk allergies) NEC: feeding intolerance, distend ab; grossly bloody stool; tx: bowel rest w/ng decompression, systemic antibiotics, monitor, SERIAL AB films (if air, then sx of explorative laparotomy) |
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DIARRHEA: acute v chronic
Norwalk Salmonella Tx travelers diarrhea Foods to avoid w/virus Bloody stool dx test b/w mom and baby Ipecac v. charcoal dehydration tx |
Acute: <14 days
Salmonella: meat Norwalk: water, salads, shellfish Travel: fluroquinolone then tmp/smx or azithromycin Food: dairy, etoh, caffeine Blood: Apt test (+)=baby; also for newborn baby post-emergency cesarean section Ipecac: for POISONS. >6mos, c/i if ingest alkali/acid Charcoal: for carbon tetrachloride or benzene or phenobarbital, TCAs, sustained-release theophylline dehydration tx: NS or ringer's lactate, 20mL/kg 1-2h |
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Cough causes
Tx pertussis, tx acute bronchitis |
Asthma, bronchitis, aspiration, irritants, allergies, uncomplicated pneumonia, posnasal drip, viral upper resp, gerd, acei, lung cancer (other symptoms)
Tx pertussis azithromycin 5days or erthromycin 14d; droplet (can give to a sister's infant if need) s/s: mild cough w/thick nasal secretions; spasmotic coughing w/cyanosis; tired; lost wt; feeding less; no void Tx acute bronchitis w/oral or inhaled steroid |
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Sore Throat
-Posterior cervical adenopathy -Anterior adenopathy -Laryngitis w/pharygitis |
Post: EBV (also exudative pharyngitis like GAS incorrect ebv tx gives maculopalpular rash after pcn
GAS: uveal edema; tx fluroquinolone/clindamycin Ant: viral or bacterial Lw/P: voice change; viral infection=supportive |
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abuse/battery
mongolian spots subcutaneous fat lesions |
recommend to be alert to physical or behavioral s/s and then ask appropriate questions
d/t unintended pregnancy, depression, anxiety, panic, somatoform, ptsd, suicide, chronic pain, frequent ab/pelvic pain, substance abuse or eating disorder children: AGGRESSIVE, ANXIOUS, BEDWET, DEPRESSION CORNER/BUCKET-handle fx of metaphysis of LONG bones, posterior rib, scapular fx, etc M: well-defined, PURPLE lesion over buttocks, lower back, extensor surface of extremities of blacks/asians/latin americans; disappear 1-2y/o, SFL: RED sharply demarcated, hard lesions on cheeks, buttocks, limbs; |
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INFANT LIMP
Discitis Hip Septic Arthritis unsuspected fx Toddler's Fx Undx congenital dysplasia of hip Transient synovitis Legg-Calve Perthes Slipped Femoral Epiphysis Malignancy Osgood-Schlatter Dz Osteomyelitis |
Discitis: walks stiffly
H: trendelenburg gait, claw toes or cavus deformity; IR cause cap pressure w/in acetabulum<30deg, pain during leg roll, FABER Septic: high ESR CRP WBC; monoarticular, fever, infant=crying irritable poor feed; ambul=no more mvmt; hip flx Ab ER; <4mos=s.aureus GBS; <5yrs=s. aureus, s. pyogenes Unsus: lower leg or foot injury Todd: tibia spiral fx from twisting w/planted foot Undx: painless limp when learn to walk; xray shows abnl hip align; splint or Sx Trans: self-limit; boys POST viral infection; almost like septic joint but nL LABS L: painless limp (maybe pain@anterior thigh, groin, knee); AVN of femoral head boys after trauma/infection unknown; nL early xray; Later xray shows collapse flat, wide femoral head; bone scans/mri; conservative Slipped: adolescence d/t endocrine cause (obesity) knee pain; femoral head medial/posterior DISPLACE; limited IR and obligate ER w/hip passively flex; early xray=widen; later xray=slipp; Sx pin; closely followed; fat or growth spurt skinny kid M: night pain unless no pathology then growing pain OSD: active kids (mostly boys); tenderness, swollen, prominent tibial tuberosity d/t patellar tendon; nL x-rays; tx. rest O: focal bone tenderness leading to bone death, fever; plain film bony changes |
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Fatigues
-physiological psychological physical |
Physio: overwrk, lack of sleep, pregnancy, physical stress
Psychological: stress, depression, anxiety, adjustment Physical: infections, endocrine imbalances, anemia, cardiovascular, cancr If more than 6mos, progression is related to physical cause (not inc stress, overwrk, etoh) |
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insect or animal or human bite
-local, delayed, or anaphylaxis -Animal |
remove stingers rapidly w/card
tetanus for all L: histmaine-like rxn; ice, anti-histamines D: IgE: oral steroids Anaphy: 0.3-0.5mL 1:1000 sol Epi, antihistamines, steroids, bronchodilators; no perfumes, bright clothing, barefoot A: cleaning, irigation, debridement; close if less than 24 hrs ago; 5-7days Augmentin |
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HEADACHES
migraine tension cluster acute infantile hemiplagia trigeminal neuralgia tx radio imaging use? |
m: nausea, fhx, Unilateral, zigzag, tx: nsaids+triptans; prophylaxis=b-blockers+TCAs; maybe verapamil, caffeine; not narcotics
t: dx of exclusion but #1 for adults, later in workday=stress/fatigue, bilateral precranial muscle tenderness; photophobia or phonophobia; NO aggravation; tx NSAIDS; NO caffeine c: trigger by etoh/vasodilator intake; stabbing eye, ear, sweat, horner's syndrome; tx o2, sumatriptan, inhaled anesthetics(lidocaine) or pacing around; prophylactic: ergotamine, verapamil, lithium, divalproex, methysergide, prednisone TN: tx carbamazepine or anticonvulsants AIH: sudden HA w/hemiplegia symptoms d/t TBE of MCA or its major branches; hx of migraine HAs; RAD: steadily more severe, not fit any primary classifications; no respond to 1st-line tx; neuro abnLs |
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Jaundice
-Unconjugated -Conjugated |
U: Gilbert+Crigler-Najjar (1) (congenital w/incr) or hemolysis (anemia by spherocytosis, thalassemias, sickle, malaria, TTP, HUS)
C: tx hep w/a-INF; Dubin-Johnson Hep A (2-8wks inc; 2-3wks trans; incr conjugated+transaminases+serology); Hep B (hepatocellular carcinoma, Anti-HBs=resolve/vac; antiviral therapy), early in life=chronic dz; HBs=1st; HBe=active Hep C (chronic liver dz; 1-3wks exp, 4-12wks detect; asymptomatic; cirrhosis, hepatocellular carcinoma, antiviral therapy); tx interferon Hep D (mediterreanean, middle east, south america); Hep E (2nd/3rd trimesters); Alcohol abuse (AST>ALT 2:1); Physical Obstruction (gallstones so U/S, CT, MRI, ERCP) |
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acute bacterial cystitis
urethritis Recurrent utis pyelonephritis interstitial cystitis vulvovaginitis tx asymptomatic? acute prostatitis |
aBc: frequency, hematuria, dysurian, back pain; UA & culture when suspected
u: gradual onset r: tx single dose post sex p: aBc w/fever i: NO back pain, chronic, hematuria, cystoscopy v: vaginal irritation, no odor/discharge only tx asymptomatic bacteriuria in PREGNANCY ap: boggy, tender, warm prstate |
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HEMATURIA
-meds -cystitis -nephrolithiasis -pyelonephritis -bladder cancer -STD -Micturition bleed -pediatric -<40y/o w/only moderate blood and nL everything else |
beets
M: PCN, cephs, sulfonamides, phenytoin, cyclophosphamide, mitotane, anticoagulants, nitrofurantoin C: suprapubic pain, dysuria, urgency, frequency in women N: NO dysuria or frequnecy P: systemic infection B: asymptomatic, male, smoking, PRINTING/LEATHER dye STD: NO hematuria BUT dysuria or frequency Mi: throughout=bladder/renal; terminal=bladder neck/prostatic urethral Ped: poststreptococcal infection/glomeurlonephritis=#1 <40: reassurance; if over, then cystoscopy/renal biopsy |
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DYSMENORRHEA
Gonadal dysgenesis Hypothalamic failure/functional Pituitary failure PCOS Constitutinal delay Pregnancy thin membrane labia minora @2wks/old |
PrimaryAmenorrhea: d/t Pg release and tx by NSAIDs, pain days before period though few yrs after began menses
G: primary amenorrhea d/t XO H: anorexia nervosa, incr exercise, chronic/systemic illness P: decr GnRH stimulation d/t head trauma, shock, infiltrate process, pituitary adenoma, craniopharyngoma PCOS: nL breast C: only boys Preg: #1 2ndary TMLM: do nothing; if older than 6y/o, leads to vulvovaginitis, UTIs |
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Pelvic Pain
-Ovarian cyst -PID -Ectopic pregnancy -Uterine Leiomyoma -Appendicitis -Endometriosis -Mass <15y/o |
O: unilateral
PID: fever, vag d/c (CBC, ESR) Ec: like PID but abnL menses+inc pain L: enlarged uterus En: cyclic pain, unable to conceive A: nausea, anorexia (CBC) 15: mostly malignant; transvaginal u/s and Sx >15y/o: commonly cysts; monitored if <6cm by U/S |
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Sports physical
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Marfans, general apperance
Heat illness Bp, Congenital cardiac anomalies=#1 w/hcom Asthma, pulm disorders, ortho injuries, missing 1 of paired organ Eating disorders, body weight, menorrhagia |
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EYE REDness
-viral conjunctivitis -bacterial conjunctivitis -gonococal conjunctivitis -pain -scleritis -episcleritis -corneal abrasion -acute glaucoma -irititis -keratitis |
V: palapable LN (#1 adenovirus=self-limit), no coritcosteroids
B: gritty, d/c, pain, photophobia, no corticosteroids, gentamycin (g- rods=contacts) or tmp-smx for everything else G: 2-5d emergency lead to ulcer/perf, clean and reforms immediately, IV cefriaxone w/topical fluroquinolone/tobramycin (vs. chlamydia=6-12d w/silver nitrate) Pain: not conjunctivitis but corneal abrasion etc S: unilateral pain, dec vision, boring, HA w/RA+wegner's E: mild irritation CA: dec visions, intense pain, tearing, trauma AG: pain, dec vision, redness, dilated pupil I: like AG but constricted pupil K: contacts, discharge, dec vision |
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INJURIES SPORTS
-stinger/burner -major clavicle separation -patellofemoral syndrome -acl -pcl -mcl Juvenile RA |
S: symptoms resolve (notPT), return to play unless both sides=image;
C: Sx if >50%; if less, then sling, early ROM until pain subsides to return P: patella tracking laterally to vasta lateralis; so strengthen medialis; pain with leg held in flexion for lengthy time! Not acute d/t Female Q angle A: popsensation, immediate effusion, instability P: lateral blow to knee M: locking, catching, giving way, +mcmurrays test RA: large joints, blindness (slit-lamp), tx steroids |
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Ottowa ankle rule
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Not walk 4 steps
Tenderness over distal 6cm of tibia/fibula and malleoli Mid-foot/navicular tenderness Proximal 5th metatarsal tenderness RICE+early mobilization. >48hrs NSAIDs. Then PT |
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ToRCHeS
seizures |
ALL have thrombocytopenia, hemolytic anemia
TOXOPLASMA GONDII: Chorioretinitis, Calcifications (corteX), hydrocephalus RUBELLA: that DEAF and DUMB CAT (catacts, glaucoma) ate my BLUEBERRY MUFFIN and stepped on my PDA CMV: CALCIFIC (periVentricular), RASH (petechiae), HSM, jaundice, miCroCephaly; (Cataracts, seizures, hepatosplenomegaly); HIV: HSM, NEURO problems HSV2: TEMPORAL ENCEPHALITIS, head, eyes, skin lesions SYPHILLIS: saddle nose, saber shins, hutchinson teeth; (scraping skin lesion, hepatosplenomegaly, anemia, persistent rhinitis, maculopapular rash, snuffles, interstitial keratitis) Listeria, E. coli, Group B Strep seizures: febrile outside of CNS; if>15min, possibly become afebrile seizures in next 5-7yrs |
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ADHD
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Fhx
Childhood dx continue to adulthood Meds inhibit DA and NE reuptake |
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childhood development
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see notebook
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Staphylococcal scalded skin dz (aka Ritter)
anaphylactoid purpura |
S: baby appears ill, papules, bright erythematous rash, fever, crust/fissure around eyes+mouth+nose, desquamation, +nikolsky, <5y/o; NEUTROPHILS tx antibiotics, no scarring
AP: SMALL blood vessel acute VASCULITIS; large joints, GI symptoms, renal involvement, hematuria, petechial rash of butt & LE, |
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Acne tx, RF
-open/close comedones -inflammatory= pustules/erythema -severe nodular/cystic Neonatal Acne |
C: topical retinoids
I: antibiotic alone or w/topical retinoids or benzoyl peroxide S: oral isoretinoin Neo: 2-4wks d/t maternal hormone transmission; resolves few weeks to months, tx 2.5% benzoyl peroxide Tx: tretinoin topical (d/c lead to worsen acne/scarring), maybe additional benzoyl peroxide for resistant propionibacterium acnes; oral antibiotics last not cephs, some women ocps, topical steroids RF: hormones, keratinazation, immune response, Stress |
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-rosacea
-psoriarisis -pityriasis rosacea -hot tub folliculitis -HSV -shingles -enterovirus -tinea -Lichen Planus -Contact Dermatitis -Atopic dermatitis -head lice tx -Scabies -Molluscum contagiosum |
R: no comedo form(acne vulgaris), eye involvement, no topical steroids, tx tetracyclines
P: tx corticosteroids, calcipotriene (Vit d derivative that induces epidermal differentiation+inhibits keratinocyte prolif) PR: papulosquamous, antihistmaines or corticosteroids Hot: self-limiting HSV: lip w/burning and eruption of vesicle, fever, malaise, TEnder ADEnopathy, trigger by uv/infection, tx valcyclovir 1g daily Shingles: tx any antiviral preferably w/in 72hrs, no antiviral resistance Enterov: hand foot mouth dz; self-limit Tinea: tx griseofulvin LP: rare, pruritic, additional w/itch; flexors of wrists/forearms/inner thighs/oral mucosa CD: redness, weeping, oozing, pruritic; tx. topical emollients/steroids AD: d/t environmental/soaps/hot water irritants; inflammatory patches/weeping, crusted plaques of neck/face/groin/extensor on infants but flexors of older; tx. avoidance, hydration, topical steroids HL: 1:1 vinegar-h2o ratio; wash everything w/hot h2o; replace brushes; another tx 7-10d lindane, permethrin, Scab: never above neck; tx. 1% lindane or 5% permethrin (ok for small children) MC: d/t poxvirus, central-umbilication, skin-color, dome shape, 1-5mm, face/eyelids/neck/axillae/thighs, tx observe or liquid nitrogen or extrusion by needle/curette or 0.9% cantharidin |
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strabismus
-referral -dx -tx |
refer to opthamologist;
dx. cover-uncover test at 3-4y/o; tx. patch good eye, sx, eyeglasses <6y/o |
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BABY SAFETY
water temp asphyxiation&choking Pedestrian injury Baby-walker injury Accidental poisoning & Drowning |
temp: 49C (120F) so not to burn
Asph: 1y/o Ped: 6y/o Walker: 6mos Pois: 2y/o; endoscope exam w/in 12-24hrs to determine esophagus/stomach damge; no vomiting; give small h2o or milk; |
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IMMUNIZATIONS
Tetanus Rabies Chickenpox Hepatitis B |
T: Tetanus immune globulin if superficial/risk; adult Td every 10yrs; Tdap is given as a onetime, first time only dose that includes the tetanus, diphtheria, and acellular pertussis vaccinations
R: only if non-immunized dog; antibiotic prophylaxis for cat, monkey bites, human (esp if infant, diabetic, or immunocompromised) C: immediately after delivery if mom had it 5d prior or w/in 2 days; if exposed postnataly 2 or more days, no VZIG or isolation need Hep: infected via delivery if HBs (sometimes pregnancy & postnatal); chronic liver dz; hepatocellular carcinoma; NECESSARY immunization via hepB Ig & vaccine; test serum 1mos after 3rd dose |
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Erythema Toxicum
Salmon Patch/birthmark Pustular Melanosis Sebaceous nevi Milia/Epstein's pearls Seborrheic Dermatitis Impetigo |
ET: benign pustules, yellow-white, 1-2mm, surrounding edge of erythema, EOSINOPHILS present; no tx.
SP: flat vascular lesion, NUCHAL+OCCIPUT region, 1st weeks of life, no therapy PM: benign, self-limit, blacks, 1-2mm pustules, "MILKY" easily wipes away, hyperpigmented, weeks-mos. SN: small, sharply edged lesions HEAD, NECK of infants, YELLOW-ORANGE, hairless, possible MALIGNANCY degeneration M: fine, yellowish white, 1-2mm over FACE+GINGIVAE of neonate d/t palate formation; keratinized material, SPONTANEOUS resolve SD: cradle cap in newborn period; greasy, scaly, erythematous; face, neck, axilla, diaper; localize to scalp, intertriginous areas, PURITUS Impetigo: honey-crust w/ erythema; spread by scratch; tx. topical STEROIDS/ANTIBIOTICS |
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SLEEPING ISSUES
learned behavior somniloquy |
LB: root of many sleep disturbances; allowing to sleep in parent's bed or stay up late
S: sleepwalking |
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DEFICIENT or EXCESS
Marasmus Pellagra Beriberi Rickets Hyperostosis skin erythema Heart calcification Sensory Neuropathy only Cows milk Scurvy Homocystinuria Cystinuria Phenylketonuria Maple Syrup Dz |
M: inadequate caloric intake d/t insufficient food resources, poor feeding technique, metabolic disorders, congenital anomalies; wt loss, constipation, muscle atrophy, loss of skin turgor, hypothermia, edema
P: niacin def, dermatitis, diarrhea, dementia B: thiamine def (B1); necessary for acetylcholine synthesis and carb metabolism; breast milk, cow's milk, cereals, fruits, vegetables, eggs, meet legumes; CHF, peripheral neuritis, psychic disturbances R: vit D; osseous changes, rachitic rosary (enlarge costochondral jx), craniotabes, scoliosis, pelvic/leg deformities, pigeon breast, rachitic dwarfism H: excess vit A=excess bone growth; Skin: excess NICOTINIC ACID; pruritis, tachy, liver damage, hyperglycemia, hyperuricemia Heart: excess vit D Sense: excess pyridoxine (B6) Cow: lack of Fe Scurvy: lack of vit C; wounds not heal well; bony atrophy w/epiphyseal separation HC: TBE=unable to move R side of body (cerebral vasculature); slow wt gain; mild delay development; AR; HOMOCYSTEINE METHYLTRANSFERASE deficiency; CYSTATHIONINE SYNTHASE deficiency; ↓affinity of cystathionine synthase for pyridoxal phosphate; ↑homocysteine blood/urine, osteoporosis, TALL, LENS SUBLUXATION, ATHEROSCLEROSIS C: AR PCT defective of COAL transport (cysteine, ornithine, lysine, arginine) leading to cystine kidney stones; Tx: B6 or Acetazolamide P: retardation, seizures; R: ↓ phenylalanine hydroxylase or ↓THB cofactor Musty Body Odor, MR, fair skin; tx: ↓phenylalanine, ↑tyrosine maternalPKU: microcephaly, congenital heart defects MSD: abnL metabolism of leucine; seiaures, rapid deterioration of CNS; M: I Love Vermont maple syrup SMELLING URINE from BRANCHED maple trees Ile Leu Val=branched AA b/c ↓α-KETOACID DEHYDROGENASE=severe cns defects |
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Waardenburg syndrome
Surge-Weber syndrome Tuberous Sclerosis Marfan Syndrome Ehlers-Danlos Syndrome Prader-Willi Treacher Collins Hypothyroidism Galactosemia Phenylketonuria Biotinidase def |
W: deafness, pigment changes; AD, white forelock, heterochromia irides, lateral displacement of inner canthi
SW: grand mal seizures, mental deficiency, hemiparesis, hemianopsia TS: AD; oval/irregular macules; cerebral tubers; myoclonic seizures; adenoma sebaceum; shagreen patch (over sacrum) M: lens subluxation, myopia, MV prolapse ED: berry aneurysm, unstable joints, easy bruise, flat feet PW: infantile hypotonia&poor feeding; then, obesity/overeat TC: nL intelligence; malar hypoplasia, micrognathia, abnL ears, hearing loss H: immediate tx of physiological thyroid hormone (sodium-L-thyroxine 10-15mg/(kg*d); use neonatal metabolic screen then other tests later G: damage to liver, brain, eyes after being fed milk w/lactose; lethargy, V/D, hypotonia, hepatomegaly, jaundice, FTT, CATARACT; tx. no lactose-contain milk, casein, milk solids, whey, curds P: AR; unable to metabolize to tyrosine; x low phenylalanine B: AR; no biocytin to free biotin; several months/years after birth; dermatitis, alopecia, ataxia, hypotonia, seizures, developmental delay, deafness, immunodeficiency, metabolic acidosis; tx. administrate free biotin |
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toxicology+antedotes
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my saved flashcards: toxins
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MOM'S EFFECTS
Diabetic Phenytoin (dilantin) Valproate Alcohol SLE previous CMV pregnant lady HIV's meds |
D: sacral agenesis, transposition of great vessels, VSD, renal defects, anencephaly, small left colon, hypoglycemia (prevent by early feedings), hypocalcemia
P: 1st trim; fetal hydantoin syndrome: pre- & postnatal growth retardation, hypoplasia of dital phalanges+NAILS, altered CNS, ocular hypertelorism, accentuated CUPIDS'S bow of upper lip V: NTDs A: FAS: growth retard (IQ=67), development delay, microcephaly, microphthalmia, flat philtrum, ptosis, cleft, SLE: (heart issues): AV block, transposition of great vessels, valve&septal defects; anti-Ro abs, ANA CMV: next baby has limited risk; hearing/neurological risks; dx urine viral culture HIV: continue infant's ZIDOVUDINE to dec transmission to baby |
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SUPPLEMENTATION If
INH therapy in pregnant teen Measles Sickle cell Dz/Hemolytic Anemia 1 Day old Newborn |
INH: give B6
M: vit A (blindness, bitot's spos, erophthalmia) S: FOLATE; educate about ab palpation+temp taking; propylactic PO PCN; ; all children receive 7-valent PNEUMOCOCCAL vaccine @2mos & 23-valent @2y/o; HiB vaccine any age 1: vit K |
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SCREEN TEST
Platelet Count CBC Ig Levels Skin Candida Test Nitroblue Tetrazolium test |
PC: wiskott aldrich
CBC: asplenia/howell-jolly bodies Ig: B-cell defects Skin: T-cell def NBT: phagocytic-cell defect, chornic granulomatous dz |
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Trisomy 21
Alport syndrome Turner syndrome nL infant PE findings |
21: brushfield spots, upslanting palpebral fissures, palmar creases; endocardial cushion defect, VSD, TOF; short stature; hx of duodenal atresia at birth; double bubble KUB; microcephaly; centrally placed hair whorl; small ears; redundant skin of nape of the neck; flat nasal bridge; widely spaced 1st & 2nd toe; hypotonia
A: lead to ESRD; XD w/some AR; hematuria, deafness, ocular defects T: edema over dorsum of hands/feet, loose skin folds at nape of neck; sexual infantilism, streak gonads, shielf chest, low hairline, coarctation of aorta, high palate, horseshoe kidney; nL: coarse tremulous movements, ankle clonus, vascular instability, harlequin color change, softness of parietal bones, palpable liver 2 cm below coastal margin |
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Jaundice RF
dx studies reduce jaundice Physiological jaundice Bilirubin encephalopathy Jaundice 1st 24hrs G6PD deficiency or spherocytic anemia Choledochal Cyst |
leads to neurological damage
sulfisoxazole & other drugs compete w/bilirubin metabolic acidosis dx: direct serum bilirubin, cbc, baby blood type, cooms, peripheral smear -PHENOBARBITAL induces glucuronyl transferase thus reduce jaundice hypoalbuminemia nonesterified fatty acids (inc cold stress) Physio: healthy baby develop 2nd/3rd day; peaks at 12mg/dL by 4th/5th day; disappears by end of wk; rate inc<5mg/dL per 24hr and max conjugated bilirubin=1mg/dL BEncephalopathy: 18-20mg/dL 24hrs: hemolytic anemia w/indirect hyperbilirubinemia, reticulocytosis, red-cell destruction G6PD: no blood group or Rh incompatibility CC: direct>20% of total (consider CF, a1-antitrypsin); u/s+Tc99 (maybe liver biopsy, tissue for enzyme acivity; not d/t ABO or Rh incompatibility |
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FEEDING
TPN Kwashikorker Marasmus Dehydration HyperNa+ Short bowel syndrome |
TPN: risk of sepsis; reversible mucosa atrophy w/oral feed
K: FLAME: Fatty Liver, Anemia, Malabsorption, Edema M: low protein (>8%), low energy D: 5-9%; restlessness, absent/reduced tears, weak radial pulses, orthostatic hypoTN; Na+: doughy skin; tx NS (154mEq over 48h); [if SIADH=packed cells; seizures=hypertonic saline3%) SBS: nutrient malabsoprtion; parenteral nutrition req |
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Caloric intake
-1st yr -breastmilk -twins w/one baby with lower wt for date |
1st: req 120 kcal/kg/d then 100; if FTT, additional 50-100% (RTA=common cause)
Milk: risk of hypocalcemia, hypophosphatemia; only gut maturation, stops intestinal atrophy Lower Wt: small for getational age; congenital anomalies; inc future growth retardation; asphyxia, meconium aspiration syndrome=pneumothorax, pneumomediastinum, major pulm problems, pulm hemorrhage, hypoglycemia, inc hct (EMCO for this, severe pneumonia, persistant fetal circulation, diaphragmatic hernia) |
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PHYSIO Changes
Body Wt Hct Meconium Bilirubin Temperature |
Wt: loss of 1.5-2%/d 1st 5 days of life
Hct: dec d/t higher O2 Mec: first 2 days until soft yellow stools at 1-2d's Bili: peaks 3-5d Temp: stable |
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BLOOD
Blood O mom w/Blood A baby Rh incompatibility Petechiae Twin w/higher Hct |
O mom: hemolysis, jaundice, nL HCT, inc rets, nucleated rbcs & microspherocytes
Rh: frequently weak direct coombs test (-coombs=g6pd, spherocytosis aka nonimmune) P: dec platelets Twin: suspicion esp w/15% Hct difference; risk of hyperbilirubinemia, hypoCa++, renal vein thrombosis, CHF, convulsions; |
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MOTHER'S DRUGS
Heroin |
H: narcotics; 1st 2days; hyperirritability, coarse tremors, V/D, fever, high-pitched cry, hyperventilation, seizures; inc. surfactant
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BIRTH complications
cold room SGA+ electrolytes Erb-Duchenne Klumpke What breathing dx screen? Postmature babies+chronic placental insufficiency Cardiovascular: 60RR, grunting, intercostal retraction, nasal flar, cyanosis VACTERL Cleft lip+palate Polydactyl Meningitis infant vs. adult Purporic Rash day 2 of life Inguinal Hernia |
Cold: inc RR b/c unable to shiver to inc metabolic rate
SGA: leads to hypoglycemia+polycythemia (sugar=30mg/dL< is nL for the 1st day; Ca++ decline 2-3postatal days=nL; high Mg++ d/t MgSO4 therapy leading to dec muscle tone+flopiness; hct>65% is polycythemia, tremulosness, jitteriness ED: affects C5-C6; no abduct or ER or suppination d/t forceps delivery K: C7-T1; palsy of hand, Horner's syndrome like; not d/t fractures Dx screen: FLUROSCOPY for characteristic movements on inspiration and expiration; improve spontaneously Postmature: >42wks, apneic, limp, pale, pa soup amniotic fluid requires suction under direct vision Cardio: dec lung compliance, dec lung volume, R-to-L blood shunt VACTERL: d/t DIABETIC moms; Vertebral anomalies, Anal atresia, Cardiovascular anomalies, TE fistula, Esophageal atresia, Renal/radial anomaly, Limb defects Cleft: rf of recurrent OM and HL; repair Lip w/in 2-3mos; palate 6mos-5yrs Poly: black healthy kids; simple excision Meningitis: no bruzinski or kernig's sign or nuchal rigidity; petechiae(few purple spots) if n. meningitidis (b/c no luck with amoxicillin) Purporic: congenital SYPHILLIS, RUBELLA, CMV are highly contagious; lead to jaundice; negative hemolytic studies IH: no dx studies needed; just surgical consult |
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INTRACRANIAL HEMORRHAGES
Epidural Subdural Subarachnoid Parenchymal Pontine Caput Succedaneum Cephalhematomas Intraventricular Hemorrhage c/i to LP |
E: bEla; cross tentorium; cross midline
Subd: Sdcgv; trauma, shaken baby, cross Suture lines Suba: "worst HA in my life"; berry aneurysm, AVM P: BG, internal capsule rupture Pon: unconscious, symmetrically small pupils (also, coma, narcotis, pilocarpine, Horner syndrome; epi, phenylephrine; antihistamines; atropine-like; CN3 palsy) CS: soft-tissue swell/edema resolve in few days; ecchymotic; ACROSS suture lines Ceph: not cross suture lines; SUBPERIOSTEAL hemorrhages; no discoloration; swell 1st FEW HRS; resolve w/in 1st few weeks/months IVH: small preterm infants; lead to progressive posthemorrhagic HYDROCEPHALUS; ENLARGING head CIRCUMFERENCE; apnea; bradycardia; lethargy; bulging fontanelle; widely split sutures; ventricular-peritoneal shunt LP: bleding diathesis, open fontanelle, severe cardioresp distress, skin infection at puncture site, severe thrombocytopenia |
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SCREEN
Cholesterol (genetic) |
1st or 2nd relatives after 2y/o;
nL for dietary fat=40% (meat, milk; contains Zn, Fe, Ca) |
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Angioedema
Holt-Oram Syndrome Marfan Syndrome William Syndrome |
A: AD; deficient of C1 esterase inhibitor; ab pain, V/D; nL labs
HOS: AD; ASD or VSD; skeletal abnL of forearm+hand; affected carpal bone abnL M: ectopia lentis, progressive dilatation of aortic root+ascending aorta, aortic aneurysm W: supraventricular aortic stenosis; peripheral pulmonic stenosis, pulm valve stenosis, ASD, VSD, hyperCa+ |
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HEART SOUNDS
Aortic Stenosis/Pulmonic Stenosis ASD VSD Tricupsid Regurgitation Mitral Valve Prolapse Ebstein's Anomaly TOF Wolf-Parkinson White Congenital Heart Block |
AS/PS: systolic ejection; 2nd intercostal space; WIDELY SPLIT
ASD: loud S1, S2 FIXED split at ULSB; VSD: HARSH/blowing holosystolic murmur LLSB w/radiation precordium TR: Holosystolic+S3 at LLSB; asphyxia; EKG=RV hypertrophy MVP: girls; AD; systolic apical murmur w/midsystolic CLICK; nL ekg, cxr; tx PCN prophylaxis for dental procedures EA: atrialization of RV; quadruple rhythm, systolic murmur pulmonic, mid-diastolic LLSB; EKG=RA hypertrophy+ventricular block pattern R chest leads; downward displacement of tricupsid valve; TOF: ekg of RV hypertrophy; IHOP; no cyanosis first few days of life WPW: no murmurs/cyanosis, no abnLs, SVT; resolve w/in 30mins CHB: SLE, gestational diabetes, petechiae, bruising, 60HR, 40RR, hepatomegaly |
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CONSTIPATION
Hirschsprung Dz Cystic Fibrosis |
H: delayed passage of meconium; s/s green/brown vomit; insert finger for explosive stoolsstool-filled megacolon; poor tone; no wrkup need;risk of enterocolitis; dx. barium enema+rectal manometry or histochemical tissue w/inc. acetylchoinesterase and no ganglia cells; tx sx
CF: foul, smelling stools, losing wt; tx pancreatic enzymes; vit ADEK |
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BLOODY STOOLS
Peptic Ulcer Dz Meckel Diverticulum Intussusception Crohn Dz Enterohemorrhagic E. Coli |
PUD: black stools; NIGHT ab pain; GI bleed, fhx; fiberoptic endoscopy; upper Gi series
MD: reddish color stools, PAINLESS, very ACTIVE child, Fe deficient; several episodes (Tc99m), lead to bleeding/perforation/diverticulitis/volvulus; tx sx excision I: 4-10mos/o; obtunded, vomit; loose/bloody stool=red currant jelly; SAUSAGE-shaped mass in RUQ; dx contrast enema; maybe d/t meckel's or polyps C: D, fever, wt loss; periumbilical/postprandiol pain; possible arthritis/arthralgia; EEC: poorly cooked beef; sorbitol-MacConkey agar |
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AB PAIN
Hookworm Cholecystitis/cholelithiasis Pancreatitis Lactose intolerance Colic |
H: necator americanus, ancylostoma duodenale; Eosinophilia, pica, +Guiac, Anemia
C/C: Hemolytic Anemia, RUQ pain, N/V, fever, jaundice; dx U/S P: trauma and pain to back; paralytic ileus; dx Amylase; tx Supportive Care L: milk hx, distension, crampy, flatulence; dx Hydrogen Excretion in Breath after oral administration of lactose or w/d of lactose; acidic stool pH; direct enzyme measurement Colic: inc crying, fussiness, passage of flatus during evening hrs; d/t swallowed air, milk intolerance, maternal diet changes; tx Upright Position, Burping, Rocking, assistance in passing gas |
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acute BILIOUS VOMIT
-Malrotation w/volvulus |
1st few weeks;
dilated stomach+proximal bowel loops; CURLY Q twist of barium; tx sx |
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NON-BILIOUS VOMIT
Hypertrophic Pylori stenosis GERD Streaks of blood emesis Reye Syndrome WoLman dz |
PS: not look ill; thickened pylorus via u.s; 1st born males; metabolic alkalosis w/low K+ and Cl-
GERD: spit up meals since 1m; 95%growth; asymptomatic tx small feeds, thickened formula, no high-fat meals Streaks: asymptomatic; family w/similar symptoms; no intervention R: V, seizures, coma, liver failure post-ASA use; no dx tests (inc LFTs+Ammonia); support tx W: Lysosomal acid Lipase def.; HSM, D/V, FTT, icterus, malabsoprtion; KUB radiograph showing CALCIFICATION of ADRENAL gland; no tx |
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Dx SCREENS
Barium Swallow+Upper GI series Oral Reflux meds Esophageal manometry Close observation Surgical correction w/fundoplication |
Ba: antral web, pyloric stenosis, malrotation, annular pancreas
EM: poor esophageal sphincter CO: growing well, developing properly, no other med problems Sx: poor wt gain, reflux-associated apnea, bradycardia after failed pharm therapy |
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URINARY TRACT
Nephrotic causes d/t drugs Prune Belly Syndrome Diabetic Insipidious Fanconi Syndrome Vesicoureteral Reflux Urine Samples Henoch-Schonlein Purpora/Anaphylactoid Bartter Syndrome/Juxtaglomerular hyperplasia |
N: trimethadione, penicillamine, captopril, probenicid, ethosuximide, methimazole, lithium, procainamide, chlorpropamide, phenytoin, paramethadione, tolbutamide, NSAIDs, Au, Mercury-Meds
P: males, lax/wrinkled ab wall, dilated urinary tract, intra-ab testes; renal dysfx/dysplasia; oligohydramnios, pulm hypoplasia, pneumo; congenital hip dislocation, clubfeet, intestine malrotation, 2ndary volvulus DI: XR; several months old; high Na+ and K+; d/t lithium (also ATN) FS: panproximal tube dysfx; anorexia, polydipsia, polyuria, V, fevers, glucosuria (nL serum), basic urine pH, hyperchloremic metabolic acidosis, mild albuminuria; d/t outdated tetracyclines, aminoglycosides, cephalothin, cidofovir, valproic acid, streptozocin, 6-mcp, azathioprine, cisplatin, ifosfamide, heavy metals paraquat, maleic acid, glue sniff/toluene; tx by replace deficiencies VR: abnL urine movement; lead to hydronephrosis, colic pain, lethargia; Grade 1-5 (1=non-dilated; 5=dilated everything); dx fluroscopic void cystourethrogram; tx deflux endoscopic injections; low-dose antibiotics, last=sx Samples: suprapubic tap; if bladder cath, >10^3-10^4; if bag specimens & unforeskinned= contamination HSP: recent URI; incr. IgA; extensor forearm surface, legs, butt; proteinuria, microhematuria; self-limiting; periarticular swelling B: AR: HYPOKALEMIA, alkalosis, hyperaldosteronism, normotension, hypereniemia; FTT; constipation, weakness, vomit, polyuria, polydipsia; tx K+ |
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Asthma prevention
Dx Tx acute v chronic |
Air filters NOT effective.
Allergen impermeable covers for mattress and pillows DX: Hx no tests (may see eosinophilia, cxr hyperinflation/atelectasis/depress diaphragm) Tx: acure: bronchodilators or MDI; 5 day PO prednisone/IV methylprednisone Chronic: avoid triggers; inhaled corticosteroids; leukotriene receptor antagonists |
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Asthma severity
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Tx exacerbations: inhaled short B2 agonist, IV corticosteroids
4Severe: continuous, limit activity, frequent night; FEV1<60%; high corticosteroids, long bronchodilators, PO steroids 3ModeratePersistent3: daily, >1exacerbations/wk, >1 night symptoms, FEV1=60-80%, medium cortico, low/med inhaled steroids&long broncho, Consider leukotriene inhibitor/theophylline 2MildPersistent2: >2/week, <1/day, >2/month nightly, FEV>80, low dose inhaled steroid, consider leukotriene inhibitor, cromyln, theophylline 1MildIntermittent1: <2/week, asymptomatic, <2/month, FEV>80, no meds |
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REPRO MALES
Varicocele Hydrocele Spermatocele Orchitis Seminoma Embryonal carcinoma Yolk Sac Tumor epididymitis |
V: bag of worms (pampinform plexus); SMA compress L renal vein; can be mistaken for inguinal hernia; tx reassurance, educate
H: fluid d/t inguinal lymphatic system caused by repeated, chronic infection of Wuchereria bancrofti or Brugia malayi, trauma, cancer, orchitis; indirect inguinal hernia; tx observe if small; sx if large S: painless; epididymal duct; tx observe or spermatocoloectomy O: c. trachomatis, n. gonorrhea, or epididimitis; tx nsaids, cefalexin, ciprofloxacin Sem: painless; fried-egg apperance EC: painful YST: schiller-duval E: d/t gonococcal, chlamdiae, acute, painful scrotal well; UA=pyuria; tx culture, IM ceftriaxone, PO doxycycline |
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CARDIOLOGY
Rheumatic Fever Kawasaki Dz Myocarditis Paroxysmal Atrial Tachycardia Juvenile RA Tricupsid Atresia Transposition of Great Vessels Total Anomalous Pulmonary Venous Return Pulmonic Atresia Bechet syndrome |
RF: longterm antibiotic prophylaxis; JONES criteria; steroids/salcylates for enlarged heart/inflamaation; barbituarates/chlorpromazine for chorea
K: conjunctivitis, prolonged fever, limp d/t arthralgia, exanthem, adenopathy, pharyngitis; INC platelets, epidermal peelling of hands+feet; tx IVIG+high-dose ASA M: pallor, dyspnea, tachypnea, tachycardia, cardiomegaly, ADENOVIRUS/COXSACKVIRUS B, only ventricular & LA dilation+poor ventricular fx (not glycogen storage dz=muscle thickening or pericarditis=pleural effusion); if both R+L ventricular forces=glycogen storage dz PAT: >250bpm, >60RR, hepatomegaly, cardiomegaly, poor peripheral pulses JRA: spiking fevers, spindle-shaped swelling of finger joints, upper sternal pain; polyarthritis (>4), pauciarticular, rash TA: ekg=L axis deviation+ LV hypertrophy (unlike transposition of great arteries, truncus arteriosus, TOF, presistent fetal circulation); dec pulm artery blood flow; TGV: single S2, no resp distress; no cardiomegaly, nL pulm vasculature, EGG on a STRING, TAPVR: below diaphragm; obstruction; venous congestion/SNOWMAN PA: intact ventricular septum, early cyanosis, nL/diminish lung mark, cardiomegaly B: VASCULITIS of small/medium; NONdestructive arthritis in multiple large joints (knees); fever, ERYTHEMA NODOSUM, aphthous stomaitis, uveitis, CNS issues (PSEUDOTUMOR CEREBRI) |
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study biochem
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other flashcards
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NEURO
Myasthenia Gravis Guillian Barre Charcot-Marie-Tooth dz Werdnig-Hoffman Bell Palsy Todd's paralysis Supratentorial Brain Tumor Subtentorial Brain Tumor Myotonic Muscular Dystrophy Duchene Muscular Dystrophy Tuberculous meningitis Pontine Glioma Craniopharyngoma |
MG: ptosis, dysphagia, facial muscle weakness; rapid fatiguing of muscles; nL conduction velocity in motor nerve; EMG; dx study=edrophonium chloride (neostigimine for younger kids)
GB: weak LE to trunk; no DTRs; atrophy, pain; inc CSF protein; demyelination motor nerves; tx IV Ig/steroids, plasmapheresis BP: post resp infection; rapid weakness of entire side of face; CMT: peroneal&intrinsic foot muscle atrophy to intrinsic hand muscles+proximal legs WH: ant horn in utero or 1st 6mos; hypotonia, weakness, delayed developmental motor TP: follows a general/jacksonian seizure and not last more than 24-48hrs; incontinence Supra: subacute, repeated HA; gradual weakness (craniopharygioma) Sub: medulloblastoma or cerebellar astrocytoma; 50-60% of brain tumors MMD: inc. CK; late walker; clumsy; sluggish when runs/climb stairs/ground-rise/tricycle; ptosis, baldness, hypogonadism, facial immobility, neonatal resp distress, cataracts; dx. check parents' percussion & grip DMD: XR; enlarge calves; hip girdle weakness; inc lordosis; gower sign; later wheelchair use; mental impairment & cardiomyopathy; death d/t resp/cardio fail, pneumonia, aspiration TM: CT=enhanced basal cisterns, inc protein; LOW GLUCOSE (compared to viral, bacterial meningitis, stroke, pseudotumor cerebri, etc); PG: CN abnL (esp CN7, lower bulbar n), long-tract signs, unsteady gait 2ndary spasticity, behavior change; C: poor growth, papilledema; supratentorial; |
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LYSOSOMAL STORAGE DZ
Fabry's Dz Tay Sach's Metachromatic leukodystrophy Krabbe's Gaucher's Neiman-Pick Mucopolysaccharidoses Hurlers Hunters |
AR
F: XR; a-galactosidase a; ANGIOKERATITIS; older children, acroparesthesia, cataracts TS: Spot in macula (cherry); Ashkenazic Jews; CNS degeneration; Hex A deficiency; psychomotor retardation, hypotonia, pronounce startle reflex, severe hyperacusis, seizures, loss of vision, macrocephaly ML: demyelination; arylsulfatase A; cerebroside sulfate; progressive ataxia, peripheral neuropathy, gray macular lesions of eyes K: optic atrophy; globoid cells; galactocerebrosidase G: crumpled tissue paper; asepetic necrosis of femur; b-glucocerebrosidase NP: foam; cherry spot; lymphadenopathy Hurl: gargoyle; obstruction; hepatosplenomegaly; a-L-iduronidase Hunt: XR; mild hurler's+aggression; iduronate sulfatase |
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Transient Tic
Chronic motor tics Gilles de la Tourette syndrome Cerebral Palsy |
TT: #1, boys, fhx, eye blinking, facial movements, throat clearing for weeks-years, no meds (zach collar)
CMT: persist; up to 3 MUSCLE groups T: lifelong by motor/vocal tics; obsessive-compulsive behavior, ADHD; tx meds, psychosocial therapy CP: movement/posture disorder; a/w epilepsy, abnL vision, speech, intellect; defect in developing brain; no tx available but multidisciplinary approach |
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NEURO
Encephalitis Rabies |
E: change mental status; HSV=skin lesions, EBV=parotid swell; West Nile=flaccid paralysis+maculopalpular rash
R: fear of drinking h2o d/t laryngeal spasm, mouth foaming, alternating mania/stupor; no tx=death |
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INFECTION
Mumps Measles Rubella Varicella Herpangia Shigella Trichophyton tonsurans Tinea Capitis Parvovirus Group B Strep Trichinella spiralis cryptosporidium enterobius vernicularis Sporothrix schenckii Rochalimaea henselae Pseudomonas |
Mu: fever, neck muscle pain, HA, malaise; pain behind mandible; swell in front/back of ear; not tolerate sour liquids/taste; no rash
Measles/rubeolla: cough coryza, conjunctivitis, maculopapular rash, koplick spots, erythematous maculopapular rash Rubel: diffuse maculopapular rash last 3 days; posterior cervical/occipital LNs; diffuse maculopapular rash; V: prodrome fever, anorexia, HA mild Ab pain; rash starts on scalp; pruritic H: sudden fever, HA, backache, vomit Shig: brief, generalized tonic clonic seizure, febrile, nL LP; large, watery stool w/blood; dx stool culture; tx supportive TT: koh prep, (-)wood's lamp TC: not seborrhea; 6m-puberty Pb19: erythema infectiosum/5thDz; serious anemia; lead to 2ndary hydrops fetalis; roseola/viral exanthum GBS: meningitis; bulge fontanelle, seizures, nucahl rigidity; dx LP; tx antibiotics TS: weakness, fever, eosinophilia; C: diarrhea of immunocompromised; epidemics of daycare centers; dx stool culture EV: rectal itch SS: infect cutaneous and subcutaneous tissue RH: cat-scratch dz; fleas=transmission factor; P: opportunistic d/t burns, trauma, swimming pools; prefer warm/moiste environments (unlike staph); |
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VACCINATION
Flu -d/t |
pts on long-term ASA therapy
d/t (chronic cardiac, pulm, heme, neuro) |
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Kawasaki+Scarlet Fever
Mononucleosis Osteomyelitis Periorbital v. Orbital Cellulitis SJS |
K+S: similar scarlatiniform rash, desquamation, erythema of mucous membranes, cardiac involvement; tx ASA, IV gamma globulin
Mono: diffuse adenopathy, tonsillar enlargement, enlarge spleen, small hemorrhages of soft palate, periorbital swelling Ost: d/t deep cellulitis; s. aureus; dx on clinical grounds; no x-ray; bone scans w/radionuclides; tx 3 wks antibiotics P: proptosis, pain, edema of conjunctiva, opthalmoplegia, dec visual acuity Orb: infection of adjacent paranasal sinus SJS: erythema multiforme, vesicular, ulcerated lesions of mucous membranes of eyes, mouth, anus, urethra |
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IMMUNE ABNLS
DiGeorge Bruton Wiskott-Aldrich Severe Combined Immunodeficiency Dz Job Buckley |
Di: T-cell dz; CATCH: cardiac, abnormal faces, thymic hypoplasia, Cleft palate; HypoCa++
B: B-cell dz; 3mos/o; recurrent OM, pneumonia, diarhea, sinusitis WA: T,B-cell dz; dec IgM, inc IgA+IgE; ECZEMA, recurrent OM, lymphopenia, thrombocytopenia SCID: T,B cell deficiency; marked lymphopenia, agammaglobulinemia; hypoplasia of thymus; chronic diarrhea, recurrent, serious bacterial/fungal/viral infections; WASTING JB: phagocytic chemotaxis; incr IgE; eczema-like rash, severe staph infections |
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PNEUMONIA TYPES
Chlaymdia Mycoplasma Staph Tuberculosis |
C: 1-3mos/o; rales; HYPERINFLATION w/interstitial infiltrates
M: HA, malaise, fever, LRI; dyspnea/fever WORSENS; interstitial/bronchial patter of lower loes S: several days T: high-risk group; variable clinical/cxr for kids; hilar lymphadeonapthy, focal hyperinflations, atelectasis |
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HEME
Idiopathic Thrombocytopenia Purpura Thrombic Thrombocytopenia Purpura G6PD Eosinophilia Fetomaternal Transfusion ALL poor prognosis DIC Spherocytosis a/w Hodgkins |
ITP: most common; preceding viral infection; dx of exclusion; PC<20k w/other nL labs; tx exogenous IV gamma globulin
TTP: rare in kids G6PD: pallor, dark urine, jaundice; HEINZE BODY; (-)coomb's test; AA, greek, chinese, middle eastern FMT: pale but nL PE; Mom=A, Rh+; Baby=O, Rh-; no blood-group incompatibility ALL: <12mos or >10-15yrs; CNS leukemia, WBC>100k, mediastinal mass DIC: mutliple nonblanchin purple lesions of varioius sizes scattered on the trunk/extremities; petechiae; fragmented cells, few platelets, inc PT/PTT, dec [fibrinogen], inc fibrin split products, inc thrombin generation E: NAACP: Neoplasm, Allergy/ Asthma/eczema, Addison's disease, Collagen vascular diseases, Parasites (helminth); serum sickness, angioneurotic edema S: hyperthermia, G6PD, ABO incompatibility (not Rh) H: younger age if underdeveloped country; swollen neck/groin glands; inc cough; fevers, wt loss; no hepatosplenomegaly; dx CXR, |
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Tdap v. Td booster; adults v. children
6mos, 2yrs, 4yrs 1 yr |
Tdap: 10 yrs (11-12y/o)
Td: 2 yrs adults every 10 yrs; no Tdap or Td 6mos, 2yrs, 4yrs: HepB, IPV, Rotovirus, vitamins, Fluoride 2yrs: pneumo 1yr HepA V: no hx of chickenpox MMR: no booster 4-6y/o |
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Vaccine
hep A Hep B Meningococcal Flu |
A: chronic liver dz, homo male sex, travel to countries
B: high risk of exposure, health prof, lots of partners, etc Men: asplenia or endemic countries; also age 11-12, freshman dorms, military base Flu: older than 6 mos. |
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Pneumococcal vaccine
PPD sizes indicating positivies |
One time vaccination; Older than 65
Unless cardio, pulm, renal, hepatic dz or disbetes, immunodeficiency, asplenic when received before 60y/o Ppd: nL people15mm; highly suspicious10mm; hiv5mm |
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BUG BITES
Tick Scorpion Black Widow SPider Brown Recluse Spider Larval Migrans Tularemia |
T: rocky mountain; red macules on peripheral extremities-->purpuric, confluent.paralysis, ataxia, areflexia 1-2d later and ascends; tx remove it;
Scor: severe rxn pain+swell; severe systemic rxn w/shock, excess salivation, convulsions;TX tourniquets, phenobarbital, specific antivenins Black: painful local rxn w/systemic; N/V, sweating, HTN, ab pain; TX meperidine, IV CaGluconate, antivenin Brown: chronic skin ulceration Larval: barefoot beach walk in mexico Tularemia: pain, ulceration |
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BLOOD SMEAR
Howell Jolly Bodies PMNS Target Cell Uniformly small microspherocyte HLA matching |
HJB: sickle cell anemia; smal nucelar remnants
PMNS: folic acid def T: HALT: Hgb C dz, Asplenia, b-thalassemia, Liver dz, obstructive jaundice, cirrhosis, heart failure, hepatosplenomegaly Small: spherocytosis, immune hemolytic anemia, microangiography, ABO incompatibility, hypersplenism; tx phototherapy HLA: unrelated, identical twins can match |
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ENDOCRINE
Early Onset of nL puberty (constitutional) Constituionally Short stature Achondroplasia Morquio Bone Age +RF inc/dec growth Rickets Kleinfelter dx Testicular feminazation |
Early: nL girl w/acne, breast dvlpmt, fine pubic hair
Short: consistent growth rate; puberty=14y/o or else delayed is nL for short; bone age=chronological age A: disproportionate (unlike GH def proportionate); prominent foreheads; marked lumbar lordosis; stubby fingers M: excess mucopolysaccharidoses; disporportionate Bone Age: 9y/o is best indication; advanced in congenital adrenal hyperplasia; retarded by thyroxine, FTT, glucocorticoid excess R: exclusive breast-feed; no vitamin supplement; limit sun exposure; hypocalcuria; inc alkaline phosphatase; low PO4 nL Ca Klein: buccal smear+karyotyping (XXY) TF: bilateral inguinal hernias; otherwise nL; develop breast buds, female body habitus b/c androgen resistance |
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Acute Lymphotic Thyroditis
Autoimmune Thyroiditis Hashimoto Thyroditis/chronic lymphotic Congenital Dysgenetic Thyroid Gland Medullary Carcinoma Thyroid |
LT: asymptomatic; more girls; tx synthroid (v. Subacute=painful)
AT: a/w addison dz; insulin-dependent DM HT: +antimicrosomal ab; high antithyroidglobulin titer C: d/t rubella; late-onset (age 13) D: 12y/o; hot nodule; palpable; not euthyroid MCT: nL PO4, nL Ca++ |
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Cushing Syndrome
Congenital Adrenal Hyperplasia Bilateral Adrenal Hyperplasia Hyperaldosteronism Panhypopituitarism Pseudohypoparathyrodism (albright hereditary osteodystrophy) PraderWili Laurence-Moon-Biedl Syndrome Hypercalcuria Hyperglycemia measure Inadequate stores of nutrients HypocCa++ Osteogenia imperfecta |
C: primary adrenal abnormality (adenoma/carcinoma) or 2ndary hypercortisolism d/t excess adrenocorticotropin
CAH: nL PE, vomit, dehydration, hyperpigment nipples; Na=120, K=9, Glucose=120 BAH: central fat distribution, arrested growth, HTN, plethora, purple striae, osteoporosis; dx measure evening cortisol levels HA: dec K+; conn syndrome is rare for kids PanH: apnea, cyanosis, severe hypoglycemia Pseudo: low Ca, high P, high PTH; mental retardation, short stature, obesity w/round facies, short neck, subscapular cataracts; delayed bone age, mental retardation, BRACHYDACTYL(4th, 5th digits), CALCIFICATIONSof BG PW: severe hypotonia, poor feeding since birth LMB: AR: obese, mental retardation, POLYDACTYL, hypogonadism, NIGHT blindness, retinitis pigmentosa; LITTLE MOVEment in utero; HyperCa+: depress, listless, N, constipation, microscopic hematuria, HTN, Ca++/Cr ratio>0.2; HyperG: Hba1c measure 2-3mos Inadequate: glu=20mg/dL; SGA; HypoCa: tetany, convulsions; mom=DM, pregnancyHTN; SGA preme; incr Mg, intracranial hemorrhages, transient/permanenet hypothyroidism OI: nL PO4+Ca |
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Wilson
Menke |
Wilson: AR; HSM, intention tremor, dysarthria, dystonia, deteriation in school; abnL urine b/c fanconi (inc glucose, protein, uric acid); Asterxis, BG degen, low Ceruloplasmin, Caiser rings, Cirrohosis, Cu deposits, Dementia
Menke: XR, Cu def; 1st months; hypothermia, hypotonia, myoclonic seizures; chubby, rosy cheeks, kink colorless friable hair; severe MR; tx IV/SQ Cu injections and symptoms |
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TANNER STAGES
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BOYS GENITALIA
(2) inc scrotum+testes (3)inc penis (4) inc penis; darker scrotum BOOBS (2) breast+papilla (4) 2ndary mound of papilla/areola (5) only papilla PUBIC HAIR (2) sparse (3)darker (4) adult but smaller (5) larger areas |
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ADOLESCENCE
Neglect Schoolwork/no future Excessive concern of well-being+physical symptoms Constant quarrel w/friends Bickering w/siblings Superficial romantic attractions fueled more by fantasy Attempt Suicide Eating disorders Young Pregnancy Bulk Up |
Neglect: immaturity, depression
Excess: anxiety, depression Friends: no flexibility or accomodation Siblings: nL Romance: rehearsals for more serious attachments to come Suicide: hospitalization; boys more completed suicides; attempts=girls; Eating: unappreciable by parents until 10% wt loss; BULIMICS=esophageal varices, hemorrhage, dental decay, swollen reddened irritated uvula, Depression; ANOREXIA=25-30%wt loss; dehydration, hirsutism, loss of hair on head, bradycardia, cardiac conduction, hypocardia, hypothermia, impaired renal fx, multiple malnutrition effects, amenorrhea1or2, osteoporosis, OCD/narcisstic personality; tx IMIPRAMINE YP: higher risk of preeclampsia, eclampsia; high prematurity Bulk Up: inc muscle work; harmful/not helpful=vitamines, proteins, meds, hormones |
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ADOLESCENCE SEX
HSV Urethritis tx Torsion of Testes Epididymis Tubovarian abscess |
HSV: dx only when symptomatic
U: tx by ceftriaxone, doxycycline b/c for gonococcal+nongonococcal (can use azythromycin 1x) TT: no cremasteric reflex, hard to examine; +prehns sign=worsen; dx U/S; tx sx E: +sex hx/UTI; dx inc uptake w/radionuclide scan; n. gonorrhoea/chlamydia, tx antibiotics TA: lower ab pain, fever, tender adnexal mass; irregular periods, vag d/c; new sex partner; long term sequelae of ectopic pregnancy |
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SEX Dx Studies
Chocolate Agar Medium Tzanckprep |
CAM: HAEMOPHILUS DUCREYI; small papules on labia and perineum; inguinal adenopathy at same time as chancroid unllike (lymphogranuloma venereum)
Tzanck: painful, erythematous small vesicles/ulcers on glans penis; HSV, VZV, CMV |
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SPORTS INJURIES
Swimmers Football Basketball/Volleyball Running Ballet Wrestlers Ski Hockey |
Swim: rotator cuff tendinitis of biceps and/or supraspinatus; shoulder pain/tenderness
Foot: ACL, PCL, collateral ligament tears, truf toe B/V: knee; osgood-schlatter dz, sprains to knee ligaments; ankle injuries Run: strains of hamstrings, adductors, soleus, gastrocnemius; runner's knee=anterior knee pain d/t patellofemoral stress Ballet: delayed menarche, eating disorders; bunions, overuse knee, ankle Wrestlers: shoulder subluxation; prepatellar bursitis; variety of skin dz (herpes simplex (gladiatorum), impetigo, staphylococcus furunculosis/folliculitis Ski: skier's thumb (abd, hyperE=sprain of ulnar collateral ligament) Hockey: mild contusions, significant lacerations; teeth loss |
