Uworld

06/22/2015

1. Espophageal performation due to iatrogenic cause is not infrequent. Cxr

frequently demonstrate a pleural effusion, pneumomediatstinum and or
pneumothorax. A h2o soluble contrast esophagram should be used to
cinfromt diagnosis. Barium induce a granulomatous response.
2. Compartment syndrome severe pain, pain with passive ROM, does not
respond well to narcoticsparesthesia. Sensory and motor deficits occur in
later stages. Pallor and loss of limb pulses are uncommon findings.
Diagnosis: Compartment pessures must be measured immediately if the
index of suspeciicion is very high. Faciotomy is the treatment of choice.
3. Acute cholecystitis presents with RUQ pain, fever, leujocytosis. The
majoritiy of pts with acute cholecystitis may be treated with observation
and supportive care initially, followed by laparoscopic cholecystectomy
within 72 hours during the same hospization.
4. Hemorrahagic shock tachycardia, peripheral vascular constriction are
the first physiological changes. These response act to maintain the blood
pressure within normal limits until severe blood loss has occure.d
a. Class I < 15% 750 ml
i. Normal bp and major organs are satisfactorily perfused as
evidenced by normal urine output.
ii. Compensation sympathetic response that induces midld
tachyacardia and peripheral vascular constriction. Capillary refill
maintained < 2 seconds
iii. First indication of of hypovolemia
1. Change in pulse rate > 72
b. Class II 1530 % 750-1500cc
anxious and agitated. Pulse rate will be more than 100/min
arterial blood pressre remains normal and pulse pressiure is
narrowed and blood ressure starts to trend downward.
C. Class III 30-40% blood loss > 2000 cc confused indrecrease urine
output due to poor cerebral renal perfusion
D. Class IV > 40% > 2000cc lethargic, tachypneic and has markedly
decreased urine output.
5. medial meniscus twisting injuries with foot fixed.
Medial MC than lateral
Pt complain of popping sound severe pain
Examination: local tnedernes of knee at the site of injury
Locking of knee joint on extension bucket handle tear
ROM at knee Is limited ny pain in all meniscal teas

McMurray sign medial meniscus tea palable or audible snap

occurring while slowly entending the leg at the knee from full
flexion while simultaneously applying tibial torsion.
Anterior cruciate ligament h/o forcefull hyperextension injury to
knee or a noncontact torsionaly injury of the knee during
decelecration
o Lachmans test, anterior drawer and pivot shift test for clinical
diagnosis
Posterior cruiciate ligament classically seen in dashorad injury
forceful posterior directed force on the tibia with knee flexed at 90
degrees.
o Posterior drawer, reverse povot shift and posterior sag tests
MCL abduction injury to knee
o Valgus stress test
LCL adduction injury
o Varus stress trest
6. air under the diaphragm indicates perforated viscus, which is a
surgical 911. Once diagnosed immediately obtain surgical consultation for
emergent exploratory laparotomy.
7. arterial occlusion of an extremity will cause pain, pulselessness,
pallor, paresthesias and paralysis in the affected limb. Embolic occlusion
classically causes sudden onset severe pain and asymmetric pulselessness
8. all trauma patients should be triaged using the Glasgow coma scale
which can predict the severeity and prognosis of coma, during the primary
survey. The GCS assessment the patients abibility to open his/her eyes,
motor response, and verbal response.
9. FRACTURE OF SCAPHOID (Carpal Navicular) affect youngs who fall
on out stretched hand Wrist pain over the Anatomic Snuff Box.
Thumb Spica cast is indicated just with Hx & physical finding. Xray
usually appear - ve in undisplaced fracture (xray will show fracture 3
week later).If 1st Xray show displaced & angulated fracture, Open
Reduction & Internal fixation is needed. (Scaphoid fracture are notorious
for rate of nonunion).
10. splenic rupture blunt abdominal trauma often causes splenic
injury which can present with delayed onset hypotension. LUQ abdominal
pain radiating to left shoulder pain. Pt should have an abdominal CT scan w
IV contrats for diagnosis. Those with persistent hemodynamic instability
require urgent laparotomy.
Tamponade hypotension and tachycardia but pt also show neck
vein distension and electrical alternans (varying amplitude of qrs
complexes)

11. duodenal hematomas common after injury to epigastriym by

sterring wheel in car accident. Blood collects btween the submucosal and
muscular layers of duodenum causing obstruction. Most hematomas resolve
spontaneously in 1-2 weeks and intervention of choice is nasogastric suction
and parenteral nutrition. Surgery indicated to evacuate the hematoma if
more conservative method fails (laparotomy or laposcopy)
Dx. Coil spring appearance on X ray
Morton neuroma associated with pain btween 3rd and 4th toes on the
planter surface with a clicking sensation MULDER sign tht occurs when
simulataneously palpating this space and squeezing the metatarsal joints
Plantar fasciitis buring pain in the plantar NOT dorsal area of the foot
that worsens with first steps in the morning. Pain decreases as activity
increases during the day but suuaully worsens at the end of the day with
prolonged weight bearing. It is common in runners with repeated
microtrauma who develop local point tenderness on plantar aspect of
foot.
Tarsal tunnel syndrome is due ot compression of the tibial nerve as it
passes thru the ankle it is sually craused by a fracture of ankle bones. Pt
develop buring, numbernes and aching of the distal plantar surface of
foot/toes that sometimes radiates up to the calf.
Tenosynovitis is an inflammation of the tendon and it synovial sheath. It
is usually seen in hands and wrists. Often due to overuse of following bit
or puncture wound. Pt have pain and tenderness along the tendon sheath
particularly w flexion and extension movements.
Stress fracture are common in patients who suddenly increase their
physical activity, especially in female runnersw the ffemal athlete triad
18. obstructive ureterolithiasis severe left lower abdominal pain radiating
to groin, vomiting and unremarkable findings. Acute obstruction of ureter at
the Ureterovesical junction produces severe flank pain that radiates to
perineum, penis, scrotum or inner thigh.
Dx: Ultrasound, noncontrast spiral ct scan of abdomen and pelvis.
21. clavicular fracture should have a carful neurovascular
examination to rule out injury to the underlying brachial plexus and
subclavian artery
bruit is heard? Do an angiogram to reule out injury to underlying
vessel
23. pulmonary contusion clinical manigestation develop ususually in
first 24 hrs often within few mins. Tachypnea, tachycardia, hypoxia. PE:
chest wall brusing and decreased breath souds on the side of pulmonary
contusion.
Xray : patchy irregular alveolar infiltrate and a CT scan may be
employed to make early diagnosis.
ABG : hypoxemia

REMEMBER ARDS 24-48 hrs after trauma bilateral lung involvement.

Vs pulm contusion first 24 hrs.
24. acute pancreatitis is most commonly caused by gallstones and alcohol
use. Identifying the underlying cause can prevent recurrent pancreatitis.
Ultraound is the preferred test to detect gallstones and with a sensitivity of
72-84% and specificity of 99%. Stable pts should undergo cholecystectomy
for biliary pancreatitis prior to discharge.
1. Acute cardiac tamponade occurs de to a sudden rise in
intrapericardial pressure and should be suspected in all adults pts
with blunt chest trauma who present w persistent jugular venous
dstention, tachycardia and hypotension despite aggressive fluid
resuscitation. Chest x ray findings typically reveal a normal cardiac
silhouette without ttension pneumothorax
2. In contrast chronic processes such as malignancy or renal failure
cause slow accumulation of pericardial fluids that gradually increase
the intrapericardial pressure and allows the pericardial elasticity to
adapt slowly. As a result it may take 1-2 liters of fluids before the
intrapericardial pressure reaches a critical pointthat leads to same
physiology changes of acute. X ray of chest in these pts tends to
show the classic enlarged cardia silhouette in a globular shape.
3. Acute mesenteric ischemia classically present with severe acute
onset of midabdominal pain ot of proportion to PE findings. The
most common cause is an embolus from the heart. Progression to
bowel infarction cause peritoneal signs and passage of bloody stool.
1. Pathophysiology of how parvovirus B19 caues fetal demise? RBC
precursor destruction
2. Fetal demise at 34 weeks. Fetus is footling breech. Obstetric
management? vaginal delivery
3. 35 wks gestation with a fetus in transverse lie placenta previa
(mothers blood)
4. 35 weeks gestation is noted to have a fetus breech uterine septum
5. 34 wks gestation with PAINFUL 3rd trimester bleeding. Hx of placenta
previa diagnosis?--> abruption placenta
6. vasa previa 1. Aminiotomy AROM , painless bleeding, fetal bradycardia
a. fetal blood
7. GBBS is lifelong colonization tx penicillin G (alternative to penillin
allergery clindamycin, erythromycin) Delivery vaginal
7. life long immunity vvginal delivery
a. toxo tx: pyrimethamine and sulfadiazine
b. Rubella
8. life long latency CS if active HSV or few HIV
CMV tx: gancilovir Vaginal delivery
Varicella /HSv Tx acyclovir CS

 HIV tx. Triple antiviral CS

1. CMV periventricular calcification
a. Most common cause of deafness in children
b. Neonatal thrombocytopenia and petechiae
c. DNA virus STD
d. Mode of transmission body fluids
e. Most common congential viral infection CMV
2. Toxoplasmosis intracranial calcification
a. Chorioretinitis
b. Intracranial calification
c. Symmetrical IGUR
d. Mode of transmission
i. Infected cat feces raw goat milk, undercooked meat
Life long immunity
Treatment
o Know infection pyrimethamine and sulfadiazine
o Prevent vertical transmission from mother to fetus
spiramycin
1. VZV
a. zig zap skin leasions
b. mulberry skin spots
c. microphthalmia
d. extremity hypoplasia
1. rubella
a. congential deafness
b. congential cataracts
c. congenitl head disease
1. syphilis
fetal infection
o nonimmune hydrops, marcerated skin, anemia
thromhocytopenia, and hepatosplenomegaly
1. Lichen sclerosus most commonly affects postmenopausal women and
manifests with vulvar pruritus and discomfort. Exam shows porcelainwhite atrophy. Vulvar punch Biopsy should be considered to rule out
vulvar Sqamous carcinoma
a. Tx: A class I tipical Corticosteriod in ointment form should be
appolied twice daily for 4 wks at which point transition to less
potention topical steroid or topical calcineurin inhibitor for
maintenance therapy is approrita.

1. Most menstrual cycles in the first one to two yrs following menarche are
anovulatory. Females in this age group have an immature HPO axisis tat
may faile to prodguce gonadotropins LH and FSH in the proper quantitis
and ratios to induce ovulation. These cycles are typically irregular and
may be complicated by menorrhagia. Menorrhagia is defined as prolonged
or heaving menstruation typically lasting longer than 7 days or exceeding
80 ML.
2. Depression of deep tendom reflexes is the earliest sign of magnesium
sulfate toxicity. It acts on CNS depression y blocking meuromuscluar
transmission. Second sign of toxicity is respiratory depression. Treatment
requires stopping magnesium sulfate infusion and administration of Ca+2
gluconate.
3. Gesational diabetes screening 24wks to 28 wks.
4. Fasting <95 mg/dL , first postprandial hr < 140 2n post prandial <120
5. Tx: first time dietary modeication 3 meals w 2-4 snacks daily. 2nd line
insulin and metformin. Glyburide.
6. Anti-D immune globulin should be administered to any RhD-negative
mother who deliveres an RhD+ baby. The standard dose is uaulally
adequate at 28weeks. Within 72 hrs after delivery or procedure the
Kleihauer-betke tes is used to determine whether a higher dose is needed
due to increased risk of fetal blood cells entering the maternal circulation.
7. Secreening by vaginal and rectal culture for GBS colonization and
penicillin prophylasxis have drastically reduced the incidence of neonatal
gbs infection. Universal screening occurs at 35-37 weeks gestation as the
result is the most accurate within 5 weeks of anticipated delivery date.
Exceptions include hx of GBS bacteriuria, UTI and infant w early onset
GBS disease, these pt should receive antibiotics propylaxis without
testing.
8. Pseudohyphae are characteristically seen in wetmont preparation of
vaginal discharge from pt w candida vulvovaginitis. Symptomatic pts can
be treated with an azole antifungal such as fluconazole. Sexual partners
do not require treatment.
9. Screening for syphilis, HIV and Hep B is recommended in ALL pregnant
women regardless of their risk factors for STD. Screening for other
infections in pregnancy ex chlamydia, gonorrhea, hep C is based on the
patients risk factors.
a. Screening should be performed on first prenatal visist. Typically w
rapid plasma regain RPR or VDRL. Screening is + confirm with
treponemal test FTA tx w penicillin
1. Primary ovarian failure results in decreased estrogen levels and increased
FSH and LH. FSH elvation in the setting of > 3 months of amenorrhea in a
woman uner age 40 confirms the diagnosis of premature ovarian failure.

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a. Causes of premature ovarian failure include chemotherapy,

radioation, autoimmue ovarian failure, turner syndrome and fagile x
syndrome.
b. Symptoms: amenorrhea, hot flashes, vaginal and breast atropy and
psychological anxiety, depression and irritability.
c. Secondary amenorrhea pregnancy test, prolactin, fsh
Functional hypothalamic ameorrhea is due to suppression of HPO axisi by
strenuous exercise, anorexia nervosa, marijiwana use, starvation, stress,
depression, chronic illness, pt is at risk of bone loss due to estrogen def.
PCOS characterized by anovulation, signs of androgen excess and ovarian
cysts. Abnromal GnRH secreation that stimulates pituitary to secrete
excessive luteinizing Hormone. LH+ high androgen
Risk factors that increase the likelihood of osteoporosis include advanced
age, thin body habitus, cigarette, smoking, excessive alcohol
consumption, corticosteroid use, menopause, malnutrition, family hx of
osteoporosis and Asian or Caucasian ethnicity
Eclampsia is diagnosed when gand mal seizures occur in the setting of
preeclampsia. Tx: magnesium sulfate. Anti-hypertensive meds are
appropriate for preeclamptic or eclamptic pt w systolic bp > 160 mmHg
and or diastolic bp > 110 . labetalol and hydralazine
Endometritis is characterized clinically by fever and uterine tenderness n
the postpartum period and is often associated with foul smelling locha.
Risk factors include prolonged ROM > 24hrs, prolonged labor > 12 hrs ,
operative vaginal delivery and c section. It is a polymicrobial infection
caused by a combon of gram +, gram -, aerorbic and anaerobic and
occasionally mycoplasma and chlamydia. Tx IV clindamycin and
Gentamycin.
painFUL 3rd trimester vaginal bleeding with a hypertonic uterus is most
likely due to placental abruption. Risk factors such as maternal HTN,
smoking and cocaine use can cause placental hypoperfusion and
hemorrhage in the decidua basalis.
Uterine atony postpartum complication related to poor uterine tone and
most common cause of plainless hemorrhage after delivery.
HELLP syndrome is diagnosed by a combo of thrombocytopenia,
microangiopathic hemolytic anemia, and increased liver enzymes in a
pregnant woman. The pathogensis involves systemic inflammation
especially the liver activation of coagulation cascade and platelet
consumption. DIC is potentially devastating complication.
HELLP is life threatening and delivery is the cornerstone of treatment.
Immediate delivery is warranted at > 34 wk gestation or with
deteriorating maternal or fetal status. Vaginal delivery is prefferedif the
cervix is favorable or if the woman I s in labor and the fetus is vertex and
the overall clinical status is otherweise stable.

10. Common symptoms of premenstrual syndrome include mood swings,

irritability, fatigue, bloating and breast tenderness. Symotoms occur in 12 weeks pror to menses and resolve with onset o fmenstrual flow. The
diagnosis is often readily apparent and can be confirmed by menstrual
diar. SSR are first line tx.
11. False labor, usually occurs in last 4-8wks of pregnancy progressive
cervical change are absent, contractions are irregular and discomfortable
is readily relieved by sedation. All such pts need is reassurance.
12. Stress incontinence loss of small amounts of urine with increased
intra abdbominal pressure due to ineffective closure of the urethral
sphincter. Pelvic muscle exercise and urethropexy are the recommended
treatment option for stress incontinence. Kegal exercise should be
attempted ebfore pursuing surgery bc urethropexy is invasive and carries
risk. Diagnosis: inserting a cotton swag into urethral orifice and
demonstrating an angle of > 30 degree upon an increase in intra
abdominal pressure. Risk factors: pregnancy, childbirth, menopause,
obesity
13. Preterm labor refers to regular contraction causeing cervical dilation
and or effacement at < 37 weeks gestation. Pt n preterm labor at < 34
weeks should receive a tocolytic agent ex ca+2 blocker, mg sulfate for
neuroprotection and coticosteriods for acceleration of fetal lung maturity
14. Fetal fibronectin and a shortened cerix is associated with preterm birth
. fetal fibronectin is a protein produced by fetal cells btwn chorion and
decidua. It acts as a glue that keeps the fetal sac attached to uterine
lining.
15. Uterine atony MCC of post partum hemmorrahge within 24 hrs of
delivery. Risk factors: uterine overdistention (multiple gestation,
polyhydramnios, macrosomia) and uterine fatigue prolonged labor.
Management. 1. Fundal or bimanual massage (stimulates the uterus to
contract and resolves hemorrhage n most cases) 2. Iv access 3.
Crystalloid infusion to keep systolic bp > 90 mmHg. 4. Notification of
blood bank for packed RBC. Oxyctonin will cause contraction of
myometrial fibers and retraction of myometrial blood vessels and will
control bleeding in most cause. 10-40 mins after administration
16. Elective C sction has shown to be beneficial if maternal viral load at
fdelivery is > 1000 cpliies/ML as it can reduce erinatal transmission of
HIV by 50% zidovudine + c section
17. Mothers who didnt have HAART triple therapy infant should get
zidovudine and nevirapine to reduce the risk of maternal to child HIV
transmission

18. Chorioamnionitits aka Intra amniotic infection prolonged rupture of

the memebrane. > 18 hrs. diagnosis: meternal fever and >1 of the
following: utertine tenderness, maternal or fetal tachycardia, malodorous
amniotic fluid, purulent vaginal discharge. Amniotic fluid does not need to
be purulent or malodorus to make IAI diagnosis. Tx IV ampicillin,
gentamicin, clindamycin and delivery (oxytocin to accelerate labor
19. Corticosteroids to all pts < 34 weeks for lung maturation
20. Tocolysis is to prevent labor
21. Kallmann x linked recessive disorder of migration of fetal GnRH and
olfactory neurons. Resulting in hypogonadotropic, hypogonadism and
rhincecphlon hypoplasia. Normal Genotype. Female absent breast and
primary amenorrhea
22. Androgen insensitivy syndrome is characterized by a phenotypic
female w a 46 XY. Bilateral gonadectomy is recommended after
completion of pubertiy to attainment of adult height to decrease risk of
gonadal malignancy. Testes are usually found in abdomen, inguinal canal
or labia majora
23. Acute appendicitis during pregnancy is to obtain an ULTASOUND w
graded compression technique. Noncompression and dilation of appendix
are diagnostic of appendicitis. If U/s is nondiagnositic MRI can be
performed.
24. A breech presentation diagnosis before 37th week of gestation does not
require any intervention as breech presentation often convert to vertex
before the 37th week. External cephalic version is indicated if breech
presentation persists after 37th week and if this fails then planned
cesarean delivery is indicated.
25. Chlamydial azithromycin
26. Gonorrheal ceftriaxone
27. The most common cause of mucopurulent cervicitis is chlamydia
trachomatis followed by Neisseria gonorrhoease. The 2 ogranisms cannot
reliably be distinguished by examination and NUCLEIC ACID
AMPLIFICATION testing is recommednd to differentiate btween them.
28. In ovulatory phase of menstrual cycle, cervical mucus is profuse, clear
and thin. It will stretch to approx.. 6 cm when lifted vertically
spinnbarkeit and exhibit ferning on microscope slide smear preparation.
pH 6.5 or greater (more basic than any other phase.
29. Early follicular phase immediately follows menstruation thick, scant
and acidic doesnt allow penetration by spermatozoa
30. mid to late lutearl phase ovulation already occurred. Cervical mucus
becomes progressively thicker and exhibits less stretching ability

31. arrest of labor in the first stage is diagnosed when dilation is >6 cm
with rupture membranes int eh setting of no cervical changes for > 4 hrs
despite adequate contractions OR when there is no cervical changes for
>6 hrs with inadequate contractions. Patient who do not meet criteria
should be observed if there is no fetal distress.
32. Obesity is a common cause of amenorrhea. The amenorrhea is the
result of anovulation. The FSH and LH is usually normal.
33. In premature ovuarian failure the FSH and LH level Increase, usually
FSH >40 and LH >25. It occurs in women ages <40 yrs.
34. Epidural anesthesia in lbor impairs bladder function and an
overdistended bladder may lose its ability to contract and result in urinary
retention and overflow incontinence. Urinary retention is treated with
short term indwelling catheterization
35. Symptoms of menopause include irregular or absent menses, heat
intolerance, flushing, insomnia and night sweats. Hyperthyroidism and
menopause have similar presentation and serum TSH, FSH level should
be checked in pts w these symptons
36. hCG begins at 8 days after fertilization and the levels doubles 48hrs
until they peak at 6-8 weeks gestation. Alpha subunit is common for hCG,
TSH, LH FSH. It is secreted by syncytiotrophoblast and is mainly
responsible for the preservation of the corpus luteum in early pregnancy.
37. Progestreron is produced in large amounts during pregnancy and helps
to inhibit uterine contractions. Progesterone responsible for preparing the
endometrium for implantation of fertilizaed ovum.
38. Estrogen responsible for induction of prolactin during pregnancy
39. 46 xy 5 alpha reductase def. cannot convert testosterone to
dihydrotestosterone. Clinical manifestation include ambiguous genitalia at
birth undervirilization and a male internal urogenital tract due to
antimullerian hormone.
40. PCOS hyperandrogenism androgen in peripheral converts into
estrogen. Unopposed estrogen stimulation leaves them at increase risk
for endometrial cancer.
41. Obesity increase risk of endometrial cancer.
42. Pregnancy and carpal tunnel syndrome due to estrogen mediated
depolymerization of ground substance, which causes intersitital edema in
the hands and face thus increased pressure within carpal tunnel. Initial
treatment for CTS involve neutral position wrist splinting and NSAIDs.
Local corticosteroid injection is indicated in cases where wrist splinting is
insufficient to relieve symptoms. Surgical decompression of the carpal
tunnel is reseved for cases when conservative management fails.

43. Acute abnormal uternine bleeding in adolescents Is usually a result of

anovulation cycles from an immature hypothalamic-pituitary-ovarian axis.
Evaluation for pregnancy and bleeding disorders is generally advised.
High dose estrogen is the first line treatment for pt w moderate to severe
bleeding.
44. In the immediate postpartum period, a low grade fever, leukocytosis
and vaginal discharge are normal findings. The vaginal discharge lochia is
initially bloody then serous and finally white to yellow in color days frollow
delivery
45. Asymptomatic women with pelvic mass should be evaluated initially by
transvaginal U/S and then a cancer antigen CA 125 level. Any elevation of
CA 125 in postmenopausal woman arises suspicion for ovarian cancer. If
the U/s suggests a simple cyst and the CA 125 is not evelated, masses
<10 cm can be followed conservatively.
1. Suspicious features: size > 10 cm, nodular, fixed pelvic mass,
ascities and evidence of metastasis.
1. Screening for asymptomatic bacteriuria 12-16 weeks
2. Asymptomatic bacteriauria cystitis pyelonephritis pretern birth
low birth weight and perinatal mortality. Tx: nitrofurantoin for 5-7 days,
amoxicillin or amoxillin- clavulanate 3-7 days or fosfomycin as a single
does.
3. The most important complication of Preterm premature rupture of
membrane PPROM is pulmonary hypoplasia. Steroids are sued to enhance
fetal lung maturity when premature reupture of memebranse occur at
less than 34 weeks of gestation
1. Hypertension emergency is defined as marked, severe htn associated with
malignant htn or htn encephalopathy. Malignant Htn 180/120 associated
with retinal hemorrahage, exudates and/or papilledema. Pt with Malignant
can also develop nephrosclerosis (acute renal failure, ematureia,
proteinuria). HTN encephalogy is associated with cerebral edema
2. AR leads to increased LVEDV due to leakage of blood from the aorta back
into the LV. AR features include a wide pulse pressure, water hammer
pulse and LV enlargement. The Left lateral decubitus position brings the
enlarged LV closer to the chest wall and cause a punding sensation and
increased awareness of the heartbeat.
3. Peripheral artery diease intermittent cladication and <1 ankle brachial
index. PAD increased risk of MI
4. Amiodarone is an anti- arrhythimic used for ventricular tachycardia . Pts
develop lipod pneumonitis.
a. Pulmonary toxicity pulm fibrosis
b. Thyroid dysfunction hyperthrodism or hypothyroidism
c. Hepatotoxitiy elevated aminotransferase levels
d. Corneal deposits
e. Skin changes blue gray skin discorloration

1. Hydroxurea benefits pts with sickle cell diease by increasing fetal

hemoglobin. Hydroxura suppresses boen marrow. Leukopenia, anemia
and thrombocytopenia s/e
2. Biliary atreaia presents in infancy with direct hyperbilibrubinemia,
jaundice and hepatomegaly. Biospcy shows bile plugs in bile and
canalicular ducts, porta tract edema and fibrosis.
3. Alpha 1 antitrypsin cirrhosis and periportal eosinophilic inclusion bodies
are typically seen on liver biopsy
4. Sinusoidal congestion and hemorrhagic necrosis congestive heart
failure can lead to congestive hepatopathy
5. Neonatal thyrotoxicosis maternal graves diease, low birth weight,
tachycardia, warm skin, irritability. Results from transplacental passage of
anti TSH recptor antibodies during 3rd trimester. Sympatnic fetus fetal
tachycardia, hydrops, growth restriction. Tx methimazole plus a beta
blocker.
6. Streptococcal pharyngitis presents with fever, exudative pharyngitis and
tender anterior cervical lymphadenopathy. Diagnosis is ideally made by
throat culture. Tx. Pencillin or amoxicillin hastens recovery, reduces the
risk of Rheumatic fever and prevent transmission to close contacs.
7. Birth marks that need MRI caf au lait macules neurofibromatosis, ashleaf spot tuberous sclerosis port wine stain sturge weber syndrome.
8. Cutaneous stigmata of occult spinal cord malformation includes sacral
dimples and hair tuft. Need sacral ultrasound.
9. Seizures loss of consicious not seen in simple partial. Complex partial
seizures typically have automatism during their loss of consciousness.
These actives include chewing, picking movingvemtns of hands and lips.
10. All vaccines should be administered according to chronologic rather
than gestational age in preterm infants. The exception is that weight
should be >= 2kg= 4.6 lbs before the first hep b vaccine.
11. Rota virus vaccine 2-6 months prevent rota virus gastroenteritis. It
is contraindicated in pts with hx of intussusception due to risk of this side
effects.
12. Lyme arthritis (maine ) late manifestation of untreatment lyme
disease. Diagnosis should be suspected in pt with hx of travel to
northeastern or upper Midwestern us. Diagnosis: ELISA and Western Blot
testing. Tx oral doxycline or amoxicillin.
13. Membranous nephropathy is a common cuase of nephrotic syndrome.
(edema, proteinuria and hypoalbuminemia). Active heptatitis B infection
is an important risk factor and vaccination reduces this risk factor
14. Infantile hypertrophic pyloric stenosis is the most common in first born
boys age -5 weeks. Protracted projectile nonbilious vomiting causes a
hypochloremic hypokalemic metabolic alkalosis. U/S will demonstrate a
thick and elongated pyloris

15. Pseudomonal osteomyelitis diabetic patients and after puncture

wonds of the foot
16. Salmonella and s. aureus osteomyelitis in pt w sicke cell disease.
17. Chemical conjunctivitis most commonly seen first 24hrs after birth
18. Gonococcal conjunctivitis 2-5 days of life. Erythromycin ointment wihin
1 hr of birth topical
19. Chlamydia is ually milder presnts 5-14 days after birth
20. Trachoma chlamydia trachomatis Serotype A-C. major cause of
blindness worldwide. Active phase: follicular conjunctivitis and pannus
(neovascularization) formation in cornea. Concurrent infection occurs in
the nasopharynx, leading to nasal discharge. Diagnosis: giema stain
examination of conjunctival scrapings. Topical tetracycline or oral
azithromycin. Repeated infection lead to scarring of cornea.
21. Herpes keratitis pain, photophbia, and decreased vision. Dendritic
ulcer
22. Oribital cellulitis infection of posterior to orbital septum. Unilater and
common in children w paranasal sinus infection. Symptoms fever,
proptosis, restriction of extraocular movements and swollen, red eyelids.
23. Tuberous sclerosis is neurcutaneous genetic TSC1 and TSC2 gne
syndrome associated with intracranial tumors cortical tubers or
hamartomas, subependymal giant cell astrocytomas, subependymal
nodules. Additional characteristics include hypopigmented macules. Ash
leaf spots, facial angiofibromas, cardiac rhabdomyomas, renal
angioleiomymas, mental retardation, seziures.
24. Acute, unilateral cervical adenitis in children is typically caused by
streptococcal or staphylococcal infection. Treatment consists of
clindamycin plus incision and drainage.
25. Tb can present w lymphadenopathy. Hilar adenopathy is mc
manifestation but cervical adnopathy scrofula can manifestate of tb in
children.
26. Osteoid osteoma radiolucent surrounded by wide rim of
osteosclerosis. Nocturnal bout of pain in children revlieved by aspirin (or
NSAIDS) bengin long bone tumor. Gardner syndrome FAP+ sebaceous
cyst+osteoma +desmoid tumor. Tx: NSadi prescribed for symptomatic
relief and pt should be followed by serial examination and xrays every 4-5
months to monitor the lesion. Surgical resection is typically reserved for
pts w refractory symtoms.
27. Ewing sarcoma presents in long bones of extremeits w pain for
weeks/months swelling and deformity. Multiple layers of new
subperiosteal bone formation. T11:22 neural differentiation. Tx: surgery,
chemo, radiation. Onion skin lutic periosteal lesion. Mets to lungs and
bone
28. Osteosarcoma radioresistant . Sun burst appeance and codeman
triange. Retinoblastoma and irradiation association.

29. Biliary cysts are congenital or acquired dilation of biliary tree. They
may be single or multiple and extrahepatic or intrahepatic. Abdominal
pain, jaundice, and a palpable mass are characterisit findings. Biliary
cysts require surgical excision.
30. Aldolase B def. herediatary fructose intolerance. Introduction of fruits
and veggie in diet is followed by accumulation of fructose 1 phosphate.
Affected infants can present w vomiting, poor feeding and lethargy.
seizures or encephalopathy follow if fructose is not removed from the
diet. The infant is exclusively formula fed and hereditary fructose
intolerance is therefore unlikely to be cause of his symptons.
31. Many children w lead toxicity are asymptomatic and require screening
if they live in a home built before 1978 or play w toys from older
generations. Capillary (fingerstick) blood specimens are widely used for
intial screening but can have false + results. Abnormal values must be
confirmed by venous blood draw. 5-44 no medication, repat level in <1
month. Moderate 45-69 DMSA dimercaptosuccinic acid severe > 70
dimercaprol plus calcium disodium edeate EDTA. Abdominal x in moderate
to severe case.
32. Infant botulism caused by clostridium botulinum. Highest incideds in
CA, Utah, Penssylviania from soil botulism spores.
33. Congential hypothyroidism initially appear normal at birth but
gradually develop apathy, weakness, hypotnia, large tongue, sluggish
movement, abdominal bloating and an umbilical hernia. For this rason,
screening new borns for hypothyroidism, along w phenylketonuria and
galactosemia is standardly performed in all states.
34. Werdnig-hoffman syndrome is an autosomal recessive disorder that
inovelds dengeneration of the anterior horn cells and cranila nerve moto
nuclei. It is cause of floppy baby syndrome.
35. HUS toxin release from e.coli. Verotoxin invades and destroys the
colonic epithelia lining and produces bloody diarrhea. Initial presnation
abd pain and diarrhea. Uremia, thrombocytopenia and hemolytic anemia.
Tx: support plasmaphereiss, dialysis if necessy steroids. Antibiotics NOT
indicated
36. Racemic epinephrine decreases the need for intubation in pts with
croup and should always be treid before any invasive procedure. Epi acts
by its alpha and beta effects. Promtes smooth muscle relaxation.
37. Migraine headache are the most common cause of acute and recurrent
headaches in pediatric population. They typically present with unilateral
or bifrontal pain, photophobia, phonophobia, nauea, vomiting and visual,
auditory or linguistic aura. First line tx in children includes
acetaminophen, NSAD, supportive management. Triptan may be tired if
these measure are not effective.

38. Duchene muscular dystrophy -> present at 2-5 yrs with bilateral calf
pseudohypertrophy and gower sign. X linked recess. Gold standard for
diagnosis is genetic testing which would show deletion of the dysttrophin
gene on Xp21. Securum CK and aldolase level increased . muscle biopsy
fibrosis and fatty infiltrate on calf muscle.
39. Juvenile myoclonic epilepsy presents in adolescent with unilateral or
bilateral myoclonic jerks. Symptoms take place in moring and may be ppt
by sleep deprivation.
40. Lennox-gastaut childhood seizure of multiple types, impaired
cognitive function and slow spies wave activity on EEG.
41. Complex partial seizure bried episodes of impaired consciousness
failure to respond to various stimula during the episode, staring spells,
automatism, post ictal confusion. EEG pattern is usually normal and may
show brief changes.
42. Measles (rubeola) fever peaks and then rash appears face then
spreaks to body spares palms and soles.
43. Rubella 3 day meales similar to measles but is relatively mild and
shorter in duration. Rubella rash spreads cephalocaudally. No koplk spot
and lower fever
44. Roseola HHV 6 muculaopapular rash appears as the fever resolves.
45. Jejunal atresia presents with bilious vomiting and abdominal
distension. Abdominal x ray shows triple bubble sign and gasless colon.
Risk factors include prenatal exposiure to cocoaine and other
vasoconstrivitive drugs.
46. All neonatal and infants should be screened for developmental
dysplasia of the hip with barlow and ortolani maneuvers. A palpable
clunck should promot referral to an orthopedic surgeon. A soft clink, leg
length discrepancy or asymmetric inguinal skin folds require diagnostic
imagines w ultrasound age <6 months x ray >4-6 months. Treatmebf of
choice for age <6 months is pavlik hip harness
47. Riboflavin def. nonspecific symptoms, sore throat, hyperemic and
edematous oropharyngeal mucose memebranes, cheilitis, stomatitis,
glossitis, normocytic normochromic anemia, seborrheic dermatitis and
photophobia anorexia nervosa, or malabsorptive syndeom like celiac.
48. Vit A def. 2-3 yr old child with impaired adaptation to darkness,
photophobia dry scaly skin, xeerosis conjunctiva, xerosis cornea,
keratomalacia, bitot spot and follicular hyperkeratosis of shoulders,
buttocks and extensor surface.

49. Chronic granulomatous disease should be considered in any pt with

recurrent or unusual lymphadenitis, hepatic abscess, osteomyelitis at
multiple sites or unusal infections with catalase + organisems ex: s.
aureus, aspergillus, serratia marcescens and burkholderia cepacia.
Symptoms : lymphadenopathy, hypergammaglobulinemia, hepatomegaly,
splenomegaly, aniemia of chronic diease, underweight, chfornic diarrhea,
short status, gingivitis and dermatitis. Dx: Nitroblue tetrazolum slide test,
flow cytometry, or cytochrome C reduction. Tx: daily trimethoprimsulfamethoxazole or gamma interferon 3x week.
50. WAS young boy w eczema, thrombocytopena, recurrent infection w
encapsulated germs. Prestn at birth petechial, bruises, bleeding from
circumcision or bloody stool. High IgA IgE. Low IgM
51. Hereditary spherocytosis has varying degree of severeity but typically
manifests as a triad of coombs- negative hemolytic anemia, jaundice and
splenomegaly. It should be suspected in pt w reticulocutosis,
hyperbilirubinemia, spherocytosis and family history of anemia. Diagnosis
should be confirmed w eosin-5-maleimide binding and acidified glycerol
lysis test.
52. Homocytstinuria autosomal recessive disorder cystathionine
synthase def. . in addition to marfanoid body habitus, pt with
homocustinuria also have intellectual disability, downward lens dislocation
and hypercoagulability. Tx involves vitamin suppliementation and
antiplatet or anticoagulation to prevent thromboembolic event.
53. Respiratory distress syndrome is cuased by surfactant def. risk factors
include prematurity and maternal diabtete mellitus , male sex, perinatal
ashphyxia, c-section without labor. Material diabetes increases the
incidence of RDS by delaying the maturation of pulmonary surfactant
production. Increase materal hyperglycemia cuauses fetal hyperglycemia
and triggers fetal hyperinsulinism. High levels of circulating insulin
antagonize cortisol and block the maturation of sphingomyelin a vital
component of surfactant. Cxr- diffuse reticulogranular pattern (ground
glass opacitis) and air bronchograms.
54. Maternal fetal transmission of rubella virus is most tetraogenic during
the first trimester of pregnancy. Triad sensorineural deafness, cardia
defects (PDA) and leukocoria (white pupillary reflex)
55. Neonatal polycythemia hct >65% mcc delayed clamping of umbilical
cord resulting in excess transfer of placental blood. Maternal HTN,
smoking, poor placental gas exchange. Tx: asymotomatic require only
hydration by feeding or parenteral fluids. Symptomatic neonates require
partial exchange transfusion.

56. OCD acute onset PANDAS pediatric autoimmue neuropsychairtir

disorder associated with streptococcal infections. OCD is repetiveitve
mental and physical rituals that interfere w social and occupational
functioning. Tx high dose SSRI and psycho therepay. Deep brain
stimulation in seere refractory cases of ocd
57.
1. PDA
1. bening essential tremor autosomonal dominant propanolo doc
2. BPPV crystalline depositis canaliths in semicircular canalsdisrupts the
normal flow of fluids in the vestibular system.
3. Beta blocker overdose brady cardia, av block, hypotension. Diffuse
wheezing. Intoxication of ca+2 blocker , dignoxin and cholinergic agents
could show similar symtoms but wheezing is specific for beta blocker
toxicity. Tx: iv isotonic fluid IV atropine in refractory pts give I
vglucaogon. Glucagon increase intracellular levels of cyclic amp
4. Sick euthyroid symdrome sick patint a fall in total and free t3 and
normal t4 and tsh.
5. Dressler syndrome diffuse ST elevation with exception of reciprocal
depression of aVR chet pain that is imporved by leaning forward NSAIDS
are tx of choice. Anticoagulation should be avoided to prevent
development of hemorrhagic pericardial effusion.