Short Case DDx Flashcards
Outline signs of iron deficiency?
‘Mouth & Mind’
Pallor- conjunctiva, palmar
Irritability
Nail changes- koilonychia, brittle nails
Angular stomatitis
Psychomotor retardation
Pagophagia, Pica
Outline signs of calcium deficiency?
‘Heart & muscle’
Chvostek (cheek), Trosseau (BP cuff) sign
Tetany
QT prolongation
Outline signs of phosphate deficiency?
‘Bone and muscle’
Myopathy/rhabdo
Osteomalacia/Ricketts
Bone pain
Outline signs of magnesium deficiency?
‘Crazy person’
Personality change
Seizures
Fasciculations & tremors
Outline signs of zinc deficiency?
‘A to Z’
Acrodermatitis enteropathica
Alopecia
Outline signs of copper deficiency?
Pallor
Bony changes
Opposite = Wilsons Disease
Outline signs of B1/thiamine deficiency?
‘Alcoholics have no voice or heart’
Aphonic cry in infants (laryngeal paralysis)
Peripheral neuritis
Cardiomyopathy
Outline signs of B2/riboflavin deficiency?
‘Cant see my breakfast of ballsack dandruff’
Photophobia, blurred vision
Poor growth
Angular stomatitis/glossitis
Seborrhoreic dermatitis (nose & scrotum)
Outline signs of B3/Niacin deficiency?
‘B3 triple D’
Diarrhoea
Dermatitis
Dementia
Peripheral neuropathy, insomnia, psychosis
Outline signs of B6/pyradoxine deficiency?
‘B6 for seizures & slowness’
Neuro- irritability/confusion/seizures
Stomatitis/glossitis
Outline signs of B12 deficiency?
‘Big blood cells without feeling’
Anaemia
Peripheral neuropathy & demyelination
Outline signs of Vitamin A deficiency?
Xeropthalmia
- Night blindness, dry conjunctiva
Poor dental enamel
Poor epiphysis formation
Dry skin
Infection prone
Poor growth
Outline signs of Vitamin C deficiency?
Scurvy
- Leg pain/swelling at ends of long bones
- Bleeding/gum hypertrophy
- Anaemia, haemorrhage
- Poor wound healing
- Hyperchondriac/hysteria
Outline signs of Vitamin D deficiency?
Poor tooth enamel
Frontal bossing
Delayed suture closure
Pectus carinatum/rachitic rosary
Femoral/tibeal bowing, splayed wrist
Outline signs of Vitamin E deficiency?
Haemolytic anemia
Peripheral neuropathy
Retinal detatchment
Outline signs of Vitamin K deficiency?
Bleeding
Impaired bony metabolism
What are the 10 causes of cyanotic lesion?
(6 Ts, 1P, 1H, 2Ds)
TGA, TOF, TA, Tricuspid Ectasia/Ebstein’s, Truncus, TAPVD
PA
HLHS
DORV
DILV
Outline signs of TGA, age of presentation & treatment?
3 wks age
Critically unwell, cyanotic- inadequete mixing
Mild cyanosis and well- adequete mixing- VSD/ASD & PS
Exam:
- Cyanosis
- +/- failure
- Loud S2, often no murmur
ECG: RVH/BVH + RAH
CXR: egg on a string
Procedure: arterial switch
- AS/PS, AR/PR, aortic root dilatation
- CA obstruction
- Ventricular dysfunction
- Arrythmias
Outline signs of TOF, age of presentation & treatment?
Antenatal Dx, early in life, tet spells peak 2-4mo
Cyanotic, no failure (pulm stenosis)
Exam
- RV tap, thrill
- S2 single, 3-5/6 ESM on LUSE- pulm stenosis (decreases in tet spell)
CXR: boot shaped heart- cyanotic + oligaemic lung fields, right sided arch
Treatment
- Initial: knee to chest, oxygen, morphine, propanalol if tet spells
- Repair at 6mo: close VSD & widen RVOT
- +/- balloon dilatation of PV
Complications
- RBBB, CHB <1%
- Residual VSD/RVOTO
- PR/PS if patch, may require re-operation 20yrs, 30%
- +/- BT shunt
Outline signs of Tricuspid Atresia, age of presentation & treatment?
Severe cyanosis at birth
Exam
- Cyanosis
- Murmur: VSD/PDA- LLSE ejection/pansystolic 2-3/6
ECG: superior axis
CXR: boot shaped heart, decreased PBF, large heart
Fontan repair
- 10 yr survival 80%
Signs/presentation of Tricuspid atresia?
Tricuspid valve non-present (HLRH)
Cyanosis/ thrill if PS- single S2 +/- VSD or PDA murmur
Superior axis
RV enlargement, decreased PBF
Rx: vary from TV repair to fontan if severe RV insufficiency
Outline signs of Ebstein’s Anomaly age of presentation & treatment?
Tricuspid valve displaced downwards & tethered
Holosystolic murmur LLSE (TR)/ mid diastolic (TS)
R) atrial enlargement
RBBB/RAH+/- WPW
VAries
- Cyanotic/CHF to very mild
- TV repair to Fontan +/- Starnes to close of RV (depends on size of RV)
Outline signs of Truncus Arteriosus, age of presentation & treatment?
Cyanosis- if low PBF
CHF if high PBF
Associated Di George
Bounding pulses, wide pulse pressure
Hyperactive praecordium
Diastolic rumble if PBF, decrescendo murmur if truncal regurg
ECG BVH
CXR cardiomegaly
RV-TPA conduit as neonate
Upgraded 2-3yrs
Outline signs of TAPVD, age of presentation & treatment?
Varies
Obstructed
- Critically unwell, cyanosis
- Loud P2 - possibly no murmur
Not obstructed
- Mild cyanosis/FTT
- S3-4 widely split (ASD)
- CXR: Snowman sign (pulm oedema and cardiomegaly)
-
Difficult to treat, significant
Outline signs of Pulm Atresia, age of presentation & treatment?
Depends on size of RV/if alternative pathways
PA-VSD (presents like severe TOF)
- RV tap, thrill
- S2 single, 3-5/6 ESM on LUSE- pulm stenosis (decreases in tet spell)
PA-IVS
- Often needs 2 staged repair
- Shunt to PA to grow it, then definitive repair
Outline signs of DORV, age of presentation & treatment?
