Immunoodeficiencies Flashcards
- NEG NitroBlue-TetraZolium test
- Abnormal DiHydroRhodamine flow-cytometry
Pneumonias + Abscesses:
-catalase-POS bacteria #S.Aureus
-fungi #Aspergillus
___________
Prog NeuroDegeneration, LymphoHistioCytosis, Albinism (partial) Infection #pyogenic, Neuropathy peripheral.
Giant GRANULES in neuts/plts
___________
3.
Delay @umbilical-cord sloughing
-ABSENCE of Neuts/ Pus
@infection sites
-Recurrent bacterial infections \_\_\_\_\_\_\_\_\_\_\_\_ 4. a) Presents >2yrs+BALS+HypoGammaGlob
BALS - #Sinus/U+LRTIs #recurrent
- Bronchiectasis
- Autoimmune dx,
- Lymphoma,
- SinoPulmonary INFECTION
HypoGammaGlob
- low Ig AND plasma cells!!
b) Diarrhoea -Fungal: Dermatitis MucoCut Candidiasis -Bacterial Otitis/Pneumonias -Viral #recurrent
-CXR=Absence of Thymic shadow
-LN biopsy=Germinal Centre
-Protein @IL2 #defect #gamma-chain
-Reduced T-cell receptor EXCISION circles
_____________
5.
Nooooo B-cells
-Low Ig M,A,G,E,D
-HypoGammaGlob
-Recurrent bacterial infections are seen
_____________
Sinus/U+LRTIs #recurrent Severe BLOOD Transfusion - Why? COELIAC disease w/ -FALSE NEG coeliac screen -(TTG Assoc with what Ig?)
Chronic granulomatous disease
-NADPH oxidase = reduces ability of phagocytes to produce reactive oxygen species
_____________
Chediak-Higashi syndrome
-Microtubule polymerization dx –> decrease in phagocytosis
____________
3.
Leukocyte adhesion deficiency
-Defect of LFA-1 integrin (CD18) protein on neutrophils
\_\_\_\_\_\_\_\_\_\_\_\_ 4. a) CV-ID >2yr Common variable immunodeficiency CVID BALS
@XLinked Bruton Agamaglob - hypoGAMAglob too!!
b)
SCID: Severe combined immunodeficiency
-defect gamma chain @IL-2 and other interleukins
_____________
5.
BXA: Bruton’s X-linked AGammaGlobulinaemia
-B for BRUUUUton’s tyrosine kinase (BTK) defect
______________
Selective Ig A deficiency
-TTG=IgAAAAAAAAAA!!!!!!
-Blood Transfusions:
anti-IgA ABs → analphylaxis
1-inch prox to RadioCarp joint
What fractures are compartment syndrome associated with?
________
- FOOSH
- Distal-Radius# - Transverse
- Dorsal displacement + angulation
—DINNER fork dx
_________
- FOOSH
- Distal-Radius #
- Volar-Palmer displacement
-fall back onto the palm OR
-fall with wrists flexed (wtf?)
-Garden-Spade deformity
_______
- FOOSH
-Distal-Radius #
-RadioCarpal dislocation
_________ - FOOSH
-Radius #
-RadioUlnar dislocation
Rotational force
__________
_________ - FOOSH+FORCEDPronation
-Ulnar #
-RadioUlnar joint dislocation
_________ - a. Fistfight –>
1st Carpo-MCP joint #
-SIMPLE/oblique
-@-THUMB MCP-base
-Triangular fragment @ MCP-Ulnar base
b. Fistfight –>
1st Carpo-MCP joint #
-COMMINUTED #
-@THUMB MCP-base
c. 5th MCP bone #
__________
- FOOSH
- fracture NOT initially seen
- after casting THEN fracture seen..
Pain @ snuffbox – poss AVN necrosis
_________
8. FOOSH sharp lateral elbow pain Tender radial head, impaired elbow movement (inc sup and pron) \_\_\_\_\_\_\_
- Bimalleolar ankle fracture
- Forced foot eversion
Weber: C location? Tx? B location? Tx? A location? Tx? ---Maisonneuve = spiral ? # --> -? disruption + ankle joint ? \_\_\_\_\_\_
Teenage girl 12-15
Foot pain @Weight-bearing
–> reduced ADLs
What fractures are compartment syndrome associated with?
-Supracondylar + Tibial shaft
_________
- Colles - R-D dx
-DINNER fork deformity
____ - Smith (reverse colles) - R-VP dx
-GARDEN-spade deformity
____ - Barton - R-RC
_____ - Galleazzi - R-RU
________
________ - Monteggia - U-RU
______ - a. Bennet - 1st C-MCP=SIMPLE/oblique
b. Rolando - 1st C-MCP=COMMINUTED
c. Boxer - 5th MCP bone
___
- Scaphoid fracture
____ - Radial head fracture @elbow
_____ - Pott’s fracture
Weber: C above synd - ?ORIF B @synd - ?ORIF A below synd = AnkMotionBoot ---Maisonneuve = spiral fibular # --> -Synd disruption + ankle joint widening \_\_\_\_\_
- Friebergs disease
Painful wrist:
- Pain @ resisted thumb ABduction
- Pain @ radial wrist @ FINKelstein
Dx? Finkelstein? Which tendons? \_\_\_\_\_\_\_\_\_ a. Kanavel’s sign: Fixxxxed FLEXION -Fusiform swelling Pain @Passive Ext ---Conservative? Medical? Surgical?
b.
- TenoSynovitis –>
- MIGRAAAATORY polyArthritis,
- dermatitis - dry/itch/red
c. Trapped flexor tendon Digit LOCKED in Flexion Have to PASSIVELY release it -Flexor tendon sheath THICKENED + NARROWED \_\_\_\_\_\_\_\_\_ 3. AR Bone HARDER+DENSER
-Can't differentiate between: cortex + medulla @x-ray #marblebone -HSM, bone pain, Deformity \_\_\_\_\_\_\_\_\_
-? (Osteo) -? (Genesis) -? (imperfect)
Poor collagen formation ->
shit osteoid FORMATION:
-Translucent @x-ray
-Multiple fractures #baby-chicken-bone
-Blue sclera
-ALL Bone profile bloods NAD
_________
-Osteo (?) -Malacia (?) RVOLT: VitD def -> osteoid OSSIFY fail -> Small #F2T -LARGE head
CW-dx:
-Thick Costo-ChonJct
-Transverse(Harrison’s)sulcus
#diaphragm-pull
-Bowing Femur+Tib
(random but 2ndry HyperPT =
CKD + Pseudo HypoPT)
_________
Radial Nevrve ?
Median ?
Ulnar ?
Erbs = C?-? = Waiter’s Tip
—? rotated, ?nated, A?ducted
Klumpke = C?-T?
—–Hung on tree -> TOTAL ?
can’t flex MCP,
can’t ext DIP/ PIP
0-15 Muscle - Nerve
15-90 Muscle - Nerve
90-100 Muscle - Nerve
100+ = Muscle - Nerve
Supraspinatus = ? nerve
Infraspinatus = ? nerve
Teres minor = ? nerve
Subscap = ? nerve
C?-? #Erb Supraspin - A?duct 0-15 InfraSpin - ? Rot Tere Minor - ? Rot SubScap - ? Rot + A?duct
De Quervain’s TenoSynovitis
-Finkelstein to diagnose = Pain @:
Flex thumb THEN
Ulnar-deviate + wrist-Flex
- APL: Adductor pollicis Longus
- EPB: Extensor pollicis Brevis
\_\_\_\_\_\_\_\_\_\_ a. Infective Flexor-TenoSynovitis -Fusiform FFD #Kanavel -RICE, ABx Debride
b.
Gram-negative diplococci
-GONORRHOEA
c. Stenosing TenoSynovitis -Trigger Finger \_\_\_\_\_\_\_\_ 3. OsteoPETrosis --BMT, Alpha-IFN, EPO \_\_\_\_\_\_\_\_
Osteogenesis imperfecta -osteoid (Osteo) -FORMATION (Genesis) -shit (imperfect) \_\_\_\_\_\_\_\_\_\_\_
Rickets osteomalacia
- Osteo (bone)
- Malacia (ossify fail)
Harrison sulcus
Bowing leg
(random but 2ndry HyperPT =
CKD + Pseudo HypoPT)
_________
Radial Nevrve:
-Brachioradialis , Brachialis , Biceps; Extensors; Anconeus, Supinator, Triceps
Median: Pal Longus FCR - FDS FDP PronQuad + LLOAF-P
Ulnar:
FCU
ADdP / FDP
MLOAF-DigMinimi
Erbs = C5-6 = Waiter’s Tip
—medially rotated, pronated, ADducted
Klumpke = C8-T1
—–Hung on tree -> TOTAL CLAWING
can’t flex MCP,
can’t ext DIP/ PIP
0-15 SpraSpinatus - SupraScapNerve
15-90 Deltoid - Axillary
90-100 Traps - Accessory
100+ = Serr Ant - Long Thoracic
Supraspinatus = SupraScap nerve
Infraspinatus = SupraScap nerve
Teres minor = Axillary nerve
Subscap = SubScap nerve
C5-6 #Erb Supraspin - ABduct 0-15 InfraSpin - Ext Rot Tere Minor - Ext Rot SubScap - Int Rot + Adduct
Presents >2yrs
BALS:
- Bronchiectasis
- Autoimmune dx,
- Lymphoma,
- SinoPulmonary INFECTION
HypoGammaGlob
- low Ig AND plasma cells!!
________
3. Diarrhoea + Dermatitis MucoCut Candidiasis - Fungal Otitis/Pneumonias - Bacterial Viral #recurrent
Reduced T-cell receptor EXCISION circles CXR=Absence of thymic shadow Germinal Centre at lymph node biopsy Protein @IL2 defect #gamma-chain \_\_\_\_\_\_\_\_\_\_
No B-cells +
Low Ig M,A,G,E,D
HypoGammaGlob
-Recurrent bacterial infections are seen
CV-ID >2yr
Common variable immunodeficiency
CVID BALS
@XLinked Bruton Agamaglob - hypoGAMAglob too!!
________________
3.
SCID: Severe combined immunodeficiency
-defect gamma chain @IL-2 and other interleukins
_________
BXA: Bruton’s X-linked
AGammaGlobulinaemia
B for BRUUUUton’s tyrosine kinase (BTK) defect
LONG bone METAPHYSIS
-Assoc w/ Pagets, Radiation, Ret-blastoma
______
1 in 10million @young males LONG bone DIAPHYSIS -small round tumour #ONION skin appearance -Aggressive \_\_\_\_\_\_\_
3) 2 in 1 million @>40yr
________
Tumour w/ loads of HISTIOCYTES
-Undifferentiated pleomorphic sarcoma i.e.
CUO: Cell Unknown Origin
_______
Trapped flexor tendon Digit LOCKED in Flexion Have to PASSIVELY release it -Flexor tendon sheath THICKENED + NARROWED
PMH: DM rheumatoid gout
_______
Patient has:
DM/ cirrhosis/ Phenytoin user
Patients got
FLEXION contracture
of the FINGERS - mainly RING
-Nodular thickening of palmer fascia
Hueston table top test?
________
Pain and swelling
-SOAP bubble on X-ray
-Large radiolucent
Can present as path fract
-head of numerous
extending to subchondral plate
OsteosarcoMMMa
-MMMetaphysis
EM——DDDDDD——-ME
EMost-DDewDD-MostE
€ = ————- = 3
______
Ewing
-diaphysis, onion
EM——DDDDDD——-ME
EMost-DDewDD-MostE
€ = ————- = 3
____
3)
Liposarcoma - >5cm , deep \_\_\_\_\_\_ 4. Malignant Fibrous Histiocytoma \_\_\_\_\_\_\_\_ 5.
Stenosing Tino synovitis
A.k.a. trigger finger
-Analgesias/steds
_________
Dupuytrens contracture
-Peyeonie/Ledderhose
__________
Giant cell tumour
–soap bubble lucency
Chronic pain + tingling of BUM
-worsened by sitting on toilet/chair for aaaages
O/E: elicit pain @INT rotation
__________
Test integrity of structures? ACL - ? PCL - ? Meniscal tear - ? Thomas - ? Trendelenburg - ? \_\_\_\_\_\_\_\_\_
Picked up on newborn exam POSITIVE ortalini and barlow Unequal skin folds \_\_\_\_\_\_\_ 4. Viral infection -> hip pain 2-10yrs \_\_\_\_\_\_\_ 6.
Kid = Joint pain, swelling >3m -Knees, ankles, elbows -Limp -ANA+, Ant Uveitis \_\_\_\_\_\_\_\_
a. Pyrexia + Acute Hip Pain #?Flexed
- most common organism?
- young and sexual active
- fever + hot-red-swollen joint
Kocher criteria septic arthritis:
fever >3?
non-? bearing
raised ?
?ABx
? 2 decompress
Eventual surg Mx?
b.
SickleCell dx, IVDU, DM, Endocarditis
-most common pathogen?
- @sickle-cell anaemia = ?pathogen
Ix ? Tx?
______
Obese and boys
Knee/Distal thigh pain
Can’t int. rotate in flexion
_____
PMH: Alcohol XS, LT Csted use,
-O/E: Hip pain, reduced ROM of hip
-X-ray: subchondral # segmental FLAT Femoral head osteopenia. \_\_\_\_\_\_\_
Kid:
Progressive hip pain -> Limp
O/E: Stiffness + RedROM
Xray: wide right hip joint space
flattening of the femoral head
—Degen -> AVN fem head
____
(random but 2ndry HyperPT =
CKD + Pseudo HypoPT)
Piriformis Sydrome
-sciatic come out of foramen BELOW piriformis -> liable to comp
_______
ACL - Lachman PCL - Post drawer Meniscal tear - McMurray Thomas - FFD hip Trendelenburg - hip abduction \_\_\_\_\_\_\_
Hip dysplasia
_______
- Transient synovitis
_______
JIA – PauciArticular most common \_\_\_\_\_ a. Septic arthritis -S.Aureus -young + std = gonorrhoea
Kocher criteria septic arthritis:
fever >38.5 degrees C
non-WB
raised ESR/WCC
Tx:
Fluclox/Clinda for WEEEEKS
Needle Asp 2 decompress
Washout + lavage
b.
Osteoyelitis:
-Staph. aureus
- @sickle-cell anaemia = Salmonella
Ix: MRI
Tx: Fluclox/Clinda
____
Slipped Upper Femoral Epiphysis
_____
Avascular necrosis
______
Perthes dx
Worse on the ‘OUTSIDE’ of hip
-Bad @ night when lies on right side.
O/E:
- full ROM in the hip
- Deep palpation @LATERAL hip joint recreates the pain.
-Due to repeated movement of the fibroelastic iliotibial band
_______
NWB @T3 preg Groin pain + limited hip ROM -Non Weight-Bear -ESR high \_\_\_\_\_\_\_\_
3. WADDLING @PREG -Preg -> hormone -> Ligament laxity -Pain @pubic symphysis -Radiatie to groin + medial thighs.
_______
_______
Shortened Int. Rotated Flexed, Adducted -Sciatic nerve injury \_\_\_\_\_
Shortened, Ext. Rotated -AVN risk (fem circumflex + lig teres artery) -Low-energy impacts in elderly patients \_\_\_\_\_\_
Abducted, Ext. rotated,
-PALPABLE BULGE of the femoral head
_____
Pain @ walking or palpation,
Instability,
Neurovascular deficits
Signs of damage to pelvic organs e.g. haematuria or PR bleeding.
______
(random but 2ndry HyperPT =
CKD + Pseudo HypoPT)
Greater trochanteric pain syndrome
AKA Trochanteric bursitis.
—ilio-tibial band
______
Transient idiopathic osteoporosis
______
- Pubic symphysis dysfunction
_______
_______
Posterior hip dislocation
_____
NOF #
_____
Anterior hip dislocation
_____
Pelvic fractures
Cleft palate
Congen HEART disease #ToF
HypoCalcaemia,
-Recurrent viral/fungal diseases
-Retarded
____________
Rapid Swelling of FACE, LIPS, HANDS
- has low serum C4
Give these fuckers ? /
_______________
3. Diarrhoea: -Dermatitis/MucoCut Candidiasis - Fungal -Otitis/Pneumonias - Bacterial -Viral #recurrent
Fucked:
-CXR thymic shadow #absent
-IL2 dx
-T-cell EXCISION circles
-LN germ centre
_____________
4.
High AFP
cerebellar Ataxia,
Telangiectasia (spider angiomas),
10% risk of developing:
-CANCER-lymphoma/leukaemia
-recurrent CHEST infections
______________
TCP-low Plts, low IgM
Autoimmune IgA- High
Malignancy IgM-looooooow
Eczema IgE- High
-Recurrent Bacterial infections
_______________
High IgM
Low OTHER Igs!!!
Opportunistic Infection EARLY LIFE
-pyogenic + PCP/Crypto-diarrhoea/CMV
-hepatitis
______
Fred is your SPACKER* FRAT? bro, always: -staggering ?Tract -falling ?Tract *(?Tract) -----HIGH AFP
but has a
- sweet - ?
- big heart - ?
- funny eyes+high arched feet - ?
What’s he going to die from?
______________
Cataracts
Muscle weakness
FRONTAL balding
________
toddler w/ delayed motor milestones -CALF hypertrophy -prox hip girdle muscle weakness -high CK (suggest what to do? what would this show? -Gower's sign \_\_\_\_\_\_\_\_\_
Paeds clinic
-prog difficult whistling + sucking through straw
DiGeorge syndrome 22q11.2 deletion
- Hypocalc @ DiGeorge
- Hypercalc @William
_____________
Hereditary AngioOedema
- C1 inhibitor
- Give these fuckers C1-inhibitor conc / FFP
________________
3.
SCID: Severe combined immunodeficiency
-defect gamma chain @IL-2 and other interleukins
_______________
4.
Ataxic telangiectasia
__________
Wiskott-Aldrich Syndrome
-WASP gene dx
Tame-Eczema low Plts+IgM
_____________
Hyper IgM Syndromes
-CD40 gene defect
________
Fred is your SPACKER FRATaxin bro, always: - staggering (Ataxia #SpinoCerebellar tract) -falling (DC-ML) cos of prop/vib -(CST - spastic paralysis) -----HIGH AFP
but has a
- sweet (DM)
- big heart (Hypertroph CM)
- funny eyes = nystagmus/pes cavus
AR = metabolic except ataxias AD = structural except Gilbert, HL2
Die from CARDIO MYOPATHY HOCM
____________
Myotonic dystrophy
-Autosomal Dom
__________
Duchenne - XLr
-high CK (suggest to do MUSCLE BIOPSY=absent dystrophin)
Facio-Scapulo-Humeral Musc Dystrophy
IN SUMMARY:
low-ears, small jaw,
edward-scissor hand fingers,
ROCKERbottom club foot
- Low-set ears
- Micrognathia - small jaw
- Overlapping scissor hand fingers
- Structural heart defect
- Rocker bottom CLUB FOOT!!!!!!!
D>E>P
_____________
In summary:
- small brain/ scalp// eyes// lips/ palate
- Lots of FINGERSSSSSSSSSSSSSSS
micro-oPhthalmia sPlit brain fail - holoProsenceph aPlasia - SCALP CUTIS Palate - cleft Polydactyly
D>E>P
____________
Summary:
BIG brain , BIG balls, LONG face/ears
MacroCephaly - big brain
Macro-orchidism - big balls
-Looooooong face + ears
-Retarded
___________
XS Phys Growth
- MacroDOLICHOcephaly
- —-head>expected
Edward 18 -EDward SCISSOR Hand and Feet and EARS!!!! -Ed ATEeen - small jaw cant eat.. what a shit connection ffs \_\_\_\_\_\_\_\_\_\_\_\_\_
Patau 13
sPlit fail - holoprosencephaly - forebrain fail 2 develop into 2
aPlasia_Palate_Polydactyly
______________
Fragile X
-big brain, big balls, long face/ears
_____
Sotos=MacroDOLICHOcephaly
Section: Time? HCPs?
DATED MNEMONIC?
D = SECTION 1 MH Dx diagnosis: A: 2--? ----- AMHP/NR*+2docs T: 3--?------- AMHP+2 docs<24hr \_\_\_\_\_\_\_ E: 4--?time--?who+AMHP/NR+2docs D: 5(2)--?time--?who
5(4)–?time–?who
136 < ?
____________
____________
Low-set ears
Micrognathia - small jaw
Overlapping scissor hand fingers
Structural heart defect
Rocker bottom CLUB FOOT!!!!!!!
IN SUMMARY:
low-ears, small jaw,
edward-scissor hand fingers,
Rockerbottom club foot
D>E>P
Definition: section 1 - MH dx Assx: 2 - 28d Tx: 3 - 6m Emergency: 4 - 3d #GP Detention: 5(2)=3d ; 5(4)=6h #nurse - 136 <24hr #public
2--28d ----- AMHP/NR*+2docs 3--6m ------- AMHP+2 docs<24hr \_\_\_\_\_\_\_ 4--3d -- GP+AMHP/NR+2docs 5(2)--3d -- DOC
5(4)–6hrs – NURSE
136 < 24hrs
___________
___________
Edward 18
EDward SCISSOR Hand and Feet and EARS!!!!
Ed ATEeen - small jaw cant eat.. what a shit connection ffs
Subunit conjugate?
Toxoid inactivation toxins?
Inactivated preps?
Live attenuated
Rabies:
Animal in UK - ? risk =
-Tx?
Animal bite elsewhere - ? risk = -Tx + ... -Already immunised: ??? -Not prev immunised: ??? \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Summary:
BIG brain , BIG balls, LONG face/ears
MacroCephaly - big brain
Macro-Orchidism - big balls
Looooooong face+ears
Retarded
____________
PEP:
Hep A: ? / ? vaccine
Hep B - risk of needlestick transmission - ?%
look at source - ? OR ?
- HBsAg Pos+ :
- known responder = ?
- non-responder = ?
- being vacc = ? - Unknown source:
- known responders = ?
- non-responders = ?
- being vacc = ?
Hep C -
? /monthly –>
@seroconversion = ?
_________
Exp to Varicella @ preggers:
- NOT had chickenpox = ? + ?
- IC = ?
STIL: NSHhh, DTaP, RAHIM:
Subunit conjugate =
-Neisseria, S.pneu, H.flu + Hep-B/HPV
Toxoid = DTaPertussis
Inactivated = R A-H IMflu
-Rabies/A-Hep/IMflu
Rest live attenuated
Rabies:
Animal in UK - NO risk =
-WASH + ?CoAmox
Animal bite elsewhere - HR = -WASH + ... -Already immunised: 2 further doses -NotPrevImmunised: HRIg+Fullcourse \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Fragile X
-big brain, big balls, long face/ears
Sotos= XS Phys Growth MacroDOLICHOcephaly -head>expected \_\_\_\_\_\_\_\_\_\_
PEP:
Hep A: HNIg / HepA vaccine
Hep B - risk of needlestick transmission - 20-30%
look at source - HBsAg Pos+ OR unknown?
- HBsAg Pos+ :
- known responder = booster
- non-responder = HBIg + vaccine
- being vacc = HBIg + vaccine - Unknown source:
- known responders = booster
- non-responders = HBIg + vaccine
- being vacc = accHBV vaccine
In summary: 1. Booster @ known responders 2. HBIg + Vacc: @non-responders+beingVaccHBsAgPOS 3. AccHBV+Vacc: @unknown+beingVacc
Hep C -
PCR/monthly –>
@seroconversion = IFN +/- Ribavirin
Exp to Varicella @ preggers:
- NOT had chickenpox = check 4 ABs + VZIg
- IC = VZIg
NOOOOO height - short
- NOOOOO neck - webbed
- NOOOOO chest - Pectus excavatum
- NOOOOO pul valve - pul stenooooosis
Karyotype? Webbed neck in what?
____________
Micrognathia ->
Posterior DISPLACEMENT of
tongue (?upper airway obstr)
Cleft palate
____________
Transient neonatal HYPERcalcaemia Supravalvular AORTIC stenosis Short, FRIENDLY, Extrovert personality -Retarded \_\_\_\_\_\_\_\_\_\_\_\_
HyperTELORism (large dist between eyes)
Small brain + jaw
#Microcephaly #Micrognathism
Larynx dx - characteristic CRY
Feeding difficulties and poor weight gain
-Retarded
VSD
Noonan Normal Karyotype
-webbed neck in Turner/Noonan
__________
Pierre Robin sequence
__________
William syndrome 7
-Supravalvular AORTIC stenosis
Hypercalc @William
Hypocalc @ DiGeorge
__________
Cri du chat 5
-VSD
Knee EXT weak ? reflex loss Thigh numb \_\_\_\_ Foot stuff:
Ankle DORSIflex
Calf and foot numb
1st Web sensory + Eversion dx ?
Lateral foot sensory + Eversion = ?
Eversion AND inversion + - hip abduction dx - pain and sensory loss @lat side thigh, lower leg, foot-dorsum and toes 1-3 - Common peroneal fucked too (as above) # Peroneal AKA Fibular nerve ffs
Cant plantar flex + lateral aspect sensory dx ?
____
Knee FLEXION weak
Foot movements weak
Gluteal -> ankle = pain and numbness
_____
Weak hip ADduction
–Medial thigh NUMB
________
Weak hip ABduction
-positive trendelenburg
?Left/right? gluteals fucked -> RIGHT pelvic drop
_______
Inverted + Supinated plantar flexed Not passively corrected \_\_\_\_\_\_\_
Claw toes
pain @ walk
Assoc: CMTooth, SpinaBifida, CPalsy
Femoral nerve
-Patellar reflex loss
___
Lumbosacral trunk
1st Web + Eversion dx = deep C.peroneal
Lateral foot sensory + Eversion = superficial C.peroneal
L5 nerve root –> sciatic –> CPeron = S/D
Eversion AND inversion +
- hip abduction (gluteal muscles - superior gluteal nerve) -
- pain and sensory loss
@lat thigh, lower leg, foot-dorsum and toes 1-3
- Common peroneal fucked too (as above)
Cant plantar flex + lateral aspect sensory dx= S1
____
Sciatic nerve
____
Obturator
-adduction + medial thigh shit
-Adductor + gracilis + obt internus
______
Sup>Inf Gluteal Nerve:
Weak hip ABduction
-positive trendelenburg
Ipsi gluteals fucked -> contralat pelvic drop
Eg. Left gleuts fucked -> RIGHT pelvic drop
______
Talipes EquinoVarus (CLUB foot) -Manipulation + Casting STRAIGHT
_____
Pes Cavus - high arched foot!!!!
Salter-harris; 1, 2, 3, 4, 5 classes @ paeds
_______
TWISTING injury ->
- Lock + Give way
- GRADUAL Swelling
O/E: - Tender joint line (med/lat) - passive ext = IMPOSS - active ext = POSS cos pt FIGURED out way to unlock!!
Pain, ROM decr
Pos McMurray
How to investigate?!
O’Donoghue Triad?? \_\_\_\_\_\_ 3. Athletic males = unilateral X-ray – enlarged + tender tib tub
What affects inferior pole of patella similar to above condition? \_\_\_\_ 4. Lock + Give way Swelling + Pain worse with exercise \_\_\_\_\_ 5. Lock + Give way Sliding moving patella Pain @ sitting; worse @ move \_\_\_\_\_\_ 6. Teen girl injured her knee Now gets pain when going downstairs Evidence of quads wasting \_\_\_\_\_ 7. -Direct Trauma ORRRR -Severe quads contract @knee stretched in Valgus + Ext Rot
-O/E: Swollen+Tense = haemoarthrosis \_\_\_\_\_\_\_\_ 8. Old person Knee=# BEFORE ligaments rupture -Fall from a height -Car-bumper fracture \_\_\_\_\_\_\_\_ 9. Forefoot pain @ 3rd/4th Inter MTP space Shoot/Burn/Electric pain 'Pebble' in shoe Click @ squeezing metatarsals = mulder’s click \_\_\_\_\_\_ 10. Simmonds test Pop in heel Assoc with quinolones cipro!!!
Image??
________
11.
Knee joint pain, LOCKING/swelling cos
-cracks form
-@articular cartilage + subchondral bone.
Dx?
P/PM/PE/PME/Crush
P=Physis, M=Metaphysis, E=Epiphysis
__________
Meniscal Tear
Medial > Lateral
MedMen attached to MCL+jointcaps
MRI!!!
ODonnaghue triad=Torn(MedMen+MCL+ACL) \_\_\_\_\_\_\_\_ 3. OsgoodSchlatter osteochondrosis + traction apophysitis = can’t extend
Sinding Larson syndrome \_\_\_\_\_ 4. Subchondral AVN -> -bone/cart detach \+ -micro# BUT no remodelling \_\_\_\_\_ 5. Patellar SubLux Syndrome \_\_\_\_ 6. CPFS: Chondromalacia-Patello-Fem Synd -cartilage = not SMOOTH -> movement= painful \_\_\_\_\_\_ 7. Patella dislocation \_\_\_\_\_\_ 8. Tib Plateau Fracture -Schatzker Classification system -VaLLLgus – LLLat plateau -Varus – med plateau \_\_\_\_\_\_ 9. Morton's neuroma \_\_\_\_\_ 10. Achilles rupture -USS!!!! \_\_\_\_ 11. Osteochondritis Dessicans
Pain @ elbow extension + PROnation
4-5cm DISTAL to lateral epicondyle
INTERMITTENT tingling @ 4th 5th finger Pain @ elbow rest/flexed for ages \_\_\_\_\_\_\_\_\_ Ulnar paradox: If ulnar damaged at wrist, what happen?
If ulnar damaged at elbow, what happens?
3.
Shoulder initially -pain -> joint STIFFness O/E: Restricted active AND passive ROM -EXT Rot MOST marked restriction
Assoc DM + NON-dom hand
Tx?
________
4.
VIRAL illness -> fully recovered –>
-pain + weakness @Shoulder.
-muscle wasting and WINGED-SCAPULA
-Power @active movements = impaired
_______
5.
Where do the rotator cuff muscles attach?
-xray shows AVULSION # 🤔🤔
___
Nerve supply to rotator cuff muscles.
_____
Degrees of abduction of shoulder - give muscles and nerves.
Radial tunnel syndrome –
post interosseous
Similar to lateral epicondylitis
______
Cubital tunnel syndrome -
Ulnar nerve compression
Dx @ wrist =
- 2 medial lubicrals fucked so
- can’t flex-MCP and can’t ext-D/PIP
- hence lots of clawing
Dx @ elbow = FDProfundus: -medial aspect only fucked -lateral aspect okay cos of Median nerve so there’ll be less clawing \_\_\_\_\_\_\_ 3. Adhesive Capsulitis -physio NSAD steds po/iartic \_\_\_\_\_\_\_\_\_\_ 4. Parsonage – Turner syndrome \_\_\_\_\_\_ 5. Supraspin-ABd, infraspin-ER, teres Minor-ER= GREATER tubercle
Supscapularis-IR = less tubercle
_____
SUPRAspinatus= SUPRAscap nerve
Teres minor = axillary nerve
SUBSCAP = SUBSCAP nerve
______
0-15 = SUPRAspin - SUPRAscap nerve
15-100 = deltoid - axillary nerve
> 90 = trapezius - accessory
> 100 = Serratus Anterior - Long Thoracic
-Prolonged Labour ->
SWELLING @after birth
-CROSSES suture lines.
-Resolved over a couple of days.
_____________
#ventouse-delivery -> Head NORMAL @delivery -> -Later = Parietal Lateral SWELL - over Hours/ 2-3d #?Jaundiced - NOT CROSS suture lines
-Swelling @LEFT side @PARIETAL region
—–fontanelles + sutures = normal
-Cx?
-Resolve when?
______________
Baby presents as a fluctuant scalp swelling
- CROSSES suture lines.
- NOT limited by suture line
- RARE + Life threatening
________________
Large, fluctuant collection
- CROSSES sutures lines.
- RARE + may cause life-threatening blood loss.
_________________
_________________
1/+ fibrous sutures @ infant skull
PREMATURELY fuses ->
growth-pattern change of skull –>
-increase ICP + damage intracranial structures.
_____
Subdural = bridging veins cortex V venous sinus Extradural = middle meningeal SAH = nimod coiling = basilar ACA
Caput succadeneum AT delivery
- due to generalised superficial scalp oedema
______________
Cephalohaematoma AFTER delivery
- NOT cross suture lines
- between periosteum + skull.
Cx: Jaundice may develop as a complication.
Resolve < 3m
______________
Subaponeurotic haematoma
_______________
Subgaleal haemorrhages
- occur between scalp aponeurosis + periosteum
_________________
_________________
Craniosynostosis
presents in the first 3 months of life in formula-fed infants (rarely @BFed kids)
regurgitation and vomiting diarrhoea urticaria, atopic eczema 'colic' symptoms: irritability, crying wheeze, chronic cough rarely angioedema and anaphylaxis may occur
Ix:
skin ?/? testing
total ?? and specific IgE (??) for cow’s milk protein
Formula-fed:
??, ??
Breastfed:
?? breastfeeding
?? MUM drinking cows milk +/- ??
@BFeed stop = eHF from ?? months
CMPI resolves:
@?? mediated intolerance - #??Rxn
55% = milk tolerant by the age of ? years
@non-IgE mediated intolerance - #??Rxn
MOST will be milk tolerant by the age of ? years
Ix: skin prick/patch testing
total IgE and specific IgE (RAST) for cow’s milk protein
Formula-fed:
eHF, AAF,
Breastfed:
continue breastfeeding
STOP MUM drinking cows milk +/- Adcal
@BFeed stop = eHF from 12-18 months
CMPI resolves:
@IgE mediated intolerance - #immediateRxn
55% = milk tolerant by the age of 5 years
@
non-IgE mediated intolerance - #delayedRxn
MOST will be milk tolerant by the age of 3 years
? gender: 6 times greater risk Born by ?? positive ? history ?-born children Mum has ??hydramnios birth weight > ?? kg Also happens to have congenital ?? foot deformity
BDOR =???
Ix:
? used to confirm
? is the first line @ >?yrs
Tx:
- Spont stabilise by ? wks-old
- ?* harness @kids < ? months
- ? @older kids
*(dynamic Flex-Abduct orthosis)
DDH: Developmental hip dysplasia:
GIRLS: 6 times greater risk Born by BREECH positive FHx FIRSTborn children Mum has OLIGOhydramnios birth weight > 5 kg -CalcaneoValgus foot deformity
Ix:
USS used to confirm
X-ray is the first line @ >4.5yea
Barlow Dislocation Ortalini Relocation
Tx:
- Spont stabilise <6 wks-old
- Pavlik* harness @kids < 5 months
- Surg @older kids
*(dynamic Flex-Abduct orthosis)
FEMALE Short
- WEB neck
- -Short 4th MCP
- -High-arched palate
- brachial > fem COARC
- Wiiiiiiiiiiiiide space nipples
Bloods=Amenorrhoea Prim, HypoT:
- High FSH/LH
- High TSH, low T4/3
Anatomy-AORTA
- Bicuspid
- COARCTATION (brachial > fem)
Neonatal stuff: Horseshoe Hygroma Oedema
- Horseshoe kidney
- cystic Hygroma prenatally
- lymphOEDEMA @ neonates (especially FEET)
Autoimmune dx
Dx? Karyotype?
What else causes webbed neck?
Turner
45 XO
webbed neck in Turner/Noonan
_____________
Turner 45 XO ; High FSH/LH ; High TSH
KlineFortySeven 47XXY ; High FSH/LH Low Testost
KlineFelHerTits
Kallowwwman Xr ; FSH/LH lowwwww, low Testost
ANOSSSSSSSSSmia
Precocious puberty
-boys = Undescended Small Balls
-girls = Amenorrhoea
FSH/LH low,
Test low
Man or woman?
KallmaNOSMIA’s - XLr
KaLLOWman-Low balls #Undesc
-FSH/LH lowwwww,
-Test lowwwww
Man > woman
-Anosmia, Undescended/Amenorrhoea
________________________
Small Undescended Balls / Amenorrhoea in Kallmans XLr
KallMAN=balls
____________________
Tits in Klinefelter - Klein felter tits 47xxy
Klein felt her tits!!! 😂😂
Tall GUY
Tits
Small balls
FSH/LH HHHHHigh
Test low
karyotype? Man or woman?
“KLINEfelter’s - 47, XXY
KlineFortySeven…
FSH/LH HHHHHigh
Test low
MANNNNNN
-CalvinKelin is a MAN
________________________
Tits in Klinefelter - Klein felter tits 47xxy
Klein felt her tits!!! 😂😂
KlinefelTTTTTTIer - T for TITS
Small Undescended Balls / Amenorrhoea in Kallmans XLr
KallMAN=balls
Physiologic changes @preggers
- rises: ?
- drops: ?
Menstruation:
MFOL? - follicles?
______________
- MENSTRUATION d ? - ? - >
mucus = ? + forms what where?
2. FOLLICULAR phase (Endomet ? phase) d5-13 a. -FSH peak = ? - - > -oestradiol peak = ? - - > -LH peak - - > ?
b.
mucus = ? , ? , low ? , ‘stretchy’ ?
just b4 ovulation
- OVULATION d ?
- Tertiary follicle - - > ? - LUTEAL phase (Endomet ? phase)
a.
Corpus Luteum secrete ? ->
Body temp ? after ovulation
b. If fertilisation NOT occur, -what happens to corpus luteum? and -what happens to prog lvl?) d15-28 \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Oestrgoen secreted -> so body temp ?? B4/after ovulation
Prog secreted by the corpus luteum -> so body temp ?? B4/after ovulation
BASICALLY, temp @period + BP @preg = U-wave relationship bro FFS remember that shit
Physiologic changes @preggers
- rises: everything else
- drops: Hb + BP
MFOL
- Menstruation d1-5
- Follicular - Endomet PROLIF phase
- Ovulation d14
- Luteal - Endomet SECRETORY phase
Follicles: primordial, primary, secondary, tertiary
______________
- MENSTRUATION d1-4 - >
mucus = THICK + forms a PLUG @EXT OS - FOLLICULAR phase (endomet prolif phase) d5-13
a.
-FSH peak = follicle development - - >
-oestradiol peak = body temp falls - - >
-LH peak - - > ovulation
b.
mucus = clear, acellular, low viscosity, ‘stretchy’ spinnbarkeit just b4 ovulation
- OVULATION d14
-Tertiary follicle - - > corpus LAD
#Luteum, Albicans, Degraded. - LUTEAL phase (Endomet SECRETORY phase)
a.
Corpus Luteum secrete Prog ->
Body temp RISES after ovulation
b.
If fertilisation NOT occur, corpus luteum degenerate and prog lvl fall) d15-28”
___________________
Oestrgoen secreted -> so body
TEMP FALL B4
Ovulation
Prog secreted by the Corpus Luteum -> so body
TEMP RISE After
Ovulation
MGUS vs myeloma: @MGUS, absence of cx eg. ??
WhyTF would you give HaemCancer pt IRRADIATED blood products?
Philadelphia chr - (?,?) - ?=Tx? RAI staging - dx? Histology? Transform? Pseudo Pelger Huet = CML Reed Sternberg - ?*,?,? Auer Rods - ? / ? Ann Harbor ? Multiple nodes, B>T cells, Extranodal = ?**
*Hodgkin: ? - Women ? - Lacunar cells ? - Eooooosinophils ? - RS cells HIGH Lymphocytic -Predom=? prog -Deplete=? prog
**NHL - High > Low: High: ?=chest nodes/HIV/nonMalt ?=EBV/Malaria/StarrySky/C-myc ?=Tokyo/hTlv
Low: MALT-? / ? 11,14 LC/LPC waldenstroM-Macroglob-IgM ? 14,18 Skin/?
PathPhys -> what 2 products form?
MGUS = ?
MM = ?
WaldenstromMacroglob ?
Pepperpot v Raindrop skull?
_________
MAHA / AKI / TCP = ?
AIHA + TCP = ?
Self-limiting
- kids-acute
- EVANS-AIHA+TCP
- women-chronic
O-anti ? -Recieve from others ? -Give 2 others ? A - anti ? ANti-D @ Rh ?
What Tx @ Haemophilia And vWD? ? -A f? Xr -B f? Xr -C f? Ar
?+?
- 1 A?
- 2 A?
- 3 A?
Thalassemia+SCDx= ?
-?type gallstones Assoc w/ with Sssickle cell
MGUS vs myeloma: @MGUS, absence of cx eg. immune paresis, hypercalcaemia
Monoclonal myeloma
Paraprot ProtSpike
IgG>A
Ca URB RF-dialysis ANT Bone-Cytokines release-> oClast -> -RAINDROP* LyticLesions IgG>A ESRouleax clump/Clots
*PepperPot = fucking HyperParaThyroidism !!!!!!!!!!!!!!!!
Irradiated blood products = AVOID
-transfusion-associated
GvH dx
Philadelphia chr - 9,22 - CML=Imatinib
RAI - CLL SmudgeSmear –RichterTransform-> NHL-Bcell
Reed Sternberg - Hodgkin*, EBV, Localised
Auer Rods - AML APML15,17
Ann Harbor Lymphoma: 1node, 2nodes, 2sideDiaphragm, Extranodal
Multiple nodes, B>T cells, Extranodal = NHL
Hodgkin: Nodular - Women+Lacunar cells Mixed - Eosinophil/RS cells HIGH Lymphocytic -Predom=BEST -Deplete=WORST
NHL - High > Low: High: B-cell diffuse=chest nodes/HIV/nonMalt Burkitt=EBV/Malaria/StarrySky/C-myc T-cell=Tokyo/hTlv
Low: MALT-pylori / Mantle 11,14 LC/LPC waldenstroM-Macroglob-IgM Follicular 14,18 Skin/SezaryMycosis
XS prolif Bone-Marrow Plasma-Cells, Heavy>light chain, Bence-Jones LIGHT @URINE MGUS=no CRABIE MM=*CRABIgG>AEsrrouleaxy WaldenstromMacroglob=IgM-LC/LPC LowGradeNHL
*Ca URB RF-dialysis ANT Bone-Cytokines release-> oClast -> -RAINDROP* LyticLesions IgG>A ESRouleax clump/Clots
*PepperPot = fucking HyperParaThyroidism !!!!!!!!!!!!!!!!
Raindrop = MM !!!
_________
MAT - TTP - large vWF multimers
AIHA + TCP = Evans ITP
SKEW - ITP - Gp2b3a ABs
O-anti A+B -Recieve FFP -Give ABO 2 others A - antiB ANti-D @ Rh neg
Desmopressin @ Haemophila -A8 Xr -B9 Xr XMAS -C10 Ar
vWDx + TXA
- 1 AD
- 2 AD
- 3 Ar
Thalassemia+SCDx= AR
- Pigmented gallstones Assoc w/ with sickle cell
- bilirubin and Hemolysis etc occurs
Precocious puberty is the development of secondary sexual characteristics before
?? years in girls, and
?? years in boys
_________
Inspire –>
- BP drop >12 #exag < – lowSV
- JVP rise
ECG sign?
Filling pericardial sac ->
compressive atelectasis ->
area of DULLness + incr tactile fremitus
below LEFT Scap
Precocious puberty is the development of secondary sexual characteristics before
8 years in girls, and
9 years in boys
__________
BP JVP @TamPax CPericardKnock-Kussmsul
BJ @TC = Inspire –>
-BP-PP-PAH* #TamPulsParadox #TamPax
-JKKK #CPericKnock-Kussm x+y
- ECG = electrical ALTERNANS
- EWART’S sign @tamponade
*PAH
AR / ASD
High Left EDV
Grip:
3 month - ?
6 month - ?
10 month - ?
Bricks
1.5yrs - ? bricks
2yrs - ? bricks
3yrs - ? bricks
Drawing ? - 2yrs ? - 3yrs ? - 4yrs ? - 5yr
3 month - reaches
6 month - palmar grip/pass
10 month - pincer
1.5yrs - 3 bricks
2yrs - 6 bricks
3yrs - 9 bricks
Line - 2yrs
Circle - 3yrs
Cross - 4yrs
Square - 5yr
IM Ben Pen doses???
< 1 year ?mg
1-10 years ?mg
> 10 years ?mg
Kid is too poorly to come to surgery, On arrival the boy is noted to be pyrexial, have cool peripheries and purpura on his legs.
< 1 year 300 mg
1 - 10 years 600 mg
> 10 years 1200 mg
Upslanting palpebral fissures
-Prominent epicanthic folds
-Low-set ears and FLAT face.
NEURO Exam = baby is HYPOtonic
Maternal age risks: 30 35 40 45
If the trisomy 21 is a result of ?
the risk is much HIGHER
Which genetic group of diseases show genetic ANTICIPATION ?
? (CGG)
? (CAG)
? (CTG)
EARLIER onset in successive generations
Down trisomy 21
30 <1/1000
35 1/(1000/3) = approx 1/270
40 1/(270/3) = approx 1/90
45 1/(90/3) = approx 1/30
If the trisomy 21 is a result of a TRANSLOCATION
the risk is much HIGHER
Which genetic group of diseases show genetic ANTICIPATION ?
fraGile x (CGG) HuntingtAn (CAG) myTonic dysTrophy (CTG)
EARLIER onset in successive generations
Down’s likely in which genetic kind of issue?
Gingival hyperplasia
______
Scaphoid abdomen
Bilious vomiting
USS = double bubble sign
Jaundice >14 days
CB > UCB cos of the back logging
________
Ax LAD
Ax RAD
Gingival hyperplasia: , ciclosporin, CCBs AML Phenytoin \_\_\_\_\_\_
Duodenal Atresia
-double bubble
Biliary Atresia
-CB>UCB #backlogging
______
RAD vs LAD
A(R>S @ V1) - WWPW - B (S»>R + Tinvert)+ VT
AAAArm switch/dextrocardia
RRRRVH - LVH
Lat (circumflex) - MMMMI - Inf (RCA)
TTTTall thin = RAD
Left post fasicle - HHHHemiblock - left ant fasicle/(bifasicular)
p176 ECG John Hampton book
Thread worm
-PINworm Nematode
Tx? Ix?
Hygiene + Mebendazole @ >6 months or older
for EVERYONE
Ix: Sellotape to the perianal area —> MCS
Sudden infant death syndrome risk factors
-what’s the funny way of remembering this?
-hot young hijabi @
WINTER prone to get?
major risk factors for SIDS are:
Sleep prone
Smoke parental
Share bed/head cover
So hot, so young - hyperthermia/premature
-hot young hijabi @
WINTER prone to get?
Which genetic group of diseases show genetic ANTICIPATION ?
? (CGG)
? (CAG)
? (CTG)
EARLIER onset in successive generations
Down’s likely in which genetic kind of issue?
30 1/1000
35 1/300
40 1/100
45 1/30
Trinucleotide repeat disorder
fraGile x (CGG) HuntingtAn (CAG) myTonic dysTrophy (CTG)
Friedreich’s ataxia* (GAA)
spinocerebellar ataxia
spinobulbar muscular atrophy
dentatorubral pallidoluysian atrophy
Down’s likely in which genetic kind of issue?
TRANSLOCATION
Age Milestone:
3 months THREEEEEEEEEEE
?? to parents voice
?? towards sound
6 SIXXXXXXXXXX months ?? syllables
9 NOOOOOOOOIIIIIINNNNNEEEEE months
Says ‘??’ and ‘??’
Understands ‘??’
12 months Knows and responds to OWN ??
12-15 months
Knows about how many ?? words
Understands simple ??
Age Milestone 3 months Quietens to parents voice Turns towards sound Squeals
6 months Double syllables ‘adah’, ‘erleh’
9 months
Says ‘mama’ and ‘dada’
Understands ‘no’
12 months Knows and responds to own name
12-15 months Knows about 2-6 words (Refer at 18 months)
Understands simple commands - ‘give it to mummy’
Malabsorption Causes may be broadly divided into
- ?
- ? (deficiency of enzyme)
- ?? (e.g. ? atrophy)
Ai eg ??
Cancer eg ??
#?????overgrowth
Malabsorption Causes may be broadly divided into
- biliary
- pancreatic (pancreatic enzyme deficiency
- intestinal (e.g. villous atrophy)
Ai eg. syst sclerosis
Cancer eg. lymphoma
#BACTovergrowth
What is the most important treatment for PREVENTION of neonatal RDS?
dexamethasone to the MOTHER!!!!!!!!!
Caffiene can be used as a ?? in newborn babies
To wean off ???
Sildenafil / ECMO used to treat ??
-Sildenafil CI?
ED Ix Tx?
Caffiene can be used as a
RESP STIMULANT @newborn babies
WEAN off ventilator
Pulmonary hypertension
-Sildefanil / ECMO
Sildenafil CI
-Nitrates/Nicorandil
@ED Check:
- Q10risk
- f.Testost > FSH LH/Prolactin
- —ED + poor libido = psychogenic
- —ED + normal libido = likely vascular dx
-viagra->vacuum
Botox indication
___________
S1-2 sounds?
-Soft -Loud
Wide split ??
Paradox split??
Fixed split??
S4-3 sounds?
____________
Causes of 1st and 2nd degree HB KIMBAD
Causes of 3rd degree complete HB FASTI
____________
Pericardial rub - ??
Pleural rub - ??
Pericardial knock - ??
____________
Causes of LBBB
RBBB causes?
SPASm HEMIFACIAL/Blepharo SPASticity SWeating axilla SWallowing achalasia \_\_\_\_\_\_\_\_\_\_\_
S1 = AV valves mitral/tricuspid closing
soft @Regurg
loud @MS
S2 = Aortic/pul closing soft @ASten Loud @ -HTN, Hyperdymamic states, -ASD-PulHtn
Wide s2-
delay RV empty
-(PS; PAH{MRegurg severe}; RBBB)
Paradox s2
-WPW-b, AS/LBBB, RVPacing, PDA
Fixed s2 - ASD
S4 = atria contract against STIFF ventricle
HOCM/HTN
ASten
S3 = diastolic filling of ventricle Const pericarditis - pericard knock, X+Y, X ✔️; Dilated CM, MRegug NORMAL<30y \_\_\_\_\_\_\_\_\_\_\_\_
1st and 2nd degree:
K+low; IHD; myocarditis;
Beta-blockers; Athletes; Digoxin
3rd degree complete block:
Fibrosis; AS; Surg Trauma; IHD/Congen
____________
Pericardial rub - pericarditis
Pleural rub - pneumonia/PE
Pericardial knock - C. Pericarditis
____________
LBBB=CM, HTN, AS, IHD
RBBB=PE, ASD, Normal
(peripheral cyanosis around the mouth and extremities) is common in neonates @ first 24 hours- dx
Central cyanosis can be recognised clinically when the concentration of REDUCED Hb in the blood exceeds ?g/dl
Ix:
?????–????? test (also known as the ?test) may be used to differentiate
CARDIAC vs NON-CARDIAC causes.
infant is given
? for ? minutes –>
ABGs are taken –> pO2 < ? kPa
indicates cyanotic ConHD (?,?,?)
Tx:
Initial management of suspected cyanotic congenital heart disease =
- ?
- ? = used to maintain a ? @ ? congenital heart defect
What closes PDA?
Acrocyanosis
Central cyanosis can be recognised clinically when the concentration of reduced haemoglobin in the blood exceeds 5g/dl
The Nitrogen-Washout test (aka the Hyperoxia test)
may be used to differentiate
CARDIAC from NON-CARDIAC causes.
The infant is given
100% O2 for 10 mins –>
ABGs taken –> pO2 <15 kPa
indicates cyanotic ConHD: (TAtr, TGa TOf )
Initial management of suspected cyanotic congenital heart disease =
- Supportive
- PGE1 = maintain PDA @ ductal-dependent ConHD
Indomethacin PGE2i closes PDA
WPW
A - which sided pathway ->?AD = dom R wave @ which lead??
B - which sided pathway ->?AD = dom R wave @ which lead??
Assoc:?
Tx:?
Avoid sotalol when? Why? \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ EEG = Hyps-arrhythmia Salaam spasm Male 4-8 months #POOR-prognosis \_\_\_\_\_\_\_
Infantile spasm –> eventually:
EEG=slow spike
< 5yrs
_________
teachers say this 4-12 y/o :
- not paying attention
- difficulty speaking #Dysarthria
- DROOL/PARAESTHESIA @face
Seizures at NIGHTTT
partial -> secondary generalisation may occur
EEG centrotemporal spikes
________
Girl teens > boys
- AM seizures
- AM absences
- sudden MYOCLONIC seizure
WPW
A - left sided RAD = dom R wave @ V1
B - right sided LAD = no dom R wave @ V1
Assoc: MESH
MVP, Ebstein anomaly, Secundum ASD, HOCM/HyperT
Tx: radioFreq ablation of acc pathway
FAPS
Avoid sotalol @AF cos it -prolongs refractory period @AVN -> -inc transmission rate through acc pathway -> -Inc vent rate = VF \_\_\_\_\_\_\_\_\_\_\_\_ Infantile spasms EEG = Hyps-Arrythmia -babieeees <8m \_\_\_\_\_\_\_\_\_
Infantile spasm –> lennox Gastaut
EEG=slow spike
< 5yrs
__________
Benign Rolandic epilepsy
EEG = Centrotemporal spikes
-Older kids <12 years
_______
Girl TEENS > boys
- AM seizures
- AM absences
- sudden Myoclonic seizure
- —–Juvenile Myoclonic Janz Syndrome
six-year-old limping for two days
No Trauma
NO PAIN
___________
Pulses paradoxes? PAH
Slow rising/plateau?
_________
COLLAPSING? API
Pulsus alternans?
_________
Bisfriens pulse - DOUBLE systolic beat
Jerky
_________
J wave Osborn
Widespread/SADDLE ST elevation
_________
PR depression?!
pericardial knock
_______
Collapsing pulse = ?
Wide Pulse Pressure = ?
Narrow Pulse Pressure = ?
JIA - ADMIT URGENT
-cos septic arth can present similarly!!!!
____________
Tamponade/ Severe asthma:
- PAH, AR/ASD, High Left EDV
AS
_________
AR/PDA/ Incr requirement
LVF
_________
HOCM/Aortic valve Dx
HOCM
_________
J = hypothermia HyperCalcemia
Widespread ST elevate = pericarditis
_________
PR depression = most sensitive for pericarditis!!!!!
pericardial knock = constr pericard
_______.
Collapsing pulse = AR/PDA/ Incr requirement
Wide Pulse Pressure = PDA/3rd HB/AR
Narrow Pulse Pressure = ASten
Acute cough > 14d
- paroxyssssssssssssmal
- APNoeic attack
- post-tussive VOMIT
- INSP whoop
- lymphocytosis
Whooping cough - WHICH 2 ABx if
onset of cough is
within the previous ? days
- School exclusion ? days after ABx
- ? days since syx if NO ABx
Whooping cough -
AZITHRO / CLARITHRO
if the onset of cough is
within the previous 21 days
School exclusion 2 days after ABx
21 days since syx, if NO ABx
A child aged < 3 months with a fever > 38ºC
I.E. red PLAN???
If amber: ????? or ????
The 2007 NICE Feverish illness in children guidelines introduced a ‘traffic light’ system for risk stratification of children under the age of ???? years presenting with a fever. These guidelines were later modified in a 2013 update.
Consider a diagnosis of ??????? if the child has:
high fever (over 39°C) and/or
persistently focal crackles.
A child aged < 3 months with a fever > 38ºC should be assessed as high risk of serious illness
If amber: safety-net or refer
The 2007 NICE Feverish illness in children guidelines introduced a ‘traffic light’ system for risk stratification of children under the age of 5 years presenting with a fever. These guidelines were later modified in a 2013 update.
Consider a diagnosis of pneumonia if the child has:
high fever (over 39°C) and/or
persistently focal crackles.
AD - long QT + NO sensorineural deafness
AR - long QT + sensorineural deafness
AD Asian men pseudoRBBB + ST elevation (downsloping mostly V1-3ish) T-invert Risk? Tx? Gene?
Antiarryhtmics causing long QT?
Others?
Electrolytes?
CASQ2 and RYR2 encodes for?
_________
fusion of the labia minora in the ?
girls between the ages of
3 months - 3 years
resolve @ around ??
Tx:
- ?
- UTI: ? + ? cream
- Fail: ?
Romano Ward, KCN(Q1+H2) fucked K channels
Jervell Nielsen
Brugada = tachy-arrhythmias, sudden cardiac death. ICD!! Gene SCN5A mutation -> fucked Na Channel
Not FAPS
- SSRI/TCA; APsych; Li
- ABx = MACROLIDES
- Low Mg K Ca/ Low Temp HypoThermia
- Typ»»Atyp
CASQ2 = calsequestrin fucked -> Ca can’t bind -> Catecholaminergic Polymorphic VT (CPVT)
and RYR2 = ryanodine receptor -> CPVT also
_____________
Labial adhesions: fusion of the labia minora in the midline.
girls between the ages of
3 months - 3 years
resolve @ around PUBERTY
- Conservative tx
- UTI: Trimeth + Oest cream
- Fail: Surgery
