Clinical Exam Flashcards
Dextrocardia investigations and associations
Mesocardia is heart in midline
Cardiac anomalies associated include mirror image, clinically corrected TGA, single ventricle with PS, TA, or TS, TOF, can be normal in 2%
Situs solitus or inversus using AXR of the atria (midline liver indicates situs ambiguous or heterotaxy)
ECG to review atria and ventricle orientation
p axis and SA node in RA position, q waves in V1/2 L loop ventricles and in V6 D loop
Arrhythmia
Echo to review IVC and great vessels
Primary ciliary dyskinesia in Kartanger syndrome
(PCD)
Heterotaxy: aspleenia syndrome (ivemarks syndrome) and polysplenia syndrome
Pain management strategy
Emotional/psychological aspects addressed
WHO analgesia triad
Review frequently
What does TESTS stand for
To check diagnosis Etiology and differentials Severity Treatment baseline Suspected complications
Surgical sieve
Vascular Infective inflam Trauma Autoimmune Metabolic Iatrogenic Neoplastic Congenital Developmental or degenerative Endocrine or environment Functional
Social history mnemonic
Pat fat hams
Patient Family Home Access Money Smoking
Don’t forget systems review mnemonic
This misbehaving bony pubertal sheep
Teeth
Hopes
Incontinence or toilet training
Sz
Behaviour
Bones/immobility complications
Puberty
Sleep Hearing Eyes Examiners ask that I didn't ask Pain
Genetic causes of developmental delay and other medical to screen for
Medical: Hearing and vision thyroid (hypothyroid) Iron and B12 (malnutrition) Metabolic causes Abuse or Neglect Brain imaging EEG or lead (neurotoxin)
Genetic with genetic test:
Fragile x
Downs
Rett syndrome
Other from history: fetal alcohol, TOrCH, perinatal, other cerebral insult
Wilms tumour associations
Hemi hypertrophy Genitourinary d/o Syndrome: - WAGR (Wilms, aniridia, GU abnormalities and mental retardation) - Denys-drash syndrome - BWS -trisomy 18
Hypertension causes
MONSTER
Cardiac - pulses, Bp, murmur
Medications
Obesity (steroids/Cushing syndrome/Phaeo)
Neonatal history
Symptoms and signs and syndromes (collagen and NF, TS, SLE)
Trends in family
Endocrine or
Renal (think of aldosterone and potassium - cramp)
White coat HTN
CF management
“The CF plan”
Team approach including GP
Hope - life expectancy steadily improving, novel therapies
Educational status - need information from reliable sources
Compliance/prevent and screen for Complications: diabetes, gord, Cor pulmonale, pneumothorax, bronchiectasis, asthma, intestinal obstruction, arthritis, osteoporosis, jaundice, nasal polyps and sinusitis
Family and sibling Emotional status
Prognosis (life limiting disorder)
Long term infections and resistance
Asospermia with Delayed puberty (males infertile)
Nutrition - often have growth failure and vit def (DEKA)
Causes of cafe au lai
neurofibromatosis type 1 and 2 McCune Albright syndrome ataxia telangiectasia fanconi anemia Russell-silver syndrome Tuberous sclerosis Gaucher disease Chediak – Higashi syndrome Turner syndrome Proteus syndrome Legius syndrome LEOPARD Bloom syndrome
Clubbing causes
CLUBBING Mostly cardio/respiratory: Congenital Cyanotic heart disease or reversal L to R shunt or eisenmenger complex/atrial myxoma Lung: Abscess Bronchiectasis CF (Don't say asthma) Empyema Fibrosis
UC/CD (IBD)
Biliary cirrhosis usually or other cirrhosis cause or chronic hepatitis
Birth defects/familial
IE
Neoplasm
GI malabsorption (coeliac)
Other: thyroid acropatchy/TB/sickle cell/pulm AV malformation
Hypotonic baby causes and management
Distribution and course of disease (degeneration or static)
Investigations: Rule out sepsis and electrolyte imbalance (mg and ca), left, urine drug screen, TFT, TORCH, EEG prognosis, CK, MRI, metabolic tests
Causes: central (cerebral due to HIE, haemorrhage, malformation, chromosomal, syndrome (Lowe), peroxisomal - zellweger and adrenal leukodystophies, metabolic like pompe, drug) and peripheral causes (including muscle myopathies and dystrophies, neuromuscular junction (botulism MG), peripheral n (CMT) anterior horn cell (SMA))
Management: Monitor contracture/hip dislocation Swallow/feeding safety (oro-motor dysfunction) Reflux Respiration and overnight oximetry Syndromes associations
Complications of childhood obesity
CV: High lipids, HTN, LVH, Risk heart disease stroke
Respiratory: sleep disordered breathing, Sleep apnoea, asthma
Renal
GIT: Non alcoholic fatty liver disease, Gallstones, GORD
Orthopaedic: SUFE, Risk degenerative joint disease
Haem: Thrombus
Surgical: Hernia
Endocrine: dm2, Precocious puberty, PCOS
Neuropsych: Pseudotumor cerebri, psychosocial, negatively affects school performance
Causes of hepatomegaly
CHIMPS CT d/o Haematological Infective and infiltrative Metabolic Parenchymal (cardiac fluid overload) Systemic
Clinical signs of chronic liver disease
Don't forget hep b at the FLAP JAP SEX CLUB Hepatic flap Jaundice Ascites/atrophy testicles with gunaecomastia/anaemia Palmar erythema Spider naevi Encephalopathy Xanthelasma Clubbing/colour change nails
Hurlers syndrome
HURLERS a mucopolysaccharoidosis (lysosomal disorder)
HSM Unusual facial features Recessive Liduronidase def Eyes clouded Retardation Short stubby fingers
Marfans
MVP Aortic aneurysm Retinal detachment Fibrillin gene on chromosome 15 Arachnodactyly PNeumothraces Skeletal abn
Causes of obesity
Overeating and under activity
Drugs
Cushing
Genetic such as prader willi
Steroid side effects
CUSHINGOID MAP
Cataracts/ Cushing moon face and buffalo hump (interscspjlar adiposity)
Ulcers - ulcers and duodenal
Skin striae, thin, bruise
HTN hirsutism hyperglycaemia heart failure
InfectionsImmunosuppressive with poor wound healing
Necrosis (avascular necrosis femoral head)
Glycosuria/growth (short)
Osteoporosis/obesity
ICP pseudotumour cerebri
Diabetes/ glucose intolerance
Myopathy (proximal) mood
Acne fat/ adrenal (suppressed hypothesis-pit-axis)
Pancreatitis psychosis/behavioural
Macrocephaly causes
Megalencephaly (large brain)
Hydrocephalus - communicating and noncommunicating choroid plexus papilloma increases production
Hyperostosis (bone overgrowth): bossing - osteogenesis imperfecta, chronic haemolytic anaemia, rickets, achondroplasia
Familial
Sturg-Weber/NF1/TS/sotos/weaver/Noonan/Costello/gorlin
Fragile x, leukodystrophies, metabolic
Tumour
abscess
NAI
AV malformation great vein of Galen (bruit temporal areas..)
(Autism kids 25% have this)
Causes of microcephaly
Genetic: trisomies: downs, Edward, patau, deletions 4p (wolf-hirschhorn) and 5p (cri-du-chat), 22q11 and 7q11.23 (Williams), smith-Leslie-opitz, Cornelia de lange, rett, Nijmegen breakage, ataxia telangiectasia
Stroke/trauma/cerebral injury
TORCH zika
Fetal hydantoin or alcohol syndrome
Perinatal insult
Inborn error of metabolism
Other: lead, chronic renal failure, anaemia, hypothyroid, congenital heart disease, malnutrition
Rett syndrome decelerated growth acquired microcephaly
Causes of short stature
Familial
Constitutional delay
Idiopathic
Endocrine - hypopit, GH def, hypothyroid, pSeudohypoparathyroidism, CAH, Cushing
Chronic disease - anaemia, endocrine: hypothyroid, GIT: coeliac/IBD, renal and liver GH deficiency (order IGF-1)
Syndrome - Genetic such as turners syndrome, others like downs syndromes
Skeletal dysplasia - Chondrodystrophy (achondroplasia)
Scoliosis
Side effects of Drugs - chronic steroid use, ADHD meds, anticonvulsants, radiotherapy
IUGR
Nutritional deficiency
Schwachman-diamond syndrome
Klippel-Fiel
Seckel syndrome
Tall stature causes
Familial or normal variant obesity Klinefleter Marfan Precocious puberty Kallman Proteus syndrome MEN2B NF1 Fragile x Sotos Weaver BWS Homocysteinuria Hyperthyroidism GH excess, acromegaly McCune Albright Hyperthyroidism
Mid parental height formula
Father + mother +/- 13cm
Divided by 2 (+/- 10cm)
Three extra primitive reflexes
Galant
Swimming
Parachute
Jaundice causes
Haemolysis (G6PD)
Haemoglobinopathies
Infection/inflammation
Reduced clearance: Gilbert’s, crigler-najjar, hypothyroid
Biliary atresia/allagile/choledochal cyst
Metabolic (galactosemia and tyrosinaemia)
Sepsis
TPN related
Splenomegaly causes
Hyperplasia: due to haemolysis
Infiltrative: such as amyloid or sarcoidosis
Congestive: (portal HTN from cirrhosis)
Neoplastic: such as ALL/lymphoma
Storage:such as gaucher hurler Neiman pick
Infections: (EBV CMV malaria)
Autoimmune
ADHD management extra information gathered by
Connors scale
Teacher report
Educational psychology assessment
Complications haemochromatosis
Haemochromatosis can cause deposits anywhere
Hypogonadism Cancer Cirrhosis Cardiomyopathy DM Arthropathy
Down’s syndrome important conditions
Cardiovascular: CHD especially endocaridal cushion defects/AVSD
Respiratory: sleep disordered breathing
Gastrointestinal: hirsprungs, atresia, coeliac, constipation
Endocrine: Thyroid dysfunction, obsess the risk
Genitourinary:
Musculoskeletal: Hip abnormalities, Atlanto-axial instability, scoliosis
Neurological: seizures, psychiatric such as depression, Alzheimer’s after 35y, abuse
Immune-Haematological: Leukaemias/ immune dysfunction, iron deficiency
Dermatological
Eye disease: cataracts and refractive errors
Hearing/ENT: serous otitis media, hearing impairment
Causes of intellectual disability
Prenatal: chromosomal - trisomy, fragile x, 22q11 deletion, genetic - TS, metabolic, syndromic - Williams, Prader-Willi, Cornelia de Lange, infections TORCH, toxins and drugs and major structural abnormalities
Perinatal: HIE, stroke, trauma, infection, hypoglycaemia
Post-natal: Injury, infection, poisoning
Grading murmur
1-6
4 = thrill
5 = heard with stethoscope just on skin
6 = heard without stethoscope
Continuous murmur differential
PDA Operative Shunt murmur AV fistula Ruptured sinus of valsava Severe coarctation Left coronary artery origin from pulmonary artery anomaly Anomalies of origin of the pulmonary artery Truncus
- aortic-pulmonary communications
- arteriovenous communications (fistulas)
- changes in arterial flows
- changes in veins flows
Holosystolic murmur causes and continuous murmur causes
VSD
MR
TR
Continuous murmur: PDA Venous hum CoA Surgical shunt such as BT AV fistulae
The four causes of a diastolic murmur
AR
PR
TS
MS
Flu vaccine funded for?
- asthma and regularly use a preventer medication (brown, orange, red or purple inhaler)?
- under 5 years and has a significant respiratory illness or been in hospital for a respiratory illness (such as pneumonia, bronchiolitis, asthma)?
does your child have a heart condition (such as congenital heart disease or rheumatic heart disease)?
does your child have cancer?
does your child have an ongoing chest (respiratory) condition, such as bronchiectasis or cystic fibrosis?
does your child have diabetes?
does your child have ongoing kidney (renal) disease?
does your child have HIV or AIDS, an auto-immune disease or another immune deficiency?
Flu immunisation is also recommended for those sharing a house with children and young people with long term (chronic) medical conditions. The flu spreads rapidly within households and children are particularly efficient spreaders. It may not be free for household members - they could ask their employer about free or subsidised flu immunisation as many employers offer this to their employees. Flu immunisation is free for some adults; for example, all those over 65 years of age and those with certain long term conditions.
Flu immunisation is recommended and free to pregnant women
Flu immunisation offers protection in pregnancy. Flu is likely to be more severe in pregnancy and can affect the mother and the unborn baby. Immunisation also offers some protection to the newborn baby.
Causes of ptosis
- Neurogenic:
- third nerve palsy,
- horners syndrome - Myogenic:
- myasthenia gravis,
- myopathy,
- myotonic dystrophy,
- congenital - Mechanical
- trauma
- eyelid oedema
- inflammation of eyelid
- neoplastic - Neurotoxic:
- envenomation
- chronic opioid abuse
Management approach to obesity
Causes
- Lifestyle (sedentery, diet)
- metabolic: Cushings, hypothyroidism
- inherited
- drugs: antipsychotics, antiepileptics, HAART
Consequences:
- Accelerated atherosclerosis
- Dyslipidaemia
- diabetes
- hypertension
- sleep disordered breathing
- restrictive ventilation defects
- fatty liver
- FSGS
- Osteoarthritis
- Psychological
Management
- lifestyle factors initially (evidence for short term LOW)
- Diet: low fat, low calories< 1500kcal, low salt<2g
- exercise: mod workload for 30mins most days of the week
- involve dietitian, family, exercise trainer
- Review regularly, aiming weight loss of 10-15%
- Pharmacological therapy (limited benefit): orlistat (fat binder, Cx GIT/steatorrhoea), fentomene (appetite suppressant Cx cardiomyopathy), topiramate (off label), metformin (if have insulin resistance)
- bariatric surgery (evidence for long term weight loss): lap banding, sleeve gastrectomy, gastric bypass
Causes of myopathy
- Hereditary muscular dystrophy
- Congenital myopathies - rare
- Acquired: PACE, PODS
- —polymyositis, dermatomyositis
- –alcohol
- –Carcinoma
- –Endocrine (hypothyroid, hyperthyroid, Cushings, Acromegaly, hypopituitarism)
- –Periodic paralysis
- –Osteomalacia
- –Drugs (chloroquine, steroids, statins, fibrates)
- –Sarcoid
- –Myasthenia Gravis
How would you assess nutrition
History:
- diet intake
- nutritional quality of food: red meat, vegetables, protein, dairy products
- appetite intake
- dysphagia
- malabsorptive symptoms
- comorbidities, chronic illness
- cognitive and functional affects
Examination:
- BMI, waist circumference
- Fe deficiency: pallor, koilonychia, angular stomatitis
- B12: atrophic glossitis, peripheral neuropathy, pallor
- Thiamine - dementia, Wernicke, kosakoff
- Vit D - osteomalacia/osteoporosis
- folate - pallor
- Vitamin A: poor eyesight
peripheral neuropathy, osteoporosis, osteomalacia, dementia, visual distrubance
Differentiating JvP
- non pulsatile
- double flicker
- moves with respiration (falls with inspiration)
- moves with position
- accentuates with hep
If hypermobile joints consider
Ethers danlos (bruises and scars)
Marfans
Osteogenesis imperfecta
If VSD murmur and limb abnormalities (wrist) think
VACTERL
Types of gaits
Gaits
Circumduction Hemiplegia Wide-based Cerebellar Hip joint abnormality Weakness or hypotonia of legs or pelvic girdle Waddling Proximal myopathies Foot drop (CMT)
Signs of chronological c liver disease
Signs of chronic liver disease (ABCDEFGHIJ)
Asterixis, Ascites, Ankle oedema, Atrophy of testicles Bruising Clubbing/ Colour change of nails (leuconychia) Dupuytren’s contracture Encephalopathy / palmar Erythema Foetor hepaticus Gynaecomastia Hepatomegaly Increase size of parotids Jaundice
Complications of hereditary haemochromatosis
(HaemoChromatosis Can Cause Deposits Anywhere)
Hypogonadism Cancer (hepatocellular) Cirrhosis Cardiomyopathy Diabetes mellitus
Power grades
0/5: no contraction
1/5: muscle flicker, but no movement
2/5: movement possible, but not against gravity (test the joint in its horizontal plane)
3/5: movement possible against gravity, but not against resistance by the examiner
4/5: movement possible against some resistance by the examiner (sometimes this category is subdivided further into 4–/5, 4/5, and 4+/5)
5/5: normal strength
Drooling management
SLT to promote oro-motor function Behavioural intervention Bibs Pharmacological options Hyoscine q6h po Hyoscine Patch q72/24 Dental intervention Surgical Botulium toxin A
complications of CLD….
Hepatic VCPBT:
Hepatic encephalopathy Esophageal varices Portal hypertension Ascites Thrombosis of portal vein Infection Carcinoma
Vitamin deficiencies Coagulopathy Pruritis Bile salt build up Transplant issues
Creon
Pancreatic enzymes amylase protease lipase
Bullying plan
1) Patient
→ teaching assertiveness skills and confidence building
2) Parent
• Source of support for child if having problems
• Act as advocate for the child to liase with the school
3) School
• Acknowledge problem exists
• Establish support mechanisms for students (assigned group of staff)
• Anti-bullying policies
• Education in classroom (organise project on bullying
• Not tolerate bullying @ school
• Provision of counsellors or local psychologists
Whole School Approaches / Intervention Programmes:
Kia Kaha, Police Youth Education Services Resource Kit. Contact your local police education officer at the nearest Police Station.
Keeping Ourselves Safe, Police Youth Education Services Resource Kit. Contact your local police education officer at the nearest Police Station.
Eliminating Violence Managing Anger, contact your local Specialist Education Services, Internet: http://www.ses.org.nz
Helplines / Advice Agencies
0800 NO BULLY (0800 66 28 55). An automated phone helpline that offers advice for pupils who are being bullied. Developed and supported by the New Zealand Police and Telecom New Zealand Limited.
The Police / Telecom “Stop Bullying” websitehttp://www.nobully.org.nz offers practical advice and gives some excellent links to other anti-bullying sites.
New Zealand Children Young Persons and Their Families Service (see phone book blue pages Government Phone Listings for local number).
Mental Health Foundation, refer to your local Health Authority.
Youthline, phone 0800 376 633.
• Lifeline: 0800 543 354 (available 24/7)
- Suicide Crisis Helpline: 0508 828 865 (0508 TAUTOKO) (available 24/7)
- Youthline: 0800 376 633
- Kidsline: 0800 543 754 (available 24/7)
- Whatsup: 0800 942 8787 (Mon-Fri 1pm to 10pm. Sat-Sun 3pm-10pm)
- Depression helpline: 0800 111 757 (available 24/7)
- Rainbow Youth: (09) 376 4155
- Samaritans 0800 726 666
Other primitive reflexes
- Placing, stepping (both from birth to 6 weeks).
- Landau re ex, a two-stage re ex. With the child supported prone (with your
hand under the abdomen), the child should (normally) extend head, trunk and hips. is is the rst, and more important, stage. Next, ex the head and neck; normally the response is exion of trunk and hips, but this is less constant than the rst stage ( rst stage from 4 months, plus second stage from 9 months; gone by 2 years). - ATNR. With the child supine, the head is rotated to one side. A ‘fencing’ posture develops, with extension of the ipsilateral upper and lower limb (i.e. the side towards which the head is turned) and exion of the opposite side (2–6 months). Persistence beyond 6 months is indicative of upper motor neurone problems, especially CP. Maintaining the ATNR posture throughout the time that the head is held turned, such that the child cannot ‘break’ from that position, is similarly signi cant.
- Neck-righting re ex. Rotation of the trunk to conform with the position of the head when the head is rotated to one side (6 months to 2 years).
- Moro re ex (birth to 4 months). As with most primitive re exes, persistence beyond the usual time of disappearance is pathological. Make a point of focusing not only on the limb movements but also the facial response, for asymmetry (e.g. in hemiplegic CP).
- Parachute re ex. With the infant held in the prone position, move him or her rapidly, face downwards, towards the oor. e normal reaction is to extend both upper limbs as if to break the fall (appears between 6 and 12 months, usually at 9 months, and persists; its absence beyond 12 months is abnormal). Asymmetry occurs with hemiplegia.
Causes of pes cavus
CMT Frederich ataxia (spinocerebellar degeneration)
Floppy weak and floppy strong infant causes
Floppy weak: SMA, congenital myotonic dystrophy, congenital myopathy, werdnig-Hoffman
Floppy strong: downs, hypotonic CP
Cause of scoliosis
Idiopathic
Paralytic (neuromuscular)
Bony or ligamentous (CT disorders)
Biprosthetic valve types
Xenografts - porcine and bovine
Allograft - cadaveric or auto
Causes of cardiomyopathy
Congenital HTN Infective Idiopathic Toxin (chemo) Infiltration - amyloid, sarcoidosis, metabolic, haemochromatosis Endocrine Hypothyroidism and acromegaly CTD Ischaemic
Causes of cardiac failure
Congenital heart disease Valvular Arrhythmia Ischaemic High output state: anaemia, thyrotoxicosis, Av fistula..
DDx of ejection systolic murmur
AS
PS
Hypertrophic cardiomyopathy
ASD
Ascites causes
Prehepatic: CHf, Budd-Chiari syndrome, IVC obstruction
Hepatic: decompensated cirrhosis with portal HTN
Nephrotic, TB, chylous, pancreatitis
Atrophic glossitis due to
Iron def, B12 and folate def
Can’t smell in what syndrome
Kallman
Ptosis causes
Congenital, MG, Myotonic dystrophy, thyrotoxicosis, horners, third nerve palsy
Causes of facial n palsy
UMN
LMN: bells, OM, acoustic neuroma, meningioma, MS, fracture, Ramsey hunt, parotid enlargement, vascular
Stamping or slapping gait with what
Sensory neuropathy
Peripheral neuropathy or nerve stuff DDx
Congenital such as CMT Vascular/vasculitis Infectious/inflam - GBS/transverse myelitis, syphillis, botulism, Lyme Trauma Autoimmune MS Metabolic - DM, thyroid, uraemia, vit B12/E, B1 and B6 def Iatrogenic/ idiopathic Neoplastic - A B C Drugs - vincristine, lead
Causes of foot drop
CommonPerineal nerve palsy, sciatic nerve palsy, lumbosacral plexus lesion, L4/L5 lesion, PMN, distal myopathy, spinal cord lesion
Genetic syndromes and gene defects assoc obesity
Prader-willi Alstrom Cohen Albrights Carpenter Rubinstein-taybi Fragile x Lawrence moon bardet biedl
Pain and temperature and proprioception test what
Pain and temp is spinothalamic pathway
Proprioception/vibration is dorsal columns
Hypertension causes in NF1 (5)
Renal artery stenosis, phaeo, coarct, neurofibromas, essential
Waddling and wide based gait indicates
Waddle weakness in proximal myopathy and wide in cerebellar
Romberg sign looks for
Dorsal column pathology
Bullying plan 5 steps
1: explore and fix cause eg smell or drooling
2: increase self esteem highlight strengths and increase support peers and family home environment and ‘buddy’ or mentor at school and adult he can trust to report to
3: school policy, avoid situations that exacerbate or change schools, karate or other activity to help
4. list some immediate things your child can do when the bullying happens. For example: first, ignore the bullying behaviour. If that doesn’t work, tell the person to stop. If the bullying continues, walk away. Tell someone.
5. Books on bullying or website WHATSUP
Cyber bullying may need restrict websites/internet use, kia kaha police programme safety in schools
6. Regularly check in with child and reassure that telling them is the right thing
Drooling (sialorrhoea) amount per day and causes and complications and management
500ml-2L per day
Overproduction or inability to swallow
Complications are social implications and embarrassment of pt and family, skin irritation, frequent bib and clothes change, smell, increased risk aspiration, choking and coughing episodes
Mx:
Saliva clinic SSH
Medications - anticholinergics such as atropine and glycopyrolate
Behavioural modifications and physical therapy (positioning and seating)
Oromotor rehabilitation / therapy by Speech Therapist (increase sucking - straw) and increase oral awareness
Orthodontic treatment
Improvement of nasal and oral airway patency - Otolaryngology (ENT)
Catellio moreles prosthesis
Surgery to the salivary glands - side effect dry mouth and dental problems
Botox injection to submandibular / parotid glands
No treatment but use waterproof bib or clothes
FTt causes
Inadequate intake, neglect
Malabsorption
Increased energy use or demands
Oral aversion plan
Eliminate cause if can - tubes, reflux, nausea
Educate
Introduce food early age and make it fun, fa,ily meals
Monitor growth
Monitor dentition
Causes of scoliosis
SCOLI
Syndrome NF1 marfans Congenital Orthopaedic (leg length) Low and high tone neuromuscular - CP, Spina bifid a, SMA, DMD Idiopathic
Sz managment
Safety Emergency plan Avoid triggers AED Assessments Monitoring (phenytoin and phenobarb) CMZ Avoid drugs that aggravate Surgery Vagal stimulation Ketogenic diet
Involuntary movements causes
Bells intend to keep moving:
Cerebellar lesions are associated with intention tremor.
Opposite BallS:
Hemiballismus is due to contralateral subthalamic nucleus lesion.
Put at globe:
Putamen / globus pallidus damage causes Atheosis
2 C’s:
Chorea is caused by Caudate nucleus lesion
CP
Drugs
Tics
Infection
Trauma NAI AV malformation
Autoimmune MS
Seizure
Mental state examination
Mnemonics for MSE: ASEPTIC
A- Appearance and Behaviour S- Speech E- Emotion [mood and affect] P- Perception [Hallucination and illusion] T- Thought content and process I- Insight and Judgement C- Cognition
Mnemonics for examination for cognition: GOAL-CRAMP
‘I’d like to start off by asking you a few questions to test your concentration and memory……….’
G- general: Alertness and Co-operation
O- orientation: Time and Place
A- attention: WORLD backwards and Serial Sevens
L- language: Naming and Repetition
C- calculation: Division and Subtraction
R- right Hemisphere Function: Intersecting pentagons and Clock-face
A- abstraction: Proverbs and Similarities
M- memory: Short term and Long-term memory
P- praxis: Wave good-bye and Comb hair
Mouthing toys age
6-15/18m
Removes clothes and independent with spoon which age?
18m
Prepositions, object use and 6 body parts what age
24m
Points to the right image of cat…what age
15-18m
Imaginative play at what age
3y
Catch well and kick well and jump two feet what age
3y
Throw ball what age
18m
Tense and big/little opposites at age..
4y
Stand on one foot for how many seconds
3 at 3 and one second per year of age after that
Can skip at 5y
Handedness by what age
18m
Mature pen grip by 5y
Short with polydactyly think
Bardt-biedl
Clindodactyly and short think
Downs, Russell-silver, seckels, shwachmans
A body habitus that is tall, slim and underweight, with long legs and long arms (i.e., arm span exceeds height by 5 cm or more).
Eunuchoid habitus. Definition
Long limbs
Dolichostenomelia is a human condition or habitus in which the limbs are unusually long. The name is derived from Ancient Greek (dolichos - long, steno - short, narrow, close, melia - of the limbs). It is a common feature of several kinds of hereditary disorders which affect connective tissue, such as Marfan Syndrome and homocystinuria.
Facial nerve palsy causes
Idiopathic Bell’s palsy most common (unknown or viral)
Trauma I.e. due to delivery traumas
AV malformation
Infective -EBV/Ramsay Hunt
Iatrogenic
Tumour/neoplastic (schwannoma)
Congenital: Möbius syndrome, Goldenhar, Poland syndrome, pseudobulbar palsy, Arnold-chiari
NMJ: MG, botulism
Muscular: hereditary myopathies, such as myotonic dystrophy
CXR in cardio patient DDx of increased and decreased pulmonary vascularity
Increased:
Truncus, TAPD, TGA, (large L to R shunt, ASD, VSD, PDA)
Decreased:
TOF, Pulmonary atresia, TA, Ebsteins, critical PS
Causes of RAH
TA Hypoplastic R heart Ebsteins PA Complex congenital
Deep Q waves on ECG seen in
HCM
TGA
anomalous left coronary artery
LAD causes
Endocardium cushion defect
TA
HCM
Inlet VSD
RAH causes
Ebsteins TA PA with intact septum Truncus TOF large VSD
Short forth metacarpal in
Turners, fetal alcohol, pseudopseudohypoparathyroidism
Trauma, infection
Micropenis causes
Kallman s and hypopit
Froehlich syndrome is
a rarely encountered condition that occurs mainly in males and is characterized by obesity, small testes, and a delay in the onset of puberty.
Bronchiectasis causes
bx causes
There are multiple causes including - CIRICCI
Cystic fibrosis
Infection with pertussis, measles, TB, adenovirus (7 &14)
Recurrent infections or aspirations
Less commonly
Immune deficiency
Ciliary dyskinesia
Congenital abnormality of CT (→ obstruction →↑ infections)
If localised areas of bronchiectasis
Inhalation of foreign body
Qualities of apex beat and causes
Quality of apex beat Quality Sustained – pressure overload in AS Forceful – LVH Thrusting – volume overload (MR/AR) or L→R shunt Parasternal heave – RVH
Palpable S2 = pulmonary hypertension
Causes of an abdominal mass
Appendiceal Abscess Tumors Wilms Neuroblastoma Hepatoblastoma HCC Teratoma Lymphoma Ovarian Cysts Renal Hydronephrosis Cystic disease Obstructed bladder
Short child syndrome characterized by a progressive loss of vision and hearing, a form of heart disease that enlarges and weakens the heart muscle (dilated cardiomyopathy), obesity, type 2 diabetes mellitus (the most common form of diabetes), and short stature.
Alström syndrome
Bardet-Biedl syndrome (BBS) is an autosomal recessive multisystemic genetic disorder characterised by six major defects which are…
Ciliopathy
obesity, learning disability, renal anomalies, polydactyly, retinal dystrophy and hypogenitalism
Pickwickian syndrome: 4 features
The combination of obesity, somnolence (sleepiness), hypoventilation (underbreathing), and plethoric (red) face.
Features of coffin lowrey syndrome
Severe ID
short stature, an unusually small head (microcephaly), progressive abnormal curvature of the spine (kyphoscoliosis), and other skeletal abnormalities.
Abnormal RAPD in affected eye less constriction both pupils - name and causes
Marcus Gunn pupil
Causes by optic nerve lesion, severe retinal disease, optic neuritis
What is an Argyll Robertson Pupil
It is bilateral small pupils that reduce in size on a near object (i.e., they accommodate), but do not constrict when exposed to bright light (i.e., they do not react to light). They are a highly specific sign of neurosyphilis; however, Argyll Robertson pupils may also be a sign of diabetic neuropathy. In general, pupils that accommodate but do not react are said to show light-near dissociation (i.e., it is the absence of a miotic reaction to light, both direct and consensual, with the preservation of a miotic reaction to near stimulus (accommodation/convergence).[1]
Beak nose and pancreatic insufficiency
Johnston-Blizzard syndrome
Ortolani and Barlow test
Ortolani opens up lower limbs and Barlow bumps back
Erbs palsy roots
C5,6
What is galant reflex used for?
To look at structural integrity T2 to S1
What conditions cause leukocoria
Many conditions cause leukocoria including cataract, retinal detachment, retinopathy of prematurity, retinal malformation, coats disease, intraocular infection endophthalmitis), retinal vascular abnormality, and intraocular tumor (retinoblastoma).
What is pellagra
Pellagra is a disease characterised by diarrhoea, dermatitis (scaly brown) and dementia. If left untreated, death is the usual outcome. It occurs as a result of niacin (vitamin B-3) deficiency. Niacin is required for most cellular processes
Brown nails can indicate?
Chronic Kidney Disease
Bleomycin important side effects
Interstitial pneumonitis leading to Lung fibrosis from oxidative damage
Bulbar palsy weather is it and causes?
Bulbar palsy results from bilateral impairment of function of the IXth, Xth and XIIth cranial nerves. This gives rise to dysarthria, dysphagia (often with choking episodes and nasal regurgitation of fluids), dysphonia and poor cough, and susceptibility to aspiration pneumonia. The lowermost part of VII may, infrequently, be involved.
The disturbance is of the motor nuclei rather than of the corticobulbar tracts. It is distinguished from pseudobulbar palsy by the presence of lower motor neurone signs. Autonomic features are uncommon.
Causes of bulbar palsy include: MND Guillain Barre syndrome poliomyelitis diphtheria myasthenia gravis neurosyphilis Tumour Stroke Syndromic or genetic
Anti epileptic med’s that can measure serum levels
Carbamazepine
Phenytoin
Phenobarbitone
Not valproate (unless suspect non compliance)
90% of Spina bifida have…
Hydrocephalus
Arnold chiari II
Scoliosis management
Monitor X-ray watch and see
Brace or cast
Surgery
Lens displacement in marfans and homocysteinuria
Marfans superior intellect so superior
Homocysteinuria inferior
Optic nerve hypoplasia association
Absent corpus callosum
Noonan complications
Noonan syndrome have an eightfold increased risk of developing leukemia or other cancers over age-matched peers. Bleeding tendency Pubertal delay Short AD
Denys-Drash
Denys–Drash syndrome (DDS) or Drash syndrome is a rare disorder or syndrome characterized by gonadal dysgenesis, nephropathy, and Wilms’ tumor.
Impairment, disability and handicap definition
Impairment – residual limitation resulting from disease, injury or congenital defect
Disability – Difficulties an individual may have in executing activities – inability to perform a functional skill
Handicap – Problems an individual may experience in life situations – interaction of a disability with the environment
Cyanosis implies?
Right to left shunt at level of heart or great vessels
Inadequate oxygenation by kings
Left lateral chest wall scar causes?
Coarctation repair PDA ligation BT shunt PA banding Thoracotamy
Absent or reduced brachial pulse causes
Congenital Embolisation Previous catheter Cervical rib BT shunt
Absent left could be from coarctation repair
Flat foot pes planus causes
Dyspraxia, ligamentous laxity, hypermobility (collagen disorder ethers-danlos and marfan), CP
Causes of pes cavus
CMT Fredereichs ataxia Neurological Trauma Orthopaedic Neuromuscular Spina bifida Diastometamyelia
Jerky pulse and collapsing pulse causes
HOCM
AI and PDA
Mean diastolic and systolic values
Age + 90/ age + 55
Causes of displaced apex
Cardiomegaly
Scoliosis
Pectus
Loud second heart sound from?
Pulmonary HTN
Increased pulmonary flow from left to right shunt in ASD, VSD, PDA
