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181 Cards in this Set
- Front
- Back
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Describe SHOCK Distributive
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Distributive(Anaphylaxis: Type I HS, IgE mediated; Sepsis: Endotoxemia activates Complement C3a & C5a= vasodilation and increases neutrophil adhesion=neutropenia). CO increases, PVR decreases, CVP decreases.
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Describe SHOCK Cardiogenic
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(PE,MI,Tension Pneumo)low CO, high PVR,high CVP.
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Describe SHOCK Hypovolemic
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Low CO, High PVR, Low CVP.
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What are good prognosis factors in Schizo? Poor?
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Good: Sudden onset or late onset, Family supprt, positive symptoms
Bad: Slow or early onset, Social WD, MRI changes |
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Differentiate Hyperthyroidism based on morphology of gland and T3 uptake?
-What is the tx for these conditions? |
HYPERTHYROIDISM With GOITER:
1)Graves=increased uptake -TSH receptor stimulating immunoglobulins -Pretibial myxedema(red, swollen, shiny skin) -exopthalmos Tx: PTU or Methimazole unless: <20 or pregnant=surgery >40= RAI 2)Thyroiditis=Decreased uptake (Transient Hyper- hypo state) a)Hashimoto=Painless Tx: B-Blocker b)Subacute(post viral): Painful w/ fever Tx: Give NSAID HYPERTHYROID w/ Multinodular: 1)Plummer(toxic nodular): Nodules have increased uptake but the rest is decreased. |
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Nasal Angiofibroma
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Nasal mass with Epistaxis
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Stroke management
RF Lower the risk |
Noncontrast CT to R/o bleed.
Heparin Age & HTN are RF Give ASA to lower the risk |
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-Age & sex of primary pulmonary HTN.
-Murmur of Pulmonary HTN -S/S -Labs -Tx -What is differential? |
-30+ female.
-Accentuation of P2 w/ parasternal heave -Dyspnea(low LV volume), JVD,RVH. -High EPO Tx: Heart lung transplant and ca channel blockers while waiting for it. Polcthemia Vera is differential & has low EPO. |
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Mastitis Tx
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Keep feeding off breast & give PO dicloxacillin to cover MRSA
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Breast feed CI
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HIV,Hep B(dsDNA), Active herpes, TB, Varicella, Syphillus,Galactossemia,sepsis,malaria
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Case Fatalaty rate
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#of deaths in new cases in year x
---------------------------- # new cases in year x |
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Boerrhaves Syndrome
-S/S -D/X |
Inferior tear of esophogus secondary to wretching by alcoholics and bullimics.
-Painful inspiration and pain after eating -D/X with barium swallow as endoscope will perforate. |
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Acoustic Neuroma
-Most Common -s/s -Associations |
-Schwannoma
-N:V, tinnitus, vertigo, unilateral hearing loss. -Neurofibromatosis type II(AD:chromosome 22) has b/l AN's |
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Lung Cx
-Dx -How to differentiate the two types -Tx |
-Dx via sputum cytology
1)Squamous=eosinophillic & hyperchromatic 2) Small cell: basophyllic & lymphocyte sized Tx; All small cell get chemo only b/c metastasize alot. Every other non-small cell type gets chemo/radiation/resection. |
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Emphysema S/S
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Flat diaphram, increased A-P diameter, Distant Heart sound
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Bronchitis S/S
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Productive cough, Coarse Rhonchi & wheezes
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Sensitivity
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A/A+C
Lower the FN rate or narrow the reference interval= higher sens 100% sensitivity has no FN |
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Specificity
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D/D+B
Lower the FP rate= higher Spec 100% spec has no FP |
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Top 3 tumors that metastasize to bone. Result?
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Follicular Cx of thyroid, Breast
Small cell lung Result is they increase osteoclast factors and get high Ca+, low Po4+ with low PTH. |
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Nagles Rule
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LMP-3mo+7days based on 28 day cycle
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Conversion disorder
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Stressor then motor or sensory loss w/ le belle indifference. The symptoms are real!!
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Labor Phases
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Labor must have contractions and dilation as contractions alone is braxton hicks(pseudo)
I: a) Latent:<3cm dilation b) Active: >3cm dilation II: full dilation to baby III: Baby to placenta |
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Multiple Sclerosis
-Pathophys -S/S -Dx -Tx |
-multifocal periventricular demyelination of white matter
-Symptoms are intermittant: 1)Diplopia(optic neuritis or intranuclear opthalmyoplegia) 2) Urinary frequency & urgncy 3) Flex neck and shoot pain down leg. 4)Trigeminal Neuralgia: pain from ear to mouth MRI w/ contrast then CSF to see: High protein & lymphocytes -increased IgG -Kappa light chains -Oligoclonal bands. Corticosteroids IFN B Avonex Betaseron Copaxone |
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Placenta Previa
Vasa Previa Placental Abruption Uterine rupture |
PP(At OS): Painless bleed diagnosed with transabdominal sono as TV is CI.
VP: Fetal bleed, HR will fall PA: Painful bleed with hyperactive uterine tone secondary to HTN & Cocaine UR: painful w/ immediate hypotention. |
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Prevalence vs. Incidence
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Prevalence=Total # of cases
Incidence=# new cases |
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Head of the Pancreas Cx
S/S Tx |
-palpable GB, Pain w/ eating, Clay colored stools, Hyperbilrubinemia
-Pancreatic enzymes & low fat diet |
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+ve B-Hcg w/ HTN & Proteinuria
S/S Tx |
<20 weeks= molar pregnancy(snowstorm on sono,pass grapes, complete=46XX, Partial=69XXY-Triploid)
>20 weeks= Pre-eclampsia (Headache, Diplopia, Edema) 1) Mild: BP<160/110, Pro<3 -Preterm=steroid and bedrest -Term: MgSo4 & deliver 2) Severe: BP>160/110,Pro>3+ -Preterm: steroids,hydralazine, MgSO4 -Term: MgSo4 & Deliver |
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Hypercalcemia causes
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All cause high Ca+ and low PO4
1) PTH Adenoma: PTH high -Resect 2) Malignancy(high osteoclast activity): PTH low |
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Perinatal mortality rate
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#perinatal death(<28 days)+Still Births
------------------------------ Normal & Stll births |
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Bells Palsy
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Acute.
Unilateral: Facial paralysis w/ taste loss(chorda tympani) & loss of orbicularis oculi(CN III). May get tinnitus or hyperacusis if stapedius muscle paralyzed. Bilateral: Think MS or Lymes disease |
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Hypersensitivity
I II III IV -How do they work? -Give Examples of each |
I: IgE mediated like anaphylaxis or allergy. Will see eosinophilia
II: Ab mediated -AI hemolytic anemia(methyldopa) -Blood transfusion reaction -Goodpasture(Linear IF pattern) -Pemphigus(Fishnet/lacelike IF pattern) -Hyperacute transplant(sec-min) III: IC mediated IV: CD4 T-cell mediated -contact dermatitis -PPD intradermal **4 decreased in HIV** |
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Pott fracture
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b/l medial malleoli fx secondary to eversion
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Supracondylar fx
S/S Sequelae Tx |
See anterior fat pad displaced on x-ray
Get median Nerve and brachial artery damage and then Volkmans ischemic contracture and then possile compartment syndrome(pain w/ passive extention of fingers). ORIF |
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Mean vs Median vs Mode
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Mean=Avg
Median=In the middle Mode= Most frequent |
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Colles Fracture
S/S Tx |
FOOSH fx of radialsuprastyloid & ulnar styloid LEADING TO DINNER FORK DEFORMITY.
Closed reduction and cast |
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Mesenteric angina
-S/S -Pathophys -Dx -Tx |
-Stomach pain after eating and will lose weight.'
-Secondary to ischemia of mesenteric Arteries from atherosclerosis. -Colonoscopy, CT abdomen & Guiac will be negative so do angiography. -Tx=modify Atherosclerosis RF's. |
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Hep B
-Makeup -Tx -Differentiate b/w 1) Acute infection 2)Chronic Infection 3)Resolved infection & immunized |
-dsDNA
-Give IFN alpha 1) Acute: HbSAg 2) Chronic: Anti Hbc Ab 3) Resolved or immune: Anti Hbs Ab |
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Odds Ratio
-When is it used -What is the formula -What does it tell you |
Used in retrospective case-control studies to see if a RF contributes to disease.
-AD/BC -Tells you odds of becoming diseased if exposed to the RF. |
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Why do neonatal menses occur?
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Maternal estrogen falls
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Hemophilia A & B
-Inheritance -Labs -S/S -Tx |
-XLR
-High PTT only A= low factor 8 B= Low 9 -Tend to get hemarthroses of the joints -Give factor to Tx. |
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-Describe V-tach
-Tx of Vtach |
-No p-wave & notching
-Amiodarone or Lidocaine/Procainamide(post MI) |
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Tx of SVT
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Carotid massage
stable use adenosine Unstable use cardioversion |
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Measles
-Virus type -S/S -Sequelae -Tx |
-Rubeola
-Fever w/ cough, conjunctivitis, coryza then head to foot morbilliform rash & buccal mucosa Koplik spots. -Sequelae is Otitis media -Tx= Vit A |
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Loop Dieuretics
-Names -Area of Action -Electrolyte changes -Uses |
-Furosemide, Bemetimide, Erythrocrynic acid(non-sulfa)
-Work at thick ascending limb -lower K+ & Ca+ in serum -Ototoxic especially with aminoglycosides -Sulfa allergy CI(Not EA) -SIADH if Na+ <120, Hypercalcemia states, CHF |
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Thiazide Dieuretics
-Names -Action area -Electrloyte changes -USEs -CI |
-Hydrochlorothiazide, metalozone
-Distal tubule -Lower K+ & Na but raise Ca+ glucose, uric acid(ppt gout attacks), lipids in serum. -HTN(1st choice), Nephro DI(after failing to [] urine post desmopressin administration, CHF,Calcium stones -sulfa drug so CI in allergy. -Toxic with lithium |
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Aldosterone Antagonists
-Names -MOA -AE -USES |
-Spirolactone & Amiloride
-Inhibits aldosterone so no Na/K or Na/H exchange.K+ spared. -Spirolactone causes gyno & impotence in men -Use for Hyperaldosteronism whether primary: renin low or secondary: renin high ie edematous states. |
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Iron OD
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Deferroxamine
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Lead OD
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Dimercaptol or Ca EDTA
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Torsades Des Pointes
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Amiodarone & Quinidine
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Wilson Disease
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AR on chromosome 13.
Copper accumulates b/c cerruplasmin is deficient. Get Hepatolenticular degeneration(hypodense basal ganglia ie Globus pallidus & putamen) causing spasticity, psychosis, Kaysner fleischner, and liver failure. -Dx via high urinary copper excretion and LOW cerruplasmin levels. -Tx: Chelate the copper |
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1 mo milestone
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Follow object to midline
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2 mo milestone
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Follow object 180 degrees
,coo,social smile Lift head when prone 45 degrees |
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4 mo milestone
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Roll from prone to supine
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Restrictive Lung Disease
-Diseases -Spirometry |
Sarcoidosis & fibrosis
- Poor compliance (can't fill so all Lung volumes decreased) -Great recoil(FEV1/FVC is about 100% or increased compared to the normal value of 80%) -PaCO2 is normal **NOTE: FEV1 & FVC are both decreased overall*** |
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Obstructive Lung disease
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Emphysema,Asthma,COPD
-Great compliance so fill well -Poor recoil so can't get air out(increased PaC02, increased RV & increased TLC) -Everything else is decreased: TV,VC,FVC,FEV1,FEV1/FVC |
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Elderly changes
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-Glucose intolerance
-High alk phos -Make more autoantibodies -Decreased Hgb & Clearance of creatinine |
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How do you decide whether to treat abnormal lipids:
What is the LDL Calculation? |
1) Get fasting lipid profile
2) Asess risk factors for CAD (Smoke,HTN,Family Hx,Age,DM) 3) Get cholesterol level No RF & cholesterol>240 order LDL *LDL>190=statin *LDL<190=lifestyle mod 2 RF and cholesterol>200 order LDL *LDL>160=statin *LDL<160=Lifestyle Cholesterol-HDL-(TG/5) |
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What are the top 3 cancers in women and top 3 cancer COD?
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Cause: Breast>lung>colon
Death: Lung>breast>colon |
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Otitis Externa
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Pseudomonas
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Otitis Media & sinusitus
-Bugs -Tx |
Bugs and Tx are the same:
S. Pneumoniae, H. Influenzae, M. Cattarrhalis. -Tx= 10 days amoxicillin |
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Neonatal Sepsis
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GBS>E.coli>Listeria(unless galactosemia which has a high E.Coli sepsis rate)
-BC,UC,CSF -If mom got ABx for being GBS+ then cultures can be falsely negative so do latex aggluttination test |
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Variant Angina
-S/S -Tx |
-Random Angina during sleep or with exercise
-Nifedipine(Ca channel blocker) and Sublingual Nitro |
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Clozapine AE
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Get a CBC b/c may cause agranulocytosis. if patient gets lethargic and infection stop this drug immediately.
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APGAR
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Color(Pink=2, Pink & Blue=1)
HR(>100=2,<100=1) RR(Active=2,labored=1) Tone(Active=2,sluggish=1) Grimace(Active=2, slight=1,0) |
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Measles Exposure in HIV +
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Give immunoglobulin unless kid has gotten it <3weeks ago.
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Hypsarrythmia
-What is it? Describe the disease it is associated with? |
EEG of infantile spasm(tonic clonic seizure clusters) seen in Tuberous sclerosis(AD disease seen at 1 year old).
-Other features of TS are ASH leaf hypopigmented macules & cortical Tubers on CT of the brain Treat with ACTH |
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3 second spike and wave pattern
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EEG of Absence seizure. Give ethosuximide or valproic acid.
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Centrotemporal Spike
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EEG of benign partial epilepsy
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6 second spike & wave
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EEG of juvenile myoclonic epilepsy(Have muscle spasms). Tx is valproic acid.
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Best Ulcer surgical option if meds dont work
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Parietal cell vagotomy b/c minimizes the risk of dumping syndrome(flushing,hypotention secondary to reactive hypoglycemia) like in Bilroth II.
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Universal donor & recipient
-Blood transfusion Rxn HS? |
Donor=O negative(no Ag for A/B Ab to attack: Type 2 HS reaction Ab attacking antigens).
Recipient=AB |
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What to do in transfusion reaction
When do you give a transfusion? What is the first sign of hemmhorrhage? |
Stop tranfusion and flush with normal saline and osmotic/Loop dieuretics.
Give packed RBC's when: TRAUMA: >1500ml lost or if patient has been given 2L NS and still hypotensive Non-Trauma: Hct<30, Met acidosis, tacypnea-tachycardia for unknown reason Lowered CVP, and HB/Hct doesnot change for 1-3 days |
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Indications for pneumococcal vaccine?
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>2 years of age and have:
-HIV, Nephrotic syndrome, Sickle cell, Functional asplenia. |
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-Which inhalational anesthetics are the fastest acting and quickest to be turned off?
-What is minimum alveolar[]? |
Those with the smallest blood -gas partition coefficients.
-% alveloli needed to be penetrated to get the effect of the inhaled anesthetic. The lower the MAC the more potent the inhaled gas. |
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3 year old milestones
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Tricycle, Copy circle & cross
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4 year old milestones
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Dress themself & hop on one foot.
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5 year old milestones
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Copy triangle
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Bronchiolitis
-S/S -Labs -Sequelae -Tx |
Wheezing especially expiratory post URI.
-See air trapping/atelectasis on x-ray but CBC normal - Increases risk of asthma in future -Bronchodilators and Ribavirin. |
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Croup
-Culprits -SS -Labs -Tx |
-RSV or Parainfluenza
-Runny nose then barking/brassy cough -See Subepiglottic narrowing on x-ray(steeple sign) -Racemic epinephrine or Steroids |
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Epiglottitis
-Culprits -SS -Labs -Tx |
-H. Influenzae
-Suddenly drool, lean forward -Thumb sign on x-ray -Intubate immediately and give cefotaxime before x-ray. |
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Cardinal movements of delivery
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Descennt, flexion, IR,Extention,ER
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Mannitol
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Osmotic dieuretic so lose free water and may get hypernatremic. Great to immediately lower ICP with bed head elevation
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Cardinal movements of delivery
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Descennt, flexion, IR,Extention,ER
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Macrocytic Anemias
-Types & associations -Way to differentiate -Dx -Tx |
Either Megaloblastic(Hypersegmented neutrophils, Howell Jowell bodies) or Non-Megaloblastic
MEGALOBLASTIC B-12: D. latum, Vegan, Pernicious Anemia(No I-factor & atrophic glossitis) Folate: Alcohol or Phenytoin/phenobarbitol -B-12 will have neurological sequelae(babinski or mental changes). Folate will not. -Dx via looking at blood cyanocobalmin & folate levels. Make sure B-12 is not pernicious with the schilling test which looks for I-factor. -Treatment is supplementation NON-MEGALOBLASTIC 1) Diamond Blackfan: 1 year old Red cell aplasia w/ webbed neck, cleft palate triphalangeal thumb 2) Fanconi: 8 year old pancytopenia w/ Neck & interdigital cafe Au lait and small eyes-head & no thumbs |
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Neonatal conjuctivitis
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0-24 hours=chemical via AgNo3
-No treatment 2-5 days=Gonnorrhea -erythromyacin topical -IV ceftriaxone 5-7 days= Chlamydia(Use erythromyacin topical & oral) |
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Lacrimal duct Obstruction
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Seen first few weeks of life and tends to be unilateral.
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Types of breech Presentations
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Frank: \/
Complete: \/\ Double footling: Two Feet down Partial:One foot down Transverse lie:- |
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Name all Tocolytics
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1) B2 agonists: Ritodrine, Terbutaline(increases glucose)
2) Ca blockers: Nifedipine 3) MgSo4 4) NSAID: Indomethicin |
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Adrenal insufficiency
-Types -SS -Dx -Tx |
CRH-ACTH-Cortisol
------------------ HYPERKALEMIC HYPOTENTION 1)Addisons(AG dysfunc=Primary) -Hypoten w/ low Na+, High K+ -GI distress -Skin Pigmentation -Eosinophilia Dx: Give ACTH(Cosyntropin) Addison= High renin-Low Aldosterone **Give Prednisone/Flucortisone 2)Pituitary tumor or long term steroid user who stops -Same symptoms as addison but no Pigmentation changes. **Give steroids immediately 3)Adrenal insufficiency w/ hirsuitism(Gonadal tumor or Adrenal Tumor) -Get Test & DHEA levels -High DHEA means get 17-OH Progesterone to r/o CAH(21 hydroxylase deficiency). |
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Adrenal Excess
-Types -SS -Dx -Tx |
CRH-ACTH-CORTISOL
--------------------------- Hypertention w/ Hopokalemia Striae, extremity wasting Moon face, Hyperglycemia 1)Pituitary tumor(Cushing) 2)Ectopic ACTH(small cell Cx) 3) Exogenous Steroids Dx: 1) 24 hour urine cortisol or low dose dex. 2) Get ACTH, if low then exogenous steroid admin 3) High dose dex and if ACTH falls then cushing. Tx: MRI to find and remove adenoma (cushing) Ketoconazole (small cell cx) |
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Neonatal Palsies
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Diaphram paralysis(C4)
Erb(C5-C6): waiter tip Klumpke(C7-T1): Total arm paralysis w/ horner syndrome |
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Todds Paralysis
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Post ictial paralysis
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Hernia types
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Femoral: Female and strangulates
Direct: Through Hesselbach triangle Indirect: In internal, out external into scrotum(Bassini repair) Pantalloon: Indirect & direct |
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DI
-SS -Dx -Tx -Drugs that cause it |
-Serum Osm >Urine Osm
-Polyuria/Polydipsia 1)Restrict water and see if urine Osm increases -Increase=Central -No change=Central or Nephro 2) Give Vasopressin Increase=central No change=Nephro Tx: Central need vasopressin Nephro need Thiazide Lithium causes nephrogenic type |
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SIADH
-SS -Dx -Tx -Drugs/conditions that cause it |
-Urine Osm>Serum Osm
-All serum electolytes diluted but treatment basedon Na+ level. Tx: Asymptomatic Na+: >120= restrict water Na+<120= NS & furosemide Symptomatic(mental changes) Hypertonic saline & furosemide. -Chlorpropamide -Post Surgery |
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Hyperaldosteronism
-SS -Dx -Tx |
Hypertention w/ Hypokalemia
Primary=Adrenal adenoma/BAH (Renin will be low) Secondary=Edema states (Renin will be high) -Nephrotic syndrome -Cirrhosis -CHF Tx: Aldosterone antagonists Spirolactone(AE on men-gyno-impotence) Amiloride |
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Typical Antipsychotics
-Type of symptoms treated -Names of drugs -AE of drugs |
-Use to treat +ve symptoms only(hallucinations, delusions, agitation)
-Great for treating a violent patient. -May cause galactohhrea, low libido and Amenhorrhea b/c block dopamine(R/O pit tumor with MRI) Haloperidol (High Potency & alot of EPS) -Azines (Low Potency & alot of Anti-choliergic symptoms ie dry & sedated) 1) Chlorpromazine: Photsensitivity & jaundice 2)Thorazine: retinal pigment deposition |
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EPS
-description -time of onset -Tx |
4 hours get dystonia:
-Muscle spasm, twist neck, roll eyes 4 days get Akinesia/Parkinson -cogwheel rigidity,shuffling gait, masklike facies. Tx: Both get: 1)Diphenhydramine(Antihist) 2)Benzotropine/trihexphenadyl (Anticholinergic) 4 weeks get akathisia -can't sit still Tx: Benzo's 4mo get tardive dyskinesia -Lip smaking, tongue writhing, choreaform Tx: Give atypical b/c irreversible |
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Atypical antipsychotics
-Names -AE |
Treat + & -ve symptoms
-Cause weight gain & diabetes Olanzipine Risperidone: Elevates prolactin(MRI to r/o pit tumor) Clozapine:Agranulocytosis(get CBC) |
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Neuroleptic malignant Syndrome
-Drugs causing it -SS -Tx |
Typical and atypical antipsychotics may cause it
High fever(107+) with muscle spasm and increased CPK, myoglobinuria. Tx: Stop drug, fluids, dantrolene. |
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Microcytic Anemias
-Types -Lab differential |
"TICS"
*Thalessemia: -High Fe,High Ferritin, N TIBC -Extramedullary hematopoesis (wide bones & HS-megaly) Alpha=Asian(Normal Hb electro but can cause spontaneous abortions) Beta=Mediterranean(High HBA2 & HbF in Hb electrophoresis) *Iron deficiency Low ferritin & Iron, High TIBC *Sideroblastic -Lead, Pyridoxine def, INH, ETOH -High Fe/Ferritin/Transferritn -Ringed Sideroblasts on smear -Basophillic strippling & epiphyseal deposits on bone in lead Tx: Pyridoxine/remove agent |
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Normocytic Anemia
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Classified based on marrow response
No reticulcytosis: 1) Aplastic anemia(pancytopenia:Low RBC, WBC, Platelets) 2) CRF (Deficient EPO) Have Reticulocytosis "GASS" Hemolytic High LDH, low haptoglobulin. a) AI=+ve Coombs Test, give steroids. b) Spherocytosis= No cental pallor, Dx w/ osmotic fragility test. Take out spleen. c)Sickle cell=Sickles w/ high HbS. Dx on electrophoresis, watch out for crises w/ parvo B-19. Give O2, Morphine,Fluid. d)G6PD(XLR): Seen post sulfa or quinidine drugs. Diagnosis via Heinz bodies and enzyme deficient |
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ITP
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Thrombocytopenia post viral illness
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Post streptococcal Glomerular Nephritis
S/S Dx Labs Tx |
Sore throat or Skin infection
then: HTN, Hematuria(coca cola),Edema(pre-orbital) -Proteinuria lasts 1 year -Hematuria lasts 6mo. -C3 & CH50 are low b/c C3 deposits in "humps" along GBM w/ IgG - High ASO titer indicates strep infection Tx: Treating strep will not resolve it |
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Von Wildebrand Disease
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Autosomal dominant. Increased PTT & Bleeding time. b/c VWF is needed to store factor 8
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Polycthemia rubra Vera
-Diagnostic criterion -Tx |
Bone marrow working OT:
-High Hct, WBC count, B-12 level,Pao2>92%, low EPO -Splenomegaly Tx: Phlebotomy |
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Panhypopituitarism
-S/S -Tx |
-Hypothyroid(low T4/Low TSH)
-Low Test/Est(Low FSH/LH Tx: Supplement the Test/Est/Levothyroxine |
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GH Adenoma
-SS -Dx -Tx |
-Large Tongue, headache, bone Pain, Hirsuitism
Dx: IGF-1 Tx: Bromocriptine |
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PTU
-Uses -AE |
Treatment of Graves disease if not preganant.
-Causes Agranulocytosis(so if patient gets fever or sore throat d/c) |
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Diabetic Nephropathy
-Screen -Ways to slow the Nephropathy - |
Proteinuria>300mg
-Screen w/ 24 hour urine albumin-creatinine ratio -Slow nephropathy by lowering protein & ACE inhibitors. |
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Conditions with low AFP
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Trisomies & baby who is younger than thought.
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Conditions with high AFP
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NT defects
-Spinal bifida -Anencephaly -Omphalocoele -CNS Anomalies CMV & PARVO PCKD |
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Conditions with High B-Hcg
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Turner & Twin
Down Sacrococcygeal Teratoma Choriocarcinoma |
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Gallstone Illeus
-Pathophysiology -S/S -Tx |
-Large radiopaque Gallstone that lodges in the Small bowel. Air seen in GB b/c fistula created with SB.
-Presents like Cholycystitis (colicky RUQ pain, billous n-v) but bowel loops are dilated and BS are decreased(illeus) -Do laparotomy to remove stone & cholycystectomy. |
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Opiod Addiction
-How long does it last -Addicts social tendencies -Is addiction common in patients -Do they develop psychosis |
-Usually lasts less than 10 years
-Addicts are social and socially deviant -Uncommon to get addicted -Opiods do not cause psychosis |
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Congeital Syphillus
-S/S |
Symptoms are early(0-2 years) & Late(2+)
Early: Fever,anemia, maculopapularrash,snuffles, hepatomegaly, failure to thrive Late: Sqaddle nose, Saber shin, Hutchinson teeth, Perioral fissure(Rhagades) |
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Breakthrough seizure management in patient on meds that have worked for a long period of time
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-Stabilize patient: airway then diazepam.
-Check the dilantin level -If low or in lower end of therapeutic range then raise the dose of dilantin |
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What to do when placing a Subclavian Vein Catheder.
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-Reverse trndelemburg to prevent air embolism (tachypnea,hypotention,continuous murmur)
-CXR to check placement & R/o pneumothorax |
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Describe a normally distributed curve
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Mean +/- 1 SD=65%
Mean +/- 2 SD=95% |
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Omphalocoele
s/s associations t/x |
Born with bowel outside stomach and covered in a membrane.
Associated with heart and kidney problems 1) Wrap bowel in sterile gauze 2) IV fluid & Antibiotics 3) Decompress w/ OG tube 4) Surgery to close abdominal wall |
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Turner Syndrome
-Genotype -S/S -Associations -Dx -Tx |
-45XO 04 46XY
-Short, wide nips,pectus excavatum, webbed neck, primary amenhorrhea(ovarian failure-streaked on U/S) -Coarctation of Aorta(UE HTN,Wide PP,Radio femoral delay, rib notching on x-ray: Tx w/ balloon angioplasty or surgical end to end repair) -Dx via buccal smear(no barr bodies) -46xy get b/l gonadectomy to prevent gonadoblastoma), if <5th percentile give GH. |
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Down syndrome
-Association -Triple scren results |
-Hischprung, endocardial cushion defect,duodenal atresia, ALL leukemia, Alzheimers
-UE3 & AFP low, Hcg high |
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Pheochromocytoma
S/S Associations D/x T/x |
P's: pounding headache, Perspiration,Pressure changes
MEN II, Neurofibromatosis, Von Hippel Lindau Urine/serum VMA & Metanephrines to screen and if positive to CT to locate Phenoxybenzamine (alpha & beta blocker) then resect. |
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Raynaud Phenomenon
Pathophys Associations & their descriptions |
Cold weather makes vessels spasm & thicken(white digit then red).
Associated with: 1)CREST(Anti centromere Ab): Calcinosis,Raynaud,Esophogus dysmotility,Sclerodactyly,Telangiectasias 2)Sys sclerosis(Anti Scl Ab): -Facial skin is taught, esophogeal acahlasia, renal dysfunction(vessels onion skin), arthritis Tx: Penicillamine 3)Thromboangitis obliterans(Breugers disease): Inflammatory disease causing Digital vessel thrombosis in male smokers |
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Cocaine
-Psychotic associations -Comorbidities -W/D duration |
-Use alcohol
-Get psychotic so use haloperidol to control agitation and psychosis -W/D will last many weeks |
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PKU
-Deficient enzyme -S/S -Labs -Tx |
Low phenalalanine hydroxylase
so phenalalanie accumulates causing brain damage Musty/Mousy odor, fair skinned-blue eyes-blond hair, badly behaved b/c retarded,eczematous rash. High phenalalanine and urinary phenylacetic acid Mom keep Phe intake<10 |
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Post op causes of fever and ways to tx/prevent
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Wind-Atelectasis in 1st 24 hours(Prevent w/ spirometry)
Water-UTI in >2days Wound- 5-10 days(Just drain no antibiotics) |
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What are normal values for
PH PaCO2 HCO3 PT PTT Platelets |
7.35-7.45
35-45 22-28 10-15 25-40 >150K |
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In pregnancy wht electrolytes increase
decrease no change |
All changes occur in the second trimester!!!!!
Increase: -Alk phos -BV,CO & GFR -Lipid level -Tidal volume -ESR Decrease: -BUN -Hgb/Hct No Change -electrolytes -LDH -RR |
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Disulfiram
-MOA -S/S |
Inhibits Aldehyde dehydrogenase fo get alot of acetylaldehyde to build up.
Get hot & flushed/n-v/ pounding headache/hypotention. |
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Management of Hepatic encephalopathy
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Goal is to reduce NH3(ammonia)
1) Stop protein intake 2) Lactulose: Gut uses it to make H+ ions that bind NH3 and create NH4. 3) Neomyacin to kill gut flora that make ammonia |
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Somatization Disorder
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Not doing it on purpose. Multiple organ systems w/ extensive medical workups.
Tx: Psychotherapy |
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Hypochondriasis
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Feel like have same disease though workup continues to be negative.
Tx: Get Psychotherapy to look into life experiences & stressors. Relieve the stressor nd relieve the condition |
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Somatoform vs factitious vs malingering.
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Somatoform: Not faking symptoms intentionally
Factitious: Fake symptoms to become a patient & have procedures done Malingering: Fake to get something(money.attention,off work) |
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Sub Arachnoid hemmhorrhage
-Pathophysiology -SS -workup |
Blood between arachnoid and pia matter usually due to trauma or ruptured berry aneurysm(PCKD)
Worst headache of my life then stiff neck then poor consciousness. Non-contrast CT head and if retinal examination is negative(looking for ICP elevation) do Tap to look for bloody CSF |
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Lower GI bleed in elderly
Dx Tx |
Angiodysplasia
Diverticulosis Hemmhorroid Hemmhorroids should be seen on rectal exam Angiodysplasia seen on colonoscopy Diverticulosis seen on barium enema If bleed is active then do schintography Tx is diathermy |
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Meckels Diverticulum
-S/S -Dx -Tx |
Painless melena
Petinecinate scan Surgery |
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GERD
-Pathophys -Dx -Assoc -Tx |
Decreased relaxation of LES
Associated wiith glandular metaplasia(barrets:squamos to columnar) and possible adenocarcinoma 24 hour PH monitoring -Diet modification and PPI/H2 blocker |
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Ovarian Cx
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Pelvic mass w/ ascites`
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Epidural vs. subdural hematoma
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Evacuate all if high ICP
Epidural: out-up-out -temporal bone skull fracture that tears the middle meningeal artery -Lens shaped -Ipsi Blown pupil(means elevated ICP) Subdural: Sickle shaped Just out or hit head a long time ago. |
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15-24 COD
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Accident>homicide>suicide
exept in african american where homicide is #1 |
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Hypoglycemic infant
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Premie=poor fat & glycogen stores
Macrosomic(DB mom): Baby making too much insulin Von Gierke(low glu-6-phosphatase): doll, large liver & kidney |
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MEN IIa
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Medullary Cx thyroid
-Calcified -TSH & T4 normal Parathyroid Adenoma -High ca, Low PO4, High PTH Pheochromocytoma -Headache, palpitation, pressure changes Dx: Get calcitonin level to screen as C-Cells in thyroid Cx make it. Tx: Resect |
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Cardiac Tamponade
-SS -Tx |
JVD, Hypotention, Pulsus paradoxus(decrease BP w/ inspiration), normal BS.
Echo if stable Pericardiocentesis if unstable |
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Asherman syndrome
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Secondary amenhorrhea in a woman with normal prolactin/TSH levels and +ve progesterone challenge who is a non-hirsuit. Occurs due to uterine scarring post D&C.
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PCOS
-S/S -Dx -Labs -Tx -How would the secondary amennhorrhea workup look |
-Obese teen w/ hirsuitism & irregular periods. Dx is clinical
-LH:FSH>2 -High DHEA and DHEA response exaggerated to ACTH stim test -High Testosterone. -Give OCP to regulate periods & prevent endometrial hyperplasia(test converts to est= hyperplasia) -Do Oral GTT & if >140 give: Metformin-Do not want babies Clomiphene-Want Babies b/c stimulates ovulation secondary amenhorrhea w/ normal TSH & prolactin & progesterone challenge who has hirsuitism. |
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Secondary amenhorrhea
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3 missed periods
1) Get Prolactin/TSH High Pro, High TSH -Correct hypothyroid and repeat(high TSH will cause high prolactin) High Prolactin, norm TSH -R/O prolactinoma w/ MRI (galactorrhea,headache, blurry vision) -R/O meds that inhibit dopamine (MAOI/TCA/SSRI/Psychotics) Normal TSH, Normal Prolactin -Do Progesterone challenge(stimulates est release and if est present pt will W/D bleed) W/D bleed Hirsuit: PCOS or Ovarian tumor Non-Hirsuit: Asherman or hypothalmic dys No W/d bleed -Get FSH High=Ovarian failure Low=Hypothalmic dysfunction |
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Solitary thyroid nodule workup
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Fine needle aspirate and if malignant remove.
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Granulosa Theca tumor
-S/S -D/X -T/X |
Produce Estrogen & inhibin so get:
-Secondary amenhorrhea or irregular menses -Precocious puberty -Post menopausal bleeds -Endometrial hyperplasia & cancer Must sample endometrium Unilateral Salpingo-oophorectomy |
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Sertoli Leydig Tumor
S/S Tx |
Produces Testosterone so get big clit, small reasts, deep voice & acne
B/L salpingo-oophorectomy |
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Benzo W/D
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Anxiety, Psychosis, Seizure
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Opiod W/D
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GIANT PUPILS
Piloerection(gooseflesh) sweating rhinnhorrhea diarrhea |
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Pseudomembraneous colitis
-Culprit -MOA -How diarrhea looks -Tx |
C.dificile
Ampicillin or clindamyacin allow colonization and bug makes enterotoxin that damages mucosa causing white plaques. Profuse & watery Metronidazole then vancomyacin |
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Traveler diarrhea
-Culprit -MOA -Tx |
No fever. Watery and not bloody or involving any leukocytes.
E.Coli enterotoxin stimulates cAMP causing secretory diarrhea TMP-SMZ |
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WBC in stool of Diarrhea
-Test to dx |
Use methylene blue test
Salmonella Shigella Yersinia Campylobacter -ulcerated & friable mucosa |
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Excessive fluid infusion
S/S Tx |
Post op patient w/ S3,JVD, Edema & rales.
Stop fluid & give furosemide |
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Benign Rolandic Epilepsy
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Kid who is fully cognisant but has facial twitching and cannot speak when he is drowsy or wakes up in the night.
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Fat embolism
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Break large bone and get tacypnea-tacycardia,low grade fever and petachiae in the axillary region.
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Hyperthyroidism Arrythmias
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A-fib & Sinus Tach
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Cardiac Enzymes
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CKMB
Up in 2hrs peaks in 24hrs Lasts 2 days Troponin(most sensitive) -Up in 6 hours -Peaks in 24 hours -Lasts 7 days |
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DIC
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Fibrinogen & All factors low.
PT & D-dimer (says lots of fibrin clots)are increased. |
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Duodenal Atresia
S/S |
-Newborn w/ bilous vomiting & nondistended. Double bubble x-ray
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Ruptured papillary Muscle
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Seen 4 days pot RCA infarction and pressents with Mitral insufficiency murmur( systolic and radiating to axilla)
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Pyloric stenosis
s/s dx tx |
6 weeker w/ non-billous vomiting, palpateable olive that pulsates.
Dx via barium swallow Rehydrate & treat hypochloremic hypokalemic metabolic alkalosis first then do pyloromyotomy |
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MRI changes in schizophrenia
-Best way to rehabilitate a schizophrenic |
-decreased prefrontal metabolic activity
-large lateral ventricles -small corpus collosum Drugs early and a home environment with minimal stress improves outcomes |
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Burn % calculation
Burn fluid equation Burn infection cause Burn Tx Burn Types |
Burn Surface Area Calculation (only count 2nd & 3rd degree):
Head=9 Arm=9 Leg =9,9(front,back) Front Torso=9,9 Rear Torso=9,9 Perineum=1 Carbon Monoxide poisoning (someone in a fire): Always give 100% O2 by mask. Burn Management: O2 by mouth to prevent CO poisoning, IV fluids to prevent hypovolemia (4ml *KG * %Body SA involved: Give ½ in first 8hours and rest over next 16 hours). Pseudomonas Infection is the #1 cause of death so give topical Silver Sulfadiazine antimicrobial & tetanus toxoid. Excise all partial and full thickness burns so grafting can occur rapidly. Use petrolatum based gauze. 1st degree: Red 2nd degree: Very swollen and Blisters 3rd degree: Charred Scald: Liquid Burn |
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Hemmhorrhagic disease of the newborn
Cause Labs |
Vitamin K deficiency
High PT & PTT but low factors 8 -10 and low protein C&S |
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If you can't get an IV line do what
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Go interosseous
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Reye Syndrome
-S/S -Tx -Best way to prevent |
ASA after viral illnes & get elevated LFT & NH3 and elevated ICP(Lethargy)
-Lower ICP Best way to prevent in a kid that must take ASA is to give them the influenza A vaccine |
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Ankylosing Spondylitis
-S/S -Labs -Dx |
Young male w/ decreased anterior spinal flexion(Schober test) & stiff back in the morning.
-Lab shows -ve ANA,RF but +ve HLA B-27) -X-ray shows bamboo spine secondary to vertebrae fusion |
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6mo milestone
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sit up, pass object hand to hand, babble
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9mo milestone
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pincer grasp
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Foreign Body Aspiration
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Repeated RLL pneumonia
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Cystic fibrosis
-S/S -Dx -Tx – |
Failure to pass meconium, b/l nasal polyps, repeated pseudomonas lung infections, clubbing,steatthorrhea.
-Sweat Cl- test -Gent w/ Carbe/Piper/ticar for lung infections and pancreatic enzymes for malabsorption |
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Adrenoleukodystrophy
-Age & inheritance -Pathophys -S/S – |
7-10 year old & x-linked
-Posterior demyelination of white matter -Apraxia, dysphagia, dysarthria, aphasia with mental deterioration. |
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Hirschprung disease
-Associatons -Pathophys -S/S -Sequelae -Dx -Tx – |
Associated with down's & T.Cruzi(Chagas disease)
-No ganglion cells in myenteric or auerbach plexi -No passage of meconium, constipation w/o stool in rectal vault, abd distention & pain. -May rupture causing necrotizing enterocolitis -Dx via KUB and Barium, confirm w/ rectal mucosa biopsy --Tx is surgical decompression w/ temporary colostomy then reattach. |
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Neurofibromatosis
-How to Dx each type |
2 types both AD: I=17, II=22
Type I: must have 2 of: 1)>6 Cafe Au lait 2) Inguinal-axiallary freckles 3) Hemartoma on iris 4) Neurofibroma Type II= B/L acoustic neuroma |
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HSP
-Pathophysiology -S/S – |
AI IgA deposition vasculitis related to strep & penicillin
-LE rash, arthritis, abd pain, hematuria, guiac +ve. |
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Congenital spherocytosis
-Pathophysiology -S/S -Labs -Dx -Tx – |
Extravascular hemolysis causing splenomegaly
-Cholycystitis(Ca bilrubinate stones) & elev conj bili. -Normocytic anemia w/ Reticulocytosis. Smear showing lack of central pallor -Dx w/ osmotic fragility test. -Tx= Splenectomy |
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When does moro reflex begin/end?
-What does asymmetric moro indicate? -What reflexes are at birth? – |
Begins at birth and ends at 6mo
-Indicates fractured clavicle(feel crepitus) or peripheral nerve injury(ERB=C5-C6: Klumpke=C7-C8). -Moro, Rooting, Grasping. |
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When do kids get cows milk? solid food? Juices?
-What if it is given before then? -What is the nutrient difference in cow vs. mom milk? -When should iron be supplemented in a kids diet – |
1 year.
-Get Renal failure from excess protein(lethargic). -Mom= high Vit C, Cow=High Vit K and protein. -Give iron at 6mo or will get ID anemia |
