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155 Cards in this Set
- Front
- Back
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zones of the neck for evaluation of penetrating trauma
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ZONE 1: clavicle --> cricoid
ZONE 2: cricoid --> angle of the mandible ZONE 3: angle of the mandible --> skull base |
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Next step in evaluation of a neck penetrating injury
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Zone 1 = 4-vessel CT angio + triple endoscopy
Zone 2 = surgical exploration Zone 3 = 4-vessel CT angio |
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Cardinal movements of labor
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engagement
descent flexion internal rotation extension external rotation expulsion |
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Rx & Tx:
IVDA has JVD, holosystolic murmur at the left sternal border |
Rx: tricuspid regurg (2nd/2 bacterial endocarditis)
Tx: empiric vancomycin, tx heart failure, replace tricuspid valve |
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age for separation anxiety
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9 months
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age for gender identity
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2-3 years
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how does weight increase in first 2 years
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4 months = doubles
1 year = triples 2 years = quadruples |
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age to begin solid foods
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4-6 months
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age to drink cows milk
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1 year
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best first solid food for a baby
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iron-fortified cereal
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car seats in children <2
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rear-facing
middle, back seat |
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car seats in children 2-4
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front-facing
back seat |
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car seats in children 4-12
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car seat until outgrown
booster seat in the back until child is 4'9" AND 8-12 y/o |
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when booster seat is outgrown what must be used
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lap/shoulder seat belt
rear seat |
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at what age can children usually begin to sit in the front seat
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>/= 13 y/o
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how many DTaP vaccines does a 6 y/o recieve
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5
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what age is a meningococcal vaccine indicated
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after age 11
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Why shouldnt cow's milk be used before 1 year
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a/w hemorrhagic gut
a/w development of allergies low in iron --> iron-def anemia |
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social/cognitive, gross motor, fine motor, & language milestones:
2 months: |
SOCIAL/COGNITIVE:
social smile GROSS MOTOR: lifts head 45 degrees FINE MOTOR: eyes follow object to midline LANGUAGE: coos |
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social/cognitive, gross motor, fine motor, & language milestones:
4 months |
SOCIAL/COGNITIVE:
laughs aware of caregiver localizes sound GROSS MOTOR: lifts head 90 degrees FINE MOTOR: eyes follow object past midline LANGUAGE: coos |
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social/cognitive, gross motor, fine motor, & language milestones:
6 months |
SOCIAL/COGNITIVE:
differentiates parents from other people stranger anxiety GROSS MOTOR: rolls over holds self up with hands sits without support FINE MOTOR: grasps/rakes attempts to feed self LANGUAGE: babbles |
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social/cognitive, gross motor, fine motor, & language milestones:
9 months |
SOCIAL/COGNITIVE:
interactive games separation anxiety (9-15 months) GROSS MOTOR: crawls pulls to stand FINE MOTOR: "pincer" grasp LANGUAGE: first words |
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social/cognitive, gross motor, fine motor, & language milestones:
12 months |
SOCIAL/COGNITIVE:
separation anxiety (9-15 months) GROSS MOTOR: walks with help FINE MOTOR: makes tower of 2 blocks LANGUAGE: 5 - 10 word vocabulary |
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social/cognitive, gross motor, fine motor, & language milestones:
18 months |
SOCIAL/COGNITIVE:
parallel play GROSS MOTOR: walks well walks backward FINE MOTOR: makes tower of 4 blocks uses cup or spoon LANGUAGE: 10 - 50 word vocabulary 2-word sentences (e.g. "me want") |
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social/cognitive, gross motor, fine motor, & language milestones:
2 years |
SOCIAL/COGNITIVE:
dresses self with help GROSS MOTOR: runs climbs stairs FINE MOTOR: makes tower of 6 blocks LANGUAGE: 50 - 75 word vocabulary 3-word sentences (e.g. "me want milk") |
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social/cognitive, gross motor, fine motor, & language milestones:
3 years |
SOCIAL/COGNITIVE:
magical thinking GROSS MOTOR: climbs/descends stairs FINE MOTOR: makes tower of 9 blocks able to draw circle, arrow |
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social/cognitive, gross motor, fine motor, & language milestones:
4 years |
SOCIAL/COGNITIVE:
plays with others GROSS MOTOR: hops on 1 foot FINE MOTOR: able to draw line image ("+") able to draw closed line image (triangle) LANGUAGE: 250+ word vocabulary 4-word sentences (e.g. I want some milk) |
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social/cognitive, gross motor, fine motor, & language milestones:
6 years |
SOCIAL/COGNITIVE:
able to distinguish fantasy from reality GROSS MOTOR: skips FINE MOTOR: draws a person LANGUAGE: fluent speech |
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childhood reflexes, their assoc'd CNS areas, & timing of disappearance
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MEDULLA & VESTIBULAR NUCLEI:
moro (3 months) grasp (3 months) tonic neck (3 months) MEDULLA & TRIGEMINAL NUCLEI: rooting (3 months) CORTEX: placing (2 months) |
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what is the moro reflex
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"startle" reflex:
extension of head (head falls back) causes extension & flexion of limbs (try to catch themselves from falling ) |
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what is the grasp reflex
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placing finger in infants palm causes grasping of finger
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what is the tonic neck reflex
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"fencer's position"
when head is turned, arm on face-side extends while the arm on opposite side flexes |
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what is the rooting reflex
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rubbing infants cheek causes turning of mouth toward stimuli (as if to feed from mother's breast)
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what is the placing reflex
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rubbing foot dorsum causes foot to step up
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vaccination schedule:
Hep B |
3 HEP B VACCINES:
birth - 2 months 4 months 6 months |
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vaccination schedule:
Rotavirus |
3 ROTAVIRUS VACCINES:
2 months 4 months 6 months |
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vaccination schedule:
DTaP |
5 DTaP VACCINES:
2 months 4 months 6 months 12-15 months 4 - 6 years + 1 TDaP BOOSTER: 11 - 12 years |
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vaccination schedule:
HiB |
4 HIB VACCINES:
2 months 4 months 6 months 12 - 15 months |
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vaccination schedule:
PCV (pneumococcal) |
4 PCV VACCINES:
2 months 4 months 6 months 12 - 15 months |
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vaccination schedule:
IPV (polio) |
4 IPV VACCINES:
2 months 4 months 6 - 15 months 4 - 6 years |
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vaccination schedule:
MMR |
2 MMR VACCINES:
12 - 15 months 4 - 6 years |
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vaccination schedule:
VZV (varicella) |
2 VZV VACCINES:
12 - 15 months 4 - 6 years |
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vaccination schedule:
Hep A |
2 HEP A VACCINES:
12 - 18 months (given in 2 doses, at least 6 months apart) |
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vaccination schedule:
MCV4 (meningococcal) |
2 MCV4 VACCINES:
11 - 12 years 13 - 18 years |
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vaccination schedule:
HPV |
3 HPV VACCINES:
11 - 12 years (given as 3 doses over 6 month period) |
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vaccination schedule:
Influenza |
INFLUENZA VACCINE:
annually starting at 6 months |
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Total number of shots given for all vaccines:
Hep B, Rota, DTap/TDaP, HiB, PCV, IPV, MMR, VZV, Hep A, MCV4, HPV |
3 Hep B
3 Rota 6 DTap(5) / TDaP (1) 4 HiB 4 PCV 4 IPV 2 MMR 2 VZV 2 Hep A 2 MCV4 3 HPV |
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Rx for roseola infantum
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antipyretics
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Rx for cerebral palsy to alleviate contractures and improve function
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PHARMACOLOGICAL:
dantrolene baclofen benzo botox NON-PHARMACOLOGICAL: PT bracing surgery |
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Rx for mastitis
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continue breast feeding (must get infection out)
oral antibiotics |
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number of calories in breast milk/formula
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20 kcal/ounce (same in each)
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caloric needs for an infant younger than 6 months
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100-120 kcal/kg/day
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work up performed on a newborn with a single umbilical artery
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Renal US
(up to 7% will have clinically significant, but asymptomatic, renal anomalies) |
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MC problems in a premature infants
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TOP 4:
RDS retinopathy of prematurity intraventricular hemorrhage necrotizing enterocolitis OTHERS: hypoglycemia persistant PDA infection/sepsis |
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what is caput succedaneum
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diffuse swelling or edema of the scalp
DOES cross suture lines resolves within a few days |
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what is cephalohematoma
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subperiosteal hemorrhage
DOES NOT cross suture lines resolves in weeks to months |
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next step in a newborn with bloody vaginal d/c in the 1st wk of life
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reassurance (to parents)
normal 2nd/2 fetal withdrawal form maternal hormones (e.g. estrogen) |
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what is cutis marmorata
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spider webbing/marbling of the skin
non-concerning |
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what is erythema toxicum neonatorum
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2-3 mm yellow pustule with red base
(similar in appearance to a white head) usual gone in 3 weeks tell parents to leave alone microscopic examination: NOT necessary for dx) numerous eosinophils |
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what does microscopic examination of erythema toxicum neonatorum show
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eosinophils (NOT necessary for dx)
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what is harlequin color change
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GRAVITY-DEPENDENET SIDE:
intense reddening GRAVITY-NONDEPENDENT SIDE: blanching LINE OF DEMARCATION: between the 2 sides |
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pathophysiology & tx:
harlequin color change |
PATHOPHYS:
immaturity of autonomic innervation to skin vessels TX: none; resolves in days to 3 wks |
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what are macular stains
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aka stork bites
vascular malformations usually found in the nape of the neck (also upper eyelids & middle of forehead) benign but permanent |
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what is milia (miliaria)
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2nd/2 accumulation of sweat beneath eccrine sweat ducts that are obstructed by keratin at the stratum
corneum develops in 1st week after birth a/w excess warmth (e.g. incubator, excess clothes, fever) Tx: reduce sweating (e.g lose clothing & cool baths) |
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what are mongolian spots
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bluish discoloration over buttocks & base of spine
benign; fades in 1 - 2 yrs document findings (to avoid later confusion with bruises) |
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compare acne neonatorum vs infantile acne
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ACNE NEONATORUM:
onset 3 weeks of age maternal hormone stimulation of sebaceous glands Tx mild: leave alone; resolves in 4 months Tx severe: benzoyl peroxide & topical retinoids INFANTILE ACNE: onset 3-4 months of age Tx mild: leave alone; resolves by 1 - 3 years Tx severe: benzoyl peroxide & topical retinoids |
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what are transient neonatal pustular melanosis
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superficial pustules overlying hyperpigmented macules
tell parents to leave alone |
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Rx for thrush in infants
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nystatin oral suspension
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what is craniosynostosis; next step in management
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premature closure (< 3 months) of cranial sutures
next step: measure head circumference |
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what is expected time frame of closure of anterior fontanelle
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3 months: 1%
12 months: 38% 24 MONTHS: 96% |
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what is craniotabes
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soft occipital bone (like a ping pong ball) from 3 - 12 months of age
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what should be suspected with craniotabes
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rickets
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MCC's of delayed closure of anterior fontanelle
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downs
achondroplasia rickets hypothyroidism increased intracranial pressure |
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interventions to prevent SIDS
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sleeping on back
firm sleeping surface avoid soft objects in bed avoid overheating pacifier use while sleeping avoid smoking |
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questions for adolescents in annual exam
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"SHADESSS:
Strengths home environement activities drugs education/employment sexual activity suicide (or depression) safety |
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MCC of death in adolescents
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accidents (2nd/2 incr'd risk-taking activity)
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vasopressor:
causes renal vasodilation (theoretically) |
dopamine
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vasopressor:
high doses optimize alpha-1 vasoconstriction |
epinephrine
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vasopressor:
ADH analogue |
vasopressin
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vasopressor:
DOC for anaphylactic shock |
Epinephrine
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vasopressor:
DOC for septic shock |
NE
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vasopressor:
DOC for cardiogenic shock |
dobutamine
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vasopressor:
causes vasoconstriction with bradycardia |
phenylephrine
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med used to accelerate fetal lung maturity
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betamethasone or dexamethasone
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how long is betamethasone/dexamethasone given
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48 hours
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when does betamethasome/dexamethasone stop working
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>34 weeks
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a/w red currant jelly stools
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intussuception
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timeline of measles
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MEASLES (aka rubeola):
9 - 10 days (from prodrome to resolution of rash) PRODROME: lasts 2 - 3 days KOPLICK SPOTS appear 1 - 2 days after prodrome onset occurs 2 days prior to rash RASH: 5 days after prodrome onset duration 4 - 5 days |
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features of the measles timeline (i.e. prodrome, koplick spots, & rash)
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PRODROME:
fever, malaise, anorexia 3 C's: cough, coryza, conjuctivitis KOPLICK SPOTS (pathognomonic for measles): white-gray spots w/red base on buccal mucosa RASH: erythematous, maculopapular rash spreads from head --> feet resolves from head --> feet |
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what is coryza
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"CORYZA" = "COLD" SX'S:
nasal mucosa inflammation, giving rise to nasal congestion & loss of smell (source: Wikipedia) |
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Rx for measles
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supportive care (antipyretics, fluids)
monitor & tx superinfections, if necessary Vit A (NOTE: Rivavirin not well studied; not currently standard of care) |
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features of rubella
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aka German Measles
PRODROME: fever malaise anorexia LYMPHADENOPATHY: suboccipital posterior cervical RASH: 1 - 5 days after start of prodrome starts on face and generalizes POLYARTHRITIS: may be seen for up to 1 month especially, women & adolescents |
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features of coxsackie
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aka hand, foot, & mouth disease
CONSTITUTIONAL: fever anorexia MUCOUS MEMBRANES: oral vesicles on buccal mucosa & tongue RASH: hands & feet (sometimes butt) duration: 3-5 days |
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features of scarlet fever caused by strep pyogenes
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CONSTITUTIONAL:
fever/chills ORAL MUCOSA: positive throat culture or rapid strep test strawberry tongue beefy-red pharynx cervical lymphadenopathy RASH: "sandpaper-like" (coarse to touch) "sunburn-like" (erythematous & blanching) starts at trunk and generalizes spares palms and soles later desquamation of hands & feet |
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features of roseola
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CONSTITUTIONAL:
sudden, high fever (> 102F) for 3 - 4 days no other signs of infection child often acts/plays normally RASH: onset: when fever disappears trunk --> entire body duration: 24 hours ORAL MUCOSA: erythematous papules on soft palate and uvula OTHER SX'S: mild cervical lymphadenopathy edematous eyelids bulging anterior fontanelle (infants) |
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common misdiagnoses of roseola
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misdx'd as acute otitis media --> tx'd as such--> rash
misdx'd as subsequent antibiotic allergy (b/c onset of roseola rash appears when fever subsides 3-4 days later) |
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what is the treatment for roseola infantum
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antipyretics as needed
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causes of acute, bilateral cervical lymphadenitis
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VIRAL URI: rhinovirus, adenovirus, influenza, GAS
VIRAL MONO: ebv, cmv, mycoplasma OTHER VIRAL: HIV, HSV |
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causes of acute, unilateral cervical lymphadenitis
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BACTERIAL:
S. aureus, GAS >> ANAEROBES, GBS |
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causes of chronic unilateral cervical lymphadenitis
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Bartonella (cat scratch fever)
Toxoplasmosis TB (scrofula) Actinomyces (sinuses drain pus) |
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causes of noninfectious cervical lymphadenitis
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kawasaki
hodgkin's lymphoma |
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what is PFAPA syndrome
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PF = periodic fever
A = aphthous ulcer P = pharyngitis A = adenitis |
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Rx for PFAPA syndrome
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steroids (sx'c relief within hours)
cimetidine (prevention of episodes) |
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what are the different stages & classic sx's of pertussis
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INCUBATION:
7 - 10 days asymptomatic CATARRHAL 7 - 10 days mild URI sx's PAROXYSMAL 7 - 10 days paroxysms of cough with inspiratory "whoop" worse at night often post-tussive emesis & exhaustion CONVALESCENT 2 - 3 weeks waning of sx's |
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Rx for pertussis
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ISOLATION from school/day care:
until AB's x 5 days if untx'd, 3 weeks after onset of sx's MACROLIDE ANTIBIOTIC: azithromycin (5 days) clarithromycin (7 days) erythromycin (14 days) TMP-SMX (14 days) PROPHYLAXIS: close contacts - full course of one of the above AB's) |
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what is needed to work up in a child diagnosed with a UTI
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VCUG
RENAL US, if: 2 m/o - 2 y/o female < 3 y/o (or unable to verbalize urinary sx's) febrile UTI recurrent UTI's other red flags (abnl void pattern, poor growth, FHx of renal ds, HTN, urinary tract abnl's) |
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what are some causes of desquamation of the hands and feet
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kawasaki
scarlet fever acrodynia (i.e. mercury poisoning) TSS SJS |
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which viral infection is characterized by rash that appears when fever dissipates
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roseola infantum (HHV-6)
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features of immunodeficiency:
Bruton's Agammaglobulinemia |
X-LINKED (boys)
B-CELL DEFICIENCY: defective tyr kinase gene --> low levels of all Ig's no B-cells on smear INFECTIONS: recurrent bacterial infections after 6 months |
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features of immunodeficiency:
Thymic Aplasia |
aka DiGeorge Syndrome
3RD/4TH POUCHES FAIL TO DEVELOP: No thymus --> no T-cells (no thymic shadow on CXR) No parathyroids --> no PTH --> low Ca2+ --> tetany INFECTIONS: recurrent viral, fungal, protozoal infections A/W CONGENITAL DEFECTS: 90% have chrom 22q11 deletion congenital heart/great vessels defect |
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features of immunodeficiency:
Severe Combined Immunodeficiency (SCID) |
EARLY STEM CELL DIFFERENTIATION DEFECT:
7+ gene defects --> adenosine deaminase def Defective B-cells & T-cells No thymic shadow on CXR DO NOT GIVE live vaccines TRIAD: Severe recurrent infections: chronic mucocutaneous candidiasis RSV, VZV, HSV, measles, influenza, parainflenza PCP pneumonia Chronic diarrhea Failure to thrive |
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features of immunodeficiency:
Chronic Mucocutaneous Candidiasis |
T-CELL DYSFUNCTION vs. C. Albicans
Rx: Antifungals (ketoconazole, fluconazole) |
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features of immunodeficiency:
wiskott-aldrich syndrome |
"WAITER"
W = Wiskott A = Aldrich I = Immunodeficiency T = Thrombocytopenia --> pupura E = Eczema (central --> trunk) R = Recurrent pyogenic infections |
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features of immunodeficiency:
ataxia-telangiectasia |
IgA DEFICIENCY:
incr'd cancer risk: lymphoma & acute leukemias radiation sensitivity (avoid x-rays, if possible) +/- incr'd AFP in children > 8 months ATAXIA: cerebellar ataxia poor smooth pursuit of moving target with eyes TELANGIECTASIA: telangiectasias of face > 5 y/o |
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features of immunodeficiency:
selective immunoglobulin deficiencies |
MC = IgA DEFICIENCY:
most "appear" healthy recurrent sinus & lung infections a/w atopy, asthma possible anaphylaxis to blood transfusions & blood products |
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features of immunodeficiency:
chronic granulomatous disease |
PHAGOCYTES LACK NADPH OXIDASE ACTIVITY:
susceptible to catalase+ bugs (S. Aureus, E. Coli, Klebsiella spp., Aspergillus spp., Candida spp.) DX: NEG NBT (NitroBlue Tetrazolium) test TX: prophylactic TMP-SMX IFN-gamma also helpful |
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what is a normal NitroBlue Tetrazolium (NBT) test
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"normal" = NBT+
pigment changes from yellow --> blue-black as it is metabolized by macrophages via NADPH oxidase |
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features of immunodeficiency:
chediak-higashi disease |
DEFECTIVE PHAGOCYTIC LYSOSOMES
defective LYST gene (lysosomal transport) Dx'c: giant cytoplasmic granules in PMN's TRIAD: partial albinism recurrent respiratory tract & skin infections neurologic d/o's (peripheral neuropathy & seizures) |
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features of immunodeficiency:
job syndrome |
HYPERIMMUNOGLOBULIN E SYNDROME:
Deficient IFN-gamma --> PMNs fail to respond to chemotactic stimuli (e.g. C5a, LTB4) High levels of IgE & eosinophils TRIAD: eczema recurrent cold S. Aureus abscesses course facial features [broad nose, prominent forehead ("frontal bossing"), deep set eyes, & "doughy" skin] RETAINED PRIMARY TEETH is common |
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features of immunodeficiency:
leukocyte adhesion deficiency syndrome |
ABNORMAL INTEGRINS:
phagocytes unable to exit circulation e.g. delayed separation of umbilicus |
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immunodeficiency:
congenital heart defect + low calcium + recurrent infections |
DiGeorge Syndrome
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immunodeficiency:
candidiasis + chronic diarrhea + failure to thrive |
SCID
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immunodeficiency:
negative nitroblue tetrazolium test |
CGD
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immunodeficiency:
poor smooth pursuit of eyes + elevated AFP after 8 months |
Ataxia-Telangiectasia
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immunodeficiency:
partial albinism + recurrent URI's +neurological d/o's |
Chediak-Higashi Syndrome
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when do infections typically begin in children with immune d/o's
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3 months of life
(circulating maternal Ig levels no longer high enough to fight infectious insults) |
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what is cradle cap; what is tx
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seborrheic dermatitis
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what is the treatment for cradle cap
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selenium sulfide shampoo
topical antifungals |
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what causes bilious emesis in a newborn
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duodenal atresia
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MCC's of brain tumors in adults
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"MGM Studios"
metastasis glioblastoma multiforme meningioma schwannoma |
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MCC's of brain tumors in children
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astrocytoma
medulloblastoma ependymoma |
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Dx
female in 80th percentile of height and 25 percentile in head circumference with chromosomal abnormality |
47 XXX
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malignancy a/w downs
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ALL
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GI complication a/w downs
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duodenal atresia
hirschsprung celiac disease annular pancreas |
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MCC of mental retardation in men
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fragile X
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MC malformation of head and neck
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unilateral cleft lip
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features of fetal alcohol syndrome
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short palpebral fissures
thin upper lip smooth philtrum flattened midface < 10th percentile for head circumference < 10th percentile for height & weight disproportional low wt to ht FTT (despite adequate intake) |
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defect a/w lithium use during pregnancy
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Dx: Ebstein's anomaly
ATRIALIZATION OF VENTRICLE: tricuspid leaflets displaced into right ventricle hypoplastic right ventricle tricuspid regurg; wide split S2 PATENT FOREMAN OVALE (80%): R--> L shunt DILATED RIGHT ATRIUM: incr'd risk of SVT & WPW |
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features of tuberous sclerosis
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DERMATOLOGIC:
distinctive brown, fibrous plaque on forehead ash leaf spots (hypopigmented macules) shagreen patch (leathery cutaneous thickening) facial angiofibromas (aka adenoma sebaceum) NEUROLOGIC: seizures MR |
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glycogen storage disease:
lactic acidosis, hyperlipidemia, hyperuricemia |
von gierke's (type I)
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glycogen storage disease:
diaphragm weakness --> respiratory distress |
pompe's (type II)
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glycogen storage disease:
increased glycogen in liver, severe fasting hypoglycemia |
von gierke's (type I)
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glycogen storage disease:
hepatomegaly, hypoglycemia, hyperlipidemia (normal kidneys, lactate and uric acid) |
cori's (type III)
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glycogen storage disease:
painful muscle cramps, myoglobinuria with strenuous exercise |
mcardle's (type V)
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glycogen storage disease:
severe hepatosplenomegaly, enlarged kidneys |
von gierke's (type I)
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genetic disorder:
cleft lip/palate, polydactyly |
patau (trisomy 13)
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genetic disorder:
high pitched cry |
cri du chat
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genetic disorder:
elfin facies with cardiac defects |
william's
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genetic disorder:
tall, thin man with gynecomastia and testicular atrophy |
kleinfelter's
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genetic disorder:
obesity and overeating |
prader-willi
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genetic disorder:
micrognathia, rocker bottom feet |
Edward (trisomy 18)
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genetic disorder:
happy mood, inappropriate laughter, ataxic gait |
angelman's
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genetic disorder:
large ears, MR, macroorchidism |
fragile X
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genetic disorder:
MR, simian crease, GI and cardiac defects |
down's (trisomy 21)
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genetic disorder:
short stature, infertility, coarctation of aorta |
turner's
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