Step studying 3 Flashcards
Define Bipolar I
1 manic episode (+/- depressive or hypomanic episode)
Define Bipolar II
Hypomanic episode + >/= 1 major depressive episode
What do different fetal decelerations mean
VEAL CHOP
o V = variable decelerations . . . C = cord compression
o E = early decelerations . . . H = head compression
o A = acceleration . . . O = oxygenation
o L = late decelerations . . . P = placental insufficiency (fetal hypoxia)
What acid-base abnormality will you see in primary hyperaldosteronism
Metabolic alkalosis (due to increased hydrogen excretion)
Best diagnostic test for bronchiectasis
CT chest - will show bronchial dilation, lack of airway tapering, and bronchial wall thickening
Name 3 causes of delayed passage of meconium
- imperforate anus
- meconium ileus
- Hirschsprung
Diagnosis of imperforate anus
- Physical exam
- US of anus
- Cross table x-ray (to determine severity)
What else should you look for in a pt with imperforate anus
Part of a syndrome called VACTERL • V = vertebral anomalies • A = imperforate Anus • C = cardiac • T = tracheoesophageal fistula • E = esophageal atresia • R = renal • L = limb
Cause of meconium ileus
Cystic fibrosis = leads to obstruction of the ileum and a narrow, underdeveloped colon
What are the syndromes of defect in bilirubin conjugation
- Neonatal physiologic jaundice (newborns have low UGT activity)
- Gilbert (mildly low UGT activity)
- Crigler-Najjar (absence of UGT)
What are the syndromes of impaired transport of bilirubin
- Dubin Johnson (deficiency in bilirubin canalicular transport protein; black liver but clinically benign)
- Rotor (milder version of Dubin Johnson with no black liver)
What is the difference between breast milk jaundice and breastfeeding jaundige
- Breast feeding jaundice is a problem of quantity (Decreased intake causes decreased stooling and therefore decreased bilirubin elimination and increased intrahepatic circulation)
- Breast milk is a problem of quality (Thought to be due to human milk causing increase of intestinal absorption of bilirubin)
Tx of breast feeding jaundince
Feed baby more
Tx of breast milk jaundice
Switch to formula for 12-24 hours, then can resume breast feeding
Diagnosis of pyloric stenosis
US will show donut sign/target sign (thickened pylorus)
Tx of pyloric stenosis
Pyloromyotomy
What is the difference between duodenal atresia and intestinal atresia
- Duodenal atresia (congenital failure of duodenal development)
- Intestinal atresia (caused by vascular accidents in utero e.g. mom does cocaine and cuts off blood supply to gut)
Diagnose: Premature neonate + GI bleed
Necrotizing enterocolitis
Tx of necrotizing enterocolitis
NPO, IVF, TPN
Best diagnostic test of intussusception
Air enema
This is also treatment
Where does Meckel diverticulum most often occur
2 feet from ileocecal valve (RLQ pain)
Diagnosis of Meckels
♣ Tc-pertechnetate scintigraphy
• Tc-pertechnetate radioisotope has an affinity for parietal cells of gastric mucosa
• Will have increased uptake in the area of diverticulum due to gastric epithelium
Tx of allergic rhinitis
Intranasal steroids
What should you think of if you see multiple duodenal ulcers
Zollinger Ellison
Why might Zollinger Ellison cause steatorrhea
Excess acid in intestines causes inactivation of pancreatic enzymes
What coronary artery supplies
- Anterior (V1-V6)
- Inferior (II, III, aVF)
- Posterior (depression in V1-V3)
- Lateral (I, aVL, V5, V6)
- Anterior = LAD
- Inferior = RCA or LCX
- Posterior = LCX or RCA
- Lateral = LCX
Definition of Pre-eclampsia
o New hypertension (>20 weeks gestation)
♣ >140/90 on two occasions at least four hours apart
o Proteinuria
♣ Urine P:C > 0.3
♣ 24hr urine protein > 300mg
What are severe features of pre-eclampsia
- Thrombocytopenia (platelets <100,000)
- Impaired LFTs (2x normal)
- Renal insufficiency (Cr > 1.1)
- Pulmonary edema (SOB)
- New onset cerebral disturbance, or visual impairment (HA, vision changes)
- Epigastric/RUQ pain
- BP >160/110
- Proteinuris >500mg
Management of Pre-E w/o severe features
- Deliver at 37 weeks
- Mg typically not needed
Management of Pre-E with severe features
- Deliver at >/= 34 weeks
- O2
- MgSO4 for seizure ppx
- Anti-hypertensives if HTN >160/110
What antihypertensives are used in Pre-E
Labetalol, Hydralazine, Nifedipine
Most common complication of sickle cell TRAIT
Painless hematuria (due to sickling in renal medulla)
What is Centor criteria
• Used for evaluation of group A strep pharyngitis • Criteria: o C = absence of Cough o E = tonsillar Exudates o N = Nodes (lymphadenopathy) o T = temperature >/= 38 C
What are the L to R shunts
ASD, VSD, PDA
What will you hear in ASD
Fixed split S2
- increased blood in R heart delays closure of pulmonary valve
What is PDA
Persistent connection between aorta and pulmonary artery
What will you hear in PDA
Continuous machine like murmur
Tx of PDA
- Indomethacin to close PDA
- Prostaglandins keeps PDA open
What are the R to L shunts
o Truncus arteriosus (1 vessel) o Transposition (2 switched vessels) o Tricuspid atresia (3 = tri) o Tetralogy of Fallot (4 = tetra) o TAPVR (5 letters in the name)
What is the risk factor for transposition of great vessels
Diabetic mother
Components of tetralogy of fallot
o (a) Pulmonary valve stenosis
o (b) RV hypertrophy
o (c) VSD
o (d) Overriding aorta (sitting over VSD)
Tx of croup
- Supportive
- Racemic epi, steroids, O2
Tx of epiglottitis
- Intubation in the OR
- IV abx
Bug responsible for epiglottitis
H. flu
Dx of retropharyngeal abscess
CT scan
Tx of retropharyngeal abscess
I&D + IV abx
Tx of peritonsillar abscess
I&D + IV abx
What is Legg-Calve-Perthes
o Idiopathic avascular necrosis of the femoral head
o Typically presents as thigh or knee pain with limp in a child
o X-ray in the frog position will show joint space widening due to loss (necrosis) of the femoral head height
Tx of Legg-Calve-Perthes
♣ Pt made non-weight bearing with immediate ortho referral
♣ Goal is to prevent further necrosis and promote bone remodeling by maintaining femoral head within the acetabulum
♣ Best accomplished by casting the affected leg in abducted and internally rotated fashion
What type of pt has a slipped capital femoral epiphysis (SCFE)
o Fracture through the growth plate (physis), which results in slippage of the overlying end of the femur (metaphysis)
Occurs in overweight patients or patients going through a growth spurt
Tx of SCFE
Surgery
